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Uzsen H, Tural Buyuk E, Odabasoglu E, Koyun M. The effects of vibration and pressure interventions on children's pain, fear and anxiety: A randomized controlled trial. J Pediatr Nurs 2024; 75:196-204. [PMID: 38171061 DOI: 10.1016/j.pedn.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
AIM The effects of vibration and pressure methods on the level of fear, anxiety, and pain of pediatric patients who were admitted to the emergency department for intramuscular injection were evaluated. METHODS This was a parallel group and a randomized controlled study conducted in Turkey. The study sample consisted of 114 children aged between 5 and 10 years who presented to the emergency department to receive intramuscular ceftriaxone injection as part of their treatment. The children were randomized into three groups: Vibration Intervention Group (n = 38), Pressure Intervention Group (n = 38) and Control Group (n = 38). Before the procedure, the level of anxiety and fear of the children were evaluated, and the level of perceived pain during the procedure was immediately evaluated after the intervention. Parents and nurses also rated the level of pain. Data were analyzed with non-parametric tests using SPSS version 26.0. RESULTS According to the evaluations made by children, mothers, and nurses, there was a significant difference between pain scores of children in the vibration and pressure intervention groups during the procedure and children in the control group (p < 0.000). There was a significant difference between anxiety and fear scores of children in the vibration and pressure groups and children in the control group before and after the intervention according to the evaluations of the children, mothers, and nurses (p < 0.000). CONCLUSION Vibration and pressure interventions used during intramuscular injections administered to children in the emergency department were found to reduce pain, anxiety, and fear based on the evaluations of children, mothers, and nurses. PRACTICE IMPLICATIONS Vibration and pressure are effective and useful in relieving pain associated with intramuscular injections in children aged between 5 and 10 years.
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Affiliation(s)
- Hatice Uzsen
- Nursing Department, Pediatric Nursing, Health Sciences Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Esra Tural Buyuk
- Nursing Department, Pediatric Nursing, Health Sciences Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Emel Odabasoglu
- Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Merve Koyun
- Nursing Department, Pediatric Nursing, Health Sciences Faculty, Ondokuz Mayis University, Samsun, Turkey.
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Odabasoglu E, Tural Buyuk E, Uzsen H, Koyun M. The effect of the distraction methods used before the COVID-19 test on the fear and anxiety levels of children: a RCT study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:745-754. [PMID: 36641806 DOI: 10.1080/09603123.2023.2166022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
The current study aimed to investigate the effect of the distraction methods employed before nasopharyngeal swab sampling from children within the scope of the COVID test on their anxiety and fear levels. The study was an RCT with parallel groups conducted according to the CONSORT statement at the pediatric emergency unit of a hospital in Turkey. Children aged 5-10 years were randomized into three groups: Kaleidoscope, Visual Illusion Cards, and control. Data were collected by the researchers using the Descriptive Characteristics Form, the Children's Anxiety Meter-State, and the Children's Fear Scale. According to the reports of the children, the parents, and the nurse, the mean anxiety score and the mean fear score in the experimental groups were significantly lower after the nasopharyngeal swab procedure compared to the control group (p < .05). Fear and anxiety were observed less in the visual illusion cards group and the kaleidoscope group.
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Affiliation(s)
- Emel Odabasoglu
- Cerrahpaşa/Florence Nightingale Faculty of Nursing, Department of Child Health and Diseases Nursing, Istanbul University, Istanbul, Turkey
| | - Esra Tural Buyuk
- Health Sciences Faculty, Department of Pediatric Nursing, Ondokuz Mayis University, Samsun, Turkey
| | - Hatice Uzsen
- Health Sciences Faculty, Department of Pediatric Nursing, Ondokuz Mayis University, Samsun, Turkey
| | - Merve Koyun
- Health Sciences Faculty, Department of Pediatric Nursing, Ondokuz Mayis University, Samsun, Turkey
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Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children's pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs 2023; 73:e27-e35. [PMID: 37455147 DOI: 10.1016/j.pedn.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study was conducted to determine the effects of visual and/or auditory distraction techniques applied to children aged 7-12 during invasive procedures on pain, anxiety, and medical fear. METHODS This single-blinded, randomized controlled trial was carried out in the pediatric emergency department of a public hospital between November 2021 and March 2022. In the study, 144 children were assigned to three different intervention groups, in which a kaleidoscope, music, and virtual reality were applied during invasive procedures, and the control group in which the standard invasive procedure was applied, by using the stratified block randomization method. The data were collected using a Personal Information Form, Wong-Baker Faces Pain Rating Scale, Children's Anxiety Meter-State, and Child Medical Fear Scale. RESULTS In the study, the levels of pain, anxiety, and medical fear after the invasive procedure were lower in the intervention groups than in the control group. In addition, there was no difference between the three different distraction techniques in terms of reducing pain and medical fear, but the virtual reality application was more effective in reducing the level of anxiety. CONCLUSION Visual and/or auditory distraction techniques are effective methods that can be used by nurses in pediatric healthcare to reduce invasive procedure-related pain, anxiety, and medical fear. IMPLICATIONS FOR PRACTICE This study provides evidence that can guide the use of non-pharmacological methods such as distraction to prevent the traumatic effects of invasive procedures in children.
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Affiliation(s)
- Nursen Goktas
- Mehmet Akif Ersoy State Hospital, Child Monitoring Center, Canakkale, Turkey
| | - Dilek Avci
- Bandirma Onyedi Eylul University, Faculty of Health Sciences, Balikesir, Turkey.
