1
|
Lewis EC, Komkov S, Rickles J, Saccoccio M, Thomesen M, Turcotte L, Zempsky WT, Waynik I. Decreasing Pain in Hospitalized Patients by Increasing Topical Anesthetic Use for Peripheral IVs. Pediatr Qual Saf 2024; 9:e753. [PMID: 39131230 PMCID: PMC11315564 DOI: 10.1097/pq9.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Venous access is a common source of pain for hospitalized patients. Topical anesthetics are effective at decreasing needle pain, can improve success rate, and decrease procedure time; however, use before peripheral intravenous line (PIV) placement is inconsistent. The aim was to reduce pain experienced by hospitalized pediatric patients by increasing topical anesthetic use for PIV placement from a mean of 11% to 40% within 6 months. Methods The Model for Improvement was utilized. An institutional clinical pathway and PIV order panel were developed. Pre-checked orders for topical anesthetics were added to order sets. Visual aids were placed on IV carts, including reminders for anesthetics, pathway use and scripting examples. Nurses received individual feedback. Statistical process control charts were posted weekly on daily management system boards on medical-surgical floors, and data were shared at daily nursing huddles to increase awareness of performance and discuss opportunities for improvement. Results Topical anesthetic use for PIV placement increased from a mean of 11% to 46%. Documentation of comfort measures during PIV placement increased from a mean of 6% to 13%. The percentage of PIV placements with an order for a topical anesthetic in the electronic health record increased from a mean of 14% to 54%. PIV procedures with documentation of placement attempts increased from a mean of 47% to 70%. Conclusions Through systems and culture change, awareness of the importance of pain prevention for venous access procedures increased, and patient-centered care improved with greater collaboration between nurses, providers, and families for venous access planning.
Collapse
Affiliation(s)
- Emilee C. Lewis
- From the Division of Pediatric Hospital Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, N.C
| | | | | | | | | | | | - William T. Zempsky
- Connecticut Children’s, Hartford, Conn
- Division of Pain a Palliative Medicine, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, Conn
| | - Ilana Waynik
- Connecticut Children’s, Hartford, Conn
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, Conn
| |
Collapse
|
2
|
Fuchs A, Cordes BL, van Dick R, Ebers G, Kaluza A, Konietzny C, Baumann U. Interventions to alleviate anxiety and pain during venipuncture in children with chronic gastrointestinal and/or liver disease: A single-center prospective observational study. JPGN REPORTS 2024; 5:110-118. [PMID: 38756111 PMCID: PMC11093924 DOI: 10.1002/jpr3.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 05/18/2024]
Abstract
Objectives The goal of this longitudinal study was to reduce anxiety and pain in children with chronic conditions from the gastrointestinal tract during venipuncture. These children undergo regular venipuncture as part of their medical management and the procedure is often accompanied with anxiety and pain. In addition, children as well as their parents and health care professionals (HCPs) often suffer "compassionate pain" because of emotional interference. Method In a realistic clinical setting, different psychological and medical interventions were examined: (1) Psychoeducational brochures and (2) four different medical-technical interventions during venipuncture. In a large hospital in Germany, 169 children, their parents, and HCPs were asked to rate anxiety and pain during venipuncture before and after the intervention. Results Children showed a clear preference for some of the medical-technical interventions. Using Linear Mixed Models anxiety and pain rated by the children themselves showed no significant reduction. However, parents and HCPs reported a significant reduction. Age, gender, and status of liver transplantation were associated with a reduction in anxiety and pain in most of the analyses. Conclusion Both psychoeducational brochures and medical-technical interventions had a positive impact on anxiety and pain. However, effectivity for the medical-technical interventions was lower than in previous studies utilizing individual interventions. Reasons for this difference as well as possibilities to improve the intervention are discussed. In addition, this study provides practical day-to-day information about the implementation of interventions for the work in pediatric units such as when and how to provide psychoeducational materials.
Collapse
Affiliation(s)
- Albert Fuchs
- Department of Social PsychologyGoethe University FrankfurtFrankfurt am MainGermany
| | - Berrit L. Cordes
- Department of Social PsychologyGoethe University FrankfurtFrankfurt am MainGermany
| | - Rolf van Dick
- Department of Social PsychologyGoethe University FrankfurtFrankfurt am MainGermany
| | - Gianna Ebers
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannover Medical SchoolHannoverGermany
| | - Antonia Kaluza
- Department of Social PsychologyGoethe University FrankfurtFrankfurt am MainGermany
| | - Christiane Konietzny
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannover Medical SchoolHannoverGermany
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannover Medical SchoolHannoverGermany
| |
Collapse
|
3
|
Thompson A, Rodrigo ML, Roberts A, Waddell J, Carter R. Effect of vibratory device on the time of administration of vaccines and on patient satisfaction measures. J Child Health Care 2024:13674935241242156. [PMID: 38556616 DOI: 10.1177/13674935241242156] [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] [Indexed: 04/02/2024]
Abstract
Previous studies have demonstrated that Buzzy® is effective for pain reduction during vaccination. This study aimed to determine if Buzzy® would have an effect on either duration of vaccine administration and/or patient satisfaction. Pediatric patients aged birth to 18 years old receiving a vaccination were randomized to either a control group receiving no intervention, or the experimental group, utilizing Buzzy®. Time of administration was measured by the number of seconds required by nursing to administer vaccines. Patient satisfaction was measured with a survey given to guardians. Time required was reduced by almost 2 min when utilizing Buzzy®, with median time dropping to 190, 95% CI [26.99, 415.92] seconds from 333, 95% CI [51.35, 627.21] seconds. Patient satisfaction surveys showed positive impacts of using the device, with 100% that used the device reporting that it "made a difference in the pain level experienced," but did not demonstrate statistical significance. This study shows that use of Buzzy® increases efficiency of appointments with possible positive effect on patient satisfaction.
Collapse
Affiliation(s)
| | | | | | - Jaylyn Waddell
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca Carter
- University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
Integration of child life services in the delivery of multi-disciplinary differences in Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) care. J Pediatr Urol 2022; 18:612.e1-612.e6. [PMID: 36031554 DOI: 10.1016/j.jpurol.2022.08.001] [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: 11/17/2021] [Revised: 04/25/2022] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Multiple studies have demonstrated the benefit of incorporating certified child life specialist (CCLS) services in various aspects of pediatric care. Although the significance of psychosocial support of patients with Disorders of Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) is increasingly recognized, the involvement of CCLS services into the DSD and CAH multidisciplinary care model has yet to be described. OBJECTIVE To evaluate the feasibility, acceptability, and patient and family experience of routinely incorporating CCLS services into the multidisciplinary DSD and CAH care model. STUDY DESIGN As part of a quality improvement initiative, CCLS services were routinely incorporated in the multidisciplinary DSD and CAH clinics at our institution. Encounters for patients seen in clinic between July 2018 through October 2019 were reviewed for demographic information, DSD diagnosis classification, CCLS documentation, and whether an exam under anesthesia (EUA) was required due to an incomplete clinical exam. CCLS documentation was reviewed for assessments, interventions, whether patients tolerated their physical exams, time of CCLS services, and additional CCLS support beyond the physical exam. All patients were limited to one physical exam per clinic visit. RESULTS Out of the 45 encounters with CCLS involvement, 42 (93.3%) exams were well-tolerated. CCLS assessments considered patient development, communication considerations, temperament, medical stressors, coping preferences, and patient preferences for activities and distractions. Interventions included preparing patients for their physical exams, encouragement before and during exams, addressing patient stressors, distractions and coping mechanisms, and advocating for the patient. No patients required an EUA. DISCUSSION The CCLS aimed to provide families with a sense of control during clinic visits and teach them to advocate for themselves. The CCLS helped prepare and distract patients for their clinic visit and addressed the sensitive nature of the physical exam by focusing on the emotional and development needs of patients. CCLS contributions to a positive patient experience are consistent with multiple studies demonstrating the benefit of CCLS services for pediatric care. This quality improvement initiative ultimately helped to create a positive experience for patients and families. CONCLUSION This study demonstrates the feasibility, acceptability, and positive impact of CCLS services in the delivery of patient and family-centered care for patients with DSD and CAH as part of the multidisciplinary team model.
