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Oulton K, Williams A, Gibson F. Acceptability of a novel device to improve child patient experience during venepuncture for blood sampling: Intervention with 'MyShield'. J Child Health Care 2024; 28:53-68. [PMID: 35544716 DOI: 10.1177/13674935221098297] [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] [Indexed: 11/15/2022]
Abstract
This study aimed to explore the acceptability of a novel device ('MyShield'): a device used for distraction during clinical procedures. It is a cardboard cuff, designed to fit around the arm, either above the elbow or around the wrist and used to hide the procedure from view. This device was tested in practice, to establish acceptability to children, parents and clinical staff. Fifty-eight children tried 'MyShield' during a venepuncture procedure. Feedback from 54 children, 58 parents/carers and 16 clinical staff was collected using surveys and interviews. In 24 cases, observational data were also collected. A large majority of children (94%, n = 51) and parents (96%, n = 56) reported a positive experience when using 'MyShield'; saying they would likely use it again. Potential of 'MyShield' in promoting parent/clinician interaction with the child was highlighted. Data suggests that 'MyShield' may be a useful device for children undergoing venepuncture, when used in conjunction with standard care, and subject to individual preferences and choice. Further work is required to establish mechanism of action and whether use of 'MyShield' has any impact across a range of short- and long-term outcome measures relating to patient experience and effectiveness.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
| | | | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
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Villegas Estévez FJ, López Alarcón MD, Beato C, Sanz-Yagüe A, Porta-Sales J, Morera López RM. Procedural pain in patients with cancer: a Delphi expert management consensus. BMJ Support Palliat Care 2023; 13:e428-e436. [PMID: 34210716 DOI: 10.1136/bmjspcare-2020-002668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Diagnosis, treatment and care of cancer often involve procedures that may be distressing and potentially painful for patients. The PROCEDIO Study aimed to generate expert-based recommendations on the management of moderate to severe procedural pain in inpatients and outpatients with cancer. METHODS Using a two-round Delphi method, experts from pain and palliative care units, medical and radiation oncology and haematology departments expressed their agreement on 24 statements using a 9-point Likert scale, which were classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was achieved if at least two-thirds of the panel scored within the range containing the median. RESULTS With an overall agreement on the current definition of procedural pain, participants suggested a wider description based on evidence and their clinical experience. A strong consensus was achieved regarding the need for a comprehensive pre-procedural pain assessment and experts emphasised that healthcare professionals involved in procedural pain management should be adequately trained. Most panellists (98.2%) agreed that pharmacological treatment should be chosen considering the duration of the procedure. Transmucosal fentanyl (96.5%) and morphine (71.7%) were recommended as the most appropriate drugs. Oral and nasal transmucosal fentanyl were agreed as the most suitable for both outpatients and inpatients, while consensus was reached for intravenous and subcutaneous morphine for inpatients. CONCLUSIONS These results provide updated expert-based recommendations on the definition, prevention and treatment of moderate to severe procedural pain, which could inform specialists involved in pain management of patients with cancer.
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Affiliation(s)
| | | | - Carmen Beato
- Departamento de Oncología Médica, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | - Josep Porta-Sales
- Unidad de Cuidados Paliativos, Institut Catalá d'Oncologia, Girona, Spain
| | - Rosa M Morera López
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain
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Fan L, Zeng J, Ran L, Zhang C, Wang J, Yu C, Zhao N. Virtual reality in managing dental pain and anxiety: a comprehensive review. Front Med (Lausanne) 2023; 10:1285142. [PMID: 38131048 PMCID: PMC10736194 DOI: 10.3389/fmed.2023.1285142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives This study aimed to identify, analyze, and summarize the clinical efficacy of virtual reality (VR) distraction therapy for oral treatment in different hospital settings in contrast to medical interventions that induce anxiety and pain. Furthermore, this review aimed to determine the implications for research and clinical practice of VR distraction therapy. Data This review investigated the clinical efficacy of VR in the oral treatment of procedural pain or anxiety. Quality assessment of the included studies was conducted. A narrative synthesis of the collected data was performed. Sources Literature studies from six electronic databases were searched for a comprehensive review, namely, the Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials (Central), MEDLINE (PubMed), EMBASE, Scopus, and Web of Science. Study selection One thousand five hundred twenty-two patients aged between 0 and 60 years who used VR during dental treatment were included in this review. Among these studies, 8 and 14 studies comprised adult and pediatric patients. Conclusion Overall, the reviewed studies underscore the efficacy of VR to mitigate pain and anxiety in the context of dental treatment. VR is an innovative pain and anxiety management approach that facilitates dental treatment patients to immerse themselves in a virtual world while using distractions to reduce pain and anxiety. Clinical significance VR is an effective and novel non-pharmacological method of behavioral management that contributes to improving medication safety for dental patients. VR as a distractive approach can reduce the fear associated with medical interventions and prevent severe pain sensitivity, anxiety, and medical avoidance among adults and children.
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Affiliation(s)
- Lin Fan
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Longkuan Ran
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chao Zhang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jing Wang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Cong Yu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Nan Zhao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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4
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Geagea D, Ogez D, Kimble R, Tyack Z. Demystifying hypnosis: Unravelling facts, exploring the historical roots of myths, and discerning what is hypnosis. Complement Ther Clin Pract 2023; 52:101776. [PMID: 37402329 DOI: 10.1016/j.ctcp.2023.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/04/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND PURPOSE Hypnosis, a mind-body treatment dating back to early human history, has regained attention in the last decade, with research suggesting its effectiveness for varied physiological and psychological ailments such as distress, pain, and psychosomatic disorders. However, myths and misconceptions have prevailed among the general public and clinicians, hindering the adoption and acceptance of hypnosis. It is important to distinguish myths from facts and discern what is hypnosis and what is not to enhance the understanding, acceptance, and adoption of hypnotic interventions. METHODS This narrative review traces the history of myths surrounding hypnosis in contrast to the evolution of hypnosis as a treatment modality. In addition to comparing hypnosis to other interventions with similar procedures and features, the review unravels misconceptions that have impeded the adoption and acceptance of hypnosis in clinical and research settings and presents evidence to demystify this intervention. RESULTS This review examines the roots of myths while presenting historical facts and evidence that support hypnosis as a treatment modality and alleviate misconceptions depicting it as mystical. Further, the review distinguishes hypnotic and non-hypnotic interventions with overlapping procedures and phenomenological features to enhance our understanding of hypnotic techniques and phenomena. CONCLUSION This review enhances the understanding of hypnosis in historical, clinical, and research contexts by disproving related myths and misconceptions to promote the adoption of hypnosis in clinical and research contexts. Further, this review highlights knowledge gaps requiring further investigations to steer research toward an evidence-based practice of hypnosis and optimise multimodal therapies embedding hypnosis.
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Affiliation(s)
- Dali Geagea
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.
| | - David Ogez
- Department of Anaesthesiology and Pain Medicine, University of Montreal, Montreal, Canada
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, The University of Queensland, Brisbane, Australia
| | - Zephanie Tyack
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia; Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Kristensen HN, Laugesen B, Stinson J, Haslund-Thomsen H. The Impact and Influence of Hospital Clowns on Hospitalized Children Undergoing Painful Procedures: A Mixed Methods Study. Glob Qual Nurs Res 2023; 10:23333936231186599. [PMID: 37538194 PMCID: PMC10395183 DOI: 10.1177/23333936231186599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023] Open
Abstract
Hospital clowns are widely used in pediatric settings. However, the field of pain and pain experience in children is complex and multifaceted. Therefore, the aim of this study was to expand knowledge on the impact and influence of hospital clowns on 4 to 15-year-old children's experiences of managing painful procedures and conditions. A convergent mixed method study was conducted integrating findings from three individual studies: a prospective non-blinded study and two focused ethnographic studies. The findings illuminated a child-clown interaction characterized by a close relationship evolving during a continuous, mutually focused attention, conceptualized as WE. This WE represent a responsive interaction between child and clown, which supported the child during the procedures, and generated three integrated findings: an age-differentiated approach; understanding the child's condition; and previous experiences as a part of the child's history. The WE approach strengthened the child's competences and ability to manage during painful procedures.