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Yıldırım BG, Gerçeker GÖ. The Effect of Virtual Reality and Buzzy on First Insertion Success, Procedure-Related Fear, Anxiety, and Pain in Children during Intravenous Insertion in the Pediatric Emergency Unit: A Randomized Controlled Trial. J Emerg Nurs 2023; 49:62-74. [PMID: 36376127 DOI: 10.1016/j.jen.2022.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Distraction methods such as virtual reality and cold vibration device are recommended during intravenous interventions. Few studies have focused on the impact of nonpharmacological interventions on intravenous insertion success. METHODS A randomized controlled study evaluated effect of virtual reality and cold vibration device application on first-attempt intravenous insertion success and procedure-related pain, fear, and anxiety during intravenous insertion in children. Children aged 4 to 10 years (N = 150) undergoing peripheral intravenous catheterization insertion in the pediatric emergency department were randomized to 1 of 3 groups: virtual reality, cold vibration (Buzzy), and control group. Distraction technique of talking and asking questions of children was used in control group. Primary outcome was first-attempt intravenous insertion success; secondary outcomes were procedure-related pain, fear, and anxiety. Study data were collected using Difficult Intravenous Access score, Emotional Appearance Scale for Children, Wong-Baker Faces Pain Rating Scale, Color Analog Scale, Children's Anxiety Meter-State, and Child Fear Scale. Data were analyzed using chi-square test, Fisher exact test, and Kruskal-Wallis test. RESULTS There were no significant differences in first-attempt intravenous insertion success rates (virtual reality = 47.2%, Buzzy® = 50%, control = 46.9%), preprocedural emotional appearance scores, and procedure-related pain and anxiety scores. There was no difference between groups for vital signs before, during, and at fifth minute of procedure. DISCUSSION Virtual reality and Buzzy may decrease procedure-related fear in children during intravenous insertion. This research has shown that pediatric emergency nurses can reduce pain and anxiety by talking to children, and simple distractions such as asking questions are as effective as more technological ones.
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Virtual Reality during Intrathecal Pump Refills in Children: A Case Series. J Clin Med 2022; 11:jcm11195877. [PMID: 36233743 PMCID: PMC9571798 DOI: 10.3390/jcm11195877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022] Open
Abstract
Virtual reality has proven to be an effective approach to decrease pain in acute settings, both in adults and children. The aim of this study is to evaluate whether virtual reality (VR) could reduce pain during an intrathecal pump refill procedure in children receiving intrathecal drug delivery, compared to a standard refill procedure. This is a three-arm crossover randomized controlled trial, evaluating the effect of VR on pain in children with cerebral palsy undergoing an intrathecal pump refill compared to a standard refill and a refill with distraction (watching a video). Pain was evaluated using the Wong–Baker Faces Scale. Secondary outcomes were procedural pain, fear, state anxiety, the incidence of adverse events and satisfaction. Six children participated in this study, whereby all children underwent the three conditions. Five children indicated an equal of lower pain score during VR, compared to a standard refill. This finding of an equal or lower pain intensity score for the VR condition compared to the control condition was also revealed by the ratings of the parents, physician and the researcher. The influence of VR on anxiety and fear seem to be in line with the influence of watching a video. In terms of satisfaction, all children and parents agreed with the statement that they would like to use VR again for a next refill. Due to the lack of adverse events, the high degree of satisfaction of children with VR and the decreased pain levels after a refill with VR, physicians may aim to explore the implementation of VR during intrathecal pump refill procedures in children in a daily clinical routine care setting.
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Effect of Distraction Intervention for Needle-Related Pain and Distress in Children: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179159. [PMID: 34501749 PMCID: PMC8430753 DOI: 10.3390/ijerph18179159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 12/02/2022]
Abstract
A systematic review and meta-analysis conducted to evaluate the combined effect of distraction intervention for needle-related pain in order to provide the basis for developing an effective nursing intervention for children. We searched three electronic databases, PubMed, Embase, and CINAHL, for original articles published in the period from 1 January 2011 to 31 July 2019. In addition, a manual search was performed on the basis of references in the literature and the references of the articles in pursuit of comprehensive data until 10 December 2019. Meta-analysis was performed by the synthesis of the effect size, homogeneity, heterogeneity, and trim-and-fill method using MIX 2.0 Pro. Well-planned RCTs, single-center studies, high-quality studies, participants older than 10 years of age, and visual and clown distraction interventions were effective for needle-related pain and distress management among children. The results showed evidence supporting the effect of distraction interventions for children’s needle-related pain and distress. Through this review, strategies were identified to design better interventions to improve the outcomes.
