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Panda PK, Bhardwaj S, Murugan VK, Elwadhi A, Dhamija P, Tiwari L, Sharawat IK. Early versus late switch over of antiseizure medications from intravenous to the oral route in children with seizures: Single-blinded, randomized controlled trial (ELAIO trial). Epilepsy Res 2024; 202:107360. [PMID: 38652997 DOI: 10.1016/j.eplepsyres.2024.107360] [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: 01/16/2024] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Early switch-over of anti-seizure medications (ASMs) from intravenous to oral route may reduce the duration of hospitalization, drug acquisition costs, and behavioral upset in hospitalized children with seizures. OBJECTIVE The primary objective was to compare short-term seizure recurrence within 1 week in hospitalized children aged 1 month to 18 years with new-onset/breakthrough seizures after an early versus late switch-over from intravenous to the oral route of ASMs. Secondary objectives were to compare the incidence of status epilepticus, duration of hospital stay, drug acquisition costs, and caregiver-reported satisfaction scores in both groups. METHODS In this single-blind randomized controlled trial, patients with seizures were categorized based on the number of ASMs required and the history of status epilepticus. Patients in each category were randomized in a 1:1 ratio into either early or late switch-over (ES or LS) groups. In the ES groups, ASMs were tapered one-by-one between 0 and 24 hours of seizure freedom, while in the LS groups, they were tapered one-by-one between 24 and 48 hours of seizure freedom. RESULTS A total of 112 children were enrolled in the study, with 56 in each arm. Seizure recurrence at 1 week and 12 weeks was comparable in ES and LS groups (3/55 vs. 1/54 at 1 week, p=0.61; 7/49 vs. 6/49 at 12 weeks, p=0.98). Drug acquisition costs were significantly lower in the ES group (393±274 vs. 658±568 INR, p=0.002). Thrombophlebitis and dysphoria were significantly more common in the LS group (p=0.008 and 0.03, respectively). CONCLUSION The early switch-over of ASMs from intravenous to oral route is safe without any significant increased risk of short-term seizure recurrence and also associated with a reduction in the incidence of thrombophlebitis and ASM acquisition costs. TRIAL REGISTRATION NO CTRI/2021/03/032145.
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Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Sanjot Bhardwaj
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Vignesh Kaniyappan Murugan
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aman Elwadhi
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Puneet Dhamija
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Lokesh Tiwari
- Pediatric Intensive Care Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
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McNeil MJ, Garcia Quintero X, Gonzalez M, Zheng Y, Ugaz Olivares C, Morales R, Boldrini E, Rebollo de Campos D, Ferreira D, Coopasamy K, Caneba J, Padernilla ML, Friedrichsdorf S, Baker JN, Friedrich P. Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries. Cancers (Basel) 2024; 16:1025. [PMID: 38473383 DOI: 10.3390/cancers16051025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.
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Affiliation(s)
- Michael J McNeil
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ximena Garcia Quintero
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Miriam Gonzalez
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yawen Zheng
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Roxana Morales
- Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Daiane Ferreira
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Joliza Caneba
- Philippines General Hospital, Manila 1000, Philippines
| | | | - Stefan Friedrichsdorf
- Division of Pediatric Pain, Palliative Care & Integrative Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford University, Palo Alto, CA 94305, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Duncanson E, Le Leu RK, Chur-Hansen A, Masotti T, Collins KL, Burke ALJ, Macauley LP, McDonald S, Jesudason S. Nephrology nurses' perspectives working with patients experiencing needle-related distress. J Ren Care 2023. [PMID: 37975628 DOI: 10.1111/jorc.12483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients. OBJECTIVES To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress. DESIGN A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied. PARTICIPANTS Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service. RESULTS Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies. CONCLUSION This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.
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Affiliation(s)
- Emily Duncanson
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
| | - Richard K Le Leu
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tahlia Masotti
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kathryn L Collins
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anne L J Burke
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Luke P Macauley
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Shdaifat E, Sudqi AM, Abusneineh FT, Al-Ansari NM. Assessment of Parent and Nurse Perceptions of Parental Participation in Hospital Paediatric Care. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2208160] [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
Background:
Parent and nurse perceptions about the care of hospitalized children have been examined in developed countries, but little is known in developing countries.
Objective:
The study aims to evaluate the perceptions of nurses and parents towards parental participation in care for hospitalized children and associated factors.
Methods:
A cross-sectional design was used to collect data from nurses and parents in paediatric units in the Eastern Region of Saudi Arabia using a convenience sampling technique. Data were collected using the Parent Participation Attitude Scale (PPAS), and the agreement and differences between groups were analysed.