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Affiliation(s)
| | - Britt Laugesen
- Aalborg University Hospital, Denmark
- Aalborg University, Denmark
| | - Jennifer Stinson
- University of Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Kammerer E, Eszczuk J, Caldwell K, Dunn J, Appelman-Eszczuk S, Dunn J, MacNeil M, Ali S. A Qualitative Study of the Pain Experiences of Children and Their Parents at a Canadian Children's Hospital. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121796. [PMID: 36553240 PMCID: PMC9777277 DOI: 10.3390/children9121796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
Current literature is lacking in describing families' experiences in being involved in children's pain management. This study sought to understand children and their parents' experiences with pain management at a tertiary care children's hospital. Twelve child-parent dyads were recruited to participate in the study from January to August 2022. Children and their parents chose whether to be interviewed together or separately. Transcripts were analyzed using inductive, data-driven codes. Codes and themes were developed using a codebook and member-checking. Three main themes were identified: a. Painful experiences can have a significant positive or negative effect on families' lives and healthcare trajectories; b. There can be a mismatch between families' expectations of pain management and how they perceive the pain was managed; c. Families feel that they must advocate for better pain care, but often feel too intimidated to do so, or worry that their concerns will be dismissed by healthcare professionals. Families want healthcare professionals to proactively manage their children's pain, supporting the shaping of early positive memories of the child's healthcare interactions. Healthcare providers must further recognize that poorly treated pain can significantly impact families' lives and should both seek and be receptive to child and parent input for better pain care.
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Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Joshua Eszczuk
- Faculty of Kinesiology, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Katie Caldwell
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Jacob Dunn
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Jennifer Dunn
- Alberta Health Services, Edmonton, AB T6G 2B7, Canada
| | - Megan MacNeil
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Correspondence:
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Biophilic virtual reality on children's anxiety and pain during circumcision: A randomized controlled study. J Pediatr Urol 2022; 19:201-210. [PMID: 36336624 DOI: 10.1016/j.jpurol.2022.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/08/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effects of the biophilic virtual reality (BVR) method on children's pain and anxiety undergoing circumcision. MATERIALS AND METHODS This randomized controlled study used a parallel trial design guided by the CONSORT checklist. A total of 106 children were included in the analysis. Intraoperative anxiety was assessed by using the simplified Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS), Visual Analogue Scale (VAS), heart rate (HR), and Anxiety index (Ai). Intraoperative pain was assessed by using the Faces Pain Scale-Revised (FPS-R), and Pain index (Pi). The Pearson correlation analysis was used to analyze the relationship between Ai and the CmYPAS. The primary outcomes were CmYPAS, VAS, and FPS-R, which were analyzed using the Kruskal-Wallis test. RESULTS Baseline variables were not significantly different between the BVR group (34 patients), the indoor virtual reality (IVR) group (36 patients), and the blank control group (36 patients). The CmYPAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (25.0[22.9-29.2], 22.9[22.9-29.2], 33.3[33.3-38.5] respectively; P < 0.001). The VAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (5.0[3.0-7.0], 3.0[2.0-5.0], 6.0[5.0-8.8] respectively; P < 0.001). The FPS-R scores during surgery were significantly lower in the BVR group and IVR group versus the blank control group (2.0[1.8-4.2], 3.0[2.0-4.8], 5.5[5.0-8.0], respectively; P < 0.001). At removal of the foreskin, Pi were significantly lower in the BVR group and IVR group versus the blank control group (6.9[4.1], 7.7[3.3], 9.8[6.2] respectively; P = 0.033). The Ai scores at each time point were significantly lower in the BVR group and IVR group versus the control (P = 0.015, P = 0.006 respectively). The correlation analysis of Ai (at removal of the foreskin) and CmYPAS scores in children showed that the Pearson correlation coefficient was 0.194 (P = 0.046). DISCUSSION This is the first RCT to investigate the effects of BVR in children undergoing circumcision. This study demonstrates a reduction in pediatric intraoperative pain and anxiety with the use of virtual reality (VR). CONCLUSION Intraoperative VR may be an effective noninvasive modality for reducing pain and anxiety during circumcision. Pi and Ai might be used to assess subjective pain and anxiety in patients.
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Situación actual y retos de los pediatras españoles en el manejo del dolor infantil. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mozo Del Castillo Y, Toledo Del Castillo B, Navarro Marchena L, Leyva Carmona M, Monfort Carretero L, Míguez Navarro MC, Marsinyach Ros I. Challenges and current status of children pain management in Spain. An Pediatr (Barc) 2022; 97:207.e1-207.e8. [PMID: 35970753 DOI: 10.1016/j.anpede.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Pain in children population is prevalent, but its proper diagnosis and management are frequently insufficient in pediatrics daily practice. Lack of knowledge of the professionals in charge is a recognized barrier to ensure an appropiate approach to pain in this population. Our present study reflects the current status of pain management and the challenges in diagnosis and treatment that pediatricians face in their daily work. This information is obtained from a survey made with a voluntary questionaire, desinged and distributed online by "Grupo Español para el Estudio del Dolor Pediátrico (GEEDP)" to pediatricians in Spain from october 2021 to march 2022. The final objective of the questionaire was to shed some light into the problem and find out which areas of pain management knowledge are in need of improvent.
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Affiliation(s)
| | - Blanca Toledo Del Castillo
- Unidad de Pediatría Interna Hospitalaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain
| | - Lucía Navarro Marchena
- Servicio de Atención Paliativa y Paciente Crónico Complejo, Hospital Infantil Sant Joan De Dèu, Barcelona, Spain
| | - Moisés Leyva Carmona
- Unidad de Cuidados Paliativos Pediátricos, Hospital Universitario Materno Infantil Torrecárdenas, Almería, Spain
| | - Laura Monfort Carretero
- Servicio de Atención Paliativa y Paciente Crónico Complejo, Hospital Infantil Sant Joan De Dèu, Barcelona, Spain
| | - María Concepción Míguez Navarro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain; Unidad de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Itziar Marsinyach Ros
- Unidad de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Halal Mehdi Alfatavi H, Sadeghi T, Baqer Hassan Mohammed AL-Dakheel M, Asadi Noghabi F, Sahebkar Moeini M. Effects of Whistling Compared with Buzzy Device During Blood Sampling on Pain and Fear in Children’s Emergency Department. Compr Child Adolesc Nurs 2022; 45:414-424. [DOI: 10.1080/24694193.2022.2091683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | - Tahereh Sadeghi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Fariba Asadi Noghabi
- Department of Nursing, School of Nursing and Midwifery, Mother and Child Welfare Research Center Hormozgan University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebkar Moeini
- MSN Pediatric Nursing, Nurse in Social Security Organization, Farabi Hospital, Mashhad, Iran
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Spiritual pain as part of the hospitalization experience of children and adolescents with acute lymphoblastic leukemia: A phenomenological study. Eur J Oncol Nurs 2022; 58:102141. [DOI: 10.1016/j.ejon.2022.102141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 02/07/2023]
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Ogez D, Aramideh J, Rondeau E, Mizrahi T, Charest MC, Plante C, Duval M, Sultan S. Développement et évaluation d’un programme d’entraînement à la communication hypnotique à destination des infirmières en oncologie pédiatrique : la formation Rel@x. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les enfants atteints d’un cancer sont régulièrement confrontés à des procédures douloureuses au cours de leur prise en charge. Afin de les accompagner au mieux dans leurs soins, des techniques de communication dérivées de l’hypnose ont montré d’excellents niveaux d’efficacité sur la réduction de la détresse et de la douleur associées à ces procédures. Nous avons mené une étude préliminaire évaluant les effets d’une formation à la communication hypnotique sur la pratique des infirmières lors de procédures douloureuses auprès d’enfants atteints d’un cancer. Les résultats ont montré une bonne acquisition des techniques par les infirmières et des effets importants de ces techniques sur les niveaux de douleurs et de détresse des enfants. Cette étude a aussi permis de récolter des recommandations d’amélioration de la formation pour développer un design plus simple de la formation Rel@x, qui sera testée auprès d’un échantillon d’infirmières et de patients plus important.
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Geagea D, Griffin B, Kimble R, Polito V, Terhune DB, Tyack Z. Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol. Pilot Feasibility Stud 2022; 8:58. [PMID: 35264248 PMCID: PMC8905723 DOI: 10.1186/s40814-022-01017-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. Methods An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. Discussion Ethical approval was obtained from the Queensland Children’s Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings. The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000988954 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01017-z.