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Jang E, Zhimanov E, Parsh B. Minimizing immunization injection pain in children. Nursing 2021; 51:13-14. [PMID: 33674527 DOI: 10.1097/01.nurse.0000734008.07791.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Emily Jang
- At Sacramento State School of Nursing in Sacramento, Calif., Emily Jang and Ekaterina Zhimanov are nursing students and Bridget Parsh is a professor of nursing. Dr. Parsh is also a member of the Nursing2021 editorial board
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Gerçeker GÖ, Bektaş M, Aydınok Y, Ören H, Ellidokuz H, Olgun N. The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: Randomized controlled trial. Eur J Oncol Nurs 2020; 50:101886. [PMID: 33321461 DOI: 10.1016/j.ejon.2020.101886] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Port needle insertions are painful and distressing for Pediatric Hematology-Oncology patients. Virtual Reality (VR) can be used during needle-related procedures in these patients. This study aimed to investigate the effect of VR distraction during access to the venous port with a Huber needle in reducing needle-related pain, fear, and anxiety of children and adolescents with cancer. METHODS This randomized controlled study used a parallel trial design guided by the CONSORT checklist. The sample of children (n = 42) was allocated to the VR group (n = 21) and the control group (n = 21). Port needle-related pain was assessed using the Wong-Baker Faces Pain Rating Scale after the procedure. Before and after the port needle insertion procedure, anxiety and fear assessed using self- and parent-report using the Children's Anxiety Meter and Child Fear Scale. The primary outcome was the patient-reported pain scores after the procedure and fear and anxiety scores before and after the procedure. Pain, anxiety, and fear scores of the two groups and within groups were analyzed and also Spearman correlation analysis was used. RESULTS Self-reported pain scores of patients in the VR and control group were 2.4 ± 1.8 and 5.3 ± 1.8, respectively. This study found a statistically significant difference between groups in pain scores (p < .001). A statistically significant difference was found between groups according to the self- and parent-reported fear and anxiety scores after the procedure. Self-reported fear scores in the VR and control group were 0.8 ± 0.9, 2.0 ± 1.0, self-reported anxiety scores were 2.9 ± 2.0, 5.4 ± 2.0, respectively (p < .001). CONCLUSION Virtual reality is an effective distraction method in reducing port needle-related pain, fear, and anxiety in Pediatric Hematology-Oncology patients. ClinicalTrials.gov NCT04093154.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, 35340, Turkey.
| | - Murat Bektaş
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, 35340, Turkey.
| | - Yeşim Aydınok
- Ege University Hospital, Department of Paediatric Hematology-Oncology, Izmir, Turkey.
| | - Hale Ören
- Dokuz Eylül University Hospital, Department of Paediatric Hematology, Izmir, Turkey.
| | - Hülya Ellidokuz
- Dokuz Eylül University Hospital, Institue of Oncology, Izmir, Turkey.
| | - Nur Olgun
- Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey.
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Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial. Burns 2020; 46:1571-1584. [DOI: 10.1016/j.burns.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
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Assessing the Outcomes of an Animal-Assisted Intervention in a Paediatric Day Hospital: Perceptions of Children and Parents. Animals (Basel) 2020; 10:ani10101788. [PMID: 33019696 PMCID: PMC7601402 DOI: 10.3390/ani10101788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Scientific evidence of the effects of intervention with dogs as a non-pharmacological distraction strategy in child hospital care is still small. In addition, the results of implementation of animal-assisted programmes at a paediatric day hospital are not known. Thus, in this pilot study, we conducted preliminary research on the efficacy of an intervention based on the use of therapy dogs at a Spanish day hospital. An intra-subject quasi-experimental longitudinal design was used. The study showed that implementation of an animal-assisted programme at a paediatric day hospital is feasible. Children and parents both gave this programme their highest satisfaction rating. The results portray a significant improvement in the child’s self-assessment of their emotional well-being. In parallel, the parents confirmed this significant improvement in the child’s mood. The research suggests that conducting an animal-assisted session just before an outpatient medical procedure is an effective approach in the promotion of emotional welfare, a compromised area for a high percentage of paediatric patients during hospitalisation periods. Abstract There is a growing interest in the use of animal-assisted intervention (AAI) as a non-pharmacological strategy to improve child welfare in hospitals. However, the efficacy of implementation of programmes based on activities with dogs in a paediatric day hospital is not known. An intra-subject quasi-experimental longitudinal design was used for the purpose of assessing the feasibility of such an intervention, as well as exploring the perceptions of its outcomes by children and parents/guardians. A total of 55 children in outpatient care at a paediatric day hospital participated in an AAI session. The application of this intervention was feasible. Self-assessment by the paediatric patients revealed a statistically significant improvement in their emotional state after the session, which was large in size. Parents confirmed this improvement in their child, perceiving significant changes in their mood, which were large in size. This study suggests that AAI is an effective approach when it comes to promoting the emotional welfare of children during their stay in hospital care environments. Participating in recreational occupations with dogs could contribute in a relevant and efficient way to the development of significant and gratifying experiences and to a more positive perception of healthcare centres on the part of children.
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Moline RL, Chambers C, McMurtry CM. Study protocol for a randomized controlled trial of a child and parent mindfulness intervention for pediatric venipuncture. PAEDIATRIC & NEONATAL PAIN 2020; 3:20-28. [PMID: 35548848 PMCID: PMC8975227 DOI: 10.1002/pne2.12038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/11/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
Children commonly undergo painful needle procedures. Unmanaged procedural pain can have short‐ and long‐term consequences, including longer procedure times, greater distress at future procedures, and vaccine hesitancy. While parent behaviors are one of the strongest predictors of children's response to acute pain, pediatric procedural pain management interventions focus almost exclusively on the child. Further, existing parent‐involved pediatric pain management interventions typically fail to improve child self‐reported pain during painful procedures. The current protocol offers the first randomized controlled trial involving a mindfulness intervention for pediatric acute pain that includes children and their parents. This study aims to conduct a single‐site, two‐arm, parallel‐group RCT to examine the effects of a mindfulness intervention for parents and children before child venipuncture compared to a control group on primary (child self‐report of pain and fear), secondary (parent self‐report and child report of parent distress), and tertiary outcomes (parent report of child pain and fear). Parent‐child dyads (n = 150) will be recruited from the McMaster Children's Hospital outpatient blood laboratory. Dyads will be randomly assigned to either a mindfulness group guided through a mindfulness intervention or control group guided through an unfocused attention task. Parents will accompany their child for their venipuncture. Postvenipuncture measures will be collected (eg, child pain‐related outcomes as reported by parents and children). The first enrollment occurred in October 2019. We offer a novel intervention that aims to facilitate both parent and child coping during child venipuncture. The current protocol offers the first randomized controlled trial involving a mindfulness intervention for pediatric acute pain that includes children and their parents. This study aims to conduct a single‐site, two‐arm, parallel‐group RCT to examine the effects of a mindfulness intervention for parents and children (aged 7‐12) before child venipuncture compared to a control group on primary (child self‐report of pain and fear), secondary (parent self‐report and child report of parent distress), and tertiary outcomes (parent report of child pain and fear). We offer a novel intervention that aims to facilitate both parent and child coping during child venipuncture.
