Procedural pain in children: a qualitative study of caregiver experiences and information needs

Healthcare professionals' perspectives on optimizing pain care-related education at a Canadian children's hospital: A qualitative study

Objectives

Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice.

Methods

Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital's Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education.

Results

Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities.

Conclusion

Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families.

Healthcare Professionals' Perspectives on Improving Family-Centred Pain Care in a Tertiary Pediatric Centre

BACKGROUND

Despite being a core component of family-centered and compassionate care, children's pain is often undertreated in Canadian hospitals. Nurses' and other healthcare professionals' (HCPs) ability to understand and respond to a child and their family's pain care needs is integral to improving this care in a family-centered manner.

PURPOSE

To understand nurses' and other HCPs' perceptions of child and family needs to make care more collaborative and patient- and family-centered.

METHODS

Eighteen participants were recruited and represented the specialties of nursing (n = 8), psychology (n = 1), child life services (n = 2), medicine/surgery (n = 3), and administration/leadership (n = 4); 3 of the administrators had a nursing background. Transcripts were analysed using a semantic, inductive approach with two coders using a codebook to ensure reliability.

RESULTS

Participants felt that pain care was important, but that it needs to take greater priority in the hospital. In our analysis, we identified four core needs that nurses and other HCPs have to provide better pain care: 1. Better acknowledgement of child and family experiences; 2. Better visual and written knowledge translation tools for patients and families; 3. Better provision of verbal pain education to children and families by nurses and other HCPs; and 4. Help for patients and families to advocate for better pain care when they feel their needs are not being met.

CONCLUSIONS

Nurses and other HCPs value patient- and family-centered pain care, and wish to empower families to advocate for it when it is sub-optimal.

Poke Plan: An Initiative to Improve Distraction and Pain Mitigation With Venous Access in Hospitalized Children

BACKGROUND

Adequate pain control and anxiety relief during peripheral intravenous cannula (PIV) placement improves patient, parental, and staff satisfaction and reduces health care-induced stress in children. We noted a low rate of analgesic/anxiolysis use (<20%) and child life utilization (3%) in our institution. This quality improvement project was initiated to increase pain mitigation strategies in hospitalized children requiring PIV access.

METHODS

From November 2020 to March 2021, we created a key driver diagram and summarized possible interventions with the aim to increase our use of pain control strategies to >40% and child life utilization to 25%. For 12 months, 8 Plan-Do-Study-Act cycles were conducted focusing on nursing education and training, improved documentation, electronic medical record optimization, easy access to analgesics and anxiolytics, family involvement, and weekly huddles. Our primary measure was the percentage use of pain medications for PIV access. The utilization of PIV experts from the ICU (advanced practice registered nurses and physicians) served as the balancing measure.

RESULTS

A total of 883 patient charts were reviewed. The use of topical anesthetics and anxiolytics increased from 16.2% at baseline to 78.9% after the implementation of the quality improvement project. Eighty percent of parents reported their child was kept comfortable during the procedure using pain mitigation and comfort measures. A slight increase from 2% to 5.8% was noted in the utilization of advanced practice registered nurses and intensivists.

CONCLUSIONS

Implementation of a standardized approach for PIV placement improved team communication and provided better preparation for pain control before needle insertions in hospitalized children.

Extended Reality Use in Paediatric Intensive Care: A Scoping Review

Background: Extended reality (XR) technology such as virtual and augmented reality is increasingly being utilised in paediatric medicine due to its role in medical education and reported positive impacts on outcomes including pain, anxiety, and sleep. To the author's knowledge, no previous reviews investigating the use of XR in paediatric intensive care have been undertaken. Objectives: To scope the use of XR in paediatric intensive care, and assess its barriers to adoption, including safety considerations, cleaning and infection control. Eligibility criteria: All articles of any methodological design discussing the use of XR within paediatric intensive and critical care were included. Sources of evidence: Four databases (EMBASE, CINAHL, PsychInfo, PubMed) and Google Scholar were searched without any limitations on publication year. Charting methods: Data was extracted into Microsoft Excel by two authors independently (AG & SF) and cross-checked for completeness. Results: One hundred and eighty-eight articles were originally identified. Following the application of eligibility criteria 16 articles utilising XR in clinical interventions (n = 7) and medical education (n = 9) were included. Articles utilised VR and AR for highly variable purposes within both medical education (eg disaster preparedness, intubation) and clinical interventions (eg decrease pain, nausea, anxiety and improve Glasgow Coma Scale). Conclusions: While research into the use of XR in paediatric intensive care is still in its infancy it has increased dramatically over the past 5 years within two key areas. Firstly, in healthcare education, to assist in the acquisition of PICU-specific knowledge and practice of skills such as intubation of difficult airways. Secondly, studies have evaluated and demonstrated that with appropriate use, VR appears to be a safe and feasible intervention to decrease pain and anxiety in PICU patients.