Results:
The present results found that both parents and nurses agreed on 7 out of 20 statements regarding parental involvement in care for their children. Nurses in paediatric surgery had a higher perception of involving parents (P = 0.002), while nurses in Well Baby Nursery (WBN) ward had the lowest perception. The present findings confirm that married caregivers had higher perceptions (P = 0.035) than their single counterparts.
Conclusion:
Parent participation attitude was agreed on for seven statements between parents and nurses. More studies are required to explore the relationship between healthcare providers and parents with regard to parental participation in caring for hospitalized children.
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. Home administration of needle injections for children with rheumatic diseases: A qualitative study on nurses' perception of their educational role. J Pediatr Nurs 2022; 66:e137-e144. [PMID: 35491289 DOI: 10.1016/j.pedn.2022.04.011] [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: 10/19/2021] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore nurses' perceptions of their educational role, pedagogical competence, and practice in teaching children with rheumatic diseases and their parents to manage subcutaneous injections at home. DESIGN AND METHODS In this qualitative study, we used thematic analysis to analyze data from three focus groups with 14 nurses responsible for patient education at one pediatric ward and two outpatient clinics. RESULTS We identified three main themes capturing nurses' perceptions of their educational role: myriad expectations, awareness of own competence, and facilitation and prioritization of patient education. Nurses perceived patient education as an expected but challenging duty of their work. They described a lack of pedagogical competence, insecurity in managing parents' and children's fears and worries, and limited organizational structures guiding their educational role. Nurses who worked in outpatient clinics felt freer to individualize education compared to ward nurses. CONCLUSIONS Nurses perceive their educational role as significant in enabling children and parents to manage subcutaneous injections at home; however, they require pedagogical competence integrated with daily practice to provide high-quality care. Short-term admissions require a different organization of patient education than before. PRACTICAL IMPLICATIONS Nurses need increased training in communication and management of children's pain and fear during needle injections. Competence development should include opportunities for reflection and guidance in clinical practice. Pediatric specialist nurses at outpatient clinics seem to have better competence to provide individual patient education for these families. The potential advantage of web-based solutions for nurses' patient education is a promising avenue for future research.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, Medical Faculty, University of Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway.
| | - Helge Skirbekk
- Department of Health Management and Health Economics, Medical Faculty, University of Oslo, Norway; Department of Undergraduate Studies, Lovisenberg Diaconal University College, Norway.
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Norway.
| | - Hilde Wøien
- Department of Nursing Science, Medical Faculty, University of Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Norway.
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Hjelmgren H, Ygge BM, Nordlund B, Andersson N. Nurses' experiences of blood sample collection from children: a qualitative study from Swedish paediatric hospital care. BMC Nurs 2022; 21:62. [PMID: 35292007 PMCID: PMC8922753 DOI: 10.1186/s12912-022-00840-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Nurses play an active role in supporting the children with the blood sampling experience. Unfortunately, the blood sampling collection procedure is often affected by pre-analytical errors, leading to consequences such as delayed diagnosis as well as repeated sampling. Moreover, children state that needle procedures are the worst experience of their hospital stay. The nurses’ experiences of errors occurring during blood sample collection is unknown. Therefore, the aim of this study therefore was to describe paediatric nurses’ experiences of blood sampling collections from children. Method We used a qualitative study design with a (reflexive) thematic analysis (TA) method described by Braun and Clarke. Three focus group interviews were conducted, with 19 nurses collected by purposeful sampling from Sweden working at two different paediatric hospitals, focusing on their experiences of the blood sample collection procedure. Results From the three focus group interviews we analysed patterns and meanings of the following main theme Paediatric blood sampling is a challenge for the nurses and the four subthemes Nurses’ feelings of frustration with unsuccessful samplings, Nurses believe in team work, Venous blood sampling was experienced as the best option, and Nurses’ thoughts and needs regarding skills development in paediatric blood sampling. Conclusion The narrative results of this study illustrate that nurses working in paediatric hospital care face a big challenge in blood sampling collection from children. The nurses felt frustrated due to unsuccessful blood samplings and frequently could not understand why pre-analytical errors occurred. Nevertheless, they felt strengthened by colleagues in their team and shared feelings of responsibility to help each other with this complex procedure. The implications of this study are that paediatric hospital care needs to focus on improving guidelines for and increasing competence in blood sampling children and helping nurses to understand why samplings may be unsuccessful and how this can be avoided.