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Affiliation(s)
- Rachel L Moline
- Department of Psychology University of Guelph Guelph ON Canada
| | - Christine Chambers
- Department of Psychology and Neuroscience Dalhousie University Halifax NS Canada.,Department of Pediatrics Dalhousie University Halifax NS Canada.,Centre for Pediatric Pain Research IWK Health Centre Halifax NS Canada
| | - C Meghan McMurtry
- Department of Psychology University of Guelph Guelph ON Canada.,Pediatric Chronic Pain Program McMaster Children's Hospital Hamilton ON Canada.,Department of Paediatrics Schulich School of Medicine & Dentistry Western University London ON Canada
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Bray L, Sharpe A, Gichuru P, Fortune PM, Blake L, Appleton V. The Acceptability and Impact of the Xploro Digital Therapeutic Platform to Inform and Prepare Children for Planned Procedures in a Hospital: Before and After Evaluation Study. J Med Internet Res 2020; 22:e17367. [PMID: 32780025 PMCID: PMC7448172 DOI: 10.2196/17367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/16/2020] [Accepted: 06/13/2020] [Indexed: 01/06/2023] Open
Abstract
Background There is increasing interest in finding novel approaches to improve the preparation of children for hospital procedures such as surgery, x-rays, and blood tests. Well-prepared and informed children have better outcomes (less procedural anxiety and higher satisfaction). A digital therapeutic (DTx) platform (Xploro) was developed with children to provide health information through gamification, serious games, a chatbot, and an augmented reality avatar. Objective This before and after evaluation study aims to assess the acceptability of the Xploro DTx and examine its impact on children and their parent’s procedural knowledge, procedural anxiety, and reported experiences when attending a hospital for a planned procedure. Methods We used a mixed methods design with quantitative measures and qualitative data collected sequentially from a group of children who received standard hospital information (before group) and a group of children who received the DTx intervention (after group). Participants were children aged between 8 and 14 years and their parents who attended a hospital for a planned clinical procedure at a children’s hospital in North West England. Children and their parents completed self-report measures (perceived knowledge, procedural anxiety, procedural satisfaction, and procedural involvement) at baseline, preprocedure, and postprocedure. Results A total of 80 children (n=40 standard care group and n=40 intervention group) and their parents participated in the study; the children were aged between 8 and 14 years (average 10.4, SD 2.27 years) and were attending a hospital for a range of procedures. The children in the intervention group reported significantly lower levels of procedural anxiety before the procedure than those in the standard group (two-tailed t63.64=2.740; P=.008). The children in the intervention group also felt more involved in their procedure than those in the standard group (t75=−2.238; P=.03). The children in the intervention group also reported significantly higher levels of perceived procedural knowledge preprocedure (t59.98=−4.892; P=.001) than those in the standard group. As for parents, those with access to the Xploro intervention reported significantly lower levels of procedural anxiety preprocedure than those who did not (t68.51=1.985; P=.05). During the semistructured write and tell interviews, children stated that they enjoyed using the intervention, it was fun and easy to use, and they felt that it had positively influenced their experiences of coming to the hospital for a procedure. Conclusions This study has shown that the DTx platform, Xploro, has a positive impact on children attending a hospital for a procedure by reducing levels of procedural anxiety. The children and parents in the intervention group described Xploro as improving their experiences and being easy and fun to use.
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Affiliation(s)
- Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Ashley Sharpe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Phillip Gichuru
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | | | - Lucy Blake
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Victoria Appleton
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
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Eijlers R, Staals LM, Legerstee JS, Berghmans JM, Strabbing EM, van der Schroeff MP, Wijnen RMH, Kind LS, Hillegers MHJ, Dierckx B, Utens EMWJ. Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival. J Clin Psychol Med Settings 2020; 28:313-322. [PMID: 32306238 PMCID: PMC8192387 DOI: 10.1007/s10880-020-09716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children.