Collapse
|
5
|
Chumpitazi CE, Chang C, Atanelov Z, Dietrich AM, Lam SH, Rose E, Ruttan T, Shahid S, Stoner MJ, Sulton C, Saidinejad M. Managing acute pain in children presenting to the emergency department without opioids. J Am Coll Emerg Physicians Open 2022; 3:e12664. [PMID: 35310402 PMCID: PMC8918119 DOI: 10.1002/emp2.12664] [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: 09/16/2021] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 02/06/2023] Open
Abstract
Pediatric pain is challenging to assess and manage. Frequently underestimated in children, untreated pain may have consequences including increased fear, anxiety, and psychological issues. With the current opioid crisis, emergency physicians must be knowledgeable in both pharmacologic and non-pharmacologic approaches to address pain and anxiety in children that lead to enhanced patient cooperation and family satisfaction. This document focuses pain management and distress mitigation strategies for the brief diagnostic and therapeutic procedures commonly performed.
Collapse
Affiliation(s)
- Corrie E. Chumpitazi
- Department of PediatricsDivision of Emergency Medicine, Baylor College of Medicine, Texas Children's HospitalHoustonTexasUSA
| | - Cindy Chang
- Department of Pediatrics, Division of Emergency MedicineCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Zaza Atanelov
- North Florida Regional Medical Center Emergency DepartmentHCA/University of Central Florida College of Medicine ConsortiumFloridaUSA
| | - Ann M. Dietrich
- Department of Pediatrics and Emergency MedicineUniversity of South Carolina College of MedicineGreenvilleNorth CarolinaUSA
| | - Samuel Hiu‐Fung Lam
- Department of Emergency MedicineSutter Medical Center SacramentoSacramentoCaliforniaUSA
| | - Emily Rose
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Tim Ruttan
- Dell Children's Medical Center, Department of PediatricsThe University of Texas at Austin Dell Medical School, US Acute Care SolutionsAustinTexasUSA
| | - Sam Shahid
- American College of Emergency PhysiciansIrvingTexasUSA
| | - Michael J. Stoner
- Nationwide Children's HospitalThe Ohio State University College of MedicineColumbusOhioUSA
| | - Carmen Sulton
- Emory University School of MedicineChildren's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Mohsen Saidinejad
- Department of Emergency MedicineHarbor UCLA Medical CenterTorranceCaliforniaUSA
| | | |
Collapse
|
6
|
Cozzi G, Cognigni M, Busatto R, Grigoletto V, Giangreco M, Conte M, Barbi E. Adolescents' pain and distress during peripheral intravenous cannulation in a paediatric emergency setting. Eur J Pediatr 2022; 181:125-131. [PMID: 34218317 PMCID: PMC8760195 DOI: 10.1007/s00431-021-04169-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/24/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
The objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13-17 years), older children (8-12 years), and younger children (4-7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2-6) versus older and younger children (5; IQR = 2-8 and 6; IQR = 2-8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known: • Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New: • Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients • The number of pain relief techniques employed during procedures was inversely proportional to patient's age, topical or local anaesthesia were rarely used.
Collapse
Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Mariasole Conte
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy ,University of Trieste, Trieste, Italy
| |
Collapse
|
7
|
Effects of Green Color Exposure on Stress, Anxiety, and Pain during Peripheral Intravenous Cannulation in Dental Patients Requiring Sedation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115939. [PMID: 34205936 PMCID: PMC8199048 DOI: 10.3390/ijerph18115939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/29/2021] [Accepted: 05/30/2021] [Indexed: 12/26/2022]
Abstract
Intravenous cannulation is an invasive procedure that causes stress, anxiety, and pain for many patients. A recent animal study found that exposure to green light induced antinociceptive and anxiolytic effects. This study examined whether green color exposure reduced stress, anxiety, and pain during peripheral intravenous cannulation (PIC) for sedation in dental patients. In this controlled clinical trial, 24 patients (mean age 40.9 years) were randomized to wear clear glasses or green-colored glasses for 15 min before PIC on two separate days in a cross-over manner. The primary outcome measures were salivary alpha-amylase (sAA) activity and stress-related hemodynamic changes, and the secondary outcome measures were the visual analog scale anxiety (VAS-A) and pain (VAS-P) scores during PIC. The sAA level in the clear group significantly increased during PIC compared with baseline, but did not increase in the green group. Median VAS-P scores during PIC were lower in the green group than in the clear group (VAS-P, 17.0 vs. 50.0). Green color exposure with glasses significantly reduced stress and pain during PIC without any adverse effects. This simple, safe, and effective method may be useful during painful medical procedures.
Collapse
|
8
|
Erdogan B, Aytekin Ozdemir A. The Effect of Three Different Methods on Venipuncture Pain and Anxiety in Children: Distraction Cards, Virtual Reality, and Buzzy® (Randomized Controlled Trial). J Pediatr Nurs 2021; 58:e54-e62. [PMID: 33485746 DOI: 10.1016/j.pedn.2021.01.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to determine the effect of the distraction cards, virtual reality and Buzzy® methods on venipuncture pain and anxiety in children aged 7-12 years. DESIGN AND METHODS This was a randomized controlled trial with parallel groups conducted between November 16, 2017 and August 14, 2018 at the pediatric venipuncture unit of a university hospital in Western Turkey. The sample consisted of 142 children who met the inclusion criteria. The experimental group consisted of 108 children divided into three groups: Distraction Cards (DC; n = 35), Virtual Reality (VR; n = 37), and Buzzy® (n = 36). The control group (n = 34) received no intervention during venipuncture. Data were collected using a descriptive characteristics form, and the Visual Analog Scale (VAS), Wong-Baker FACES, and Children's Fear Scale (CFS). The participants themselves and their parents and the researcher scored venipuncture pain and anxiety levels. The study was approved by the Ethics Committee. Permission was obtained from related institutions. Informed consent was obtained from parents. Verbal consent was obtained from children prior to participation. RESULTS Buzzy® group had the lowest mean VAS score (2.2 ± 2.0), followed by the VR (2.7 ± 2.8), DC (3.4 ± 2.4), and control (5.2 ± 2.8) groups (p < 0.05). According to all raters (child, parent, and researcher), the Buzzy® group had the lowest mean Wong Baker FACES score, followed by the VR, DC, and control groups (p < 0.05). According to all raters, the Buzzy® group had the lowest mean CFS score, followed by the VR, DC, and control groups (p < 0.05). CONCLUSIONS The DC, VR, and Buzzy® methods were effective in reducing venipuncture pain and anxiety in children. PRACTICE IMPLICATIONS Nurses can use the DC, VR, and Buzzy® methods to help reduce venipuncture pain and anxiety in children. The clinical trial registration number is NCT04421430. (https://clinicaltrials.gov/ct2/show/study/NCT04421430).
