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Bosch Alcaraz A, Corrionero Alegre J, Gil Domínguez S, Luna Castaño P, Piqueras Rodríguez P, Belda Hofheinz S, Ángeles Saz Roy M, Zuriguel Pérez E, Fernández Lorenzo R, Mata Ferro M, Martín Gómez A, Serradell Orea M, Martínez Oliva M, González Rivas S, Añaños Montoto N, José Espildora González M, Martín-Peñasco Osorio E, Carracedo Muñoz E, López Fernández E, Lozano Almendral G, Victoria Ureste Parra M, Gomez Merino A, García Martínez A, Morales Cervera D, Frade Pardo L, García Piñero JM. Intention to use physical restraint in paediatric intensive care units and correlated variables: A multicentre and cross-sectional study. Intensive Crit Care Nurs 2024; 83:103690. [PMID: 38598942 DOI: 10.1016/j.iccn.2024.103690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/31/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To determine the intention to use physical restraint (PR) and the relationship with sociodemographic and professional variables of the Paediatric Intensive Care Unit (PICU) nurses. RESEARCH METHODOLOGY/DESIGN AND SETTING A multicentre and correlational study was carried out from October 2021 to December 2023 in five paediatric intensive care units from five maternal and child hospitals in Spain. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire was provided. Moreover, sociodemographic and employment variables were registered. RESULTS A total of 230 paediatric nurses participated in the study. A total of 87.7 % were females with an average age of 35.5 ± 9.7 years and working experience of 10.5 ± 8.4 years. The mean scores obtained were 21.1 ± 3.8 for attitude, 13.1 ± 5.0 for subjective norms, 14.4 ± 4.3 for perceived behavioural control and 28.0 ± 6.0 for intention. The nurses apply more physical restraint to anxious patients, with scarce analgesics and sedation, those affected with pharmacological withdrawal symptoms and those with a high risk of accidental removal of vital support devices or fall from bed. The sex (p = 0.007) and type of employment contract (p = 0.01) are the variables that are significantly correlated with the intention to use of PR. CONCLUSION The paediatric nurses analysed had a moderate attitude, social pressure and perceived behavioural control towards the use of PR. IMPLICATIONS FOR CLINICAL PRACTICE It is important to know the factors that influence the intention to use physical restraint in order to standardise safe practice for critically ill paediatric and to ensure that patients' rights are respected by obtaining informed consent and assessing the prescription, continuation and removal of physical restraint.
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Affiliation(s)
- Alejandro Bosch Alcaraz
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona (UB), Barcelona, Spain; Mental Health, Psychosocial and Complex Nursing Care Research Group-NURSEARCH, University of Barcelona, Barcelona, Spain.
| | | | | | | | - Pedro Piqueras Rodríguez
- Pediatric Intensive Care Unit Nursing Supervisor, La Paz Hospital, Madrid, Spain; Research Member in Health Care, Health Research Institute, La Paz Hospital - IdiPAZ, Madrid, Spain
| | | | - M Ángeles Saz Roy
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona (UB), Barcelona, Spain; Mental Health, Psychosocial and Complex Nursing Care Research Group-NURSEARCH, University of Barcelona, Barcelona, Spain.
| | - Esperanza Zuriguel Pérez
- Nurse, Department of Knowledge Management and Evaluation, Vall d'Hebron Hospital, Barcelona, Spain; Multidisciplinary Nursing Research Group. Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - María Mata Ferro
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain
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DePorre AG, Larson I, Staggs VS, Nadler C. Characteristics of Patients Associated With Restraint Use at a Midwest Children's Hospital. Hosp Pediatr 2023; 13:877-885. [PMID: 37691599 DOI: 10.1542/hpeds.2023-007210] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Restraint use is associated with negative mental health outcomes, injury risk, and known disparities in use. Improved understanding of restraint use among hospitalized children is critical given the increased frequency of hospitalized children with complex and/or acute mental health needs. Our objective is to describe the demographic and clinical features of children associated with mechanical restraint. METHODS In a single-center retrospective cohort study of patients hospitalized from 2017 to 2021, restraint encounters were identified from electronic health records. Odds of restraint was modeled as a function of patient demographic and clinical characteristics, as well as hospitalization characteristics using logistic regression modeling adjusted for clustering of hospitalizations within patients and for varying lengths of stay. RESULTS Among 29 808 children (46 302 encounters), 225 patients (275 encounters) had associated restraint use. In regression modeling, odds of restraint were higher with restraint at the preceding hospitalization (adjusted odds ratio [aOR] 8.6, 95% confidence interval [CI] 4.8-15.5), diagnosis of MH conditions such as psychotic disorders (aOR 5.4, 95% CI 2.7-10.4) and disruptive disorders (aOR 4.7, 95% CI 2.8-7.8), male sex (aOR 1.9, 95% CI 1.5-2.5), and Black race (aOR relative to White patients 1.9, 95% CI 1.4-2.6). CONCLUSIONS Our results suggest racial inequities in restraint use for hospitalized children. This finding mirrors inequities in restraint use in the emergency department and adult settings. Understanding the behavioral needs of such patients may help in reducing restraint use and improving health equity.
