Cross-sectional study on differences in pain perception and behavioral distress during venipuncture between italian and chinese children

Children's experiences of intravenous injection using the draw, write, and tell method: A mixed-methods study

PURPOSES

This study aimed to explore children's perceptions and experiences of receiving intravenous (IV) injections and the self-reported pain scores and management strategies that can support children while receiving IV injections.

DESIGN AND METHODS

This mixed-methods study included 17 children aged 4-11 years who presented to the outpatient clinic of a pediatric hospital and received IV injections. Data were collected using the draw, write, and tell method (DWT) and Facial Pain Rating Scale. Descriptive statistics and content analyses were performed.

RESULTS

The children's self-reported mean pain score was 4.82, indicating moderate pain. Many expressions indicated that IV injections were painful or caused tingling or stinging sensations. A vague fear of needles in addition to pain was identified after listening to the children and analyzing their own interpretation of drawings. Three main themes were identified: (1) physical and emotional experiences, (2) parents as my secure base, and (3) comfort and relief strategies.

CONCLUSIONS

Children expressed their experiences during IV injections, the alleviation of their pain and fear, and their suggestions for comfort and relief strategies visually, auditorily, and verbally. Parents played an important role in supporting their children and reducing pain, anxiety, and distress related to the IV procedure.

PRACTICE IMPLICATIONS

The DWT, as an arts-based and child-centered approach, is a useful and valid method to understand children's experience related to the IV injection. Children experience comfort and relief within a family-centered care context during IV injection. Nurses should promote children's and parents' participation in the development of strategies to reduce the negative effects of IV injections in children.

The effect of timing of intravenous paracetamol on perioperative pain and cytokine levels following laparoscopic bariatric surgery, a randomized controlled trial

OBJECTIVE

Bariatric surgeries involve manipulation of the viscera and are associated with significant postoperative pain. Paracetamol is a nonopioid analgesic with a rapid onset, and it is effective and safe. The study compared the effects of pre- and postincisional intravenous paracetamol administration for optimal postoperative pain management in patients undergoing bariatric surgeries.

METHODS

This is a prospective, double-blinded, placebo-controlled randomized clinical trial of adult patients, admitted electively for laparoscopic bariatric surgery. The patients were randomly divided into two groups. One group of patients was given paracetamol at the beginning of the operation, prior to the surgical incision, the other group of patients received the same treatment at the end of the operation.

RESULTS

Patients who were given preincisional intravenous paracetamol presented significantly lower visual analog scale (VAS) scores following the surgery compared with patients who were given intravenous paracetamol in the last 30 minutes of the operation (VAS, median [IQR] = 2 [2-3] vs. 5 [3-6]; p < 0.001). They also required fewer postoperative opioids and tramadol (in milligrams, respectively, 1 [0-5] vs. 7.5 [5-10] and 300 [100-400] vs. 400 [200-500]) compared with later analgesia administration (p < 0.001 and p = 0.03). The levels of inflammatory markers measured at fixed intervals from paracetamol administration were not statistically different between the study groups.

CONCLUSION

Early analgesia with intravenous paracetamol, given before the surgical incision, may result in lower VAS scores postoperatively compared with the same treatment administered toward the end of the operation.

Need for pharmacological analgesia after cast immobilisation in children with bone fractures: an observational cross-sectional study

BACKGROUND

Bone fractures are a common reason for children and adolescents to seek evaluation in the ED. Little is known about the pain experienced after cast immobilisation and discharge from the ED and its optimal management. We aimed to investigate the administration of pharmacological analgesia in the first days after cast immobilisation and to identify possible influencing variables.

METHODS

A prospective observational cross-sectional study was conducted at the ED of the children's hospital, Institute for Maternal and Child Health of Trieste, Italy, from October 2019 to June 2020. Patients aged 0-17 years with bone fractures were included. The primary outcome was the administration of analgesia during the 10 days following discharge, while secondary outcomes were the associated variables, including age, gender, fracture type and location, the mean limitation in usual activities and the frequency of re-evaluation at the ED for pain. Data were recorded through a questionnaire, completed by caregivers and collected by the researchers mainly through a telephone interview. The primary endpoint was evaluated as the ratio between the number of children who took at least one analgesic dose and the total enrolled children, while Χ² or Fisher's exact tests were used to assess secondary outcomes.

RESULTS

During the study period, 213 patients, mean age 10 years (IQR: 8-13), were enrolled. Among them, 137 (64.3%) did not take any analgesic during follow-up. Among children who were administered analgesia, 22 (28.9%) received it only on the first day, and 47 (61.8%) for less than 5 days. One hundred and sixty one patients (75.6%) did not report any limitation in usual activities because of pain. The administration of analgesia was not related to the child's age, gender or fracture site. Displaced fractures were associated with significantly more frequent analgesia being taken (OR 5.5, 95% CI 1.4 to 21.0).

CONCLUSION

Although some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.

Ghanaian nurses' knowledge of invasive procedural pain and its effect on children, parents and nurses

AIM

To explore Ghanaian nurses' knowledge of invasive procedural pain in children who are in hospital and to identify the effect of unrelieved pain on children, parents and nurses.

METHOD

An exploratory, descriptive and qualitative design was adopted. A purposive sampling technique was used and individual face-to-face, semi-structured interviews were conducted with 16 registered nurses from four children's units at a hospital in the Eastern Region of Ghana. Thematic and content analyses were performed.

FINDINGS

Four themes emerged: types of invasive procedure; pain expression; pain assessment; and effects of unrelieved pain. Participants had adequate knowledge of painful invasive procedures, however, they were not aware of the range of available validated pain assessment tools, using observations and body language instead to assess pain.

CONCLUSION

Ghanaian nurses require education on the use of validated rating scales to assess procedural pain in children. The inclusion of pain assessment and management in pre-registration curricula could improve knowledge.

Observational Coding Systems of Parent-Child Interactions During Painful Procedures: A Systematic Review

BACKGROUND

Parent interactions with their child can influence the child's pain and distress during painful procedures. Reliable and valid interaction analysis systems (IASs) are valuable tools for capturing these interactions. The extent to which IASs are used in observational research of parent-child interactions is unknown in pediatric populations.

OBJECTIVES

To identify and evaluate studies that focus on assessing psychometric properties of initial iterations/publications of observational coding systems of parent-child interactions during painful procedures.

METHODS

To identify and evaluate studies that focus on assessing psychometric properties of initial iterations/publications of observational coding systems of parent-child interactions during painful procedures. Computerized databases searched included PubMed, CINAHL, PsycINFO, Health and Psychosocial Instruments, and Scopus. Timeframes covered from inception of the database to January 2017. Studies were included if they reported use or psychometrics of parent-child IASs. First assessment was whether the parent-child IASs were theory-based; next, using the Society of Pediatric Psychology Assessment Task Force criteria IASs were assigned to one of three categories: well-established, approaching well-established, or promising.

RESULTS

A total of 795 studies were identified through computerized searches. Eighteen studies were ultimately determined to be eligible for inclusion in the review and 17 parent-child IASs were identified from these 18 studies. Among the 17 coding systems, 14 were suitable for use in children age 3 years or more; two were theory-based; and 11 included verbal and nonverbal parent behaviors that promoted either child coping or child distress. Four IASs were assessed as well-established; seven approached well-established; and six were promising.

CONCLUSIONS

Findings indicate a need for the development of theory-based parent-child IASs that consider both verbal and nonverbal parent behaviors during painful procedures. Findings also suggest a need for further testing of those parent-child IASs deemed "approaching well-established" or "promising".