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Affiliation(s)
- Dali Geagea
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4058, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4058, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Vince Polito
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Devin B Terhune
- Department of Psychology, Goldsmiths University of London, London, SE14 6NW, UK
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.,Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
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Glare P, Aubrey K, Gulati A, Lee YC, Moryl N, Overton S. Pharmacologic Management of Persistent Pain in Cancer Survivors. Drugs 2022; 82:275-291. [PMID: 35175587 PMCID: PMC8888381 DOI: 10.1007/s40265-022-01675-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
Improvements in screening, diagnosis and treatment of cancer has seen cancer mortality substantially diminish in the past three decades. It is estimated there are almost 20 million cancer survivors in the USA alone, but some 40% live with chronic pain after completing treatment. While a broad definition of survivorship that includes all people living with, through and beyond a cancer diagnosis—including those with active cancer—is often used, this narrative review primarily focuses on the management of pain in people who are disease-free after completing primary cancer treatment as adults. Chronic pain in this population needs a different approach to that used for people with a limited prognosis. After describing the common chronic pain syndromes caused by cancer treatment, and the pathophysiologic mechanisms involved, the pharmacologic management of entities such as post-surgical pain, chemotherapy-induced neuropathy, aromatase inhibitor musculoskeletal syndrome and checkpoint inhibitor-related pain are described. The challenges associated with opioid prescribing in this population are given special attention. Expert guidelines on pain management in cancer survivors now recommend a combination of pharmacologic and non-pharmacologic modalities, and these are also briefly covered.
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Affiliation(s)
- Paul Glare
- Pain Management Research Institute, Kolling Institute, University of Sydney and Northern Sydney Local Health District, Sydney, NSW, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karin Aubrey
- Pain Management Research Institute, Kolling Institute, University of Sydney and Northern Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amitabh Gulati
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Yi Ching Lee
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Natalie Moryl
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sarah Overton
- Pain Management Research Centre, Royal North Shore Hospital, Sydney, NSW, Australia
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15
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Addab S, Hamdy R, Thorstad K, May S, Tsimicalis A. Use of virtual reality in managing paediatric procedural pain and anxiety: An integrative literature review. J Clin Nurs 2022; 31:3032-3059. [DOI: 10.1111/jocn.16217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/16/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Sofia Addab
- Experimental Surgery Faculty of Medicine McGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Reggie Hamdy
- Experimental Surgery Faculty of Medicine McGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Kelly Thorstad
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Sylvie May
- CHU Ste‐Justine Montreal Quebec Canada
- Faculty of Nursing Université de Montréal Montreal Quebec Canada
| | - Argerie Tsimicalis
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
- Ingram School of Nursing McGill University Montreal Quebec Canada
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Geagea D, Tyack Z, Kimble R, Eriksson L, Polito V, Griffin B. Hypnotherapy for Procedural Pain and Distress in Children: A Scoping Review Protocol. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:2818-2826. [PMID: 33528510 PMCID: PMC8665999 DOI: 10.1093/pm/pnab038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Inadequately treated pain and distress elicited by medical procedures can put children at higher risk of acute and chronic biopsychosocial sequelae. Children can benefit from hypnotherapy, a psychologically tailored intervention, as an adjunct to pharmacological agents to address the multiple components of pain and distress. Despite providing evidence on the effectiveness and potential superiority of hypnotherapy to other psychological interventions, research on hypnotherapy for pediatric procedural pain and distress has been predominantly limited to oncology and needle procedures. Plus, there is a lack of reporting of intervention manuals, factors influencing hypnotic responding, pain unpleasantness outcomes, theoretical frameworks, adverse events, as well as barriers and facilitators to the feasibility of delivering the intervention and study procedures. The proposed review aims to map the range and nature of the evidence on hypnotherapy for procedural pain and distress in children to identify gaps in literature and areas requiring further investigation. METHODS This review will follow the Arksey and O'Malley (2005) methodology and incorporate additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses. Relevant studies will be identified through searching published literature databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus and Web of Science) and grey literature in addition to hand-searching of reference lists and key journals. Two authors will independently screen titles and abstracts of search results followed by full-texts review against eligibility criteria. CONCLUSION Findings are anticipated to guide future research and inform the development of tailored hypnotic interventions in children.
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Affiliation(s)
- Daly Geagea
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Zephanie Tyack
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Brisbane, Australia
| | - Vince Polito
- Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
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Quintero-Castellanos JM, Hernández Á, Parra T. Pain prevalence in infants and preschool children in a Colombian hospital. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The pain prevalence in hospitalized infants and preschool children has not been accurately identified in high-income countries, and in low and medium-income countries it has not been extensively studied. The assessment instruments are limited.
Objective: To describe the prevalence and management of pain in infants and preschool children during the first 24 hours of hospitalization in a third level institution in Colombia, using the CRIES scale.
Methods: An observational study was conducted during the first 24 hours of hospitalization. Demographic information was recorded, pain was assessed at admission, after 4, and 24 hours using the CRIES scale. Pharmacological therapy was also documented.
Results: 250 children between one month and 5 years old were studied. The pain prevalence at admission was 12 %. The pain prevalence per subgroups was higher among the surgical patients, as compared to the clinical patients (35.9 % vs. 7.6 %). The pharmacological analysis revealed that 70.8 % of patients received treatment; the most widely used medications were oral acetaminophen and intravenous dipyrone.
Conclusions: Pain prevalence was lower than the levels described for the general pediatric population. This result may be due to the sensitivity of the CRIES instrument, or to a particular pain behavior. Further studies are needed to identify the sensitivity of the assessment instruments in early life and to accurately investigate any associated phenomena.
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18
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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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19
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Carvello M, Lupo R, Muro M, Grilli G, Ogorzalek K, Rubbi I, Artioli G. Nurse's knowledge and perceptions on communicative hypnosis: an observational study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021027. [PMID: 34328143 PMCID: PMC8383218 DOI: 10.23750/abm.v92is2.11211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
Background and aim of the study. Much evidence shows that hypnotic communication can have a pain-relieving effect and reduce complications such as anxiety, insomnia and depression. Whenever this technique was applied, the use of pharmaceuticals was reduced, there were fewer side effects, shorter hospitalization times frames and lower treatment costs. The aim of this study is to evaluate the knowledge and perceptions of nurses about hypnotic communication and the causes for which this technique is not frequently used. A secondary objective pointed to measuring the effectiveness of an educational event on hypnosis. Method. The evaluation was done by directly administering an anonymous and voluntary survey created ad hoc, in a pre-test and post-test modality, to nurses subscribed to a four-hour formative event on hypnotic communication organized in 2019 by the Nursing Order, Province of Ravenna. Results. 78 nurses (85.7%) participated in the study. The analysis of the pre-test results shows a gap of knowledge regarding hypnotic communication. The variation of answers between the pre-test and post-test (T-Student) has shown a radical difference in knowledge (95%-100% correct answers). The main causes were found regarding the lack of use for hypnotic communication: stereotypes and prejudices related to this technique and insufficient university education. Conclusions. The implementation of this technique, effective and efficient under various aspects, requires a preliminary creation of culture regarding this theme, capable of surpassing the stereotypes and resistances brought by a lack of theoretical elements.
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Affiliation(s)
| | - Roberto Lupo
- Hospital "San Giuseppe da Copertino", ASL (Local Health Authority) (Le), Italy.
| | - Milena Muro
- 1) Nurse at "Città della Salute e della Scienza" Hospital, Torino, Italy; 2) President of A.S.I.E.C.I, Italian Scientific Association of Experienced Nurses in Hypnotic Communication.
| | - Gloria Grilli
- Nurse at Villa Montefeltro Hospital, Sassocorvaro, Italy.
| | - Kody Ogorzalek
- Student in Foreign languages, cultures and literatures, Salento University .
| | - Ivan Rubbi
- School of Nursing, University of Bologna, Bologna, Italy.
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20
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Comparison of the Effects of Hugo's Point Massage and Play on IV-Line Placement Pain in Children: A Randomized Clinical Trial. Pain Res Manag 2021; 2021:6612175. [PMID: 34136057 PMCID: PMC8175188 DOI: 10.1155/2021/6612175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022]
Abstract
Reduction of intravenous line placement pain is one of the most important nursing priorities in the pediatric wards. The present study was aimed at comparing the effect of Hugo's point massage and play on the severity of IV-line placement pain in hospitalized children aged 3-6 years in the pediatric ward. 72 children were selected and assigned randomly to three groups, i.e., control, play, and Hugo point massage. In the massage group, the middle angle between the first and second bones of the palm of the opposite hand was massaged, and the playgroup encouraged bubble-making play. The one-way analysis of variance (ANOVA) did not show a statistically significant difference between the mean IV-line placement pain in play, Hugo's point, and control groups before interventions (p=0.838; p > 0.05). However, the ANOVA test revealed a significant difference between the mean IV-line placement pain in play, Hugo's point, and control groups after the interventions (p=0.006; p < 0.05). The result of the post hoc Scheffe test also showed a statistically significant difference between the mean intensity of IV-line placement pain in both play therapy and Hugo's point massage groups (p=0.028; p < 0.05). Moreover, this test showed that the playgroup children felt less pain than Hugo's point and control group children. This study showed that, in comparison with Hugo's point massage, the play was a more effective way for reducing pain caused by IV-line placement in children, and pediatric nurses can play a significant role in reducing and managing children's pain by using it.
