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The effect of playing games with toys made with medical materials in children with cancer on pain during intravenous treatment. Palliat Support Care 2021; 20:84-93. [PMID: 33947501 DOI: 10.1017/s1478951521000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This research aims to examine the effect of playing games with toys made of medical materials in children with cancer on pain that occurs during intravenous (IV) treatment. METHODS The randomized controlled clinical trial was conducted between May 2016 and February 2018. The study sample comprised 110 children (experimental group 55; control group 55), determined using power analysis from the study population. The data were collected by the researcher, using face-to-face interview techniques, the Information Form, and Wong-Baker FACES Pain Rating Scale (WBS). RESULTS The pre- and post-test pain mean scores of patients in the experimental group were 2.27 ± 0.91 and 0.43 ± 0.66, respectively (p = 0.0001). The pre- and post-test pain mean scores of patients in the control group were 1.72 ± 0.82 and 3.34 ± 0.77, respectively (p = 0.0001). SIGNIFICANCE OF RESULTS The experience of playing with toys made from materials used for invasive procedures relieves pain the during IV treatment.
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Páramo-Cano T, Ortiz MI, Gómez-Busto FJ, Espinoza-Ramírez AL. Management of Procedural Pain in Children. Curr Pediatr Rev 2021; 17:288-328. [PMID: 33820520 DOI: 10.2174/1573396317666210405150526] [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: 07/30/2020] [Revised: 11/02/2020] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
In recent years, there has been increased interest in the study of pain in children and its treatment. It is known that when facing diagnostic and therapeutic procedures similar to those performed on adults, children either do not receive specific pain treatment or receive it on a significantly lower scale. However, recent research suggests a change in attitude and an improvement in the current treatment of children's pain. Although current knowledge demonstrates the falsity of many preconceived ideas about pain and its management, our results suggest that attitudinal change towards childhood pain remains slow and that real improvement in the training and practical application of the pediatrician who has to treat childhood pain is urgently needed. In this context, this manuscript has prepared standards and guidelines to improve pain management practices in a large number of national and international professional settings.
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Affiliation(s)
- Tatjana Páramo-Cano
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Mario I Ortiz
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Federico J Gómez-Busto
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Ana L Espinoza-Ramírez
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
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Tan SM, Ong YKG, Pek JH. Analgesia for extremity fractures in the paediatric emergency department. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820915731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Extremity fractures are an important and common presentation at the Paediatric Emergency Department (PED). Provision of analgesia is a key management principle, but it is often suboptimal. Although there is an increase in awareness of this issue, the impact on current practice is not known. We aimed to review the current practice of providing analgesia for extremity fractures in the PED. Objective: Our objective was to determine the utilisation, adequacy and timeliness of analgesia provided for these patients. Methods: A retrospective study was carried out from November to December 2017. Patients with a diagnosis of extremity fracture involving the upper or lower limb were included. Information about patient demographics, diagnosis, pain score, analgesia use and clinical progress were collected for analysis. Results: There were 101 cases. The mean age was 8.5±4.2 years old, and 62 (61.4%) patients were male. There were 76 (75.3%) cases of fractures involving the upper limb, and 25 (24.7%) cases of fractures involving the lower limb. The mean pain score at presentation was 3.3±2.3. Analgesia was administered to only 10 (9.9%) patients, with oral paracetamol ( n=5; 5.0%) being the most common medication administered. The median time between arrival in the PED to analgesia administration was 69 minutes (range 25–328 minutes). Conclusions: Despite the increase in awareness, analgesia for these patients remains underutilised, inadequate and delayed. Further efforts at pain assessment, analgesia selection and administration are necessary to improve the provision of analgesia for these patients.
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Affiliation(s)
- Siew Ming Tan
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Yong-Kwang Gene Ong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
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Benzing AC, Bell C, Derazin M, Mack R, MacIntosh T. Disparities in Opioid Pain Management for Long Bone Fractures. J Racial Ethn Health Disparities 2020; 7:740-745. [PMID: 32378160 DOI: 10.1007/s40615-020-00701-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
An expanding body of evidence has established that racial disparities exist in the US healthcare system, manifesting in poorer health outcomes for members of the non-white population. This study examines whether disparities exist in the type of analgesia ordered for long bone fractures and the time to medication administration in a community teaching hospital serving a large Hispanic population. We reviewed de-identified data of 115 patients from the emergency department of a community Level II Trauma Center in central Florida with diagnosed long bone fractures and examined the clinical and demographic variables associated with the type of analgesic administered and factors associated with delays in medication administration. We found that women reported higher pain scores than men, but there was no difference in the type of pain medication administered. There was no difference in pain scores between white and non-white patients; however, white patients were more likely to receive opiates for their long bone fractures compared with non-white patients (70 vs 50%, p < 0.0001). Opioid pain medications were prescribed significantly more often to adult and elderly patients compared with pediatric patients who were more likely to receive acetaminophen compared with both other patient groups (p < 0.001). In summary, we found that pain score was not associated with the class of pain medication administered, but that race and age were. This study questions the utility of the pain score for acute injuries and raises concerns about the role of physician bias in analgesia administration.