Exploring the needs of children and caregivers to inform design of an artificial intelligence-enhanced social robot in the pediatric emergency department

Background & Objective

Socially assistive robots (SARs) are a promising tool to manage children's pain and distress related to medical procedures, but current options lack autonomous adaptability. The aim of this study was to understand children's and caregivers' perceptions surrounding the use of an artificial intelligence (AI)-enhanced SAR to provide personalized procedural support to children during intravenous insertion (IVI) to inform the design of such a system following a user-centric approach.

Methods

This study presents a descriptive qualitative needs assessment of children and caregivers. Data were collected via semi-structured individual interviews and focus groups. Participants were recruited from two Canadian pediatric emergency departments (EDs) between April 2021 and January 2022.

Results

Eleven caregivers and 19 children completed 27 individual interviews and one focus group. Three main themes were identified: A. Experience in the clinical setting, B. Acceptance of and concerns surrounding SARs, and C. Features that support child engagement with SARs. Most participants expressed comfort with robot technology, however, concerns were raised about sharing personal information, photographing/videotaping, and the possibility of technical failure. Suggestions for feature enhancements included increasing movement to engage a child's attention and tailoring language to developmental age. To enhance the overall ED experience, participants also identified a role for the SAR in the waiting room.

Conclusion

Artificial intelligence-enhanced SARs were perceived by children and caregivers as a promising tool for distraction during IVIs and to enhance the overall ED experience. Insights collected will be used to inform the design of an AI-enhanced SAR.

Patient and public involvement in emergency care research: a scoping review of the literature

BACKGROUND

Establishing the benefits of patient and public involvement (PPI) in emergency care research is important to improve the quality and relevance of research. Little is known about the extent of PPI in emergency care research, its methodological and reporting quality. This scoping review aimed to establish the extent of PPI in emergency care research, identify PPI strategies and processes and assess the quality of reporting on PPI in emergency care research.

METHODS

Keyword searches of five databases (OVID MEDLINE, Elsevier EMBASE, EBSCO CINAHL, PsychInfo, Cochrane Central Register of Controlled trials); hand searches of 12 specialist journals and citation searches of the included journal articles were performed. A patient representative contributed to research design and co-authored this review.

RESULTS

A total of 28 studies reporting PPI from the USA, Canada, UK, Australia and Ghana were included. The quality of reporting was variable, with only seven studies satisfying all Guidance for Reporting Involvement of Patients and the Public short form reporting criteria. None of the included studies adequately described all the key aspects of reporting the impact of PPI.

CONCLUSION

Relatively few emergency care studies comprehensively describe PPI. Opportunity exists to improve the consistency and quality of reporting of PPI in emergency care research. Further research is required to better understand the specific challenges for implementing PPI in emergency care research, and to determine whether emergency care researchers have adequate resources, education and funding to undertake and report involvement.

Designing a Child-, Family-, and Healthcare Provider-Centered Procedure Room in a Tertiary Care Children's Hospital

AIM

The study aim was to co-design new pediatric procedure room prototypes with children, caregivers, and healthcare providers (HCPs).

BACKGROUND

Medical procedures can cause pain and anxiety for children and their families. If spaces are not designed for patients' needs, procedures may take longer, require sedation, and result in an inferior care experience. Involving HCPs in co-designing optimal spaces can result in more efficient and safer environments. co-designing spaces with patients and their families can inform psychologically safer and less traumatic environments.

METHODS

We followed human-centered design methodology. Data were collected via semi-structured interviews, field observations, and two multidisciplinary design workshops with patients, caregivers, and HCPs. Themes from the data were extracted using a content analysis and used to make evidence-informed recommendations for design features.