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Affiliation(s)
- Robin Eijlers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Johan M Berghmans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
- Department of Anaesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Elske M Strabbing
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Dutch Craniofacial Centre, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Laura S Kind
- Centre for Special Care Dentistry, CBT Rijnmond, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Centre for Child Psychiatry De Bascule, Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
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Özalp Gerçeker G, Ayar D, Özdemir EZ, Bektaş M. Effects of virtual reality on pain, fear and anxiety during blood draw in children aged 5–12 years old: A randomised controlled study. J Clin Nurs 2020; 29:1151-1161. [DOI: 10.1111/jocn.15173] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Dijle Ayar
- Pediatric Nursing Department Dokuz Eylul University Faculty of Nursing Izmir Turkey
| | - Emine Zahide Özdemir
- Pediatric Nursing Department Dokuz Eylul University Faculty of Nursing Izmir Turkey
| | - Murat Bektaş
- Pediatric Nursing Department Dokuz Eylul University Faculty of Nursing Izmir Turkey
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15
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Using Buzzy, Shotblocker, and Bubble Blowing in a Pediatric Emergency Department to Reduce the Pain and Fear Caused by Intramuscular Injection: A Randomized Controlled Trial. J Emerg Nurs 2019; 45:502-511. [DOI: 10.1016/j.jen.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022]
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16
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A Vibrating Cold Device to Reduce Pain in the Pediatric Emergency Department: A Randomized Clinical Trial. Pediatr Emerg Care 2019; 35:419-425. [PMID: 28121978 DOI: 10.1097/pec.0000000000001041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pain of intravenous (IV) catheter insertion can be mitigated with appropriate analgesia, thereby avoiding unnecessary distress. Our objective was to compare the self-reported pain of IV catheter insertion in children when using a vibrating cold device (VCD) versus standard of care 4% topical lidocaine cream (TL). METHODS This was a 2-arm randomized controlled noninferiority trial with a convenience sample of 4- to 18-year-olds requiring nonemergent IV catheter insertion. Self-reported pain was measured with the Faces Pain Scale-Revised, anxiety with the Child's Rating of Anxiety scale, and observed pain with the Face, Legs, Activity, Crying, Consolability scale. Caregivers and nurses completed satisfaction surveys. RESULTS Two hundred twenty-four children were included in the analysis: 114 (90%) of 127 in the VCD group and 110 (89%) of 124 in the TL group. Faces Pain Scale-Revised scores for both groups were equivalent (median, 2.0 cm; interquartile range, 0-5 cm; linear regression difference, 0 [95% confidence interval, -0.82 to 0.82]), as were median Face, Legs, Activity, Crying, Consolability scale scores (difference, 0.33 [95% confidence interval, -0.01 to 0.68]). The time of completion for the IV procedure was significantly shorter for the VCD group compared with the TL group (median, 3.0 vs 40.5 minutes; P < 0.0001). There were no significant differences between groups for self-reported state or trait anxiety, success of IV catheter insertion on first attempt, or satisfaction of caregivers or staff. CONCLUSIONS A VCD and TL showed equal effectiveness in reducing pain and distress for children undergoing IV catheter insertion. The VCD has the added benefit of quick onset time and an acceptable alternative for caregivers and nurses.
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17
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Gerçeker GÖ, Ayar D, Özdemir EZ, Bektaş M. The impact of the difficult vascular access, fear, and anxiety level in children on the success of first-time phlebotomy. J Vasc Access 2018; 19:620-625. [PMID: 29562830 DOI: 10.1177/1129729818765598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE: This study aimed to investigate the success of first-time phlebotomy and the affecting factors in children between 4 and 10 years of age. METHODS: This descriptive, comparative, and cross-sectional study was conducted on 155 children who underwent phlebotomy. The Sociodemographic Data Form, the Children's Anxiety Meter-State, the Children's Fear Scale, and the Difficult Intravenous Access score were used to collect the data for the study. The relationship between the success of first-time phlebotomy, mean pre-phlebotomy fear and anxiety score, and Difficult Intravenous Access score were examined. The variables affecting the success of first-time phlebotomy were assessed by regression analysis. RESULTS: Phlebotomies failed in 18.1% of children. A statistically significant relationship was found between the success of first-time phlebotomy, Children's Anxiety Meter-State, Children's Fear Scale mean scores assessed by the researchers, and Difficult Intravenous Access score. Factors affecting the success of first-time phlebotomy include difficult vascular access, age, mean Children's Anxiety Meter-State score, mean Difficult Intravenous Access score, and duration of the last phlebotomy performed. These factors explain 42% of the total factors affecting the success of first-time phlebotomy. CONCLUSION: Child's fear, anxiety before phlebotomy, and difficult vascular access affects the first-time phlebotomy success.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Dijle Ayar
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Emine Zahide Özdemir
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Murat Bektaş
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
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18
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Khadra C, Ballard A, Déry J, Paquin D, Fortin JS, Perreault I, Labbe DR, Hoffman HG, Bouchard S, LeMay S. Projector-based virtual reality dome environment for procedural pain and anxiety in young children with burn injuries: a pilot study. J Pain Res 2018; 11:343-353. [PMID: 29491717 PMCID: PMC5817417 DOI: 10.2147/jpr.s151084] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is a non-pharmacological method to distract from pain during painful procedures. However, it was never tested in young children with burn injuries undergoing wound care. AIM We aimed to assess the feasibility and acceptability of the study process and the use of VR for procedural pain management. METHODS From June 2016 to January 2017, we recruited children from 2 months to 10 years of age with burn injuries requiring a hydrotherapy session in a pediatric university teaching hospital in Montreal. Each child received the projector-based VR intervention in addition to the standard pharmacological treatment. Data on intervention and study feasibility and acceptability in addition to measures on pain (Face, Legs, Activity, Cry, Consolability scale), baseline (Modified Smith Scale) and procedural (Procedure Behavior Check List) anxiety, comfort (OCCEB-BECCO [behavioral observational scale of comfort level for child burn victims]), and sedation (Ramsay Sedation Scale) were collected before, during, and after the procedure. Data analyses included descriptive and non-parametric inferential statistics. RESULTS We recruited 15 children with a mean age of 2.2±2.1 years and a mean total body surface area of 5% (±4). Mean pain score during the procedure was low (2.9/10, ±3), as was the discomfort level (2.9/10, ±2.8). Most children were cooperative, oriented, and calm. Assessing anxiety was not feasible with our sample of participants. The prototype did not interfere with the procedure and was considered useful for procedural pain management by most health care professionals. CONCLUSION The projector-based VR is a feasible and acceptable intervention for procedural pain management in young children with burn injuries. A larger trial with a control group is required to assess its efficacy.