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21
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. I don't want to think about it: a qualitative study of children (6-18 years) with rheumatic diseases and parents' experiences with regular needle injections at home. Pediatr Rheumatol Online J 2021; 19:8. [PMID: 33482852 PMCID: PMC7821489 DOI: 10.1186/s12969-021-00495-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living. METHODS This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16 years (n = 7) and their parents (n = 8) were interviewed individually 4 to 6 months after the onset of needle injection treatment. The focus groups included children aged 11 to 17 years (n = 9) and parents (n = 8) with a minimum of 6 months of experience with injection treatment. Data were analyzed using thematic analysis. RESULTS The main themes; "challenges," "motivational factors," and "routines" captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The children's experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet. CONCLUSIONS Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Undergraduate Studies Lovisenberg Diaconal University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Undergraduate Studies Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Gunnvald Kvarstein
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Hilde Wøien
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Lambert V, Boylan P, Boran L, Hicks P, Kirubakaran R, Devane D, Matthews A. Virtual reality distraction for acute pain in children. Cochrane Database Syst Rev 2020; 10:CD010686. [PMID: 33089901 PMCID: PMC8094164 DOI: 10.1002/14651858.cd010686.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The effectiveness of VR distraction on acute pain intensity in children is uncertain. OBJECTIVES To assess the effectiveness and adverse effects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, handsearched relevant journals and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs), including cross-over and cluster-RCTs, comparing VR distraction to no distraction, non-VR distraction or other VR distraction. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post-procedure). Secondary outcomes were adverse effects, child satisfaction with VR, pain-related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables. MAIN RESULTS We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their different perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results. We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision. 1: VR distraction versus no distraction Acute pain intensity: during procedure Self-report: one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Observer-report: no data. Behavioural measurements (observer-report): two studies, 62 participants; low-certainty evidence. One study (n = 42) found no beneficial effect of non-immersive VR. One study (n = 20) found a beneficial effect favouring immersive VR. Acute pain intensity: post-procedure Self-report: 10 studies, 461 participants; very low-certainty evidence. Four studies (n = 95) found no beneficial effect of immersive and semi-immersive or non-immersive VR. Five studies (n = 357) found a beneficial effect favouring immersive VR. Another study (n = 9) reported less pain in the VR group. Observer-report: two studies (216 participants; low-certainty evidence) found a beneficial effect of immersive VR, as reported by primary caregiver/parents or nurses. One study (n = 80) found a beneficial effect of immersive VR, as reported by researchers. Behavioural measurements (observer-report): one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Adverse effects: five studies, 154 participants; very low-certainty evidence. Three studies (n = 53) reported no adverse effects. Two studies (n = 101) reported mild adverse effects (e.g. nausea) in the VR group. 2: VR distraction versus other non-VR distraction Acute pain intensity: during procedure Self-report, observer-report and behavioural measurements (observer-report): two studies, 106 participants: Self-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (very low-certainty evidence). Observer-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (low-certainty evidence). Behavioural measurements (observer-report): one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) reported a difference in mean pain change scores with fewer pain behaviours in VR group (low-certainty evidence). Acute pain intensity: post-procedure Self-report: eight studies, 575 participants; very low-certainty evidence. Two studies (n = 146) found a beneficial effect favouring immersive VR. Two studies (n = 252) reported a between-group difference favouring immersive VR. One study (n = 59) found no beneficial effect of immersive VR versus television and Child Life non-VR distraction. One study (n = 18) found no beneficial effect of semi-immersive VR. Two studies (n = 100) reported no between-group difference. Observer-report: three studies, 187 participants; low-certainty evidence. One study (n = 81) found a beneficial effect favouring immersive VR for parent, nurse and researcher reports. One study (n = 65) found a beneficial effect favouring immersive VR for caregiver reports. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Behavioural measurements (observer-report): two studies, 106 participants; low-certainty evidence. One study (n = 65) found a beneficial effect favouring immersive VR. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Adverse effects: six studies, 429 participants; very low-certainty evidence. Three studies (n = 229) found no evidence of a difference between groups. Two studies (n = 141) reported no adverse effects in VR group. One study (n = 59) reported no beneficial effect in reducing estimated cyber-sickness before and after VR immersion. 3: VR distraction versus other VR distraction We did not identify any studies for this comparison. AUTHORS' CONCLUSIONS We found low-certainty and very low-certainty evidence of the effectiveness of VR distraction compared to no distraction or other non-VR distraction in reducing acute pain intensity in children in any healthcare setting. This level of uncertainty makes it difficult to interpret the benefits or lack of benefits of VR distraction for acute pain in children. Most of the review primary outcomes were assessed by only two or three small studies. We found limited data for adverse effects and other secondary outcomes. Future well-designed, large, high-quality trials may have an important impact on our confidence in the results.
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Affiliation(s)
- Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Patrick Boylan
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Lorraine Boran
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Paula Hicks
- Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Erdoğan Ç, Turan T, Pınar B. The effect of maternal voice for procedural pain in paediatric intensive care unit: A randomised controlled trial. Intensive Crit Care Nurs 2020; 56:102767. [PMID: 31735564 DOI: 10.1016/j.iccn.2019.102767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/24/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of the maternal voice in reducing pain during painful procedures in children between one and three years old receiving treatment in paediatric intensive care unit. DESIGN AND METHODS This research was designed as a randomised controlled experimental study. Sixty children were randomised into two groups, the maternal-voice group and the controls. The children in the maternal-voice group listened to the maternal voice during the procedure. Although questionnaire forms were used to determine the descriptive characteristics of infants, the Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment scale was used to evaluate pain level. Heart rate and oxygen saturation were also measured. RESULTS There were significant differences in the pain, heart rate and oxygen saturation levels between the maternal-voice and control groups. Pain levels and heart rates of the children in the experimental group during and after the painful procedures were much lower, and their oxygen saturations were higher than those of the children in the control group. PRACTIC IMPLICATIONS Distraction methods, such as listening to the maternal voice, should be used as a nursing intervention to reduce pain and decrease heart rate and increaseoxygen saturation in children during painful procedures in the paediatric intensive care unit. The maternal voice is recommended as a helpful option in cases when a pain control method is required. Future research needs to explore different interventional practices.
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Affiliation(s)
- Çiğdem Erdoğan
- Faculty of Health Science, Pediatric Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Türkan Turan
- Faculty of Health Science, Pediatric Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Bakiye Pınar
- Pamukkale University Hospital, Pediatric Intensive Care Unit, Pamukkale University, Denizli, Turkey
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24
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Velazquez Cardona C, Rajah C, Mzoneli YN, Friedrichsdorf SJ, Campbell F, Cairns C, Rodseth RN. An audit of paediatric pain prevalence, intensity, and treatment at a South African tertiary hospital. Pain Rep 2019; 4:e789. [PMID: 31984294 PMCID: PMC6903419 DOI: 10.1097/pr9.0000000000000789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/25/2019] [Accepted: 08/21/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pain in paediatric inpatients is common, underrecognised, and undertreated in resource-rich countries. Little is known about the status of paediatric pain prevention and treatment in low- and middle-income countries. OBJECTIVES This audit aimed to describe the prevalence and severity of pain in paediatric patients at a tertiary hospital in South Africa. METHOD A single-day prospective observational cross-sectional survey and medical chart review of paediatric inpatients at Grey's Hospital, Pietermaritzburg, South Africa. RESULTS Sixty-three children were included, and mean patient age was 9.7 years (SD 6.17). Most patients (87%) had pain during admission, with 29% reporting preexisting (possibly chronic) pain. At the time of the study, 25% had pain (median pain score 6/10). The worst pain reported was from needle procedures, including blood draws, injections, and venous cannulation (34%), followed by surgery (22%), acute illness/infection (18%), and other procedures (14%). Pharmacological treatments included WHO step 1 (paracetamol and ibuprofen) and step 2 (tramadol, tilidine, and morphine) analgesics. The most effective integrative interventions were distraction, swaddling, and caregiver participation. Although a pain narrative was present in the majority of charts, only 16% had documented pain intensity scores. CONCLUSION The prevalence of pain in hospitalised children in a large South African Hospital was high and pain assessment inadequately documented. There is an urgent need for pain education and development of guidelines and protocols, to achieve better pain outcomes for children. This audit will be repeated as part of a quality-improvement initiative.