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Affiliation(s)
- Henrik Hjelmgren
- Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. .,Department of Women's and Children's Health, Karolinska Institute, 171 77, Stockholm, Sweden.
| | - Britt-Marie Ygge
- Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Björn Nordlund
- Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Nina Andersson
- Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institute, 171 77, Stockholm, Sweden
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Javed T, Khan AS, Jarral NA, Taqi Z, Raza M, Shahid Z. Medical Clowning: A Cost-Effective Way to Reduce Stress Among Children Undergoing Invasive Procedures. Cureus 2021; 13:e18886. [PMID: 34804732 PMCID: PMC8599118 DOI: 10.7759/cureus.18886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Distraction techniques like medical clowning and the use of soap bubbles can aid in reducing children’s stress levels while undergoing invasive medical procedures. Such complementary therapies are not a common practice in Pakistan, and data exploring the potential benefits of complementary therapies are sparse. This study aimed to determine whether distractions like medical clowns and soap bubbles could reduce anxiety and pain perceived by children undergoing invasive medical procedures in a hospital in Pakistan. Material and methods We conducted a randomized controlled trial of 76 pediatric patients (aged six to 12 years) whose treatment required a peripheral intravenous (IV) catheter insertion at the pediatric ward of the Fauji Foundation Hospital in Rawalpindi, Pakistan, from March 2016 to June 2016. Peripheral IV catheter insertion was required for all patients as part of their treatments (no participants received IV catheter placement solely for this study). Our sample size was selected via random sampling, and we excluded patients whose parents or legal guardians did not consent for their inclusion. Study participants were randomly assigned to either a clown group (n=38) or a control group (n=38). The patients in the clown group underwent IV catheter placement while interacting with the medical student clown and soap bubbles in the presence of a parent. Patients in the control group underwent IV catheter placement with support provided only by the parent. We assessed the patient’s distress and anxiety before, during, and after the procedure. We used the Observation Scale of Behavioral Distress (OSBD), before and after the procedure with the short version of self-reported Spielberger’s State-Trait Anxiety Inventory-Children (STAI-C), the visual analog anxiety scale (VAS), and pain experienced with the Wong-Baker Faces pain scale (FPS) only after the procedure. Additionally, we collected demographic information. The hospital's ethical review committee approved our study design. Results Of the 76 study participants, 53.9% were male and 46.1% were female. Most patients lived in a rural setting (67%). Mean values of the FPS, OSBD, and STAI-C for the clown group (3.21, 6.23, and 8.52, respectively) were all lower than those for the control group (8.00, 18.02, and 15.29, respectively; p<.001); however, the difference was not statistically significant for children older than 10 years. After IV catheter placement, the mean VAS score for the clown group was also significantly lower than that for the control group (2.84 vs. 8.92, respectively; p<.001). Conclusion The use of distractions via medical clowns and soap bubbles was an effective nonpharmacological method of reducing anxiety and perceived pain in children undergoing invasive medical procedures. Therefore, proceduralists could use such techniques as powerful, noninvasive, and cost-effective complementary and alternative medicine tools in pediatric treatment settings in Pakistan. Further studies on the potential benefits of the aforementioned techniques are warranted.