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Affiliation(s)
- Adrienne G DePorre
- Division of Hospital Medicine, Department of Pediatrics
- University of Missouri - Kansas City
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - Vincent S Staggs
- Biostatistics & Epidemiology Core
- University of Missouri - Kansas City
| | - Cy Nadler
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri - Kansas City
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Aarvik RS, Svendsen EJ, Agdal ML. Held still or pressured to receive dental treatment: self-reported histories of children and adolescents treated by non-specialist dentists in Hordaland, Norway. Eur Arch Paediatr Dent 2022; 23:609-618. [PMID: 35763246 PMCID: PMC9338127 DOI: 10.1007/s40368-022-00724-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/03/2022] [Indexed: 12/19/2022]
Abstract
Aim This study aimed to estimate the prevalence of a self-reported history of restraint in children and adolescents when receiving dental care by non-specialist dentists and to assess differences in dental fear and anxiety (DFA), intra-oral injection fear, and trust in dentists between patients with and without a self-reported history of restraint. Methods An electronic cross-sectional survey was distributed to all 9 years old (n = 6686) and 17 years old (n = 6327) in the Public Dental Service in Hordaland County, Norway, in 2019. For statistical evaluation, we generated descriptive statistics and Mann–Whitney U tests. Results The response rate ranged between 43.5 and 59.9% for the different questions. The prevalence of a self-reported history of being held still against one’s will during dental treatment and pressured to undergo dental treatment against one’s will was 3.6% and 5.1%, respectively. In general, these patients reported higher DFA, and higher intra-oral injection fear compared with those without such histories of restraint. Patients who had reported being held still against their will during dental treatment had significantly higher distrust in dentists than those who did not report restraint (p < 0.001). Conclusion To feel pressured to receive dental treatment and to be held still against one’s will overlap with the concepts of psychological and physical restraint. Patients with a self-reported history of restraint recorded significant differences in DFA, intra-oral injection fear, and trust in dentists compared to those who did not report restraint. Future studies should explore the role that restraint may play in relation to a patient’s DFA, intra-oral injection fear, and trust in dentists.
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Affiliation(s)
- R S Aarvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 2b, 0373, Oslo, Norway. .,Oral Health Centre of Expertise in Western Norway, Bergen, Norway.
| | - E J Svendsen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Forskningsveien 2b, 0373, Oslo, Norway.,Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - M L Agdal
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Aarvik RS, Agdal ML, Svendsen EJ. Restraint in paediatric dentistry: a qualitative study to explore perspectives among public, non-specialist dentists in Norway. Acta Odontol Scand 2021; 79:443-450. [PMID: 33587861 DOI: 10.1080/00016357.2021.1881159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to explore the perspectives of non-specialist dentists on the use of restraint in paediatric dentistry in the Public Dental Service in Norway. MATERIALS AND METHOD Two focus group interviews involving four and five dentists, respectively, were conducted in one of the most populated counties in Norway in September 2019. The thematic analysis by Braun and Clarke informed the qualitative analysis. RESULTS According to the dentists, physical restraint in paediatric dentistry is usually used when dental treatment is absolutely necessary. The qualitative analysis revealed the following three main themes: (1) some dentists justify the use of restraint in paediatric dentistry; (2) physical restraint is often legitimised by the fact that the child is sedated; (3) the use of restraint evokes difficult ethical evaluations. Additionally, the dentists had an overarching perspective of acting in the child's best interest, but they sometimes struggled to find a justifiable path in situations involving restraint. CONCLUSIONS Dentists seem to consider the use of restraint combined with sedation as legitimate for absolute necessary dental treatment. Furthermore, the use of restraint involves difficult ethical evaluations.