Collapse
Affiliation(s)
- Birgül Erdogan
- Gazi University, Department of Nursing, Faculty of Health Sciences, Turkey.
| | | |
Collapse
|
9
|
Lee-Krueger RCW, Pearson JR, Spencer A, Noel M, Bell-Graham L, Beran TN. Children's Pain During IV Induction: A Randomized-Controlled Trial With the MEDi® Robot. J Pediatr Psychol 2021; 46:991-1000. [PMID: 33764470 DOI: 10.1093/jpepsy/jsab028] [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: 08/14/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examined the impact of a humanoid robot (MEDi®) programmed to teach deep breathing as a coping strategy, on children's pain and fear as primary and secondary outcomes, respectively, during intravenous (IV) line placement. The completion of IV induction was also examined as an exploratory outcome. METHODS In this randomized controlled, two-armed trial, 137 children (4-12 years) were recruited in Short Stay Surgery at a tertiary pediatric hospital. Patients were randomly assigned to standard care (SC) with Ametop© only (N = 60) or SC and robot-facilitated intervention (N = 59) before induction. Pain and fear before, during, and after IV insertion were rated by patients and observers. RESULTS No significant differences were found between groups and there were no changes over time for pain or fear (ps > .05). Exploratory analyses show that patients in the MEDi® group were 5.04 times more likely to complete IV induction, compared to SC, Fisher's exact test: X2 (1) = 4.85, p = .04, φc = 0.22, odds ratio = 5.04, 95% CI [1.06, 24.00]. CONCLUSION This study was the first to examine children's IV induction experience when provided MEDi® support. Reasons for nonsignificance, limitations, and research suggestions were made.
Collapse
Affiliation(s)
| | | | - Adam Spencer
- Department of Surgical Services, Alberta Children's Hospital, Alberta Health Services.,Department of Anesthesiology, Cumming School of Medicine, University of Calgary
| | - Melanie Noel
- Alberta Children's Hospital Research Institute, University of Calgary.,Hotchkiss Brain Institute, University of Calgary.,Department of Psychology, University of Calgary
| | - Lisa Bell-Graham
- Department of Child Life, Alberta Children's Hospital, Alberta Health Services
| | - Tanya N Beran
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary
| |
Collapse
|
10
|
Abstract
Child life programs are an important component of pediatric hospital-based care; they address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal development and well-being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the adverse effects of hospitalization, health care encounters, and/or other potentially stressful experiences. In collaboration with the entire health care team and family, child life specialists provide interventions that include therapeutic play, expressive modalities, and psychological preparation to facilitate coping and normalization at times and under circumstances that might otherwise prove overwhelming for the child. Play and developmentally appropriate communication are used to (1) promote optimal development, (2) educate children and families about health conditions, (3) prepare children and partner with families for medical events or procedures, (4) plan and rehearse useful coping and pain-management strategies with patients and families, (5) help children work through feelings about past or impending experiences, and (6) partner with families to establish therapeutic relationships between patients, siblings, and caregivers. Child life specialists collaborate with the entire interdisciplinary team to promote coping and enhance the overall health care experience for patients and families.
Collapse
Affiliation(s)
- Barbara Romito
- Child Life Program, The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey; and
| | - Jennifer Jewell
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Meredith Jackson
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | | |
Collapse
|
11
|
Osmanlliu E, Trottier ED, Bailey B, Lagacé M, Certain M, Khadra C, Sanchez M, Thériault C, Paquin D, Côtes-Turpin C, Le May S. Distraction in the Emergency department using Virtual reality for INtravenous procedures in Children to Improve comfort (DEVINCI): a pilot pragmatic randomized controlled trial. CAN J EMERG MED 2020; 23:94-102. [PMID: 33683617 DOI: 10.1007/s43678-020-00006-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Intravenous (IV) procedures cause pain and distress in the pediatric emergency department (ED). We studied the feasibility and acceptability of virtual reality distraction for patient comfort during intravenous procedures. METHODS Children were randomized to a control (standard care) or intervention group (standard care + virtual reality). Thresholds for feasibility and acceptability (primary outcomes) were determined through a priori established criteria. The level of procedural pain (principal clinical outcome) and distress, as well as memory of pain at 24 h were collected and reported as medians (Q1, Q3) for each group. RESULTS 63 patients were enrolled, with a high rate of recruitment (78.8%) and game completion (90.3%). Patients, parents and, healthcare providers reported high satisfaction levels. There were no serious adverse events. Five of the 30 patients (16.7%) exposed to virtual reality reported mild side effects. Self-reported procedural pain (verbal numerical rating scale: 3 (1, 6)/10 vs 3 (1, 5.5)/10, p = 0.75) was similar between groups. Further exploratory clinical measures were reported for the intervention and control groups, respectively: self-rated distress during the procedure (Child Fear Scale: 1 (0, 2)/4 vs 2 (0, 3)/4); distress evaluated by proxy during the procedure (Procedure Behavior Check List: 8 (8, 9)/40 vs 10 (8, 15)/40); memory of pain at 24 h (VNRS: 2 (1, 3)/10 vs 4 (2, 6.5)/10). CONCLUSION The addition of virtual reality to standard care is feasible and acceptable for pain and distress management during IV procedures in the pediatric ED. Occasional mild, self-resolving side effects were observed in the intervention group. Self-reported pain during the procedure was similar between groups. CLINICALTRIALS. GOV IDENTIFIER NCT03750578.
Collapse
Affiliation(s)
- Esli Osmanlliu
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Evelyne D Trottier
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Benoit Bailey
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Maryse Lagacé
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.,CHU Sainte-Justine Research Centre, Université de Montréal, Montréal, Canada
| | - Mélanie Certain
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Christelle Khadra
- CHU Sainte-Justine Research Centre, Université de Montréal, Montréal, Canada.,Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Marisol Sanchez
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Corinne Thériault
- Department of Pediatric Emergency Medicine, CHU Sainte-Justine, 3175, Ch. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - David Paquin
- Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
| | - Casey Côtes-Turpin
- Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
| | - Sylvie Le May
- CHU Sainte-Justine Research Centre, Université de Montréal, Montréal, Canada.,Faculty of Nursing, Université de Montréal, Montréal, Canada
| |
Collapse
|
12
|
McGinley T, Maskell S, Cantrell K. A Systematic Literature Review of Child Life in Ambulatory Settings. Pediatr Ann 2020; 49:e491-e498. [PMID: 33170298 DOI: 10.3928/19382359-20201014-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article illustrates the growth and development of the profession of child life within the last 25 years through a literature review of child life services in ambulatory settings. We reviewed all literature chronicling child life services in ambulatory settings published between January 1993 and December 2018 in three major databases, synthesizing common themes across the literature. Over the last 25 years, growth has occurred in the provision of child life interventions in outpatient settings and more publications are being produced. In outpatient settings, procedural support interventions have been written about the most, with much of this literature coming after 2010. [Pediatr Ann. 2020;49(11):e491-e498.].
Collapse
|
13
|
The Effect of External Thermomechanical Stimulation and Distraction on Reducing Pain Experienced by Children During Blood Drawing. Pediatr Emerg Care 2020; 36:66-69. [PMID: 28885392 DOI: 10.1097/pec.0000000000001264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the sole and combined effects of external thermomechanical stimulation and distraction in pain relief of children during blood drawing.This is a randomized clinical trial. The sample consisted of 218 children aged 6 to 12 years who were randomly assigned to 4 groups: group 1 received no intervention, group 2 received external thermomechanical stimulation using Buzzy, group 3 received distraction via DistrACTION Cards, and group 4 received a combination of both external thermomechanical stimulation and distraction. Preprocedural anxiety was assessed through observers' observations using the Children's Anxiety and Pain Scale. Children's pain levels were assessed by themselves, observers, and parents, as reported using the Faces Pain Scale-Revised. Preprocedural anxiety did not differ significantly (P > 0.05). When the 3 study groups were compared with the control group, all 3 groups had significantly lower pain levels than the control group (P < 0.001). The lowest pain level was measured in the combined condition (Buzzy and DistrACTION Cards). The mean score of the device group was lower than the distraction group.