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Affiliation(s)
- Tahleel Javed
- Medicine, Foundation University Medical College, Islamabad, PAK
| | - Armughan S Khan
- Medicine, Foundation University Medical College, Islamabad, PAK
| | - Nafees A Jarral
- Medicine, Foundation University Medical College, Islamabad, PAK
| | - Zara Taqi
- Medicine, Foundation University Medical College, Islamabad, PAK
| | - Maryum Raza
- Medicine, Foundation University Medical College, Islamabad, PAK
| | - Zarmeen Shahid
- Medicine, Foundation University Medical College, Islamabad, PAK
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Nicholl A, Evelegh K, Deering KE, Russell K, Lawrence D, Lyons-Wall P, O’Sullivan TA. Using a Respectful Approach to Child-centred Healthcare (ReACH) in a paediatric clinical trial: A feasibility study. PLoS One 2020; 15:e0241764. [PMID: 33166989 PMCID: PMC7652280 DOI: 10.1371/journal.pone.0241764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 10/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a growing momentum in paediatric ethics to develop respectful research and healthcare protocols. We developed, tested and refined our 'Respectful Approach to Child-centred Healthcare' (ReACH), to underpin respectful participant interactions in a clinical trial. OBJECTIVE To determine whether a ReACH-based approach is acceptable to children and parents, and effective in obtaining compliance with common healthcare assessments in a clinical trial of healthy 4-6-year-old children. METHODS ReACH-based child assessments were evaluated at two baseline clinics and one post-intervention, using mixed methods. Children (n = 49; 46.9% female; mean age = 5.24±0.88 years at baseline) and their parents provided independent evaluation, via customised 5-point Likert scales and qualitative feedback. A dedicated child researcher evaluated adherence to the study ReACH principles. RESULTS Children achieved compliance rates of 95% for body composition (BodPod) assessments; 89% for blood pressure measurements, and 92% (baseline) and 87% (post-intervention) for blood draws. Adherence to ReACH principles during clinic visits was positively associated with child compliance, significantly for baseline BodPod (p = 0.002) and blood test (p = 0.009) clinics. Satisfaction with BodPod protocols was positively associated with compliance, for children at baseline (p = 0.029) and for parents post-intervention (p <0.001). Parents rated the study itself very highly, with 91.7% satisfied at baseline and 100% post-intervention. Qualitative feedback reflected an enjoyable study experience for both parents and children. CONCLUSIONS Adherence to our emerging ReACH approach was associated with high child compliance rates for common healthcare assessments, although no causality can be inferred at this preliminary stage of development. Participants expressed satisfaction with all aspects of the study. Our use of child-centred methods throughout a research intervention appears feasible and acceptable to children and their parents.
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Affiliation(s)
- Analise Nicholl
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Evelegh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kane Evan Deering
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Kate Russell
- Peaceful Parents, Confident Kids, Toowoomba, Queensland, Australia
| | - David Lawrence
- Faculty of Arts, Business, Law and Education, Graduate School of Education, University of Western Australia, Perth, Western Australia, Australia
| | - Philippa Lyons-Wall
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
| | - Therese Anne O’Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, Western Australia, Australia
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Sahlberg S, Karlsson K, Darcy L. Children's rights as law in Sweden-every health-care encounter needs to meet the child's needs. Health Expect 2020; 23:860-869. [PMID: 32319716 PMCID: PMC7495078 DOI: 10.1111/hex.13060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background In 2020, the United Nations Convention on the Rights of the Child (UNCRC) became law in Sweden. This puts extra demands on Swedish health care for children in need. This study aimed to investigate children's experiences and paediatric nurses' experiences of caring in accordance with the UNCRC. Methods Interviews were conducted in 2019 with 10 children and 13 nurses at a paediatric clinic in western Sweden. Child and nurse data were analysed separately with qualitative content analysis. The results are presented as a synthesis of the combined analysis of both data sets. Results Children did not always meet health‐care professionals with the necessary competence to care for them, and they were not always cared for in a child‐friendly environment. Even though nurses in paediatric care had the competence necessary to meet children's rights in health care, organizational issues made it challenging. Providing health care in accordance with the UNCRC principles required time and competence. Sufficient time to help children participate in their care and ensure that they feel secure was considered necessary—regardless of the health‐care context. Conclusion Health‐care encounters without the necessary time or competence can affect children and future encounters negatively. Instruments to safeguard children's rights in health care need to be developed and implemented, such as a documentation system to make children's rights visible and/or UNCRC certification. Implementation of UNCRC principles in all health‐care situations for children as standardized care requires competence, involvement, strong leadership and economic support. Children's voices in research can assist in guiding care.
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Affiliation(s)
- Sofia Sahlberg
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Laura Darcy
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Sanna P, Sollami A, Nicosia G, Dicembrino RB, Gandolfi R, Primosa F, La Sala R, Marletta G. The nurses' uniform in pediatrics, the opinion of children and nurses. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:67-76. [PMID: 32168315 PMCID: PMC7944664 DOI: 10.23750/abm.v91i2-s.9212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
Abstract
Background and aim: The nursing uniform represents a non-verbal mean of communication which in the case of children can arouse positive or negative emotions. The first study conducted on a sample of 107 children, aimed to define their preferences on different models of decorated nursing uniforms; the second one conducted on 101 nurses to understand the preferences, the meanings attributed to the uniform and their availability to adapt it according to the preferences expressed by the children. Methods: We conducted an observational study with a qualitative approach. For the first objective with the children, a visual stimulus was used, showing 6 models of uniform: the traditional plus 5 models of different colors and themes (cartoons characters and videogames). For the second objective with the nurses, in addition to reproducing the same visual stimulus, a semi-structured questionnaire was used. Results: Children and nurses seem to be in perfect accord, because in both groups, color models were the most chosen. Nurses defined their uniform with terms of particular moral, intellectual and professional value and declared themselves available to align with the preferences of the children. Conclusions: This study leaves little doubt about preferences; it also represents the true originality of the study because almost never in the literature have been compared the point of views of children and professionals, generally favoring the comparison between children and care givers. Our findings could represent a further landmark for guiding the choices of health organizations on currencies to be adopted in the pediatric field. (www.actabiomedica.it)
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Affiliation(s)
- Piera Sanna
- Azienda Ospedaliero-Universitaria, Parma, Italy.