RESULTS

The study took place from October 2021 to February 2022. Patients, families, and HCPs reported similar needs: (1) control over the environment, including the ability to adjust lighting, temperature, and sound; (2) space that supports patient privacy; (3) the use of evidence-based pain reduction and distraction methods; (4) attention to the sensory environment, including visual (light, color), tactile (textures of furniture and equipment), auditory, and olfactory stimuli; (5) human factors organization of the space and equipment; (6) accessible and equitable spatial design; and (7) the significance of the journey leading up to and after the procedure.

CONCLUSIONS

It is feasible to co-design procedure rooms that support evidence-based psychological, physical, and pharmacological interventions that are known to minimize pain for children.

Best Practices in Pediatric Oncology Pain Management

ABSTRACT

Pediatric oncology patients are vulnerable to pain that may be caused by the disease or its treatment, and this symptom can be challenging to manage. This article focuses on the importance of pain control, pain assessment and treatment, and special considerations in pediatric oncology pain management, including preparing children for painful procedures and the family's role in managing pain.

A Qualitative Study of the Pain Experiences of Children and Their Parents at a Canadian Children's Hospital

Current literature is lacking in describing families' experiences in being involved in children's pain management. This study sought to understand children and their parents' experiences with pain management at a tertiary care children's hospital. Twelve child-parent dyads were recruited to participate in the study from January to August 2022. Children and their parents chose whether to be interviewed together or separately. Transcripts were analyzed using inductive, data-driven codes. Codes and themes were developed using a codebook and member-checking. Three main themes were identified: a. Painful experiences can have a significant positive or negative effect on families' lives and healthcare trajectories; b. There can be a mismatch between families' expectations of pain management and how they perceive the pain was managed; c. Families feel that they must advocate for better pain care, but often feel too intimidated to do so, or worry that their concerns will be dismissed by healthcare professionals. Families want healthcare professionals to proactively manage their children's pain, supporting the shaping of early positive memories of the child's healthcare interactions. Healthcare providers must further recognize that poorly treated pain can significantly impact families' lives and should both seek and be receptive to child and parent input for better pain care.

Children's communication of emotional cues and concerns during a preoperative needle procedure

OBJECTIVE

This study explores children's expressions of emotional cues and concerns during needle procedures, nurses' responses and findings in relation to children's age and sex.

METHODS

Twenty-six children aged 6-12 years were video recorded during a preoperative needle procedure. Emotional communication was analyzed using Verona Coding Definitions of Emotional Sequences.

RESULTS

A total of 111 cues or concerns were identified in the observed needle procedures, with a distribution of 77 cues and 34 concerns. A majority of children (85%) expressed emotional cues through non-verbal communication. No differences between child age or sex related to expressed emotion were found. The child elicited the communicated emotion in 98% of sequences. Nurses' responses were coded as not providing space for communication in 75% of sequences.

CONCLUSION

Children are capable of expressing their emotional distress, primarily non-verbally, during needle procedures. A child showing less overt expressions during a needle procedure does not necessarily experience less fear or pain. The nurses' communication focused on practical information during the needle procedure, with less attention to the child's distress.

PRACTICE IMPLICATIONS

Nurses need to develop strategies to be aware of emotions the child communicates before, during and after a needle procedure.

Adapting child health knowledge translation tools for Somali parents: a qualitative study exploring process considerations and stakeholder engagement (Preprint)

Background

Objective

Methods

Results

Conclusions

Practice Patterns and Assessment of Needs for Pediatric Pain Management in Alberta Emergency Departments

Purpose

Many rural and community emergency departments (EDs) experience barriers to providing optimal pain care to children. In preparation for a quality improvement initiative, our team conducted a provincial pediatric pain management practice and needs assessment.

Methods

An online survey was sent to ED administrators and educators from March to May 2017. Themes included pain assessment, pain and distress management strategies, available resources, education, barriers to care, and opportunities for improvement.

