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Procedural and postoperative pain management in children: experiences, assessments and possibilities to reduce pain, distress and anxiety
Jönköping University, School of Health Science, HHJ. CHILD.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction

Children’s visits to hospital are often connected with painfulexaminations and treatments. If these situations are associated withunsuccessful alleviation of pain, the children may develop distress, anxiety and even pain sensitization. Effective pain management including pharmacological treatment and coping methods that support the children when undergoing examinations or treatments could reduce these harmful effects. Distraction methods such as serious games and music medicine are techniques to deviate attention away from procedural or postoperative pain, and these may help children create positive experiences. There is a need to examine these interventions among children in hospital.

Aim

The overall purpose of this thesis was to investigate procedural and postoperative pain management among children in hospital. The specific aims were

  • to describe a group of children’s experiences of pain in conjunction with procedural pain
  • to validate an observational behavioural scale for procedural pain assessment in children aged 5-16 years
  • to study pain intensity and distress among children using serious games and music medicine
  • to describe children’s experiences of the use of serious games and music medicine.

Methods

Two hundred and twelve children who underwent a medical or surgical procedure at the Queen Silvia Children’s hospital in Gothenburg participated in one or two studies, and data were collected with assessment scales, vital signs and interviews. All the data were analyzed using approved methods of analysis.

Results

The results showed that the children emphasized nurses who were clinically competent and that they wanted to participate in decision making concerning distraction techniques as a complement to pharmacological treatment. An observational assessment scale, the Face, Legs, Activity, Cry and Consolability (FLACC) scale, was avaluable tool for assessing procedural pain and complementing retrospective self-reported pain and distress. Distraction techniques were helpful coping strategies for the children, who also needed to feel secure in the pain management. In children undergoing needle related procedures, serious games reduced pain intensity, but only for those who liked the game, and the interviews showed increased wellbeing. Music medicine reduced morphine consumption and decreased the children’s distress when they underwent day surgery.

Conclusions

The conclusions of this thesis are that procedural pain can be evaluated using the FLACC scale, the children want to participate in decision-making on distraction techniques such as serious games or music medicine and these self-selected distraction techniques are also helpful coping strategies for the children.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences, Jönköping University , 2010. , 69 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 13
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-13811ISBN: 978-91-85835-12-6 (print)OAI: oai:DiVA.org:hj-13811DiVA: diva2:371276
Public defence
2010-11-19, Hälsohögskolan, Jönköping, 14:05
Note
All articles have been reprinted with kind permission of the respective journals.Available from: 2010-11-19 Created: 2010-11-19 Last updated: 2010-11-19Bibliographically approved
List of papers
1. Children's experiences of procedural pain management in conjunction with trauma wound dressings
Open this publication in new window or tab >>Children's experiences of procedural pain management in conjunction with trauma wound dressings
2011 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 7, 1449-1457 p.Article in journal (Refereed) Published
Abstract [en]

Aim.  This paper is a report of the experiences of children (5–10 years) of procedural pain when they underwent a trauma wound care session.

Background.  Procedural pain in conjunction with trauma wound care often induces anxiety and distress in children. Children need to alleviate pain and avoid the development of fear in conjunction with examinations and treatments. The nurse could help children to reach this goal by using the comfort theory, which describes holistic nursing in four contexts: physical, psychospiritual, environmental and sociocultural. Few studies have focused on children’s experiences of comforting activities in conjunction with trauma wound dressings.

Methods.  This study was conducted between May 2008 and January 2010. Thirty-nine participants aged 5–10 were consecutively included in this study. The wound care session was standardized for all the participants, and semi-structured qualitative interviews with open-ended questions were conducted with all the children in conjunction with the procedure. All the interviews were transcribed verbatim and analysed with qualitative content analysis.

Findings.  Four themes were identified: clinical competence, distraction, participation and security. The children were helped to reach comforting activities to enhance pain management.

Conclusion.  Children require more than just analgesics in wound care. They also need to experience security and participation in this context. When children feel clinical competence in wound care, they trust the nurse to carry out the wound dressing and instead can focus on the distraction that increases their positive outcomes.