Collapse
|
14
|
Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. La gestion de la douleur et de l’anxiété chez les enfants lors de brèves interventions diagnostiques et thérapeutiques. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
RésuméLes interventions médicales courantes utilisées pour évaluer et traiter les patients peuvent causer une douleur et une anxiété marquées. Les cliniciens devraient adopter une approche de base pour limiter la douleur et l’anxiété chez les enfants, notamment à l’égard des interventions diagnostiques et thérapeutiques fréquentes. Le présent document de principes est axé sur les nourrissons, les enfants et les adolescents qui subissent des interventions médicales courantes mineures, mais douloureuses. Il n’aborde pas les soins prodigués à l’unité de soins intensifs néonatale. Les auteurs examinent des stratégies simples et fondées sur des données probantes pour gérer la douleur et l’anxiété et donnent des conseils pour en faire un volet essentiel de la pratique clinique. Les professionnels de la santé sont invités à utiliser des façons de procéder peu invasives et, lorsque les interventions douloureuses sont inévitables, à combiner des stratégies simples de réduction de la douleur et de l’anxiété pour améliorer l’expérience du patient, du parent et du professionnel de la santé. Les administrateurs de la santé sont encouragés à créer des politiques pour leurs établissements, à améliorer la formation et l’accès aux lignes directrices, à créer des environnements propices aux enfants et aux adolescents, à s’assurer de la disponibilité du personnel, de l’équipement et des agents pharmacologiques appropriés et à effectuer des contrôles de qualité pour garantir une gestion de la douleur optimale.
Collapse
Affiliation(s)
- Evelyne D Trottier
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Marie-Joëlle Doré-Bergeron
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Laurel Chauvin-Kimoff
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Krista Baerg
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Samina Ali
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| |
Collapse
|
15
|
Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health 2019; 24:509-535. [PMID: 31844394 PMCID: PMC6901171 DOI: 10.1093/pch/pxz026] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2019] [Indexed: 12/17/2022] Open
Abstract
Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.
Collapse
Affiliation(s)
- Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Marie-Joëlle Doré-Bergeron
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Laurel Chauvin-Kimoff
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Krista Baerg
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Samina Ali
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| |
Collapse
|
16
|
Adams AJ, Cahill PJ, Flynn JM, Sankar WN. Utility of Perioperative Laboratory Tests in Pediatric Patients Undergoing Spinal Fusion for Scoliosis. Spine Deform 2019; 7:875-882. [PMID: 31731997 DOI: 10.1016/j.jspd.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 02/10/2019] [Accepted: 02/16/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES We aimed to characterize the frequency of perioperative laboratory tests for posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and to assess whether test results affected clinical management. SUMMARY OF BACKGROUND DATA Perioperative laboratory tests for PSF including complete blood count, coagulation laboratory tests, basic metabolic panels (BMPs), and type and screen, are commonly ordered based on providers' discretion or existing order sets. Studies have shown unnecessary laboratory tests as financially and physically costly in adults; however, no studies have examined the necessity of common perioperative laboratory tests in pediatric spinal deformity surgery. METHODS Retrospective review of patients aged 10-18 years who underwent PSF for AIS at our center in the past three years. The clinical utility of perioperative laboratory tests was assessed based on detected incidence of anemia, blood transfusions, hematology/endocrinology/nephrology consultations, insulin administration, and postponed/canceled surgeries. RESULTS A total of 234 patients were included (mean age 14.4 ± 1.8 years, 75% female). Of 105 (44.9%) patients with preoperative coagulation laboratory tests, 21 (20%) had abnormal results; however, none had subsequent hematology consultations or canceled/postponed surgeries. Postoperatively, only 5 (2.1%) patients and 30 (12.8%) patients had hemoglobin values less than 8 g/dL on postoperative day (POD) 1 and 2, respectively. Multivariate analysis identified POD1 hemoglobin ≤9.35 g/dL as the only predictor of hemoglobin <8 g/dL on POD2. Overall, there were 8 (3.4%) indicated blood transfusions postoperatively. Costs of unnecessary laboratory tests averaged $95.27 (range $49.72 to $240.27) per patient. CONCLUSIONS Many perioperative laboratory orders may be unnecessary in pediatric spinal deformity surgery, subjecting patients to extraneous costs and needlesticks. In particular, preoperative coagulation laboratory tests, perioperative BMPs, and additional postoperative CBCs for those with hemoglobin >9.35 on POD1 may not be warranted. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Alexander J Adams
- Division of Orthopaedic Surgery, the Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, 2nd Floor Wood Building, Philadelphia, PA, 19104, USA
| | - Patrick J Cahill
- Division of Orthopaedic Surgery, the Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, 2nd Floor Wood Building, Philadelphia, PA, 19104, USA
| | - John M Flynn
- Division of Orthopaedic Surgery, the Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, 2nd Floor Wood Building, Philadelphia, PA, 19104, USA
| | - Wudbhav N Sankar
- Division of Orthopaedic Surgery, the Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, 2nd Floor Wood Building, Philadelphia, PA, 19104, USA.
| |
Collapse
|
17
|
van der Heijden MJE, Mevius H, van der Heijde N, van Rosmalen J, van As S, van Dijk M. Children Listening to Music or Watching Cartoons During ER Procedures: A RCT. J Pediatr Psychol 2019; 44:1151-1162. [PMID: 31621845 DOI: 10.1093/jpepsy/jsz066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aims to determine if listening to music and watching cartoons are effective to distract children from pain and distress during procedures in the emergency room (ER). METHODS This study is a single-center, 3-armed, superiority randomized controlled trial comparing listening to music, watching cartoons, and standard care during ER procedures in children aged 3-13 years. The primary outcome was pain measured from video footage with the Alder Hey Triage Pain Score (AHTPS). Children older than 4 years self-reported pain with the Faces Pain Scale-Revised (FPS-R). The secondary outcome was distress measured with the Observational Scale of Behavioral Distress-revised (OSBD-r). Another indicator of distress was heart rate. RESULTS Data of 191 participants were analyzed for the 3 groups: music (n = 75), cartoon (n = 62), and control (n = 54). The median age was 7.3 years (4.9-9.7). In multivariable analysis, pain assessed with the AHTPS was significantly lower (B = -1.173, 95% confidence interval -1.953, -0.394, p = .003) in the music group than in the control groups. Across the 3 groups, 108 children self-reported pain with the FPS-R after the procedure. The scores were lowest in the music group, but the differences between groups were not significant (p = .077). OSBD-r distress scores assigned during the procedures were not significantly different between the 3 groups (p = .55). Heart rate directly after the procedure was not statistically significantly different between the 3 groups (p = .83). CONCLUSIONS Listening to recorded music is a beneficial distraction for children experiencing pain during ER procedures, whereas watching cartoons did not seem to reduce pain or distress.
Collapse
Affiliation(s)
- Marianne J E van der Heijden
- Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital.,Department of Internal Medicine, Erasmus MC, Sophia Children's Hospital
| | - Hiske Mevius
- Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital
| | | | | | | | - Monique van Dijk
- Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital.,Department of Pediatric Surgery, Red Cross Children's Hospital
| |
Collapse
|
18
|
|
19
|
Canbulat Şahiner N, Türkmen AS. The Effect of Distraction Cards on Reducing Pain and Anxiety During Intramuscular Injection in Children. Worldviews Evid Based Nurs 2019; 16:230-235. [DOI: 10.1111/wvn.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Nejla Canbulat Şahiner
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
| | - Ayşe Sonay Türkmen
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
| |
Collapse
|
20
|
Ballard A, Khadra C, Adler S, D Trottier E, Bailey B, Poonai N, Théroux J, Le May S. External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol. BMJ Open 2019; 9:e023214. [PMID: 30782698 PMCID: PMC6340451 DOI: 10.1136/bmjopen-2018-023214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department. METHODS AND ANALYSIS This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority. ETHICS AND DISSEMINATION This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT02616419.