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Affiliation(s)
- Caridad Velazquez Cardona
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Grey's Hospital Pain Services Commitee, Pietermaritzburg, South Africa
| | - Chantal Rajah
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Youley Nosisi Mzoneli
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Stefan Joerg Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Fiona Campbell
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Carel Cairns
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Grey's Hospital Pain Services Commitee, Pietermaritzburg, South Africa
| | - Reitze Nils Rodseth
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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25
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Abstract
INTRODUCTION Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns (HCs) related to painful medical procedures in children may offer pain relief, but this has not been systematically evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison with standard care on the experience of pain in children receiving venipuncture. MATERIALS AND METHODS A sample of 116 children aged 4 to 15 years consecutively admitted to the hospital was allocated to either the experimental (presence of HC) or control group (standard care) before venipuncture. Self-reported pain after the procedure was assessed using the Faces Pain Scale combined with a 0 to 10 Numerical Rating Scale. Separate analysis was conducted in age groups from 4 to 6 (N=37) and 7 to 15 (N=74) years. RESULTS Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the 2 age groups. Children aged 7 to 15 years had lower pain scores when the clown was present compared with the control group (P=0.025). Children aged 4 to 6 years had higher pain scores with the clown present, although the difference was not statistically significant (P=0.054). Children with pain (N=49) or previous experiences with venipuncture (N=56) did not score pain significantly differently. DISCUSSION Assessing the pain experience of children receiving venipuncture with the presence of an HC indicates a pain relieving effect for children older than 6 years. However, future studies should carefully study the effects on younger children where mixed effects may be present.
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Mariani Wigley ILC, De Tommasi V, Bonichini S, Fernandez I, Benini F. EMDR and Nonpharmacological Techniques for Anxiety Prevention in Children Prior to Invasive Medical Procedures: A Randomized Controlled Trial. JOURNAL OF EMDR PRACTICE AND RESEARCH 2019. [DOI: 10.1891/1933-3196.13.3.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nonpharmacological Techniques (NPT) have been suggested as an efficient and safe means to reduce pain and anxiety in invasive medical procedures. Due to the anxious and potentially traumatic nature of these procedures, we decided to integrate an eye movement desensitization and reprocessing (EMDR) session in the preprocedure NPT. The main purpose of this study was to evaluate the efficacy of one session of EMDR in addition to the routine NPT. Forty-nine pediatric patients (Male = 25; Female = 24) aged 8–18 years (M = 13.17; SD = 2.98) undergoing painful and invasive medical procedures were randomized to receive standard preprocedural care (N = 25) or a session of EMDR in addition to the standard nonpharmacological interventions (N = 24). Participants completed the anxiety and depression scales from the Italian Psychiatric Self-evaluation Scale for Children and Adolescents (SAFA) and rated anxiety on a 0–10 numeric rating scale. Participants in the NPT+EMDR condition expressed significantly less anxiety before the medical procedure than those in the NPT group (p = .038). The integration of EMDR with NPT was demonstrated to be an effective anxiety prevention technique for pediatric sedo-analgesia. These results are the first data on the efficacy of EMDR as a technique to prevent anxiety in pediatric sedo-analgesia. There are important long-term clinical implications because this therapy allows an intervention on situations at risk of future morbidity and the prevention of severe disorders.
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Chan E, Hovenden M, Ramage E, Ling N, Pham JH, Rahim A, Lam C, Liu L, Foster S, Sambell R, Jeyachanthiran K, Crock C, Stock A, Hopper SM, Cohen S, Davidson A, Plummer K, Mills E, Craig SS, Deng G, Leong P. Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials. J Pediatr 2019; 209:160-167.e4. [PMID: 31047650 DOI: 10.1016/j.jpeds.2019.02.034] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/29/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice. STUDY DESIGN In 2 clinical trials, we randomized children aged 4-11 years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised. RESULTS In the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, -1.78; 95% CI, -3.24 to -0.317; P = .018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, -1.39; 95% CI, -2.68 to -0.11; P = .034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy. CONCLUSIONS In children aged 4-11 years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe. TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry: ACTRN12617000285358p.
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Affiliation(s)
- Evelyn Chan
- General Pediatrics, Monash Children's Hospital, Clayton, Victoria, Australia; General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Michael Hovenden
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Emma Ramage
- Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Norman Ling
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Jeanette H Pham
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Ayesha Rahim
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Connie Lam
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Linly Liu
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Samantha Foster
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Ryan Sambell
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Kasthoori Jeyachanthiran
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine Crock
- School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Amanda Stock
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Simon Cohen
- Pain Management, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Andrew Davidson
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Karin Plummer
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Erin Mills
- Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Simon S Craig
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia; Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Gary Deng
- DataConnect, Melbourne, Victoria, Australia
| | - Paul Leong
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia; Monash Lung & Sleep, Monash Medical Centre, Clayton, Victoria, Australia.
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Kristensen HN, Sørensen EE, Stinson J, Thomsen HH. "WE do it together!" An Ethnographic Study of the Alliance Between Child and Hospital Clown During Venipunctures. J Pediatr Nurs 2019; 46:e77-e85. [PMID: 30935724 DOI: 10.1016/j.pedn.2019.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Hospital clowns are widely used as a means of non-pharmacological intervention in the treatment of hospitalized children. However, little research has examined the impact of clowns on common painful needle-related procedures. This study explored children's pain experience and their ability to cope during a venipuncture while interacting with a clown in the acute admission unit. DESIGN AND METHODS An ethnographic fieldwork study was conducted. Data were collected over a 10-month period through participant observation and informal interviews, supplemented by video recordings. The participants comprised 38 acutely admitted children aged 4 to 15 years undergoing a venipuncture in the presence of a hospital clown. Analysis was structured in three stages: before venipuncture; during venipuncture; and after venipuncture. RESULTS The development of a responsive interaction between child and clown, identified as a WE, was found to be beneficial to the child during venipuncture procedure. The WE was characterized by three themes "How do WE do this together?"; "WE are together"; and "I/WE did it!" CONCLUSIONS The study emphasizes the importance of a WE established between child and hospital clown from the first encounter until a final evaluation. This WE was verbalized repeatedly by the clown and the child and was essential in shaping a tailored approach which met the needs of each child. This approach seemed to strengthen the child's competence in pain management and ability to cope, thus building competence for future venipunctures. PRACTICE IMPLICATIONS Establishing a WE might advance the psychosocial care of hospitalized children undergoing acute painful procedures.
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Affiliation(s)
- Helle Nygaard Kristensen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Helle Haslund Thomsen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark; Clinic for Anesthesiology, Child Diseases, Circulation, and Women, Aalborg University Hospital, Denmark.
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Efficacy of hypnosis on pain, wound-healing, anxiety, and stress in children with acute burn injuries: a randomized controlled trial. Pain 2019; 159:1790-1801. [PMID: 29939959 DOI: 10.1097/j.pain.0000000000001276] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
No randomized controlled trial has investigated the efficacy of hypnosis for reducing pain and improving wound-healing in children with burns. This randomized controlled trial aimed to investigate whether hypnosis decreases pain, anxiety, and stress and accelerates wound-healing in children undergoing burn wound procedures. Children (4-16 years) with acute burns presenting for their first dressing change were randomly assigned to a Hypnosis Group who received hypnosis plus standard care or a Standard Care Group who received standard pharmacological and nonpharmacological intervention. Repeated measures of pain intensity, anxiety, stress, and wound-healing were taken at dressing changes until ≥95% wound re-epithelialization. Data for 62 children were analyzed on an intent-to-treat basis using Generalized Estimating Equations (n = 35 Standard Care Group; n = 27 Hypnosis Group). An effect on the primary outcomes of pain and wound healing was not supported {self-reported pain intensity largest Mean Difference [MD] = -0.85 (95% confidence interval [CI]: -1.91 to 0.22), P = 0.12; MD for re-epithelialization = -0.46 [95% CI: -4.27 to 3.35], P = 0.81}. Some support was found for an effect on the secondary outcomes of preprocedural anxiety (MD = -0.80 [95% CI: -1.50 to -0.10], P = 0.03 before the second dressing change) and heart rate as a measure of stress (MD = -15.20 [-27.20 to -3.20], P = 0.01 and MD = -15.39 [-28.25 to -2.53], P = 0.02 before and after the third dressing change). Hypnosis may be effective for decreasing preprocedural anxiety and heart rate in children undergoing repeated pediatric wound care procedures but not for reducing pain intensity or accelerating wound healing.