Results

Forty-five respondents, from 31 EDs representing all five geographic health zones in Alberta, completed the survey. Use of a pain assessment tool was reported at 93.5% (29/31 sites) of the sites. Topical anesthesia was employed “most of the time” before suturing at 67% (18/27) of sites, versus 15% (4/27) before blood work or IV insertion. Eighty-one percent (22/27) of sites reported physically restraining children for procedures “often”, while 37% (10/27) reported use of comfort positioning “often”. Digital distraction devices were available at 37% (10/27) of sites. Reported challenges included lack of resources (33.3%, 12/36), staff education/knowledge (33.3%, 12/36), and absent policies/poor policy adherence (25.0%, 9/36). Opportunities for improvement included staff member education (73.5%, 25/34) and more resources (58.8%, 20/34). Respondents rated their site’s overall ability to manage children’s pain as 50/100 [IQR:21,61].

Conclusion

General EDs report providing suboptimal children’s pain care, with use of physical restraint for medical procedures, and under-utilization of evidence-based, inexpensive treatment options. There are many gaps in children’s pain care in rural and community EDs which could be addressed through collaborative quality improvement initiatives.

How Anxiety Our Adult Patients Before Venepuncture Procedure: A Study in UiTM Medical Centre Sungai Buloh (UiTMMC)

Background: Venepuncture is one of the commonest stressful invasive procedures in the health care setting. Unfortunately, to date, there was a lack of locally published studies that studied anxiety, especially before the procedure among adult patients. Hence, this study was conducted to determine the factors associated with the state and trait-anxiety among adult patients before the venepuncture procedure in UiTMMC. Methods: A cross-sectional pilot study was conducted among patients while waiting for a venepuncture procedure in March 2020. Patients aged 18 years old and above, Malaysian, able to understand English or Malay and had experienced venepuncture in UiTMMC were recruited. Malay validated version of the State-Trait-Anxiety-Inventory (STAI) Questionnaire was used to assess the anxiety level. Data were analysed using IBM SPSS Version 26.0, and multiple linear regression was used to determine the associated factors for state and trait-anxiety before the venepuncture procedure. Results: A total of 330 patients with a mean age of 46.34 ± 14.34 years participated in this study. The mean of the state-anxiety score was 38.02 ± 14.25 and the mean trait-anxiety score was 36.46 ± 11.47. The correlation between state-anxiety and trait-anxiety scores was highly significant (r=0.870, p<0.001). Factors associated with state-anxiety and trait-anxiety contributed with 72.6% and 58.5% variances, respectively. Conclusions: Adult patients who waiting for venepuncture in were average low state and trait anxiety scores. Although the associated factors were majority non-modifiable, this finding still can instil awareness to the health care workers who are dealing with needle procedurals.

Assessing procedural pain in infants: a feasibility study evaluating a point-of-care mobile solution based on automated facial analysis

BACKGROUND

The management of procedural pain in infants is suboptimal, in part, compounded by the scarcity of a simple, accurate, and reliable method of assessing such pain. In this study, we aimed to evaluate the psychometric properties of the PainChek Infant, a point-of-care mobile application that uses automated facial evaluation and analysis in the assessment of procedural pain in infants.

METHODS

Video recordings of 40 infants were randomly chosen from a purposely assembled digital library of 410 children undergoing immunisation as part of their standard care in Prishtina, Kosovo, between April 4, 2017, and July 11, 2018. For each infant recording, four 10 s video segments were extracted, corresponding to baseline, vaccine preparation, during vaccination, and recovery. Four trained assessors did pain assessments on the video segments of 30 infants, using PainChek Infant standard, PainChek Infant adaptive, the Neonatal Facial Coding System-Revised (NFCS-R) single, the NFCS-R multiple, and the Observer administered Visual Analogue Scale (ObsVAS), on two separate occasions. PainChek Infant's performance was compared to NFCS-R and ObsVAS using correlation in changes in pain scores, intra-rater and inter-rater reliability, and internal consistency.

FINDINGS

4303 pain assessments were completed in two separate testing sessions, on Aug 31, and Oct 19, 2020. The study involved videos of 40 infants aged 2·2-6·9 months (median age 3·4 months [IQR 2·3-4·5]). All pain assessment tools showed significant changes in the recorded pain scores across the four video segments (p≤0·0006). All tools were found to be responsive to procedure-induced pain, with the degree of change in pain scores not influenced by pre-vaccination pain levels. PainChek Infant pain scores showed good correlation with NFCS-R and ObsVAS scores (r=0·82-0·88; p<0·0001). PainChek Infant also showed good to excellent inter-rater reliability (ICC=0·81-0·97, p<0·001) and high levels of internal consistency (α=0·82-0·97).