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Affiliation(s)
- Christelle Khadra
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - Ariane Ballard
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - Johanne Déry
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Direction of Nursing, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - David Paquin
- Department in Creation and New Media, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | | | - Isabelle Perreault
- Department of Surgery, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - David R Labbe
- Department of Software and IT Engineering, École de Technologie Supérieure, Montreal, QC, Canada
| | - Hunter G Hoffman
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Sylvie LeMay
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
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Brown EA, De Young A, Kimble R, Kenardy J. Review of a Parent’s Influence on Pediatric Procedural Distress and Recovery. Clin Child Fam Psychol Rev 2018; 21:224-245. [DOI: 10.1007/s10567-017-0252-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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20
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Green E, Cadogan J, Harcourt D. A qualitative study of health professionals' views on using iPads to facilitate distraction during paediatric burn dressing changes. Scars Burn Heal 2018; 4:2059513118764878. [PMID: 30627440 PMCID: PMC6305946 DOI: 10.1177/2059513118764878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Distraction is a non-pharmacologic pain management technique commonly used to avert a person's attention from procedural pain and distress during stressful procedures such as treatment after a burn injury. In recent years, computer tablets (such as iPads) have been used within paediatric burns services to facilitate distraction by way of apps, games, cartoons and videos during dressing changes. However, we know very little about health professionals' experiences of using them in this context. METHODS The current study explored health professionals' experiences of using iPads to facilitate distraction during paediatric burn dressing changes. Fifteen health professionals from a single paediatric burns unit were interviewed. Thematic analysis revealed two key themes: (1) the iPad is a universal panacea for distraction; and (2) trials and tribulations. DISCUSSION Participants considered iPads to be potentially useful and effective distraction tools, suitable for use with a wide range of patients with burn injuries including young children, adolescents and young adults. However, issues including health professionals' understandings of one another's roles, the challenge of working in a busy burns service, and lack of experience and confidence were identified as possible barriers to their use within routine burn care. Training for staff on the use of iPads as a means of facilitating distraction, development of guidelines and a review of how they are incorporated into routine burn care are recommended.
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Affiliation(s)
- Elizabeth Green
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Julia Cadogan
- Bristol Royal Hospital for Children, Bristol, UK
- The Scar Free Foundation Centre for Children’s Burns Research, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
- The Scar Free Foundation Centre for Children’s Burns Research, Bristol, UK
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21
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Ersig AL, Schutte DL, Standley J, Leslie E, Zimmerman B, Kleiber C, Hanrahan K, Murray JC, McCarthy AM. Relationship of Genetic Variants With Procedural Pain, Anxiety, and Distress in Children. Biol Res Nurs 2017; 19:339-349. [PMID: 28413930 DOI: 10.1177/1099800417692878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study used a candidate gene approach to examine genomic variation associated with pain, anxiety, and distress in children undergoing a medical procedure. STUDY DESIGN Children aged 4-10 years having an IV catheter insertion were recruited from three Midwestern children's hospitals. Self-report measures of pain, anxiety, and distress were obtained as well as an observed measure of distress. Samples were collected from children and biological parents for analysis of genomic variation. Genotyped variants had known or suspected association with phenotypes of interest. Analyses included child-only association and family-based transmission disequilibrium tests. RESULTS Genotype and phenotype data were available from 828 children and 376 family trios. Children were 50% male, had a mean age of 7.2 years, and were 84% White/non-Hispanic. In family-based analysis, one single-nucleotide polymorphism (SNP; rs1143629, interleukin ( IL1B) 1β) was associated with observed child distress at Bonferroni-corrected levels of significance ( p = .00013), while two approached significance for association with high state anxiety (rs6330 Nerve Growth Factor, Beta Subunit, [ NGFB]) and high trait anxiety (rs6265 brain-derived neurotrophic factor [ BDNF]). In the child-only analysis, multiple SNPs showed nominal evidence of relationships with phenotypes of interest. rs6265 BDNF and rs2941026 cholecystokinin B receptor had possible relationships with trait anxiety in child-only and family-based analyses. CONCLUSIONS Exploring genomic variation furthers our understanding of pain, anxiety, and distress and facilitates genomic screening to identify children at high risk of procedural pain, anxiety, and distress. Combined with clinical observations and knowledge, such explorations could help guide tailoring of interventions to limit procedure-related distress and identify genes and pathways of interest for future genotype-phenotype studies.
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Affiliation(s)
- Anne L Ersig
- 1 College of Nursing, The University of Iowa, Iowa City, IA, USA
| | - Debra L Schutte
- 2 College of Nursing, Wayne State University, Detroit, MI, USA
| | | | - Elizabeth Leslie
- 4 School of Dental Medicine, The University of Pittsburgh, Pittsburgh, PA, USA
| | - Bridget Zimmerman
- 5 College of Public Health, The University of Iowa, Iowa City, IA, USA
| | | | - Kirsten Hanrahan
- 6 The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jeffrey C Murray
- 3 College of Medicine, The University of Iowa, Iowa City, IA, USA
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22
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Racine NM, Riddell RRP, Khan M, Calic M, Taddio A, Tablon P. Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children. J Pediatr Psychol 2016; 41:159-81. [PMID: 26338981 PMCID: PMC4884904 DOI: 10.1093/jpepsy/jsv076] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. METHODS A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0-18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. RESULTS 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. CONCLUSIONS Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors.