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Affiliation(s)
- Regina Skavhellen Aarvik
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Sundal H. Children's Co-Determination During Challenging Procedures: Nurses and Parents Experiences of Caring Under Short-Term Hospital Stays in Norway. J Pediatr Nurs 2021; 57:e34-e39. [PMID: 33012572 DOI: 10.1016/j.pedn.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Medical and clinical procedures can cause varying levels of discomfort to children. PURPOSE This study is to deepen the understanding of the lived experiences of parents and nurses related to challenging medical and clinical procedures performed on children during short-term hospital stays. DESIGN AND METHODS This qualitative study, which comprises part of a larger study, adopted a hermeneutic phenomenological approach. The data were obtained through a combination of in-depth interviews and observations of twelve parents of eleven children and seventeen nurses. A narrative re-analysis was conducted of four challenging medical and clinical procedures. Four stories were written and subsequently analyzed as one narrative that represents the findings. RESULTS The form of nurses' and parents' care for the children ranged from encouraging the children's consent and receptiveness to the procedures, to coercion. The analysis indicates that promoting the children's co-determination and participation in the procedures encouraged their consent and receptiveness and facilitated a successful outcome. In contrast, an absence of efforts to involve the children in the procedures contributed to the need for coercion to be employed by parents and nurses. Moreover, parental influence and the responsibilities of nurses had an impact on children's co-determination and participation. CONCLUSIONS Preparing parents and children before and during a procedure was important to minimize the degree of coercion of the children. PRACTICE IMPLICATIONS The findings of this study are relevant to clinical practice because they suggest preparing parents and children before and during a procedure situation.
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Affiliation(s)
- Hildegunn Sundal
- Molde University College, Norway, Faculty of Health Sciences and Social Care, Norway.
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Svendsen EJ, Bjørk IT. Health care provider's responses to children's resistance to peripheral vein cannulation: A qualitative observational study. J Clin Nurs 2021; 30:1325-1334. [PMID: 33529357 DOI: 10.1111/jocn.15681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES Health care and treatment should be voluntary, but restraint is often used during treatment of children. Knowledge about how health care providers respond to preschool children's resistance is lacking and can help understand current paediatric care in hospitals. The aim of the present article was to provide knowledge about how healthcare providers respond to preschool children's resistance during the clinical procedure of peripheral vein cannulation. DESIGN An explorative qualitative research design was developed for this study. METHODS Observations with video recording were used to collect data. Eight nurses and seven physicians participated in the study (n = 15). Their responses to preschool children's (n = 6) resistance were studied during 14 attempts of peripheral vein cannulation. Consolidated criteria for reporting qualitative research (COREQ) were used. RESULTS The healthcare providers made 380 responses to children's resistive expressions, interpreted within four main types, responses to acknowledge the child, responses to distract the child, responses to persuade the child and responses to reject the child. All main types of responses were used by both nurses and physicians. Regardless of the amount of resistance the children expressed, all children received distracting and acknowledging responses. Rejecting responses were used approximately twice as much in the implementation phase as in the preparation phase. Distraction, persuasion and rejection began in the preparation phase and increased in the implementation phase. CONCLUSIONS The main types and sub-types of responses showed how healthcare providers use a wide array of responses to meet children's resistance during peripheral vein cannulation. RELEVANCE TO CLINICAL PRACTICE The results can enable health care providers to become aware of their own practices during peripheral vein cannulation and other clinical procedures and to elaborate on their use of responses that can be considered intrinsically less child-friendly.