INTERPRETATION

PainChek Infant's use of automated facial expression analysis could offer a valid and reliable means of assessing and monitoring procedural pain in infants. Its clinical utility in clinical practice requires further research.

FUNDING

PainChek.

“Pain talk”: A triadic collaboration in which nurses promote opportunities for engaging children and their parents about managing children’s pain

Effective communication with children about pain is important and has the potential to mediate the short‐ and longer‐term effects of pain on children. Most communication studies relating to children's pain have focused on language children use to describe everyday pain experiences. However, little is known regarding how health professionals, particularly nurses, communicate with children in healthcare settings about pain. This study aimed to explore how nurses talk to children and their parents about pain and what factors influence nurses’ use of language and non‐verbal communication. A cross‐sectional mixed‐methods (predominantly qualitative) survey (“pain talk”) was conducted, comprising qualitative items about pain communication and four vignettes portraying hypothetical cases of children representing typical child pain scenarios. Participants were recruited via email, social media, newsletters, established networks, and personal contacts. A total of 141 registered (68.1%) or in‐training nurses across 11 countries with experience of managing children's pain completed the survey. Textual survey responses were analyzed using conventional qualitative content analysis. Qualitative content analysis generated a meta‐theme “Being confident and knowing how to do ‘pain talk’” and four main themes that described the functions, purpose, and delivery of “pain talk”: (a) “contextualizing and assessing,” (b) “empowering, explaining, and educating,” (c) “supporting, affirming, and confirming,” and (d) “protecting, distracting, and restoring.” “Pain talk” was a triadic collaborative communication process that required nurses to feel confident about their role and skills. This process involved nurses talking to children and parents about pain and creating engagement opportunities for children and parents. “Pain talk” aimed to promote the agency of the child and parent and their engagement in discussions and decision‐making, using information, support, and comfort. Nurses shaped their “pain talk” to the specific context of the child's pain, previous experiences, and current concerns to minimize potential distress and adverse effects and to promote optimal pain management.

Feasibility and acceptability of SARS-CoV-2 testing and surveillance in primary school children in England: Prospective, cross-sectional study

BACKGROUND

The reopening of schools during the COVID-19 pandemic has raised concerns about widespread infection and transmission of SARS-CoV-2 in educational settings. In June 2020, Public Health England (PHE) initiated prospective national surveillance of SARS-CoV-2 in primary schools across England (sKIDs). We used this opportunity to assess the feasibility and agreeability of large-scale surveillance and testing for SARS-CoV-2 infections in school among staff, parents and students.

METHODS

Staff and students in 131 primary schools were asked to complete a questionnaire at recruitment and provide weekly nasal swabs for SARS-CoV-2 RT-PCR testing (n = 86) or swabs with blood samples for antibody testing (n = 45) at the beginning and end the summer half-term. In six blood sampling schools, students were asked to complete a pictorial questionnaire before and after their investigations.

RESULTS

In total, 135 children aged 4-7 years (n = 40) or 8-11 years (n = 95) completed the pictorial questionnaire fully or partially. Prior to sampling, oral fluid sampling was the most acceptable test (107/132, 81%) followed by throat swabs (80/134, 59%), nose swabs (77/132, 58%), and blood tests (48/130, 37%). Younger students were more nervous about all tests than older students but, after completing their tests, most children reported a "better than expected" experience with all the investigations. Students were more likely to agree to additional testing for nose swabs (93/113, 82%) and oral fluid (93/114, 82%), followed by throat swabs (85/113, 75%) and blood tests (72/108, 67%). Parents (n = 3,994) and staff (n = 2,580) selected a preference for weekly testing with nose swabs, throat swabs or oral fluid sampling, although staff were more flexible about testing frequency.

CONCLUSIONS

Primary school staff and parents were supportive of regular tests for SARS-CoV-2 and selected a preference for weekly testing. Children preferred nose swabs and oral fluids over throat swabs or blood sampling.

Elaboration and validation of an algorithm for treating peripheral intravenous infiltration and extravasation in children

OBJECTIVE

to elaborate and validate the content and appearance of an algorithm for treating infiltration and extravasation of non-chemotherapy drugs and solutions administered to children.

