Parent coping and child distress behaviors during invasive procedures for childhood cancer

Child Life Specialists Decrease Procedure Time, Improve Experience, and Reduce Fear in an Outpatient Blood Drawing Lab (CLS Decrease Procedure Time)

Children can experience extreme fear when undergoing medical procedures, including blood draws. A growing body of evidence points to the benefits of Child Life Specialists supporting children throughout medical procedures in various medical settings. This prospective cohort study aimed to describe the impact of Child Life Specialist facilitated play on children's fear and caregiver satisfaction in an outpatient blood drawing lab. A nonrandomized convenience sample of 150 children and their caregivers were enrolled. Seventy-five patients received the Child Life Specialist intervention during their blood draw, while the remaining 75 patients were enrolled as controls. Children and caregivers in the intervention group spent less time in the procedure room, with a median time of 3 min (interquartile range: 2-5) as compared to 5 min (interquartile range: 5-6; P < .001) for the control group. Caregivers in the intervention group reported the atmosphere (P = .032) and experience (P < .001) more positively, and children reported lower fear scores (P = .007) as compared to the control group. The findings of this study suggest that Child Life Specialist interventions in pediatric outpatient blood drawing labs improve satisfaction and reduce fear.

Maternal coping strategies in response to child's oncological diseases in Sri Lanka

Introduction: Parents with cancer children face multiple and unexpected difficulties and apply coping strategies to minimize stressful conditions. The objective of this study was to assess maternal coping strategies in response to their children with cancer in Sri Lanka.Material and methods: A cross-sectional study was conducted among 200 mothers having children with cancers. Coping Health Inventory for Parents instrument was used to collect information about coping strategies.Results: More than 75% children were diagnosed as cancer more than 6 months before when starting this study. Maintaining family integration, cooperation, optimistic definition of the situation was the most helpful coping strategy while seeking medical helps through communication with parents and consultation with medical staff was the least helpful coping strategy among mothers. Gender of the child and current condition of the disease were significantly associated with social support and medical support. Type of disease was significantly associated with family support and the number of other children per mother was significantly associated with social support.Conclusions: Relaxation and counseling programs to modify less desirable coping strategies are emphasized for mothers who were with cancer children. More researches need to identify coping strategies and its impact on psychological and physical adjustment as well.

[Medical and psychological aspects of the treatment of connatal dacryostenosis : Parental evaluation of their own and their child's stress]

BACKGROUND

Lacrimal probing and syringing for connatal dacryostenosis can be performed under local (LA) and general anesthesia (GA). In cases of invasive medical procedures, pain and anxiety can be distressing for children and their parents.

MATERIALS AND METHODS

Using questionnaires (n = 65), parents were asked to evaluate their own stress and that of their child during lacrimal probing and syringing. Analyzing different subgroups, the impact of the kind of anesthesia (LA vs. GA), trust in medical treatment, therapeutic success, prior experiences with GA, parental educational level, age of parents and children, number of children, and time between the intervention and the interview on the stress was examined. Stress level was evaluated on a scale from 1 (no stress) to 10 (maximal stress).

RESULTS

Mean children's age was 8.5 ± 7.42 months. Mean age of the parents was 30.8 ± 6.17 years. Treating children under LA, parents reported moderate to severe stress levels for themselves (mean, M = 7.15) and for their children (M = 7.82). Children's stress levels were significantly higher when the treatment was performed under LA (n = 47; M = 7.34) in comparison to GA (n = 18; M = 6.06; p < 0.05). Parents having two or more children reported significantly lower stress levels than those with only one child. Furthermore, prior experiences with GA led to significantly higher parental stress levels when their children were treated under GA. Other factors did not show any impact on parent's and children's stress levels.

CONCLUSIONS

Parents might have been influenced by hearing the children's reaction (e. g., crying) during the intervention under LA. Nevertheless, parents had a higher acceptance of this type of intervention (LA) in comparison to GA. This effect was even stronger among parents with prior experience of GA.

The Effect of Directed Medical Play on Young Children's Pain and Distress During Burn Wound Care

Directed medical play is used to reduce children's pain and distress during medical treatment. In this pilot study, young children who attended the burn clinic received either directed medical play provided by a child life specialist or standard preparation from the burn clinic nurse to prepare for their first dressing change. Data were collected using validated instruments. Children who participated in medical play experienced less distress during their dressing change (M = 0.5, n = 12) than did those receiving standard preparation (M = 2.0, n = 9). Children who received standard care reported a 2-point increase in pain during the procedure, whereas children who participated in medical play reported a 1-point increase. Change in parental anxiety was similar for both groups. Parent satisfaction was higher for caregivers who observed medical play than standard preparation. Although all findings were in the hypothesized direction, none was statically significant, most likely because of the small sample size.

The influence of adult behaviors on child coping during venipuncture: a sequential analysis

The aim of this exploratory study was to investigate the influences of adult behaviors on child coping behaviors during venipunctures (VPs) in an emergency department. Observations of children and adults from 66 VPs were coded using a modified version of the Child-Adult Medical Procedure Interaction Scale and analyzed using sequential analysis. Results showed adult reassurance behavior promoted child distress behaviors, such as crying, as well as nondistress behaviors, such as information seeking; adult distraction behaviors promoted children's distraction, control, and coping behaviors; and children frequently ignored adult behaviors. Findings suggest further exploration of children's internal strategies for coping, such as appraisal, and clarifying the role of adult reassurance in child coping behaviors.

Post-dural puncture headache and other complications after lumbar puncture

In pediatric hematology and oncology specialties, lumbar punctures are frequently performed for diagnostic and therapeutic purposes. Lumbar puncture is a procedure that is generally well tolerated with minimal adverse effects. However, adverse effects do occur. Post-dural puncture headache (PDPH) is the most common adverse effect after lumbar puncture. A better understanding of the pathophysiology of PDPH and attention to needle selection and technique may lessen the occurrence of PDPH. A review of the literature that addresses the variables associated with PDPH and its prevention are presented. Other adverse effects after lumbar puncture include dysesthesias, backache, transient radicular irritation, nerve palsies, infectious processes, herniation, and bleeding disorders. Although most adverse effects are mild and resolve without intervention, others require astute diagnosis and management. This review discusses the general principles in the clinical presentation of adverse effects after lumbar puncture and offers interventions for management. The prevention and the recognition and treatment of adverse effects is the role of the entire health care team that cares for children who require lumbar puncture. As such, implications for the role of nursing are essential before, during, and after a lumbar puncture and are briefly discussed.