Collapse
Affiliation(s)
- Ariane Ballard
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Christelle Khadra
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Samara Adler
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Evelyne D Trottier
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Benoit Bailey
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Naveen Poonai
- Department of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Jean Théroux
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
| | - Sylvie Le May
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| |
Collapse
|
21
|
Needle-related pain and distress management during needle-related procedures in children with and without intellectual disability. Eur J Pediatr 2018; 177:1753-1760. [PMID: 30203192 DOI: 10.1007/s00431-018-3237-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/06/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
Children with intellectual disability frequently undergo needle-related procedures for diagnosis or treatment. Nevertheless, only a few studies deal with pain and distress management during the procedure in this population of children. This study aimed to investigate the number of anxiety and pain management techniques performed during needle procedure in children with intellectual disability (cases) compared to a population of children without intellectual disability (controls). This multicenter cohort study was performed from July 2016 to January 2018 in the pediatric ward of four urban hospitals in Italy. Eligible subjects were children with and without intellectual disability, from 4 to 17 years old, who needed venipuncture or intravenous cannulation for diagnosis or treatment. Use of topical anesthesia, distraction techniques, and physical or verbal comfort during procedures were recorded. Pain and anxiety scores were also recorded. Forty-seven cases and 94 controls were recruited. Three pain- and anxiety-relieving techniques were performed during the procedure in 12 (25%) cases and in 10 controls (11%); two techniques were performed in 23 (50%) cases and in 26 (28%) controls; 12 (25%) cases and 52 (55%) controls received only one.Conclusion: In this series, children with intellectual disability received significantly more relieving techniques, but experienced more pain and anxiety when compared to children without intellectual disability. What is Known: • Children with intellectual disability experience more episodes of pain than cognitively healthy ones, and almost 10% of these episodes are due to medical procedures. What is New: • Children with intellectual disability despite receiving more relieving techniques during a needle-related procedure experienced more pain and anxiety when compared to healthy children.
Collapse
|
22
|
Certified Child Life Specialists Lessen Emotional Distress of Children Undergoing Laceration Repair in the Emergency Department. Pediatr Emerg Care 2018; 34:603-606. [PMID: 30045353 DOI: 10.1097/pec.0000000000001559] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the impact of certified child life specialists (CCLSs) on the emotional responses of children undergoing laceration repair in the emergency department (ED). METHODS Patients 4 to 12 years of age who required laceration repair by suturing were prospectively enrolled at an urban tertiary pediatric ED. Certified child life specialists are not available at all times in our institution, allowing for a priori categorization of subjects into 2 comparison groups, those with and those without CCLS involvement. Subjects requiring anxiolysis, pharmacologic sedation, narcotics, or physical restraint were excluded. The Children's Emotional Manifestation Scale, a previously validated Likert-like tool, was used to quantify the patients' distress, with a higher score reflecting a more emotional child. Just before placement of the first suture, subjects were scored by trained independent observers. Baseline data included age, sex, race, type of local anesthetic, length and location of laceration, and analgesics administered. The primary endpoint of emotional score was compared with a 2-tailed Mann-Whitney U test, with a P < 0.05 considered statistically significant. RESULTS Two hundred one patients constituted the final study cohort, with 103 (51%) having CCLS involvement. Study groups did not differ in regards to any baseline demographic or clinical characteristics. The median emotional score for patients with child life services was 7 (interquartile range, 6-9) versus 9 (interquartile range, 7.5-12) for those without (P < 0.0005). CONCLUSIONS Certified child life specialist involvement is associated with less emotional distress for children undergoing laceration repair in the ED.
Collapse
|
23
|
Trottier ED, Ali S, Thull-Freedman J, Meckler G, Stang A, Porter R, Blanchet M, Dubrovsky AS, Kam A, Jain R, Principi T, Joubert G, Le May S, Chan M, Neto G, Lagacé M, Gravel J. Treating and reducing anxiety and pain in the paediatric emergency department-TIME FOR ACTION-the TRAPPED quality improvement collaborative. Paediatr Child Health 2018; 23:e85-e94. [PMID: 30046273 PMCID: PMC6054215 DOI: 10.1093/pch/pxx186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES In 2013, the TRAPPED-1 survey reported inconsistent availability of pain and distress management strategies across all 15 Canadian paediatric emergency department (PEDs). The objective of the TRAPPED-2 study was to utilize a procedural pain quality improvement collaborative (QIC) and evaluate the number of newly introduced pain and distress-reducing strategies in Canadian PEDs over a 2-year period. METHODS A QIC was created to increase implementation of new strategies, through collaborative information sharing among PEDs. In 2015, 11 of the 15 Canadian PEDs participated in the TRAPPED QIC. At the end of the year, the TRAPPED-2 survey was electronically sent to a representative member at each of the 15 PEDs. The successful introduction of the chosen strategies by the QIC was assessed as well as the addition of new strategies per site. The number of new strategies introduced in the participating and nonparticipating QIC sites were described. RESULTS All 15 PEDs (100%) completed the TRAPPED-2 survey. Overall, 10/11 of QIC-participating sites implemented the strategy they had initially identified. All 15 Canadian PEDs implemented some new strategies during the study period; participants in the QIC reported a mean of 5.2 (1-11) new strategies compared to 2.5 (1-4) in the nonactively participating sites. CONCLUSION While all PEDs introduced new strategies during the study, QIC-participating sites successfully introduced the majority of their previously identified new strategies in a short time period. Sharing deadlines and information between centres may have contributed to this success.
Collapse
Affiliation(s)
| | - Samina Ali
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | | | - Garth Meckler
- BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Antonia Stang
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta
| | - Robert Porter
- Janeway Children’s Hospital, Memorial University, St-Johns, Newfoundl
| | | | | | - April Kam
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario
| | | | - Tania Principi
- Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | | | - Sylvie Le May
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
| | - Melissa Chan
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | - Gina Neto
- CHEO, University of Ottawa, Ottawa, Ontario
| | - Maryse Lagacé
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
| | - Jocelyn Gravel
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
| | | |
Collapse
|
24
|
Ballard A, Khadra C, Adler S, Doyon-Trottier E, Le May S. Efficacy of the Buzzy® device for pain management of children during needle-related procedures: a systematic review protocol. Syst Rev 2018; 7:78. [PMID: 29788987 PMCID: PMC5964660 DOI: 10.1186/s13643-018-0738-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/01/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Needle-related procedures are the most important source of pain in children in hospital setting. Unmanaged pain could result in short- and long-term physiological, psychological, and emotional consequences. Although the efficacy of numerous interventions has been evaluated, procedural pain management is often suboptimal in children undergoing needle-related procedures. The main objective of this systematic review is to examine the evidence for the efficacy of the Buzzy® device for needle-related procedural pain in children. METHODS An electronic search will be conducted in the following databases: CENTRAL, PubMed, MEDLINE, EMBASE, PsycInfo, and CINAHL. There will be no restriction regarding the language, date of publication, and publication status. Eligible studies will be randomized controlled trials using the Buzzy® device for pain management in children undergoing needle-related procedures. Selection of studies, data extraction and management, assessment of risk of bias and quality of evidence will be performed by two independent reviewers. A third researcher will be consulted in case of discrepancies. Depending on the availability and quality of the data as well as clinical and statistical heterogeneity, a meta-analysis will be performed. Otherwise, findings will be qualitatively reported. DISCUSSION This will be the first systematic review to examine the efficacy of the Buzzy® device on pain management of children during needle-related procedures. Results of this review will guide clinical practice and recommendations for further research to improve procedural pediatric pain management. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017076531.