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Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale. Pain 2019; 159:1508-1517. [PMID: 29608509 DOI: 10.1097/j.pain.0000000000001236] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Appropriate pain measurement relies on the use of valid, reliable tools. The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED). The inclusion criteria were children aged 6 to 17 years presenting to the ED with a musculoskeletal injury and self-reported pain scores ≥30 mm on the mechanical Visual Analogue Scale (VAS). Self-reported pain intensity was assessed using the mechanical VAS, Faces Pain Scale-Revised (FPS-R), and Colour Analogue Scale (CAS). Convergent validity was assessed by Pearson correlations and the Bland-Altman method; responsiveness to change was assessed using paired sample t tests and standardized mean responses; and reliability was estimated using relative and absolute indices. A total of 456 participants were included, with a mean age of 11.9 years ± 2.7 and a majority were boys (252/456, 55.3%). Correlations between each pair of scales were 0.78 (VAS/FPS-R), 0.92 (VAS/CAS), and 0.79 (CAS/FPS-R). Limits of agreement (95% confidence interval) were -3.77 to 2.33 (VAS/FPS-R), -1.74 to 1.75 (VAS/CAS), and -2.21 to 3.62 (CAS/FPS-R). Responsiveness to change was demonstrated by significant differences in mean pain scores among the scales (P < 0.0001). Intraclass correlation coefficient and coefficient of repeatability estimates suggested acceptable reliability for the 3 scales at, respectively, 0.79 and ±2.29 (VAS), 0.82 and ±2.07 (CAS), and 0.76 and ±2.82 (FPS-R). The scales demonstrated good psychometric properties for children with acute pain in the ED. The VAS and CAS showed a strong convergent validity, whereas FPS-R was not in agreement with the other scales.
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Akgül EA, Karahan Y, Başoğlu F, Oğul A, Öztornaci BÖ, Yetim P, Sari HY. Effects of watching cartoons on pain scores in children undergoing venepuncture. Nurs Child Young People 2018:e913. [PMID: 31468905 DOI: 10.7748/ncyp.2018.e913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Children experience pain and restlessness during invasive procedures. AIM To determine the effect of watching cartoons on pain scores and the duration of crying in children aged 3-6 years undergoing venepuncture. METHOD The study included 81 children, aged 3-6 years, who presented to the blood collection unit of a teaching and research hospital. The children were divided into an experimental group (n=41) and a control group (n=40). Those in the experimental group watched a cartoon and then venepuncture was initiated. Their pain levels and the duration of crying were assessed during venepuncture. After venepuncture, they continued to watch the cartoons and their pain levels were assessed again. During the process, another researcher calculated the duration of crying. The children in the control group were subjected to the same process but were not shown the cartoon. RESULTS Significant differences in pain levels, duration of crying after the procedure and total duration of crying were found between the groups. There was no significant difference in terms of duration of crying during the procedure. CONCLUSION Watching cartoons is a non-pharmacological method of pain relief, which reduces perception of pain by distracting a child's attention.
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Affiliation(s)
- Esra Ardahan Akgül
- Faculty of Health Sciences, Department of Pediatric Nursing, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Yakup Karahan
- Faculty of Health Sciences, Department of Nursing, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Funda Başoğlu
- Faculty of Health Sciences, Department of Nursing, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Aysel Oğul
- Tepecik Education and Research Hospital, İzmir, Turkey
| | - Beste Özgüven Öztornaci
- Faculty of Health Sciences, Department of Pediatric Nursing, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Perihan Yetim
- Tepecik Education and Research Hospital, İzmir, Turkey
| | - Hatice Yildirim Sari
- Faculty of Health Sciences, Department of Pediatric Nursing, İzmir Kâtip Çelebi University, İzmir, Turkey
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Shave K, Ali S, Scott SD, Hartling L. Procedural pain in children: a qualitative study of caregiver experiences and information needs. BMC Pediatr 2018; 18:324. [PMID: 30316301 PMCID: PMC6186099 DOI: 10.1186/s12887-018-1300-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Children experience multiple painful procedures when being cared for in emergency departments (EDs). Unfortunately, evidence-based interventions to manage such pain and distress are under-utilized across EDs. Caregivers are uniquely positioned and invested to advocate for the adaptation of such evidence into practice. Our objective was to gather information from caregivers of children experiencing procedural pain in the ED to inform the development of a novel, caregiver-focused knowledge translation (KT) tool. METHODS The study design was qualitative description. Caregivers of children who underwent intravenous (IV) insertion or venipuncture in the pediatric ED at an urban tertiary care centre were interviewed. Thematic analysis was applied to the data. The TRanslating Emergency Knowledge for Kids (TREKK) Parent Advisory Group continuously informed this study, and provided input on interview guide development and piloting, data collection, analysis of the data, interpretation of the results, and development of next steps. RESULTS Interviews revealed four major themes: 1) source of healthcare information; 2) delivering healthcare information; 3) communication with caregivers; and 4) procedure-related anxiety and long-term effects. Caregivers most valued receiving information directly from their healthcare provider. They also expressed that healthcare providers should direct information about the procedure to their child and identified strategies to involve children in their care. Caregivers wanted to be empowered to ask informed questions of their healthcare providers. Finally, caregivers reported negative experiences with procedures for their children, occurring mainly at non-pediatric centres. CONCLUSIONS We have identified core information needs for caregivers whose children are experiencing IV insertion or venipuncture. These results will form the foundation for the development of a KT tool that may empower caregivers to actively participate in their child's healthcare.
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Affiliation(s)
- Kassi Shave
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Women and Children’s Health Research Institute, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Shannon D. Scott
- Women and Children’s Health Research Institute, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Department of Pediatrics, University of Alberta, ECHA 4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
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Canbulat Sahiner N, Turkmen AS, Acikgoz A, Simsek E, Kirel B. Effectiveness of Two Different Methods for Pain Reduction During Insulin Injection in Children With Type 1 Diabetes: Buzzy and ShotBlocker. Worldviews Evid Based Nurs 2018; 15:464-470. [DOI: 10.1111/wvn.12325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Nejla Canbulat Sahiner
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
| | - Ayse Sonay Turkmen
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
| | - Ayfer Acikgoz
- Nursing DepartmentHealth Science FacultyEskisehir Osmangazi University Eskisehir Turkey
| | - Enver Simsek
- Child Endocrinology DepartmentMedical FacultyEskisehir Osmangazi University Eskisehir Turkey; Birgul Kirel,
| | - Birgul Kirel
- Child Endocrinology DepartmentMedical FacultyEskisehir Osmangazi University Eskisehir Turkey; Birgul Kirel,
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Susam V, Friedel M, Basile P, Ferri P, Bonetti L. Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:6-16. [PMID: 30038198 PMCID: PMC6357594 DOI: 10.23750/abm.v89i6-s.7378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture. METHODS A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to "magic gloves" group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS). RESULTS Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System. CONCLUSION The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than "magic glove" technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.
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Affiliation(s)
- Volkan Susam
- General Medical Ward, ASST Monza-San Gerardo, San Gerardo Hospital, Italy..
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Hanrahan K, Kleiber C, Miller BJ, Davis H, McCarthy AM. The Distraction in Action Tool©: Feasibility and Usability in Clinical Settings. J Pediatr Nurs 2018; 41:16-21. [PMID: 29132876 PMCID: PMC6349520 DOI: 10.1016/j.pedn.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Distraction is a relatively simple, evidence-based intervention to minimize child distress during medical procedures. Timely on-site interventions that instruct parents on distraction coaching are needed. The purpose of this study was to test the feasibility and usability of the Distraction in Action Tool© (DAT©), which 1) predicts child risk for distress with a needle stick and 2) provides individualized instructions for parents on how to be a distraction coach for their child in clinical settings. DESIGN AND METHODS A mixed-methods descriptive design was used to test feasibility and usability of DAT in the Emergency Department and a Phlebotomy Lab at a large Midwest Academic Medical Center. Twenty parents of children ages 4-10years requiring venipuncture and clinicians performing 13 of those procedures participated. Participants completed an evaluation and participated in a brief interview. RESULTS The average age of the children was 6.8years, and 80% of parent participants were mothers. Most parents reported the DAT was not difficult to use (84.2%), understandable (100%), and they had a positive experience (89.5%). Clinicians thought DAT was helpful (100%) and did not cause a meaningful delay in workflow (92%). CONCLUSION DAT can be used by parents and clinicians to assess their children's risk for procedure related distress and learn distraction techniques to help their children during needle stick procedures. PRACTICE IMPLICATIONS DAT for parents is being disseminated via social media and an open-access website. Further research is needed to disseminate and implement DAT in community healthcare settings.