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Affiliation(s)
- Edel J Svendsen
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida T Bjørk
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Sahlberg S, Karlsson K, Darcy L. Children's rights as law in Sweden-every health-care encounter needs to meet the child's needs. Health Expect 2020; 23:860-869. [PMID: 32319716 PMCID: PMC7495078 DOI: 10.1111/hex.13060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background In 2020, the United Nations Convention on the Rights of the Child (UNCRC) became law in Sweden. This puts extra demands on Swedish health care for children in need. This study aimed to investigate children's experiences and paediatric nurses' experiences of caring in accordance with the UNCRC. Methods Interviews were conducted in 2019 with 10 children and 13 nurses at a paediatric clinic in western Sweden. Child and nurse data were analysed separately with qualitative content analysis. The results are presented as a synthesis of the combined analysis of both data sets. Results Children did not always meet health‐care professionals with the necessary competence to care for them, and they were not always cared for in a child‐friendly environment. Even though nurses in paediatric care had the competence necessary to meet children's rights in health care, organizational issues made it challenging. Providing health care in accordance with the UNCRC principles required time and competence. Sufficient time to help children participate in their care and ensure that they feel secure was considered necessary—regardless of the health‐care context. Conclusion Health‐care encounters without the necessary time or competence can affect children and future encounters negatively. Instruments to safeguard children's rights in health care need to be developed and implemented, such as a documentation system to make children's rights visible and/or UNCRC certification. Implementation of UNCRC principles in all health‐care situations for children as standardized care requires competence, involvement, strong leadership and economic support. Children's voices in research can assist in guiding care.
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Affiliation(s)
- Sofia Sahlberg
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Laura Darcy
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Lombart B, Annequin D, Cimerman P, De Stefano C, Perrin O, Bouchart C, Schommer MC, Ramelot L, Petit C, Fournier-Charriere E, Caron A, Trebosc S, Tourniaire B, Galinski M. A simple tool to measure procedural restraint intensity in children: validation of the PRIC (Procedural Restraint Intensity in Children) scale. Heliyon 2019; 5:e02218. [PMID: 31417972 PMCID: PMC6690635 DOI: 10.1016/j.heliyon.2019.e02218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/28/2019] [Accepted: 07/30/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose Restraint is often used when administering procedures to children. However, no metrologically scale to measure the restraint intensity had yet been validated. This study validated the metrological criteria of a scale measuring the restraint intensity, Procedural Restraint Intensity in Children (PRIC), used during procedures in children. Design and methods The PRIC scale performance was measured by a group of 7 health professionals working in a children's hospital, by watching 20 videos of health care procedures. This group included 2 physicians, 1 pediatric resident, and 4 nurses. The intra-class correlation coefficients were calculated to evaluate the inter-rater and test-retest reliability and the construct validity with the correlation between PRIC scale and a numerical rating scale. Results One hundred and forty measurements were made. Inter-rater and test-retest correlation coefficients were 0.98 and 0.98, respectively. The 2 scales were positively correlated with a Spearman coefficient of 0.93. Conclusions This study validated the Procedural Restraint Intensity in Children (PRIC) scale in metrological terms with some limitation. However, there is not gold standard scale to precisely validate the reliability of this tool and this study has been conducted in “experimental” conditions. Nevertheless, this is the first scale measuring the intensity of physical restraint with a metrological validation. The next step will be to validate it in real clinical situations.
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Affiliation(s)
- Bénédicte Lombart
- AP-HP, Unité Fonctionnelle de lutte contre la douleur, Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Daniel Annequin
- AP-HP, Unité Fonctionnelle de lutte contre la douleur, Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Patricia Cimerman
- AP-HP, Centre National de Ressource de lutte contre la Douleur (CNRD), Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Carla De Stefano
- APHP, Urgences – SAMU 93, hôpital Avicenne, Université Paris 13, 93000, Bobigny, France
| | - Odile Perrin
- AP-HP, Centre National de Ressource de lutte contre la Douleur (CNRD), Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Celine Bouchart
- AP-HP, Unité Fonctionnelle de lutte contre la douleur, Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | | | - Laura Ramelot
- CHC ASBL Centre Hospitalier Chrétien, Liège, Belgium
| | - Céline Petit
- CHC ASBL Centre Hospitalier Chrétien, Liège, Belgium
| | - Elisabeth Fournier-Charriere
- AP-HP, Unité Fonctionnelle de lutte contre la douleur, Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Anne Caron
- AP-HP, Unité Fonctionnelle de lutte contre la douleur, Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Solène Trebosc
- AP-HP, Unité Fonctionnelle de lutte contre la douleur, Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Barbara Tourniaire
- AP-HP, Unité Fonctionnelle de lutte contre la douleur, Hôpital Trousseau, Université Paris 6, 75012, Paris, France
| | - Michel Galinski
- Pôle Urgences Adultes, SAMU, Hôpital Pellegrin, CHU de Bordeaux, 33000, France
- INSERM U1219, “Injury Epidemiology Transport Occupation” team, Université de Bordeaux II, F-33076, Bordeaux Cedex, France
- Corresponding author.