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Affiliation(s)
| | - C Bell
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - M Derazin
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - R Mack
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - T MacIntosh
- UCF/HCA Emergency Medicine Residency of Greater Orlando, Osceola Regional Medical Center, Kissimmee, FL, USA.
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Paediatric procedural sedation and analgesia by emergency physicians in a country with a recent establishment of emergency medicine. Eur J Emerg Med 2019; 26:168-173. [PMID: 29240569 DOI: 10.1097/mej.0000000000000524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Paediatric patients receive less procedural sedation and analgesia (PSA) in the emergency department compared with adults, especially in countries where emergency medicine is at an early stage of development. The objectives of this study were to evaluate the adverse events and efficacy of paediatric PSA in a country with a recent establishment of emergency medicine and to describe which factors aided implementation. METHODS This is a prospective, multicentre, observational study of paediatric patients undergoing PSA by the first trained emergency physicians (EPs) in The Netherlands. A standardized data collection form was used at all participating hospitals to collect data on adverse events, amnesia, pain scores, and procedure completion. A survey was used to interpret which factors had aided PSA implementation. RESULTS We recorded 351 paediatric PSA. The mean age was 9.5 years (95% confidence interval: 9.1-10.0). Esketamine was most frequently used (42.4%), followed by propofol (34.7%). The adverse event rate was low (3.0%). Amnesia was present in 86.8%. The median pain score was 2 (out of 10) for patients without amnesia. Procedures were successfully completed in 93.9% of the cases. CONCLUSION Paediatric PSA provided by the first EPs in The Netherlands showed appropriate levels of sedation and analgesia with a high rate of procedure completion and a low rate of adverse events. Our paper suggests that EPs provided with a proper infrastructure of mentorship, training and guidelines can implement effective paediatric PSA.
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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: 69] [Impact Index Per Article: 8.6] [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.
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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
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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]
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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.
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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
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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
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Ortiz MI, López-Zarco M, Arreola-Bautista EJ. Procedural pain and anxiety in paediatric patients in a Mexican emergency department. J Adv Nurs 2012; 68:2700-9. [PMID: 22381114 DOI: 10.1111/j.1365-2648.2012.05969.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM This article is a report of a study carried out to investigate the procedures that are likely to induce pain and anxiety in children in a Mexican emergency department. BACKGROUND In emergency rooms, children often experience unpredictable diagnostic and therapeutic procedural-related pain that can be associated with considerable anxiety. DESIGN A prospective, descriptive and cross sectional study was conducted to investigate the prevalence of procedures or situations that probably induced anxiety and/or pain in children in an emergency room. METHODS Procedural pain and anxiety were evaluated in children and adolescents (8-16 years) who were admitted to the emergency department of a paediatric hospital between February-September 2010. Children rated their pain and anxiety using a 100-mm visual analogue scale. RESULTS A total of 252 children with a mean age of 10·1 years were evaluated. Four-hundred fifty-nine procedures were completed, with an average of 1·82 events/child. Of these procedures, 369 (80·4%) were rated painful and 357 (77·8%) were rated stressful. The most frequently reported procedural pain or stressful episodes were peripheral catheterization, clinical examination and vascular puncture. Overall, 32·5% of the painful events were rated severe, 32·0% were rated moderate and 35·5% were rated slight. However, 30% of the stressful events were rated severe, 38·9% were rated moderate and 31·1% were rated slight. Peripheral catheterization was rated severe in 58 children (33·9%), moderate in 55 children (32·2%) and slight in 58 (33·9%) children. CONCLUSION This study provides data on common emergency department procedures that cause pain and anxiety in children and young adolescents. Healthcare providers must consider the best psychological and pharmacological interventions to reduce procedural anxiety and pain.
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Affiliation(s)
- Mario I Ortiz
- Área Académica de Medicina del Instituto de Ciencias de la Salud de la Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico.
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Quin AJ, Waldron R, Page P. Infant trauma. TRAUMA-ENGLAND 2010. [DOI: 10.1177/1460408610378269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma forms the second largest cause of death in children under 1 year of age. Infants form a difficult cohort of patients; their range of development, differing physiology and inability to communicate or understand treatment makes them a challenge for any healthcare worker. Several factors compound this problem including a general lack of familiarity within non-specialised trauma services and the difficulty in studying infants as a cohort in academic research. This article aims to summarise the common problems encountered in dealing with infants in a trauma setting and specific differences in their management compared to other children or adults. Where possible it details current evidence most appropriate to the age group.
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Affiliation(s)
- Andrew J Quin
- Department of Academic Emergency Medicine, James Cook University Hospital, Middlesbrough TS4 3BW, UK,
| | - Rebecca Waldron
- Division of Health Research, Lancaster University, Lancashire LA1 4YF, UK
| | - Piers Page
- Department of Orthopaedics and Trauma, Frimley Park Hospital, Camberley, Surrey GU16 7UJ, UK
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