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Affiliation(s)
- Kirsten Hanrahan
- Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
| | - Charmaine Kleiber
- Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, United States
| | - Ben J Miller
- University of Iowa College of Education, United States
| | - Heather Davis
- Institute for Clinical & Translational Science, Carver College of Medicine Information Technology, United States
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Gates A, Shave K, Featherstone R, Buckreus K, Ali S, Scott SD, Hartling L. Procedural Pain: Systematic Review of Parent Experiences and Information Needs. Clin Pediatr (Phila) 2018; 57:672-688. [PMID: 28959897 DOI: 10.1177/0009922817733694] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parents wish to reduce their child's pain during medical procedures but may not know how to do so. We systematically reviewed the literature on parents' experiences and information needs related to managing their child's pain for common medical procedures. Of 2678 records retrieved through database searching, 5 were included. Three additional records were identified by scanning reference lists. Five studies were qualitative, and 3 were quantitative. Most took place in North America or Europe (n = 7) and described neonatal intensive care unit experiences (n = 5). Procedures included needle-related medical procedures (eg, venipuncture, phlebotomy, intravenous insertion), sutures, and wound repair and treatment, among others. Generally, parents desired being present during procedures, wanted to remain stoic for their child, and thought that information would be empowering and relieve stress but felt unsupported in taking an active role. Supporting and educating parents may empower them to lessen pain for their children while undergoing medical procedures.
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Affiliation(s)
| | - Kassi Shave
- 1 University of Alberta, Edmonton, AB, Canada
| | | | | | - Samina Ali
- 1 University of Alberta, Edmonton, AB, Canada
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Morrow AM, Burton KLO, Watanabe MM, Cloyd BH, Khut GP. Developing BrightHearts: A Pediatric Biofeedback-Mediated Relaxation App to Manage Procedural Pain and Anxiety. Pain Pract 2018; 18:698-708. [DOI: 10.1111/papr.12655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/16/2017] [Accepted: 10/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Angela M. Morrow
- Kids Rehab; The Children's Hospital at Westmead; Sydney New South Wales Australia
- School of Medicine; University of Sydney; Sydney New South Wales Australia
| | - Karen L. O. Burton
- Kids Rehab; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Melissa M. Watanabe
- Kids Rehab; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Benjamin H. Cloyd
- School of Medicine; University of Sydney; Sydney New South Wales Australia
| | - George P. Khut
- Kids Rehab; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Faculty of Art & Design; University of New South Wales; Sydney New South Wales Australia
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Delivet H, Dugue S, Ferrari A, Postone S, Dahmani S. Efficacy of Self-hypnosis on Quality of Life For Children with Chronic Pain Syndrome. Int J Clin Exp Hypn 2018; 66:43-55. [PMID: 29319458 DOI: 10.1080/00207144.2018.1396109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to assess the efficacy of self-hypnosis in a therapeutic education program (TEP) for the management of chronic pain in 26 children aged 7 to 17 years. Outcomes of the study were a total or a partial (at least 1) achievement of the therapeutic goals (pain, quality of sleeping, schooling, and functional activity). Sixteen patients decreased their pain intensity, 10 reached all of their therapeutic goals, and 9 reached them partially. Self-hypnosis was the only component of the TEP associated with these improvements. The current study supports the efficacy of self-hypnosis in our TEP program for chronic pain management in children.
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Affiliation(s)
- Honorine Delivet
- b Robert Debré University Hospital , Paris Diderot University, and Paris Descarte University , France
| | - Sophie Dugue
- a Robert Debré University Hospital , Paris Diderot University , France
| | - Alexis Ferrari
- a Robert Debré University Hospital , Paris Diderot University , France
| | - Silvia Postone
- a Robert Debré University Hospital , Paris Diderot University , France
| | - Souhayl Dahmani
- a Robert Debré University Hospital , Paris Diderot University , France
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Ring LM, Watson A. Thoracostomy Tube Removal: Implementation of a Multidisciplinary Procedural Pain Management Guideline. J Pediatr Health Care 2017; 31:671-683. [PMID: 28688940 DOI: 10.1016/j.pedhc.2017.05.004] [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: 03/06/2017] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Thoracostomy tubes are placed following cardiothoracic surgery for the repair or palliation of congenital heart defects. The aim of this project was to develop and implement a clinical practice guideline for the provision of optimal analgesia during removal of thoracostomy tubes in pediatric postoperative cardiothoracic surgery patients. METHODS Methods used include a nonexperimental design utilizing chart audits to determine baseline documentation as well as procedure note evaluation to determine both baseline documentation and compliance with the new guideline. A convenience sample of unit-based nurses completed a knowledge test and a post-implementation survey. RESULTS There was a significant increase in nursing knowledge related to the clinical practice guideline education and implementation. Documentation compliance was observed. Nursing satisfaction and feasibility of the new guideline was demonstrated. DISCUSSION This project was successful in increasing nursing knowledge of available resources for optimal procedural pain management in pediatric patients requiring thoracostomy tube removal on one in-patient acute care unit.
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Poonai N, Datoo N, Ali S, Cashin M, Drendel AL, Zhu R, Lepore N, Greff M, Rieder M, Bartley D. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial. CMAJ 2017; 189:E1252-E1258. [PMID: 29018084 DOI: 10.1503/cmaj.170017] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Oral morphine for postoperative pain after minor pediatric surgery, while increasingly popular, is not supported by evidence. We evaluated whether oral morphine was superior to ibuprofen for at-home management of children's postoperative pain. METHODS We conducted a randomized superiority trial comparing oral morphine (0.5 mg/kg) with ibuprofen (10 mg/kg) in children 5 to 17 years of age who had undergone minor outpatient orthopedic surgery (June 2013 to September 2016). Participants took up to 8 doses of the intervention drug every 6 hours as needed for pain at home. The primary outcome was pain, according to the Faces Pain Scale - Revised, for the first dose. Secondary outcomes included additional analgesic requirements, adverse effects, unplanned health care visits and pain scores for doses 2 to 8. RESULTS We analyzed data for 77 participants in each of the morphine and ibuprofen groups. Both interventions decreased pain scores with no difference in efficacy. The median difference in pain score before and after the first dose of medication was 1 (interquartile range 0-1) for both morphine and ibuprofen (p = 0.2). For doses 2 to 8, the median differences in pain score before and after the dose were not significantly different between groups. Significantly more participants taking morphine reported adverse effects (45/65 [69%] v. 26/67 [39%], p < 0.001), most commonly drowsiness (31/65 [48%] v. 15/67 [22%] in the morphine and ibuprofen groups, respectively; p = 0.003). INTERPRETATION Morphine was not superior to ibuprofen, and both drugs decreased pain with no apparent difference in efficacy. Morphine was associated with significantly more adverse effects, which suggests that ibuprofen is a better first-line option after minor surgery. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT01686802.
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Affiliation(s)
- Naveen Poonai
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis.
| | - Natasha Datoo
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Samina Ali
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Megan Cashin
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Amy L Drendel
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Rongbo Zhu
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Natasha Lepore
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Michael Greff
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Michael Rieder
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
| | - Debra Bartley
- Division of Emergency Medicine (Poonai, Zhu, Lepore), London Health Sciences Centre; Department of Paediatrics (Poonai, Datoo, Greff, Rieder) and Department of Surgery (Cashin, Bartley), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alta.; Children's Hospital of Wisconsin (Drendel), Milwaukee, Wis
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Oliveira NCAC, Gaspardo CM, Linhares MBM. Pain and distress outcomes in infants and children: a systematic review. ACTA ACUST UNITED AC 2017; 50:e5984. [PMID: 28678920 PMCID: PMC5496157 DOI: 10.1590/1414-431x20175984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/07/2017] [Indexed: 11/21/2022]
Abstract
The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.
