Association of Pre-procedural Anxiety with Procedure-related Pain During Outpatient Pediatric Burn Care: A Pilot Study

Investigating the impact of patient-centered peer counseling on anxiety and pain among burn patients: A randomized controlled trial

OBJECTIVE

Pain and anxiety are common complications in burn patients, significantly impacting treatment effectiveness and overall patient well-being. Peer counseling, a form of patient education provided by individuals with shared experiences, may hold potential to alleviate this pain and anxiety. This study seeks to investigate the effectiveness of patient-centered education through peer counseling on background pain and state anxiety levels in these patients.

METHODS

A two-arm, parallel, randomized, controlled trial design was employed. A total of 86 participants were randomly allocated to one of two groups: control and intervention groups. State anxiety and background pain levels were assessed using the Spielberger State Anxiety Inventory (STAI) and Visual Analogue Scale (VAS), respectively, before and after intervention. Statistical analyses, including Chi-square test, Fisher's exact test, independent t-test, and paired t-test, were employed to analyze the data.

RESULTS

The intervention significantly reduced pain and anxiety in the intervention group compared to baseline (p < .001). There was no significant difference between the control and intervention groups in baseline levels, but there was a significant difference after the intervention (p < .001).

CONCLUSION

This study demonstrates the efficacy of patient-centered education through peer counseling in reducing background pain and state anxiety levels in burn patients. Compared to standard education, peer counseling led to a more pronounced reduction in both pain and anxiety, suggesting its potential as a valuable nonpharmaceutical intervention to improve patient well-being during burn recovery.

PRACTICE IMPLICATIONS

Based on our findings, we recommend that healthcare providers consider implementing peer-based education programs in burn care settings.

Implementation of Virtual Reality Pain Alleviation Therapeutic into Routine Pediatric Clinical Care: Experiences and Perspectives of Stakeholders

Virtual reality (VR) needs to be implemented in clinical settings to improve pediatric patient care during painful medical procedures. Engaging doctors and nurses to lead the adoption of new clinical techniques can facilitate the transition from research to routine practice. Integrating VR into routine clinical practice could reduce patient pain and anxiety, making medical procedures smoother and more efficient. This feasibility pilot quality improvement (QI) project provides evidence for broader expansion and implementation of VR into different clinical areas. Medical providers (doctors and nurses) implemented VR during brief pediatric medical procedures and completed a demographics and feasibility survey. Qualitative feedback from semi-structured interviews indicated VR's ease of use and effectiveness in reducing anxiety and easing medical procedures. Patients (n = 30) played the VR game during either their medically necessary pin-pulling or needlestick procedures within three clinical environments. Children ranged from 5-16 years and were 50% male. The majority of patients reported enjoyment (mean 8.2 out of 10) with VR during the procedure, and only one minor technical issue was reported. Qualitative semi-structured interview data showed the benefits of using VR, including its ease of use, decreased observed anxiety, and patients having an easier time getting through the medical procedures. Feedback from medical providers regarding the dissemination of VR into pediatric clinical environments showed promising results. Standardized guidelines are needed to further implement VR pain alleviation into standard care in real-world clinical settings. This pilot study suggests that VR could be a valuable tool in pediatric pain management, warranting further research and broader clinical implementation.

Pain Assessment in the Outpatient Pediatric Burn Patient: An Integrative Review

BACKGROUND

There is no standardized practice in pediatric pain assessment with burn injuries in the outpatient clinic setting.

OBJECTIVE

This review aims to identify reliable, validated tools to measure pain in the pediatric burn clinic population.

METHODS

The literature search for this integrative review was conducted using the databases of PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, and Embase from 2011 to 2023. Quality and relevance were appraised using the Johns Hopkins Nursing Evidence-Based Practice Model. Reporting was done according to a Preferred Reporting Items for Systemic Reviews and Meta-Analysis checklist.

RESULTS

Fourteen articles and two clinical practice guidelines met inclusion criteria and were included in this review.

CONCLUSION

The Pain Observation Scale for Young Children and the COMFORT Behavior Scale tools have shown good reliability and construct validity and can be safely used to measure background and procedural pain in daily burn practice. Further research on reliable, validated pain assessment techniques in the pediatric burn population is needed.