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Lombart B. [The dilemma of restraint in paediatric care]. SOINS. PÉDIATRIE, PUÉRICULTURE 2019; 40:27-29. [PMID: 31331598 DOI: 10.1016/j.spp.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Restraint may be used in paediatrics when it is necessary to perform a technical care procedure on a child who is agitated and refusing to cooperate. Obliged to restrain, caregivers are torn between respecting the child and fulfilling the order to perform the procedure. It is important to explore ways in which professionals can overcome this dilemma by finding alternatives. The discussion takes place at the heart of a care philosophy characterised by the notion of movement.
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Affiliation(s)
- Bénédicte Lombart
- Hôpitaux universitaires de l'Est-Parisien, AP-HP, Laboratoire LIPHA-PE Institut Hannah Arendt, EA 7373, UPEC- Paris Est, École éthique de la Salpêtrière, Campus Picpus, 33 boulevard de Picpus, 75012 Paris, France; Hôpital Armand-Trousseau, 26 avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France.
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Christie S, Ng CKC, Sá Dos Reis C. Australasian radiographers' choices of immobilisation strategies for paediatric radiological examinations. Radiography (Lond) 2019; 26:27-34. [PMID: 31902451 DOI: 10.1016/j.radi.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/07/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Immobilisation may be necessary to ensure patient safety and examination success in paediatric medical imaging. Little guidance exists regarding the selection of different immobilisation methods. The purpose of this study was to explore radiographers' selection of immobilisation methods in paediatric medical imaging and the influences on their choices. METHODS Ethical approval was obtained. A mixed methods approach consisting of online questionnaire distribution followed by individual interviews was used to explore Australasian radiographers' self-reported patterns of immobilisation use and the underlying reasons and beliefs. Quantitative data were described using frequency data, with a Fisher's Exact test used to determine any association between demographic variables and immobilisation methods. Qualitative data were evaluated using content analysis. RESULTS Sixty-five radiographers returned completed questionnaires, with seven participating in interviews. Psychological immobilisation methods were preferred to minimise patient pain and distress, but physical methods were considered more effective, with parental holding the most likely method to be used (63/65, 96.9%). Participants assumed certain methods to be more appropriate based on patient age and examination type, but adapted their choices based on many other factors, seeking to provide personalised care. Further training was strongly desired (48/64, 75.0%). Participants disagreed on whether introducing written guidance would be beneficial (33/62, 53.2%). CONCLUSION Choosing an immobilisation method appears to be a case-by-case activity requiring critical assessment of multiple factors in order to balance patient care with examination success. IMPLICATIONS FOR PRACTICE Improvements in quality and quantity of education are recommended to enhance radiographers' ability to make choices based on all relevant factors.
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Affiliation(s)
- S Christie
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - C K C Ng
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - C Sá Dos Reis
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Av. de Beaumont 21, 1011, Lausanne, Switzerland; CISP - Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Portugal.