Collapse
Affiliation(s)
- Ariane Ballard
- Faculty of Nursing, University of Montreal, 2375, Chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1A8 Canada
- CHU Sainte-Justine Research Centre, 3175, Chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1C4 Canada
| | - Christelle Khadra
- Faculty of Nursing, University of Montreal, 2375, Chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1A8 Canada
- CHU Sainte-Justine Research Centre, 3175, Chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1C4 Canada
| | - Samara Adler
- Faculty of Medicine, University of Montreal, 2900, boulevard Édouard-Monpetit, Montreal, QC H3T 1J4 Canada
| | - Evelyne Doyon-Trottier
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175, Chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1C4 Canada
| | - Sylvie Le May
- Faculty of Nursing, University of Montreal, 2375, Chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1A8 Canada
- CHU Sainte-Justine Research Centre, 3175, Chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1C4 Canada
- Faculty of Nursing, University of Montreal, P.O. Box 6128, Succursale Centre-Ville, Montreal, QC H3C 3J7 Canada
| |
Collapse
|
25
|
Anim-Boamah O, Aziato L, Adabayeri VM. Ghanaian nurses' knowledge of invasive procedural pain and its effect on children, parents and nurses. Nurs Child Young People 2017; 29:26-31. [PMID: 29115759 DOI: 10.7748/ncyp.2017.e795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
Abstract
AIM To explore Ghanaian nurses' knowledge of invasive procedural pain in children who are in hospital and to identify the effect of unrelieved pain on children, parents and nurses. METHOD An exploratory, descriptive and qualitative design was adopted. A purposive sampling technique was used and individual face-to-face, semi-structured interviews were conducted with 16 registered nurses from four children's units at a hospital in the Eastern Region of Ghana. Thematic and content analyses were performed. FINDINGS Four themes emerged: types of invasive procedure; pain expression; pain assessment; and effects of unrelieved pain. Participants had adequate knowledge of painful invasive procedures, however, they were not aware of the range of available validated pain assessment tools, using observations and body language instead to assess pain. CONCLUSION Ghanaian nurses require education on the use of validated rating scales to assess procedural pain in children. The inclusion of pain assessment and management in pre-registration curricula could improve knowledge.
Collapse
|
26
|
Yılmaz D, Heper Y, Gözler L. Effect of the Use of Buzzy® during Phlebotomy on Pain and Individual Satisfaction in Blood Donors. Pain Manag Nurs 2017; 18:260-267. [DOI: 10.1016/j.pmn.2017.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/25/2017] [Accepted: 03/23/2017] [Indexed: 11/26/2022]
|
27
|
Sahiner NC, Bal MD. The effects of three different distraction methods on pain and anxiety in children. J Child Health Care 2016; 20:277-85. [PMID: 26040282 DOI: 10.1177/1367493515587062] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to investigate of three different distraction methods (distraction cards, listening to the music of cartoon and balloon inflation) on pain and anxiety relief of children during phlebotomy. This study is a prospective, randomized, and controlled trial. The sample consisted of 6 to 12 years old children who require blood tests. Children were randomized into four groups as the distraction cards, the music, the balloon inflation, and the control. Data were obtained by conducting interviews with the children, their parents, and the observer before and after the procedure. The pain levels of the children were assessed by the parent and observer reports as well as self-report using the Wong-Baker FACES. The anxiety levels of children were assessed by parent and observer reports using Children Fear Scale. One hundred and twenty children (mean age: 9.1 ± 1.6 years) were included. The self-reported procedural pain levels showed significant differences among the study groups (p = .040). The distraction card group (2.33 ± 3.24) had significantly lower pain levels (p = .057) than the control group (4.53 ± 3.23). The procedural child anxiety levels reported by the observer showed a significant difference among the study groups (p = .032). All the forms of distraction significantly reduced pain and anxiety perception.
Collapse
Affiliation(s)
- Nejla Canbulat Sahiner
- Department of Pediatric Nursing, School of Health, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Meltem Demirgoz Bal
- Department of Obstetric and Gynecologic Nursing, School of Health, Karamanoglu Mehmetbey University, Karaman, Turkey
| |
Collapse
|
28
|
Abstract
Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.
Collapse
Affiliation(s)
- Benoit Bailey
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Evelyne D Trottier
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| |
Collapse
|
29
|
Rosenberg RE, Klejmont L, Gallen M, Fuller J, Dugan C, Budin W, Olsen-Gallagher I. Making Comfort Count: Using Quality Improvement to Promote Pediatric Procedural Pain Management. Hosp Pediatr 2016; 6:359-368. [PMID: 27173738 DOI: 10.1542/hpeds.2015-0240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Pediatric procedural pain management (PPPM) is best practice but was inconsistent in our large multisite general academic medical center. We hypothesized that quality improvement (QI) methods would improve and standardize PPPM in our health system within inpatient pediatric units. We aimed to increase topical anesthetic use from 10% to 40%, improve nursing pediatric pain knowledge, and increase parent satisfaction around procedures for children admitted to a general tertiary academic medical center. METHODS We used QI methods including needs assessment, self-identified champions, small tests of change, leadership accountability, data transparency, and a train-the-peer-trainer approach to implement PPPM. We measured inpatient use of topical anesthetic (goal of 40% of admissions), nursing pain knowledge, and parent satisfaction with child comfort during procedures. We used statistical process control and basic statistics to analyze data in this interrupted time series design. RESULTS Over 18 months, use of topical lidocaine rose from 10% to 36.5% for all inpatient admissions, resulting in a centerline shift. Nursing pain knowledge scores increased 7%. Mean parent satisfaction around procedural comfort increased from 83% to 88%. CONCLUSIONS A child-focused QI initiative around PPPM can succeed in a multisite general academic medical center. Key success factors for this effort included accountability, multidisciplinary core leadership, housewide training in a novel educational evidence-based framework, and use of data and champions to promote nurse and physician engagement. Future work will focus on sustaining and monitoring change.
Collapse
Affiliation(s)
- Rebecca E Rosenberg
- Department of Pediatrics, New York University School of Medicine, New York, New York; NYU Langone Medical Center, New York, New York;
| | - Liana Klejmont
- Department of Pharmacy, Westchester Medical Center, Valhalla, New York
| | | | | | | | - Wendy Budin
- NYU Langone Medical Center, New York, New York; New York University School of Nursing, New York, New York
| | | |
Collapse
|
30
|
Schreiber S, Cozzi G, Rutigliano R, Assandro P, Tubaro M, Cortellazzo Wiel L, Ronfani L, Barbi E. Analgesia by cooling vibration during venipuncture in children with cognitive impairment. Acta Paediatr 2016; 105:e12-6. [PMID: 26401633 DOI: 10.1111/apa.13224] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/10/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022]
Abstract
AIM Children with cognitive impairment experience pain more frequently than healthy children and are more likely to require venipuncture or intravenous cannulation for various procedures. They are frequently unable to report pain and often receive poor pain assessment and management. This study assessed the effectiveness of physical analgesia during vascular access in children with cognitive impairments. METHODS We conducted a prospective randomised controlled study at a tertiary-level children's hospital in Italy from April to May 2015 to assess whether a cooling vibration device called Buzzy decreased pain during venipuncture and intravenous cannulation in children with cognitive impairment. None of the children had verbal skills and the main cognitive impairments were cerebral palsy, epileptic encephalopathy and genetic syndromes. RESULTS We tested 70 children with a median age of nine years: 34 in the Buzzy group and 36 in the no-intervention group. Parents were trained in the use of the Noncommunicating Children's Pain Checklist--postoperative version scale, and they reported no or mild procedural pain in 32 cases (91.4%) in the Buzzy group and in 22 cases (61.1%) in the no-intervention group (p = 0.003). CONCLUSION Cooling vibration analgesia during vascular access reduced pain in children with cognitive impairment.