METHOD

a methodological study of the technology formulation and validation type. To elaborate the algorithm, a bibliographic review was carried out to list the scientific evidence on the treatment of infiltration and extravasation. Content and appearance validation was in charge of 14 specialists in pediatric nursing, using the Delphi technique, adopting a value equal to or greater than 0.80 as Content Validation Index.

RESULTS

the algorithm was validated in the third evaluation by the judges, reaching a Global Content Validation Index of 0.99, being composed by the perception of the occurrence of the complication; discontinuation of intravenous therapy infusion; verification of signs and symptoms; measurement of edema; application of an infiltration and extravasation assessment scale and conduits to be used according to the characteristics of the fluid administered and the type of complication.

CONCLUSION

the algorithm was validated and can be used in a practical and objective way by health professionals, in order to promote safety in the care of hospitalized children, with regard to reducing harms caused by infiltration and extravasation.

Resource Use During Pediatric Venipuncture With Virtual Reality: Secondary Analysis of a Randomized Controlled Pilot Trial

OBJECTIVES

Virtual reality (VR) therapy is growing in use and popularity during pediatric medical procedures. Currently, data that describe the hospital resources used during pediatric procedures with off-the-shelf VR games that are not tailored to medical procedures are lacking. In this study, we aimed to characterize procedural resources associated with VR use during venipuncture in a pediatric emergency department.

METHODS

This was a secondary analysis of a 2-arm randomized, controlled pilot trial with an external group. Resource use was evaluated in 3 groups: child life (CL)-supported VR engagement, CL support without VR, and a reference group that received no intervention (ie, no CL and no VR).

RESULTS

The study sample (N = 55) included the following: 15 patients randomly assigned to VR, 20 patients randomly assigned to CL, and 20 patients in the reference group. There was a significant difference in procedure duration, with the VR group exhibiting the longest duration compared with the CL and reference groups (P = .01).

CONCLUSIONS

Longer procedure times associated with VR use during venipunctures (4-6 minutes on average) may be attributed to pauses to troubleshoot VR games not tailored for medical procedures. Although they are inexpensive and accessible, nontailored VR games may warrant the need for dedicated staff to provide restraint and/or assistance to navigate the VR application. In this study, we offer a protocol on the application of nontailored VR games for pediatric procedures. For those considering a VR program in an inpatient setting, the benefits of pain/anxiety reduction must be weighed against the resources needed, including device costs, staff availability, and increased procedure duration.

Is venous blood a more reliable description of acid-base state following simulated hypo- and hyperventilation?

Background

ABGs are performed in acute conditions as the reference method for assessing the acid-base status of blood. Hyperventilation and breath-holding are common ventilatory changes that occur around the time of sampling, rapidly altering the ‘true’ status of the blood. This is particularly relevant in emergency medicine patients without permanent arterial catheters, where the pain and anxiety of arterial punctures can cause ventilatory changes. This study aimed to determine whether peripheral venous values could be a more reliable measure of blood gases following acute changes in ventilation.

Methods

To allow for characterisation of ventilatory changes typical of acutely ill patients, but without the confounding influence of perfusion or metabolic disturbances, 30 patients scheduled for elective surgery were studied in a prospective observational study. Following anaesthesia, and before the start of the surgery, ventilator settings were altered to achieve a + 100% or − 60% change in alveolar ventilation (‘hyper-’ or ‘hypoventilation’), changes consistent with the anticipation of a painful arterial puncture commonly encountered in the emergency room. Blood samples were drawn simultaneously from indwelling arterial and peripheral venous catheters at baseline, and at 15, 30, 45, 60, 90 and 120 s following the ventilatory change. Comparisons between the timed arterial (or venous) samples were done using repeated-measures ANOVA, with post-hoc analysis using Bonferroni’s correction.

Results

Arterial blood pH and PCO₂ changed rapidly within the first 15–30s after both hyper- and hypoventilation, plateauing at around 60s (∆pH = ±0.036 and ∆PCO₂ = ±0.64 kPa (4.7 mmHg), respectively), with peripheral venous values remaining relatively constant until 60s, and changing minimally thereafter. Mean arterial changes were significantly different at 30s (P < 0.001) when compared to baseline, in response to both hyper- and hypoventilation.