Keyword
children’s nursing, injuries and wounds, pain, sick children, wound dressing
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-13810 (URN)10.1111/j.1365-2648.2010.05590.x (DOI)
Available from: 2010-11-19 Created: 2010-11-19 Last updated: 2011-10-11Bibliographically approved
2. The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years
Open this publication in new window or tab >>The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years
2008 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, Vol. 18, no 8, 767-774 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-10369 (URN)10.1111/j.1460-9592.2008.02655.x (DOI)
Available from: 2009-09-15 Created: 2009-09-15 Last updated: 2010-11-19Bibliographically approved
3. The use of Virtual Reality for needle-related procedural pain and distress in children and adolescents in a paediatric oncology unit
Open this publication in new window or tab >>The use of Virtual Reality for needle-related procedural pain and distress in children and adolescents in a paediatric oncology unit
2009 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, Vol. 13, no 2, 102-109 p.Article in journal (Refereed) Published
Abstract [en]

Aim: It is essential to minimize pain and distress during painful procedures in children. This study examined the effect of using non-immersive Virtual Reality (VR) during a needle-related procedure on reported pain or distress of children and adolescents in a paediatric oncology unit and surveyed their response to the use of VR-equipment during the procedure.

Method: Twenty-one children and adolescents were included in an intervention group with non-immersive VR and another 21 children and adolescents in a control group where they underwent either venous punctures or subcutaneous venous port devices. Self-reported pain and distress, heart rate and observational pain scores were collected before, during and after the procedures. Semi-structured qualitative interviews were conducted in conjunction with the completed intervention.

Results: Self-reported and observed pain and distress scores were low and few significant differences of quantitative data between the groups were found. Two themes emerged in the analysis of the interviews; the VR game should correspond to the child and the medical procedure and children enjoyed the VR game and found that it did distract them during the procedure.

Conclusion: The interviews showed that non-immersive VR is a positive experience for children undergoing a minor procedure such as venous puncture or a subcutaneous venous port access.

Keyword
Nursing; Distraction; Childhood cancer; Pain management
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-8627 (URN)10.1016/j.ejon.2009.01.003 (DOI)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2010-11-19Bibliographically approved
4. School-aged children's experiences of postoperative music medicine on pain, distress, and anxiety.
Open this publication in new window or tab >>School-aged children's experiences of postoperative music medicine on pain, distress, and anxiety.
Show others...
2009 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 19, no 12, 1184-1190 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school-aged children who had undergone day surgery. Background: Music medicine has been proposed to reduce distress, anxiety, and pain. There has been no other study that evaluates effects of music medicine (MusiCure((R))) in children after minor surgery. Methods: Numbers of participants who required analgesics, individual doses, objective pain scores (Face, Legs, Activity, Cry, Consolability [FLACC]), vital signs, and administration of anti-emetics were documented during postoperative recovery stay. Self-reported pain (Coloured Analogue Scale [CAS]), distress (Facial Affective Scale [FAS]), and anxiety (short State-Trait Anxiety Inventory [STAI]) were recorded before and after surgery. In conjunction with the completed intervention semi-structured qualitative interviews were conducted. Results: Data were recorded from 80 children aged 7-16. Forty participants were randomized to music medicine and another 40 participants to a control group. We found evidence that children in the music group received less morphine in the postoperative care unit, 1/40 compared to 9/40 in the control group. Children's individual FAS scores were reduced but no other significant differences between the two groups concerning FAS, CAS, FLACC, short STAI, and vital signs were shown. Children experienced the music as 'calming and relaxing.' Conclusions: Music medicine reduced the requirement of morphine and decreased the distress after minor surgery but did not else influence the postoperative care.

Keyword
children, music medicine, nursing, pain, postoperative
National Category
Nursing Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:hj:diva-10963 (URN)10.1111/j.1460-9592.2009.03180.x (DOI)19863741 (PubMedID)
Available from: 2009-12-02 Created: 2009-12-02 Last updated: 2012-01-05Bibliographically approved

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