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Lombart B, De Stefano C, Dupont D, Nadji L, Galinski M. Caregivers blinded by the care: A qualitative study of physical restraint in pediatric care. Nurs Ethics 2019; 27:230-246. [PMID: 30975025 DOI: 10.1177/0969733019833128] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The phenomenon of forceful physical restraint in pediatric care is an ethical issue because it confronts professionals with the dilemma of using force for the child's best interest. This is a paradox. The perspective of healthcare professional working in pediatric wards needs further in-depth investigations. PURPOSE To explore the perspectives and behaviors of healthcare professionals toward forceful physical restraint in pediatric care. METHODS This qualitative ethnographic study used focus groups with purposeful sampling. Thirty volunteer healthcare professionals (nurses, hospital aids, physiotherapists, and health educators) were recruited in five pediatric facilities in four hospitals around Paris, France, from March to June 2013. The data were processed using NVIVO software (QSR International Ltd. 1999-2013). The data analysis followed a qualitative methodological process. ETHICAL CONSIDERATIONS The research was conducted in compliance with the Declaration of Helsinki. Written informed consent was collected systematically from participants. FINDINGS This study provides elements to help understand why restraint remains common despite its contradiction with the duty to protect the child and the child's rights. All participants considered the use of forceful physical restraint to be a frequent difficulty in pediatrics. Greater interest in the child's health was systematically used to justify the use of force, with little consideration for contradictory or ethical aspects. Raising the issue of forceful restraint always triggered discomfort, unease and an outpour of emotions among healthcare professionals. The findings have highlighted a form of hierarchy of duties that give priority to the execution of the technical procedure and legitimize the use of restraint. Professionals seemed to temporarily suspend their ability to empathize in order to apply restraint to carry out a technical procedure. This observation has allowed us to suggest the concept of "transient empathic blindness." CONCLUSION Using physical restraint during pediatric care was considered a common problem by participants. This practice must be questioned, and professionals must have access to training to find alternatives to strong restraint. Conceptualizing this phenomenon with the concept of "transient empathic blindness" could help professionals understand what happens in their minds when using forceful restraint.
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Affiliation(s)
- Bénédicte Lombart
- Assistance Publique - Hôpitaux de Paris (AP-HP), France; Laboratoire Interdisciplinaire d'étude du Politique Hannah Arendt (LIPHA Paris Est), France
| | - Carla De Stefano
- Assistance Publique - Hôpitaux de Paris (AP-HP), France; Université Paris 13, France; Sorbonne University, France
| | | | - Leila Nadji
- Laboratoire Interdisciplinaire d'étude du Politique Hannah Arendt (LIPHA Paris Est), France
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Svendsen EJ, Pedersen R, Moen A, Bjørk IT. Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians. Int J Qual Stud Health Well-being 2018; 12:1363623. [PMID: 28889788 PMCID: PMC5653956 DOI: 10.1080/17482631.2017.1363623] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to explore nurses’ and physicians’ perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.
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Affiliation(s)
- Edel Jannecke Svendsen
- a Department of Nursing, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Reidar Pedersen
- b Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Anne Moen
- a Department of Nursing, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Ida Torunn Bjørk
- a Department of Nursing, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
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Kirwan L, Coyne I. Use of restraint with hospitalized children: A survey of nurses' perceptions of practices. J Child Health Care 2017; 21:46-54. [PMID: 27638180 DOI: 10.1177/1367493516666730] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Restraint is often perceived as necessary to ensure that medical procedures are carried out safely. The limited research into nurses' perceptions of restraint practices with hospitalized children hinders understanding the extent of the problem. A survey design was used to investigate nurses' perceptions of restraint use from five units in one children's hospital in Ireland. Findings revealed that restraint is a common practice, with physical and psycho- logical restraints most commonly used and newborn to 4-year-old children most likely to be restrained. Restraint was most often used for cannulation and latterly for administering medication and preventing interference to intravenous lines. To promote the use of thera- peutic holding for the safe delivery of procedures, nurses require education and skills training. Restraint should only be used as a last resort and in all situations, nurses should assess the need to use restraint and explore any alternatives in order to gain the child's cooperation. More research is needed into the situational variables that can lead to restraint usage in order to identify learning needs and promote the use of alternative interventions.