Collapse
Affiliation(s)
- Silvana Schreiber
- Institute for Maternal and Child Health; IRCCS ‘Burlo Garofolo’; Trieste Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health; IRCCS ‘Burlo Garofolo’; Trieste Italy
| | - Rosaria Rutigliano
- Institute for Maternal and Child Health; IRCCS ‘Burlo Garofolo’; Trieste Italy
| | | | | | | | - Luca Ronfani
- Institute for Maternal and Child Health; IRCCS ‘Burlo Garofolo’; Clinical Epidemiology and Health Services Research Unit; Trieste Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health; IRCCS ‘Burlo Garofolo’; Trieste Italy
| |
Collapse
|
31
|
Mutlu B, Balcı S. Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: a randomized controlled trial. J SPEC PEDIATR NURS 2015; 20:178-86. [PMID: 25817062 DOI: 10.1111/jspn.12112] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose was to determine the effects of the balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples. DESIGN AND METHODS In this prospective randomized controlled study, 9- to 12-year-old children in the intervention groups were asked to cough or inflate balloons during the venipuncture procedure. The Faces Pain Scale-Revised was used to assess pain intensity. RESULTS Pain intensity significantly differed between the control (n = 44) and intervention groups (balloon inflation [n = 44] and cough trick [n = 44], p < .001). PRACTICE IMPLICATIONS Coughing and inflating balloons during venipuncture do not require preparation and are time saving, easy, accessible, and effective in reducing pain.
Collapse
Affiliation(s)
- Birsen Mutlu
- Istanbul University Florence Nightingale Nursing Faculty-Pediatric Nursing, Istanbul, Turkey
| | - Serap Balcı
- Istanbul University Florence Nightingale Nursing Faculty-Pediatric Nursing, Istanbul, Turkey
| |
Collapse
|
32
|
Trottier ED, Ali S, Le May S, Gravel J. Treating and Reducing Anxiety and Pain in the Paediatric Emergency Department: The TRAPPED survey. Paediatr Child Health 2015; 20:239-44. [PMID: 26175559 PMCID: PMC4472050 DOI: 10.1093/pch/20.5.239] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Management of children's pain and anxiety in the emergency department is likely suboptimal. OBJECTIVE To determine the availability of currently used strategies in Canadian paediatric emergency departments. METHODS A cross-sectional survey involving all centres of the Pediatric Emergency Research Canada group was performed. The primary outcome was the availability of specific procedures for pain and anxiety management for children in the emergency department. One person per centre was identified to complete the survey. Data were collected from October 2013 to January 2014 using an electronic survey tool. RESULTS All 15 Pediatric Emergency Research Canada centres agreed to participate. The verbal numerical scale was widely used (80%) to assess pain. One-half of respondents (53%) had access to a child life specialist. The following techniques were available for minor procedures: television as a distraction tool (87% of respondents), topical anesthetic before intravenous needle insertion (73%) and positioning of the child on parent's lap (60%); most remaining centres reported that these could be easily implemented. Intravenous morphine was available at every centre. Intranasal fentanyl was available (60%) or considered to be easy to implement (33%). Few centres reported availability of clinical guidelines regarding pain for doctors (27%) and nurses (40%); all respondents considered them to be easy to implement. CONCLUSIONS There was wide variation in paediatric pain and anxiety management strategies among tertiary care Canadian emergency departments. Several pain-reduction procedures (distraction, positioning on parent's lap, topical anesthetic, intranasal administration) were identified that could be easily implemented to address the gap.
Collapse
Affiliation(s)
- Evelyne D Trottier
- Division of Pediatric Emergency Medicine, Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Sylvie Le May
- Centre hospitalier universitaire Sainte-Justine Research Centre
- Faculty of Nursing, University of Montreal, Montreal, Quebec
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec
- Centre hospitalier universitaire Sainte-Justine Research Centre
| |
Collapse
|
33
|
Canbulat Şahiner N, İnal S, Sevim Akbay A. The Effect of Combined Stimulation of External Cold and Vibration During Immunization on Pain and Anxiety Levels in Children. J Perianesth Nurs 2015; 30:228-35. [DOI: 10.1016/j.jopan.2014.05.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/15/2014] [Accepted: 05/30/2014] [Indexed: 10/23/2022]
|
34
|
Gómez-Neva E, Bayona JG, Rosselli D. Flebitis asociada con accesos venosos periféricos en niños: revisión sistemática de la literatura. INFECTIO 2015. [DOI: 10.1016/j.infect.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
35
|
Tyson ME, Bohl DD, Blickman JG. A randomized controlled trial: child life services in pediatric imaging. Pediatr Radiol 2014; 44:1426-32. [PMID: 24801818 DOI: 10.1007/s00247-014-3005-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/24/2014] [Accepted: 04/10/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children undergoing procedures in pediatric health care facilities and their families have been shown to benefit from psychosocial services and interventions such as those provided by a Certified Child Life Specialist (CCLS). The comprehensive impact of a CCLS in a pediatric imaging department is well recognized anecdotally but has not been examined in a prospective or randomized controlled fashion. OBJECTIVE We prospectively assessed the impact of a CCLS on parent satisfaction, staff satisfaction, child satisfaction, and parent and staff perceptions of child pain and distress in a pediatric imaging department. MATERIALS AND METHODS Eligible children between 1 and 12 years of age (n = 137) presenting to the pediatric imaging department for an imaging procedure were randomly assigned to an intervention or control arm. Those assigned to the intervention received the comprehensive services of a CCLS. The control group received standard of care, which did not include any child life services. Quantitative measures of satisfaction and perception of child pain and distress were assessed by parents and staff using a written 5-point Likert scale questionnaire after the imaging procedure. Children 4 and older were asked to answer 3 questions on a 3-point scale. RESULTS Statistically significant differences between the intervention and control groups were found in 19 out of 24 measures. Parents in the intervention group indicated higher satisfaction and a lower perception of their child's pain and distress. Staff in the intervention group indicated greater child cooperation and a lower perception of the child's pain and distress. Children in the intervention group indicated a better overall experience and less fear than those in the control group. CONCLUSION Child life specialists have a quantifiably positive impact on the care of children in imaging departments. Measures of parent satisfaction, staff satisfaction, child satisfaction, child pain and child distress are shown to be positively impacted by the services of a CCLS. These results have significant implications for hospitals striving to increase satisfaction, decrease costs and improve quality of care. In a health care landscape that is changing quickly and increasingly focused on the cost of care, future research should assess whether the core tenants of the child life profession support and contribute quantifiably to high-quality, cost-effective practices in health care.
Collapse
Affiliation(s)
- Mary E Tyson
- Pediatric Imaging Sciences, Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, USA,
| | | | | |
Collapse
|
36
|
Whelan HM, Kunselman AR, Thomas NJ, Moore J, Tamburro RF. The impact of a locally applied vibrating device on outpatient venipuncture in children. Clin Pediatr (Phila) 2014; 53:1189-95. [PMID: 24924565 DOI: 10.1177/0009922814538494] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the impact of a locally applied vibrating device on outpatient venipuncture in children. METHOD A retrospective review of survey data collected prospectively as part of a quality improvement project. Both patients and phlebotomists were surveyed. The sample consisted of 64 children aged 4 to 18 years (29 prior to the implementation of the vibrating device and 35 afterward) and 7 phlebotomists. RESULTS Prior to the use of the vibrating device, 17 children (59%) indicated that they wished something had been done to decrease venipuncture pain. Eighty percent of the cohort that used the vibrating device indicated that they would like it used for future procedures. Children with previous venipuncture experiences appeared to benefit most from use of the vibrating technique. The phlebotomists reported that vibration made the procedure easier in 81% of the cases; none reported that it complicated the procedure. CONCLUSIONS Locally applied vibration appears to be a well-accepted technique to minimize pediatric venipuncture discomfort that may facilitate completion of the procedure.