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Affiliation(s)
| | | | - Maria Khan
- Department of Psychology, York University
| | - Masa Calic
- Department of Psychology, York University
| | - Anna Taddio
- Hospital for Sick Children, and University of Toronto
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23
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Martin S, Smith AB, Newcomb P, Miller J. Effects of therapeutic suggestion under anesthesia on outcomes in children post tonsillectomy. J Perianesth Nurs 2015; 29:94-106. [PMID: 24661479 DOI: 10.1016/j.jopan.2013.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/27/2013] [Accepted: 03/30/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tonsillectomy causes discomfort in children. Positive therapeutic suggestions (TS) may be given to patients while they are emerging from general anesthesia as a potential tool to decrease distress. PURPOSE This study examined impact of TS on outcomes, when delivered to children emerging from general anesthesia post tonsillectomy. DESIGN A double blinded randomized controlled trial was conducted with 94 patient/parent pairs. METHODS TS and noise recordings were played via headphones post tonsillectomy upon arrival to the Post Anesthesia Care Unit until the child showed signs of waking. FINDINGS Pain scores at 30 minutes post extubation show significantly lower pain in the TS group, P = .04 (Mann Whitney U for independent samples). The TS group had 70% increased likelihood of receiving less intravenous (IV) opioid. CONCLUSION TS may help lower pain in children post tonsillectomy and decrease demand for IV opioid pain management in the 4- to 8-year-old tonsillectomy population.
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Nuvvula S, Alahari S, Kamatham R, Challa RR. Effect of audiovisual distraction with 3D video glasses on dental anxiety of children experiencing administration of local analgesia: a randomised clinical trial. Eur Arch Paediatr Dent 2014; 16:43-50. [PMID: 25256207 DOI: 10.1007/s40368-014-0145-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
AIM To determine the effect of three-dimensional (3D) audiovisual (AV) distraction in reducing dental anxiety of children. STUDY DESIGN A randomised clinical trial with a parallel design carried out on 90 children (49 boys and 41 girls) aged between 7 and 10 years (mean age of 8.4 years) to ascertain the comparative efficacy of audio (music) and AV (3D video glasses) distraction in reducing the dental anxiety of children during local analgesia (LA) administration. METHODS Ninety children were randomly divided into three groups; control (basic behaviour guidance techniques without distraction), audio (basic techniques plus music) and AV (basic techniques plus 3D AV) distraction groups. All the children experienced LA administration with/without distraction and the anxiety was assessed using a combination of measures: MCDAS(f) (self-report), pulse rate (physiological), behaviour (using Wright's modification of Frankl behaviour rating scale and Houpt scale) and preferences of children. RESULTS All 90 children completed the study. A highly significant reduction in the anxiety of audiovisual group as reported by the MCDAS(f) values (p<0.001) and Houpt scale (p=0.003); whereas pulse rate showed statistically significant increase (p<0.001) in all the three groups irrespective of distraction. The child preferences also affirmed the usage of 3D video glasses. CONCLUSIONS LA administration with music or 3D video glasses distraction had an added advantage in a majority of children with 3D video glasses being superior to music. High levels of satisfaction from children who experienced treatment with 3D video glasses were also observed.
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Affiliation(s)
- S Nuvvula
- Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, 524003, India,
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25
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Im ES, Kim JS. Distraction Techniques for Children Undergoing Procedures: A Critical Review of Korean Intervention Research. CHILD HEALTH NURSING RESEARCH 2014. [DOI: 10.4094/chnr.2014.20.4.340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eun Seon Im
- Doctoral Student, Department of Nursing, Graduate School of Chosun University, Gwangju, Korea
| | - Jin Sun Kim
- Department of Nursing, Chosun University, Gwangju, Korea
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26
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Ersig AL, Kleiber C, McCarthy AM, Hanrahan K. Validation of a clinically useful measure of children's state anxiety before medical procedures. J SPEC PEDIATR NURS 2013; 18:311-9. [PMID: 24094126 PMCID: PMC4282760 DOI: 10.1111/jspn.12042] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Assessment of children's anxiety in busy clinic settings is an important step in developing tailored interventions. This article describes the construct validation of the Children's Anxiety Meter-State (CAM-S), a brief measure of state anxiety. DESIGN AND METHODS Existing data were used to investigate the associations between child self-reports of anxiety, parent reports of child anxiety, and observed child distress during an intravenous procedure. RESULTS Children's (n = 421) CAM-S scores were significantly associated with all parent measures and observed distress ratings. PRACTICE IMPLICATIONS Findings support the use of the CAM-S for assessment of child anxiety in clinical settings.
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Affiliation(s)
- Anne L Ersig
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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27
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Koller D, Goldman RD. Distraction techniques for children undergoing procedures: a critical review of pediatric research. J Pediatr Nurs 2012; 27:652-81. [PMID: 21925588 DOI: 10.1016/j.pedn.2011.08.001] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 07/25/2011] [Accepted: 08/08/2011] [Indexed: 11/18/2022]
Abstract
Pediatric patients are often subjected to procedures that can cause pain and anxiety. Although pharmacologic interventions can be used, distraction is a simple and effective technique that directs children's attention away from noxious stimuli. However, there is a multitude of techniques and technologies associated with distraction. Given the range of distraction techniques, the purpose of this article was to provide a critical assessment of the evidence-based literature that can inform clinical practice and future research. Recommendations include greater attention to child preferences and temperament as a means of optimizing outcomes and heightening awareness around child participation in health care decision making.
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Foster RL, Park JH. An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children. Pain Manag Nurs 2011; 13:94-106. [PMID: 22652282 DOI: 10.1016/j.pmn.2011.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 06/22/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022]
Abstract
Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.