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Affiliation(s)
- N C A C Oliveira
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C M Gaspardo
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M B M Linhares
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Gates A, Shave K, Featherstone R, Buckreus K, Ali S, Scott S, Hartling L. Parent experiences and information needs relating to procedural pain in children: a systematic review protocol. Syst Rev 2017; 6:109. [PMID: 28587663 PMCID: PMC5461670 DOI: 10.1186/s13643-017-0499-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 05/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There exist many evidence-based interventions available to manage procedural pain in children and neonates, yet they are severely underutilized. Parents play an important role in the management of their child's pain; however, many do not possess adequate knowledge of how to effectively do so. The purpose of the planned study is to systematically review and synthesize current knowledge of the experiences and information needs of parents with regard to the management of their child's pain and distress related to medical procedures in the emergency department. METHODS We will conduct a systematic review using rigorous methods and reporting based on the PRISMA statement. We will conduct a comprehensive search of literature published between 2000 and 2016 reporting on parents' experiences and information needs with regard to helping their child manage procedural pain and distress. Ovid MEDLINE, Ovid PsycINFO, CINAHL, and PubMed will be searched. We will also search reference lists of key studies and gray literature sources. Two reviewers will screen the articles following inclusion criteria defined a priori. One reviewer will then extract the data from each article following a data extraction form developed by the study team. The second reviewer will check the data extraction for accuracy and completeness. Any disagreements with regard to study inclusion or data extraction will be resolved via discussion. Data from qualitative studies will be summarized thematically, while those from quantitative studies will be summarized narratively. The second reviewer will confirm the overarching themes resulting from the qualitative and quantitative data syntheses. The Critical Appraisal Skills Programme Qualitative Research Checklist and the Quality Assessment Tool for Quantitative Studies will be used to assess the quality of the evidence from each included study. DISCUSSION To our knowledge, no published review exists that comprehensively reports on the experiences and information needs of parents related to the management of their child's procedural pain and distress. A systematic review of parents' experiences and information needs will help to inform strategies to empower them with the knowledge necessary to ensure their child's comfort during a painful procedure. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016043698.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Kassi Shave
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Kelli Buckreus
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.,Women and Children's Health Research Institute, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada. .,Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
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Prospective Mediation Models of Sleep, Pain, and Daily Function in Children With Arthritis Using Ecological Momentary Assessment. Clin J Pain 2017; 32:471-7. [PMID: 26340651 DOI: 10.1097/ajp.0000000000000298] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Sleep is an emerging area of concern in children with juvenile idiopathic arthritis (JIA). Research shows the presence of poor sleep quality and related adverse outcomes in pediatric pain populations, including JIA, but few studies have examined the prospective patterns of association between sleep and associated outcomes. This prospective study evaluated the direction and magnitude of associations between subjective sleep characteristics (sleep quality, difficulty initiating sleep, and sleep duration), pain intensity, and functional limitations in children with JIA. We hypothesized that pain intensity would partially mediate the relationship between sleep and functional limitations. METHODS Children and adolescents with JIA (n=59; age range, 8 to 18 y) recruited during clinic visits, completed smartphone-based diaries for 1 month. Subjective sleep characteristics were reported each morning; pain and functioning were assessed 3 times daily. RESULTS As hypothesized, the associations between sleep quality and functional limitations and between difficulty initiating sleep and functional limitations were partially mediated by pain intensity, at any given moment (z=-3.27, P=0.001, z=2.70, P<0.05). Mediation was not detected in a model testing the association between sleep duration, pain intensity, and functional limitations (z=-0.58, P=0.56). DISCUSSION Results suggest that sleep is integral to understanding the momentary association between pain intensity and functioning in children with JIA.
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Castarlenas E, Solé E, Racine M, Sánchez-Rodríguez E, Jensen MP, Miró J. Locus of control and pain: Validity of the Form C of the Multidimensional Health Locus of Control scales when used with adolescents. J Health Psychol 2016; 23:1853-1862. [PMID: 27682338 DOI: 10.1177/1359105316669860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to examine the factor structure, reliability, and validity of the Form C of the Multidimensional Health Locus of Control scales in adolescents. A confirmatory factor analysis indicated that adequate fit of a four-factor model and the internal consistency of the scales were adequate. Criterion validity of the four scales of the Form C of the Multidimensional Health Locus of Control was also supported by significant correlations with measures of pain-related self-efficacy, anxiety, and coping strategies. The results indicate that the four Form C of the Multidimensional Health Locus of Control scale scores are reliable and valid and therefore support their use to assess pain-related locus of control beliefs in adolescents.
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46
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Oliveira N, Santos J, Linhares M. Audiovisual distraction for pain relief in paediatric inpatients: A crossover study. Eur J Pain 2016; 21:178-187. [DOI: 10.1002/ejp.915] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - J.L.F. Santos
- Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - M.B.M. Linhares
- Ribeirão Preto Medical School; University of São Paulo; Brazil
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Bahorski JS, Hauber RP, Hanks C, Johnson M, Mundy K, Ranner D, Stoutamire B, Gordon G. Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study. Int J Nurs Stud 2015; 52:1553-64. [DOI: 10.1016/j.ijnurstu.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 12/23/2022]
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Shomaker K, Dutton S, Mark M. Pain Prevalence and Treatment Patterns in a US Children's Hospital. Hosp Pediatr 2015; 5:363-70. [PMID: 26136310 DOI: 10.1542/hpeds.2014-0195] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hospitalized children experience significant pain despite improvement efforts. This study was undertaken to better understand the epidemiology of acute pain in hospitalized children and the extent to which existing measures reveal targets for improving pain management. METHODS A cross-sectional survey was used to audit pain assessment, intensity, prevalence, source, and treatment hospital-wide on a single day in 2011. Chart audits were performed on patients aged 0 to 21 years. All patients had the option to participate in a structured interview about their pain experience. RESULTS The audit included 112 children, 47 of whom were interviewed. Pain prevalence obtained by child/parent interview (72%) was more than twice that documented by nurses (30%). Infants, but not cognitively impaired children, had significantly lower rates of pain detection and analgesic ordering than older age groups. Procedural pain was the most frequently cited source of pain among interviewed patients and was poorly addressed in the medical record. Fifty percent of children with documented moderate-to-severe pain received scheduled pain medications. More than one-third of interviewed patients would have wanted more pain medication if it could have been safely given. CONCLUSIONS Specific gaps remain in the quality of pain management provided to hospitalized children. Focus on infant pain detection, assessment and management of procedural pain, and scheduled analgesic ordering are sensible targets for future process improvement efforts.
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Affiliation(s)
- Kyrie Shomaker
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; and
| | - Shirl Dutton
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; and
| | - Melissa Mark
- Cancer and Blood Diseases Institute,Cincinnati Children's Hospital, Cincinnati, Ohio
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Mutlu B, Balcı S. Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: a randomized controlled trial. J SPEC PEDIATR NURS 2015; 20:178-86. [PMID: 25817062 DOI: 10.1111/jspn.12112] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose was to determine the effects of the balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples. DESIGN AND METHODS In this prospective randomized controlled study, 9- to 12-year-old children in the intervention groups were asked to cough or inflate balloons during the venipuncture procedure. The Faces Pain Scale-Revised was used to assess pain intensity. RESULTS Pain intensity significantly differed between the control (n = 44) and intervention groups (balloon inflation [n = 44] and cough trick [n = 44], p < .001). PRACTICE IMPLICATIONS Coughing and inflating balloons during venipuncture do not require preparation and are time saving, easy, accessible, and effective in reducing pain.
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Affiliation(s)
- Birsen Mutlu
- Istanbul University Florence Nightingale Nursing Faculty-Pediatric Nursing, Istanbul, Turkey
| | - Serap Balcı
- Istanbul University Florence Nightingale Nursing Faculty-Pediatric Nursing, Istanbul, Turkey
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Messerer B, Krauss-Stoisser B, Urlesberger B. [Non-pharmaceutical measures, topical analgesics and oral administration of glucose in pain management: Austrian interdisciplinary recommendations on pediatric perioperative pain management]. Schmerz 2015; 28:31-42. [PMID: 24550025 DOI: 10.1007/s00482-014-1391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Non-pharmaceutical procedures are increasingly being used in pediatric pain therapy in addition to pharmaceutical procedures and have a supporting function. This article describes the non-pharmaceutical procedures which have an influence on perioperative and posttraumatic pain in children and adolescents. Prerequisites for every adequate pain therapy are affection, imparting a feeling of security, distraction and the creation of a child-oriented environment. Topical analgesics are indicated for application to intact skin for surface anesthesia. For a safe use consideration must be given to the duration of application, the dose and the maximum area of skin treated in an age-dependent manner. For simple but painful procedures in premature infants, neonates and infants, pain can be effectively reduced by the oral administration of glucose. The positive effect is guaranteed particularly for the use in a once only pain stimulation. Non-nutritive sucking, swaddling, facilitated tucking and kangaroo mother care, for example can be used as supportive measures during slightly painful procedures. There is insufficient evidence for a pain reducing effect in older infants and small children. Physical therapeutic procedures can be used as accompanying measures for acute pain and are individually adapted. However, the limited amount of currently available data is insufficient to make a critical scientific assessment of the individual measures. The effects can, however, be observed in the daily routine practice. Psychological methods can facilitate coping with pain. In situations with mental and psychiatric comorbidities or psychosocial impairment, a psychologist should be consulted. Acupuncture and hypnosis are also a meaningful addition within the framework of multimodal pain therapy.
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Affiliation(s)
- B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
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