Collapse
Affiliation(s)
- Hilary M Whelan
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | - Neal J Thomas
- Pennsylvania State University College of Medicine, Hershey, PA, USA Penn State Hershey Children's Hospital, Hershey, PA, USA
| | - Jeffrey Moore
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Robert F Tamburro
- Pennsylvania State University College of Medicine, Hershey, PA, USA Penn State Hershey Children's Hospital, Hershey, PA, USA
| |
Collapse
|
37
|
Canbulat N, Ayhan F, Inal S. Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Manag Nurs 2014; 16:33-9. [PMID: 24912740 DOI: 10.1016/j.pmn.2014.03.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the effect of external cold and vibration stimulation via Buzzy on the pain and anxiety level of children during peripheral intravenous (IV) cannulation. This study was a prospective, randomized controlled trial. The sample consisted of 176 children ages 7 to 12 years who were randomly assigned to two groups: a control group that received no peripheral IV cannulation intervention and an experimental group that received external cold and vibration via Buzzy. The same nurse conducted the peripheral IV cannulation in all the children, and the same researcher applied the external cold and vibration to all the children. The external cold and the vibration were applied 1 minute before the peripheral IV cannulation procedure and continued until the end of the procedure. Preprocedural anxiety was assessed using the Children's Fear Scale, along with reports by the children, their parents, and an observer. Procedural anxiety was assessed with the Children's Fear Scale and the parents' and the observer's reports. Procedural pain was assessed using the Wong Baker Faces Scale and the visual analog scale self-reports of the children. Preprocedural anxiety did not differ significantly. Comparison of the two groups showed significantly lower pain and anxiety levels in the experimental group than in the control group during the peripheral IV cannulation. Buzzy can be considered to provide an effective combination of coldness and vibration. This method can be used during pediatric peripheral IV cannulation by pediatric nurses.
Collapse
Affiliation(s)
- Nejla Canbulat
- Nursing Department, Karamanoğlu Mehmet Bey University, Karaman, Turkey.
| | - Fatma Ayhan
- Selcuk University, Institute of Health Science, Surgical Nursing, Konya, Turkey
| | - Sevil Inal
- Istanbul University, Health Science Faculty, Midwifery Department, Istanbul, Turkey
| |
Collapse
|
38
|
Abstract
Child life programs are an important component of pediatric hospital-based care to address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal development and well-being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the adverse effects of hospitalization, health care, and/or other potentially stressful experiences. Using therapeutic play, expressive modalities, and psychological preparation as primary tools, in collaboration with the entire health care team and family, child life interventions facilitate coping and adjustment at times and under circumstances that might otherwise prove overwhelming for the child. Play and developmentally appropriate communication are used to: (1) promote optimal development; (2) educate children and families about health conditions; (3) prepare children and families for medical events or procedures; (4) plan and rehearse useful coping and pain management strategies; (5) help children work through feelings about past or impending experiences; and (6) establish therapeutic relationships with patients, siblings, and parents to support family involvement in each child's care.
Collapse
|
39
|
Canbulat N, İnal S, Sönmezer H. Efficacy of Distraction Methods on Procedural Pain and Anxiety by Applying Distraction Cards and Kaleidoscope in Children. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:23-8. [DOI: 10.1016/j.anr.2013.12.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/17/2013] [Accepted: 10/28/2013] [Indexed: 12/24/2022] Open
|
40
|
Abstract
This article reviews common office procedures and analgesia considerations for pediatric outpatients. Layer times of onset of analgesics to coincide with procedures. Pediatric procedural distress is multimodal. Always address parent and child fear and attention, along with pain.
Collapse
Affiliation(s)
- Amy Baxter
- Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta Scottish Rite, 1001 Johnson Ferry Road North East, Atlanta, GA 30342, USA; Department of Emergency Medicine, Medical College of Georgia at Georgia Regents University, 1120 15th Street, Augusta, GA 30912, USA.
| |
Collapse
|
41
|
|
42
|
Braswell LE. Peripherally Inserted Central Catheter Placement in Infants and Children. Tech Vasc Interv Radiol 2011; 14:204-11. [DOI: 10.1053/j.tvir.2011.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
43
|
Baxter AL, Watcha MF, Baxter WV, Leong T, Wyatt MM. Development and validation of a pictorial nausea rating scale for children. Pediatrics 2011; 127:e1542-9. [PMID: 21624874 DOI: 10.1542/peds.2010-1410] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The lack of a widely used, validated measure limits pediatric nausea management. The goal of this study was to create and validate a pictorial scale with regular incremental levels between scores depicting increasing nausea intensity. METHODS A pictorial nausea scale of 0 to 10 with 6 faces (the Baxter Retching Faces [BARF] scale) was developed in 3 stages. The BARF scale was validated in emergency department patients with vomiting and in healthy patients undergoing day surgery procedures. Patients were presented with visual analog scales for nausea and pain, the pictorial Faces Pain Scale-Revised, and the BARF scale. Patients receiving opioid analgesics or antiemetic agents had their pain and nausea assessed before and 30 minutes after therapy. Spearman's ρ correlation coefficients were calculated. A Wilcoxon matched-pair rank test compared pain and nausea scores before and after antiemetic therapy. RESULTS Thirty oncology patients and 15 nurses participated in the development of the scale, and 127 patients (52, emergency department; 75, day surgery) ages 7 to 18 years participated in the validation. The Spearman ρ correlation coefficient of the first paired BARF and visual analog scale for nausea scores was 0.93. Visual analog scales for nausea and BARF scores were significantly higher in patients requiring antiemetic agents (P = .0001) and decreased significantly after treatment (P = .0002), while posttreatment VAS (P = .20) and FPSR scores (P =.47) for patients receiving only antiemetic agents did not [corrected]. CONCLUSIONS We describe the development of a pictorial scale with beginning evidence of construct validity for a self-report assessment of the severity of pediatric nausea. The scale had convergent and discriminant validity, along with an ability to detect change after treatment.
Collapse
Affiliation(s)
- Amy L Baxter
- Medical College of Georgia, Pediatric Emergency Medicine Associates, Atlanta, Georgia, USA.
| | | | | | | | | |
Collapse
|
44
|
Abstract
Indications for pediatric procedural sedation and analgesia are generally based on the need to manage pain or elicit cooperation for a single major procedure in the emergency department setting. However, multiple minor procedures such as vascular access, urethral catheterization, lumbar puncture, or superficial abscess drainage may be required in the care of a single child, and combining these activities may produce as much stress as a single major procedure. The use of procedural sedation in children based on total procedural requirements is proposed with 2 illustrative cases as examples of this concept.
Collapse
|
45
|
Mahoney L, Ayers S, Seddon P. The Association Between Parent's and Healthcare Professional's Behavior and Children's Coping and Distress During Venepuncture. J Pediatr Psychol 2010; 35:985-95. [DOI: 10.1093/jpepsy/jsq009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
Page LO, Golden JA. Functional behavioral assessment as a model for multidisciplinary assessment and treatment. J Child Health Care 2009; 13:347-60. [PMID: 19833671 DOI: 10.1177/1367493509344825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavior, whether internalizing or externalizing, constitutes a primary challenge in any inpatient setting. In many cases, behavior may interfere with progress during inpatient treatment, resulting in the need for a behavioral strategy for those concerns. A multidisciplinary team approach is often necessary to fully identify and remediate interfering difficulties. Functional behavioral assessment (FBA) is a team-based technique that offers a positive option to these types of difficulties. This article provides a rationale for and delineates the use of FBA as a strategy for assessment and treatment for a complex care patient. Two uncontrolled case studies (pediatric rehabilitation and cancer) are used to illustrate the use of FBA in the tertiary hospital setting. Both cases demonstrated improvements in behavior with limited resources (time and training) needed to implement behavioral plans. Additional case-controlled research is needed to demonstrate the feasibility and utility of FBA as a strategy for multidisciplinary treatment planning and intervention.
Collapse
|
47
|
Zempsky WT. Optimizing the management of peripheral venous access pain in children: evidence, impact, and implementation. Pediatrics 2008; 122 Suppl 3:S121-4. [PMID: 18978004 DOI: 10.1542/peds.2008-1055c] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- William T. Zempsky
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut; Pain Relief Program, Connecticut Children's Medical Center, Hartford, Connecticut
| |
Collapse
|