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Affiliation(s)
- Lisa Kirwan
- 1 Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Imelda Coyne
- 2 School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Zhang Y, Liu L, Hu J, Zhang Y, Lu G, Li G, Zuo Z, Lu H, Zou H, Wang Z, Huang Q. Assessing nursing quality in paediatric intensive care units: a cross-sectional study in China. Nurs Crit Care 2016; 22:355-361. [PMID: 27212426 DOI: 10.1111/nicc.12246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/02/2016] [Accepted: 03/31/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nursing-sensitive indicators are considered effective tools for improving the quality of care in hospitals. However, these have not been used in paediatric intensive care units (PICUs) in China. AIM To develop nursing-sensitive indicators for PICUs and to assess the quality of nursing in PICUs in China based on the nursing-sensitive indicators. DESIGN Multi-centre, cross-sectional study. METHODS Structure, process and outcome indicators were developed and measured from 1 January to 31 March 2014 in seven PICUs in China. RESULTS The structure indicators showed that one nurse cared for an average of 2·8 patients in a PICU, and 44% of nurses had a bachelor's degree. The process indicators revealed that hand-washing compliance varied across PICUs, whereas pain management and physical restraint have not been adequately addressed in China. The outcome indicators revealed that the incidence rates of ventilator-associated pneumonia and central-line-associated blood stream infections were 2·96 and 0·7, respectively, per 1000 device days. Patients were intubated for a total of 4392 mechanical ventilator days, and 32 patients (7·29‰) had an unplanned extubation. Nurses were moderately satisfied in their jobs (3·1 ± 0·3), and parents reported that nurses provide high quality of care. CONCLUSIONS This study developed and used nursing-sensitive indicators to assess the quality of nursing in PICUs in China, which provided a reference for national and international comparisons of nursing quality in PICUs. Nursing staffing levels and education should be improved. Pain management and physical restraints should be regulated in China's PICUs. Nurse managers need to explore staff attitudes towards implementation of family-centred care. The development of a national database of nursing quality indicators can contribute to quality and safety improvement. RELEVANCE TO CLINICAL PRACTICE This study developed a set of nursing-sensitive indicators, and these indicators were used to assess and improve the quality of nursing in PICUs.
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Affiliation(s)
- Yuxia Zhang
- Nursing Department, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Linxia Liu
- Pediatric Intensive care unit, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Jing Hu
- Pediatric Intensive care unit, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Yanhong Zhang
- Operating room, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Guoping Lu
- Pediatric Intensive care unit, Children's Hospital of Fudan University, Shanghai, P.R. China
| | - Guangyu Li
- Pediatric Intensive care unit, Beijing Children's Hospital, Beijing, P.R. China
| | - Zelan Zuo
- Pediatric Intensive care unit, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Hua Lu
- Pediatric Intensive care unit, Shanghai Children's Medical Center, Shanghai, P.R. China
| | - Huan Zou
- Pediatric Intensive care unit, Children's Hospital of Shanghai, Shanghai, P.R. China
| | - Zaihua Wang
- Pediatric Intensive care unit, Wuhan Children's Hospital, Wuhan, P.R. China
| | - Quelan Huang
- Pediatric Intensive care unit, Shenzhen Children's Hospital, Shenzhen, P.R. China
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Svendsen EJ, Moen A, Pedersen R, Bjørk IT. Resistive expressions in preschool children during peripheral vein cannulation in hospitals: a qualitative explorative observational study. BMC Pediatr 2015; 15:190. [PMID: 26586285 PMCID: PMC4653884 DOI: 10.1186/s12887-015-0508-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/14/2015] [Indexed: 11/23/2022] Open
Abstract
Background Children may resist common medical procedures, and this may lead to the use of restraint. This can be challenging to all of the involved parties, but empirical research is scarce on children’s expressions during these procedures. Methods To explore preschool children’s resistive expressions during peripheral vein cannulation we video recorded and performed an in-depth analysis of naturally occurring situations with six newly hospitalized preschool children. Results Fourteen attempts of peripheral vein cannulation were recorded. A typology of resistive expressions was developed consisting of: protest, escape, and endurance. During the expression of protest, the children showed an insistent attitude where they were maintaining their view. The expression of escape was when children were panicked, avoiding hands of adults when being approached. When expressing endurance the children were stiff, motionless and introverted. Less physical restraint is required during endurance, but children still appear to refuse participation. Conclusions We identified three types of resistive expressions that can be used to better understand the individual child and inform clinical judgment in challenging procedural situations. This knowledge can help to sensitize health care providers in their attempt to arrange for children’s participation.
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Affiliation(s)
- Edel Jannecke Svendsen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Moen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ida Torunn Bjørk
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
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