| | | | | | | | - Rebecca Gandolfi
- Author without institutional affiliation (indipendent researcher).
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Svendsen EJ, Pedersen R, Moen A, Bjørk IT. Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians. Int J Qual Stud Health Well-being 2018; 12:1363623. [PMID: 28889788 PMCID: PMC5653956 DOI: 10.1080/17482631.2017.1363623] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to explore nurses’ and physicians’ perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.
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Affiliation(s)
- Edel Jannecke Svendsen
- a Department of Nursing, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Reidar Pedersen
- b Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Anne Moen
- a Department of Nursing, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Ida Torunn Bjørk
- a Department of Nursing, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
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Danielsson L, Lundström M, Holmström IK, Kerstis B. Anaesthetizing children-From a nurse anaesthetist's perspective-A qualitative study. Nurs Open 2018; 5:393-399. [PMID: 30062034 PMCID: PMC6056443 DOI: 10.1002/nop2.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/12/2018] [Indexed: 12/16/2022] Open
Abstract
AIM The aim of this study was to describe nurse anaesthetists' experiences of encountering and caring for children in connection to anaesthesia. DESIGN Qualitative design. METHODS Sixteen written narratives based on eight nurse anaesthetists' experiences of meeting children was analysed using qualitative content analysis. RESULTS The overarching theme was: "anaesthetizing children is a complex caring situation, including interactions with the child and parents as well as ensuring patient safety, affected by the perioperative team and organizational prerequisites". The nurses stated that in their interaction with the family, their goal was to ensure that children and parents felt secure and calm. "Striving to work in confidence" underlined the team and organizational influences. Encountering children involves more than knowledge about technical equipment, procedures and drugs. Knowledge about children's development and fears and parents' needs are essential for an optimal caring situation. Organizations need to realize that extra time, skills and resources are needed to safely anaesthetize children.
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Affiliation(s)
| | | | - Inger K. Holmström
- School of Health, Care and Social WelfareMälardalen UniversityVästeråsSweden
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Birgitta Kerstis
- School of Health, Care and Social WelfareMälardalen UniversityVästeråsSweden
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13
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Nilsson S, Hanberger L, Olinder AL, Forsner M. The Faces Emotional Coping Scale as a self-reporting instrument for coping with needle-related procedures: An initial validation study with children treated for type 1 diabetes. J Child Health Care 2017; 21:392-403. [PMID: 29110524 DOI: 10.1177/1367493517729041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the concurrent and content validity, sensitivity and inter-rater reliability of the Faces Emotional Coping Scale (FECS) to evaluate the children's anticipation of the level of emotional coping in conjunction with a venepuncture. A total of 153 children with type 1 diabetes and 86 of their parents participated in the study. The age of the children, 76 of whom were boys, ranged from 7 to 18 years. The child and his or her parent reported the child's coping ability, and the child reported the pain intensity and unpleasantness of a venepuncture. The child also wrote a short narrative about his or her experience of the needle procedure. The FECS correlated negatively with the Coloured Analogue Scale and the Facial Affective Scale and positively with the FECS by proxy. The narratives of 90 children correlated negatively with the FECS. Younger children reported significantly lower scores than older children did regarding their ability to cope with a venepuncture. The children's scores on the FECS showed good agreement with the parents' scores. In this study, the FECS was deemed valid for measuring children's ability to cope with their emotions when undergoing needle-related procedures like venepuncture.