Comparing novel virtual reality and nursing standard care on burn wound care pain in adolescents: A randomized controlled trial

PURPOSE

This study compared the effectiveness of age-appropriate, high technology, interactive virtual reality (VR) distraction with standard care (SC) provided by the nurse on adolescents' acute procedural pain intensity perception during burn wound care treatment in the ambulatory clinic setting.

DESIGN

This randomized controlled trial included 43 adolescents ages 10-21 from the ambulatory burn clinic of a large children's hospital.

METHODS

Blinded study participants were randomly assigned to either VR or SC (non-significantly different, current mean burn surface area, 1.3 and 1.7, respectively) during the first burn wound care procedure in the burn clinic. Blinded research staff collected pre-procedure data including Spielberger's State-Trait Anxiety Inventory and postprocedure wound care pain intensity using the Adolescent Pediatric Pain Tool. A total of 41 participants completed all study procedures.

RESULTS

No statistically significant difference in burn wound care procedural pain was noted between the VR and SC groups after adjusting for several factors. Pre-procedure state and trait anxiety correlated with reported pre-procedure pain. Wound care pain was found to be significantly associated with pre-wound care pain score, time from original burn to clinic burn care treatment, and length of wound care treatment. These factors accounted for approximately 45% of the variation in pain scores during wound care treatment.

PRACTICE IMPLICATIONS

VR distraction can be a useful pain management strategy but may not take the place of the unique nurse-patient relationship that occurs during clinical encounters. Tailoring pain management during burn wound care requires consideration of anxiety, time from the burn injury to the wound care procedure, length of time of the wound care procedure, and pretreatment pain level. Knowing patients' needs, desires, and temperaments along with the specifics about the healthcare procedures are critical to formulating individualized care plans that may or may not include VR. Newer technology, such as easier-to-use, less expensive VR, may assist with translation into practice making its clinical use more routine.

Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture: A Randomized Clinical Trial

IMPORTANCE

Venipuncture is one of the most painful and distressing procedures experienced by pediatric patients. Emerging evidence suggests that providing procedural information and distraction using immersive virtual reality (IVR) may reduce pain and anxiety among children undergoing needle-related procedures.

OBJECTIVES

To examine the effects of IVR on reducing the pain, anxiety, and stress experienced by pediatric patients undergoing venipuncture.

DESIGN, SETTING, AND PARTICIPANTS

This 2-group randomized clinical trial recruited pediatric patients aged 4 to 12 years undergoing venipuncture from a public hospital in Hong Kong between January 2019 and January 2020. Data were analyzed from March to May 2022.

INTERVENTIONS

Participants were randomly allocated to an intervention (an age-appropriate IVR intervention offering distraction and procedural information) or a control (standard care only) group.

MAIN OUTCOMES AND MEASURES

The primary outcome was child-reported pain. Secondary outcomes included child-reported anxiety, heart rate, salivary cortisol, length of procedure, and satisfaction of health care professionals with the procedure (rated on a 40 point scale, with higher scores indicating greater satisfaction). Outcomes were assessed 10 minutes before, during, immediately after, and 30 minutes after the procedure.

RESULTS

A total of 149 pediatric patients were recruited, with 86 female patients (57.7%) and 66 patients (44.3%) diagnosed with fever. Compared with the 74 participants in the control group (mean [SD] age, 7.21 [2.49] years), the 75 participants in the IVR group (mean [SD] age, 7.21 [2.43] years) reported significantly less pain (β = -0.78; 95% CI, -1.21 to -0.35; P < .001) and anxiety (β = -0.41; 95% CI, -0.76 to -0.05; P = .03) immediately after the intervention. Health care professional satisfaction in the IVR group (mean [SD] score, 34.5 [4.5]) was significantly higher than that in the control group (mean [SD] score, 32.9 [4.0]; P = .03). Moreover, the length of venipuncture procedure in the IVR group (mean [SD] duration, 4.43 [3.47] minutes) was significantly shorter than that in the control group (mean [SD] duration, 6.56 [7.39] minutes; P = .03).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, integrating procedural information and distraction in an IVR intervention for pediatric patients undergoing venipuncture significantly improved pain and anxiety in the IVR group compared with the control group. The results shed light on the global trends of research on IVR and its clinical development as an intervention for other painful and stressful medical procedures.

TRIAL REGISTRATION

Chinese Clinical Trial Registry identifier: ChiCTR1800018817.