Conclusion

This study has shown that substantial differences in arterial and peripheral venous acid-base status can be due to acute changes in ventilation, commonly seen in the ER over the 30s necessary to sample arterial blood. If changes are transient, peripheral venous blood may provide a more reliable description of acid-base status.

Using ways of knowing in nursing to develop educational strategies that support knowledge mobilization

There are continued challenges in achieving effective pain management for children and young people (CYP). Research has found several barriers to effective CYP pain management, which include, but are not limited to, deficiencies in knowledge among nurses and other healthcare professionals. Calls for improvements in and an increase in pain education ensue, in the expectation that an increase in knowledge will lead to an improved pain care for patients. Educational initiatives, as reported in the literature, have tended to focus on increasing empirical knowledge which has not resulted in the anticipated improvements in practice. An exploration of Carper's and Chinn & Kramer's five ways of knowing helps demonstrate why an over-reliance on empirics fails to equip nurses for the realities of clinical practice and does not facilitate knowledge mobilization or improvements in pain care for CYP. In this paper, we explore these ways of knowing to produce a model for knowledge mobilization in (pain) education. Our model puts forward a multifaceted approach to education using the active learning principles which supports and equip nurses to become effective pain practitioners.

Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals

Background

As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings.

Methods

Guided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records.

Results

Analysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field).

Conclusions

The habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12887-020-02399-w.

Evaluating the content validity of two versions of an instrument used in measuring pediatric pain knowledge and attitudes in the Ghanaian context

In this article, we compared the content validity of two instruments used in measuring pediatric pain knowledge and attitudes. This was considered necessary due to the universal differences in culture, semantics and healthcare resources in different parts of the globe. Thirteen (13) pediatric experts in Ghana assessed the content validity of two instruments: the 42-item Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS) and the 41-item Pediatric Healthcare Providers' Knowledge and Attitudes Survey Regarding Pain (PHPKASRP). The relevance and clarity of each item on these instruments were rated on a four-point likert scaled options from 1 (not relevant/ not clear) to 4 (very relevant/ very clear). The item-level content validity index (I-CVI) was calculated by dividing the number of experts who rated an item with 3 or 4 by the total number of experts. The average scale-level content validity index (S-CVI/Ave) was also estimated by summing up the I-CVIs of all items and dividing them by the total number of items. The I-CVIs on the PNKAS ranged from 0.62 to 1.00 for the relevance component and 0.69 to 1.00 for the clarity component. The I-CVIs on the PHPKASRP ranged from 0.62 to 1.00 for both the relevance and clarity components. The S-CVI/Ave were 0.87 and 0.89 for the relevance and clarity aspects on the PNKAS respectively. The S-CVI/Ave for the PHPKASRP instrument were 0.86 and 0.89 for the relevance and clarity aspects correspondingly. At the end of the validation process, 5 items were revised on both instruments whilst 37 and 36 items were maintained on the PNKAS and PHPKASRP instruments respectively. The PNKAS and PHPKASRP have an acceptable level of content validity in the Ghanaian context and recommended for educational and research purposes. Other forms of validity and reliability of these instruments should also be examined in future studies.

Validação de cartilha sobre cateterização intravenosa periférica para famílias

Objetivo: validar o conteúdo e a aparência da tecnologia didática e instrucional intitulada Punção venosa periférica para família, junto aos familiares acompanhantes de crianças hospitalizadas. Métodos: trata-se de um estudo metodológico do tipo validação de tecnologia. Os participantes foram familiares acompanhantes de crianças hospitalizadas submetidas à cateterização intravenosa periférica. A coleta e a análise dos dados foram realizadas com base no Índice de Validação de Conteúdo, que considera desejável o valor igual ou superior a 0,80.Resultados: a cartilha foi validada na primeira rodada, na qual se obtiveram índices máximos na maioria das variáveis, com índice de validação de conteúdo global igual a 0,98. Entretanto, alguns familiares apontaram alterações a serem feitas no material. Conclusão: objetivo proposto pelo estudo foi alcançado, uma vez que a cartilha está validada quanto ao conteúdo e à aparência de acordo com a avaliação do público-alvo.