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Affiliation(s)
- Stefan Nilsson
- 1 Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lena Hanberger
- 2 Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Lindholm Olinder
- 3 Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Sachs' Children and Youths Hospital, Stockholm, Sweden
| | - Maria Forsner
- 4 Department of Health and Social Sciences, Caring Sciences, Dalarna University, Falun, Sweden.,5 Department of Nursing, Umeå University, Umeå, Sweden
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Oulton K, Oldrieve N, Bayliss J, Jones V, Manning I, Shipway L, Gibson F. Using participatory and creative research methods to develop and pilot an informative game for preparing children for blood tests. Arts Health 2017. [DOI: 10.1080/17533015.2017.1392329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kate Oulton
- Great Ormond Street Hospital for Children NHS Foundation Trust, Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), London, UK
| | - Naomi Oldrieve
- St George’s University Hospitals NHS Foundation Trust, Children’s Services, London, UK
| | - Julie Bayliss
- Great Ormond Street Hospital NHS Foundation Trust, The Louis Dundas Centre Oncology Outreach and Palliative Care, Charles West Division, London, UK
| | | | - Isobel Manning
- Great Ormond Street Hospital NHS Foundation Trust, GOSH Arts, London, UK
| | - Lisa Shipway
- Great Ormond Street Hospital NHS Foundation Trust, Charles West Division, London, UK
| | - Faith Gibson
- Great Ormond Street Hospital for Children NHS Foundation Trust, Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
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15
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Kassa AM, Engvall G, Engstrand Lilja H. Young children with severe congenital malformations (VACTERL) expressed mixed feelings about their condition and worries about needles and anaesthesia. Acta Paediatr 2017; 106:1694-1701. [PMID: 28672091 DOI: 10.1111/apa.13973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 06/30/2017] [Indexed: 12/16/2022]
Abstract
AIM Our knowledge of the perceptions that children with severe congenital malformations have of their health, treatment and how to improve hospital care is limited. This study focused on patients with vertebral defects, anal atresia, cardiac defects, tracheo-oesophageal fistula, renal anomalies and limb abnormalities (VACTERL). METHODS We interviewed 10 children aged five to eight years with VACTERL association who were treated in a Swedish tertiary paediatric surgical centre, using a computer-assisted technique called In My Shoes. The interviews were analysed by qualitative content analysis. RESULTS The children described their awareness of their health history and said they felt proud but different due to their physical dysfunction. They were happy to visit the hospital to meet familiar staff, but expressed negative feelings about missing normal life. They were afraid of needle-related procedures and not wakening up after anaesthesia. Various ways of coping with difficult situations were expressed, and suggestions to improve hospital care were voiced. CONCLUSION Careful follow-up of these children by multidisciplinary teams is crucial to optimise their health and functional status. Fear of medical procedures may be reduced by carefully delivered information, listening to the children, providing continuity of care and creating individual care strategies.
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Affiliation(s)
- A-M Kassa
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Department of Paediatric Surgery; University Children's Hospital; Uppsala Sweden
| | - G Engvall
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - H Engstrand Lilja
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Department of Paediatric Surgery; University Children's Hospital; Uppsala Sweden
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Pergert P, Ekblad S, Björk O, Enskär K, Andrews T. Resourcing: An approach used by foreign-born parents struggling on in childhood cancer care. Eur J Oncol Nurs 2016; 23:1-7. [DOI: 10.1016/j.ejon.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 02/23/2016] [Accepted: 03/06/2016] [Indexed: 11/17/2022]
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Karlsson K, Englund ACD, Enskär K, Rydström I. Parents' perspectives on supporting children during needle-related medical procedures. Int J Qual Stud Health Well-being 2014; 9:23759. [PMID: 25008196 PMCID: PMC4090367 DOI: 10.3402/qhw.v9.23759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/25/2022] Open
Abstract
When children endure needle-related medical procedures (NRMPs), different emotions arise for the child and his/her parents. Despite the parents’ own feelings, they have a key role in supporting their child through these procedures. The aim of this study is to describe the meanings of supporting children during NRMPs from the perspective of the parents. Twenty-one parents participated in this study. A reflective lifeworld research (RLR) approach was used and phenomenological analysis was applied. The essential meaning of the phenomenon—supporting children during an NRMP—is characterized as “keeping the child under the protection of one’s wings,” sometimes very close and sometimes a little further out under the wingtips. The essential meaning is additionally described through its constituents: paying attention to the child’s way of expressing itself, striving to maintain control, facilitating the child’s understanding, focusing the child’s attention, seeking additional support, and rewarding the child. The conclusion is that parents’ ability to be supportive can be affected when seeing their child undergo an NRMP. To regain the role as the child’s protector and to be able to keep the child “under the protection of one’s wings,” parents need support from the staff.
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Affiliation(s)
- Katarina Karlsson
- School of Health Sciences, University of Borås, Borås, Sweden; Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden;
| | | | - Karin Enskär
- Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Ingela Rydström
- School of Health Sciences, University of Borås, Borås, Sweden
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