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Affiliation(s)
- Roxie L Foster
- University of Colorado Denver College of Nursing, Aurora, Colorado, USA
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Abstract
BACKGROUND Previous research shows that numerous child, parent, and procedural variables affect children's distress responses to procedures. Cognitive-behavioral interventions such as distraction are effective in reducing pain and distress for many children undergoing these procedures. OBJECTIVES The purpose of this report was to examine child, parent, and procedural variables that explain child distress during a scheduled intravenous insertion when parents are distraction coaches for their children. METHODS A total of 542 children, between 4 and 10 years of age, and their parents participated. Child age, gender, diagnosis, and ethnicity were measured by questions developed for this study. Standardized instruments were used to measure child experience with procedures, temperament, ability to attend, anxiety, coping style, and pain sensitivity. Questions were developed to measure parent variables, including ethnicity, gender, previous experiences, and expectations, and procedural variables, including use of topical anesthetics and difficulty of procedure. Standardized instruments were used to measure parenting style and parent anxiety, whereas a new instrument was developed to measure parent performance of distraction. Children's distress responses were measured with the Observation Scale of Behavioral Distress-Revised (behavioral), salivary cortisol (biological), Oucher Pain Scale (self-report), and parent report of child distress (parent report). Regression methods were used for data analyses. RESULTS Variables explaining behavioral, child-report and parent-report measures include child age, typical coping response, and parent expectation of distress (p < .01). Level of parents' distraction coaching explained a significant portion of behavioral, biological, and parent-report distress measures (p < .05). Child impulsivity and special assistance at school also significantly explained child self-report of pain (p < .05). Additional variables explaining cortisol response were child's distress in the morning before clinic, diagnoses of attention deficit hyperactivity disorder or anxiety disorder, and timing of preparation for the clinic visit. DISCUSSION The findings can be used to identify children at risk for high distress during procedures. This is the first study to find a relationship between child behavioral distress and level of parent distraction coaching.
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Tomlinson D, Isitt JJ, Barron RL, Doyle J, Judd P, Gassas A, Naqvi A, Sung L. Determining the Understandability and Acceptability of an Oral Mucositis Daily Questionnaire. J Pediatr Oncol Nurs 2008; 25:107-11. [DOI: 10.1177/1043454208314458] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Oral mucositis research in children receiving anticancer therapy has been impeded by the lack of an acceptable, appropriate assessment scale. Some scales attempt to measure subjective symptoms associated with mucositis such as pain and difficulty swallowing. These types of patient-reported outcomes are gaining prominence in clinical trials because they capture the perspective of the patients in whom the intervention is designed to benefit. In mucositis research, very few patient-reported outcome measures have been developed. The aim of this study was to determine whether an adaptation of the adult-validated Oral Mucositis Daily Questionnaire is understandable and acceptable for use in the pediatric oncology/hematology population. Twelve subjects were asked to rate their opinion of understandability and acceptability of the adapted Oral Mucositis Daily Questionnaire. As a result of their comments, minor changes were made. Evaluation of the psychometric properties of this instrument can now be performed.
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Affiliation(s)
- Deborah Tomlinson
- Dip Cancer Nursing, is at CHES, Hospital for Sick Children, Toronto, Ontario, Canada,
| | | | | | - John Doyle
- Section of Blood and Marrow Transplant, Hospital for Sick Children, Toronto
| | - Peter Judd
- Pediatric Dentistry, Hospital for Sick Children, Toronto
| | - Adam Gassas
- Section of Blood and Marrow Transplant, Division of Hematology/Oncology, Hospital for Sick Children, Toronto
| | - Ahmed Naqvi
- Inpatient Department, Division of Hematology/Oncology, Hospital for Sick Children, Toronto
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Kleiber C, Schutte DL, McCarthy AM, Floria-Santos M, Murray JC, Hanrahan K. Predictors of Topical Anesthetic Effectiveness in Children. THE JOURNAL OF PAIN 2007; 8:168-74. [PMID: 17010672 DOI: 10.1016/j.jpain.2006.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 07/30/2006] [Accepted: 08/02/2006] [Indexed: 01/22/2023]
Abstract
UNLABELLED Some children report significant pain with peripheral intravenous catheter (IV) insertion, despite the appropriate use of topical lidocaine anesthetics. This analysis of data from an existing study identified factors related to variation in topical anesthetic effectiveness used for IV insertion. The children (n = 218) in this investigation were 4 to 10 years old and undergoing a scheduled IV insertion. Inclusion criteria were (1) topical anesthetic was used according to manufacturer's recommendations, (2) DNA material was available, and (3) child completed a self-report measure of pain intensity (Oucher scale). Low pain phenotype was defined as a pain intensity score of 0 to 3, and high pain phenotype was an intensity score of 4 to 10. Potential predictor variables included child age, gender, number of previous painful procedures, state and trait anxiety, temperament characteristics, and alleles in 3 candidate genes in a pain pathway influenced by topical anesthetics (endothelin-1 [EDN1], endothelin receptor A [EDNRA], endothelin receptor B [EDNRB]). All subjects were genotyped for a single-nucleotide polymorphism in each gene. Children in the high pain group (n = 89) were significantly younger (P < .0001), more active (P = .0029), scored higher for trait (P = .0009) and state anxiety (P = .0312), and had the EDNRA TT genotype (high pain group, TT 67.35%; low pain group, TT 39.47%; P = .026). PERSPECTIVE The identification of factors that influence peripheral pain sensation aids in selecting the most appropriate pharmacologic and nonpharmacologic interventions. Until genotyping is available at a clinically prescriptive level, other predictors (eg, age and activity level) can be used to tailor pain-relieving strategies for children undergoing needle sticks.
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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