Stefan R Nilsson

Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial.

A nonpharmacological method can be an alternative or complement to analgesics.The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures. A randomized clinical trial was used in 40 children (aged 7-12 years) with leukemia, followed by interviews in 20 of these participants. The participants were randomly assigned to a music group (n = 20) or control group (n = 20). The primary outcome was pain scores and the secondary was heart rate, blood pressure, respiratory rate, and oxygen saturation measured before, during, and after the procedure. Anxiety scores were measured before and after the procedure. Interviews with open-ended questions were conducted in conjunction with the completed procedures. The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture. The anxiety scores were lower in the music group both before and after the procedure. The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children, including less pain and fear.

School-aged children’s experiences of postoperative music medicine on pain, distress and anxiety

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.

The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years

Objectives:  To evaluate the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural pain in children aged 5–16 years.

The use of Virtual Reality for needle-related procedural pain and distress in children and adolescents in a paediatric oncology unit

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.

Active and Passive Distraction in Children Undergoing Wound Dressings

The aim of this study was to test how distraction influences pain, distress and anxiety in children during wound care. Sixty participants aged 5-12 years were randomized to three groups: serious gaming, the use of lollipops and a control group. Self-reported pain, distress, anxiety and observed pain behaviour were recorded in conjunction with wound care. Serious gaming, an active distraction, reduced the observed pain behaviour and self-reported distress compared with the other groups. A sense of control and engagement in the distraction, together, may be the explanation for the different pain behaviours when children use serious gaming.

Children’s voices – Differentiating a child perspective from a child’s perspective

Abstract Objective: The aim of this paper was to discuss differences between having a child perspective and taking the child’s perspective based on the problem being investigated. Methods: Conceptual paper based on narrative review. Results: The child’s perspective in research concerning children that need additional support are important. The difference between having a child perspective and taking the child’s perspective in conjunction with the need to know children’s opinions has been discussed in the literature. From an ideological perspective the difference between the two perspectives seems self-evident, but the perspectives might be better seen as different ends on a continuum solely from an adult’s view of children to solely the perspective of children themselves. Depending on the research question, the design of the study may benefit from taking either perspective. In this article, we discuss the difference between the perspectives based on the problem being investigated, children’s capacity to express opinions, environmental adaptations and the degree of interpretation needed to understand children’s opinions. Conclusion: The examples provided indicate that children’s opinions can be regarded in most research, although to different degrees.

Children’s experiences of procedural pain management in conjunction with trauma wound dressings

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 childrens 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.

Validity and reliability of a new short verbal rating scale for stress for use in clinical practice.

Stress is a common experience that affects the body and the brain in many ways. It can sometimes be of interest in research and clinical practice to measure the intensity of single stress reactions. For example, data on intensity can be important for understanding factors such as stress-related behaviour and pain and for a better understanding of physiological stress reactions in hormones, muscles and the circulatory system. Stress can be measured in a number of ways, including shifts in the production of cortisol and adrenaline and in skin conductance. But performing such tests is not without its difficulties, and the results can be hard to evaluate. An alternative to physiological measurements is verbal instruments. According to a search at PubMed in November 2013 and discussions with colleagues, those that have been developed so far involve many issues and, as a result, take time to answer. Two examples are the State-Trait Anxiety Inventory for Children (STAIC) with 20 items (1) and the Multidimensional Anxiety Scale for Children (MASC) with 37 items (2). However, there is a need for an instrument that assesses the intensity of single stress attacks in a simple, valid and reliable way, and we have not been able to find one. A short verbal rating scale for stress (VRSS), reporting recent or present experience of stress and easy to use in clinical routine settings and research, would meet this demand. An important issue in the development of such an instrument is how it operates, including the theoretical framework, the context of the application and the selection of optimal responses. These are also the key factors that define how we measure the quality of an instrument (3). Instruments capturing stress should be valid and reliable, easy to understand and use and have good compliance. The aim of this study was therefore to test a new VRSS developed by one of the authors. The material consisted of two samples. The first included 28 children, seven boys and 21 girls, with a mean age of 12.6 years (range: seven to 16) visiting a clinic for recurrent pain. The second sample consisted of 34 children, 15 boys and 19 girls, aged 11.3 years (range: eight to 16). Fifteen of them were recruited from the same clinic as the first sample, and 19 were recruited from a clinic for children with needle phobias. All the children indicated that they knew what stress was and all of them were able to describe their own feeling of stress. After a brief talk about the child’s stress reaction, the child was asked to describe their latest stressful experience in a few words. For the children attending the pain clinic, this incident had happened during the last few days and not longer than a week ago. The children with needle phobias described the stress they felt when they came in for a practice injection. The researchers used a new verbal rating scale for stress (VRSS), based on a scale of zero to five, that had been developed, tested and retested in school age children, in collaboration with two psychologists. The VRSS provides an easy to understand scale that offers the children alternative responses when it comes to describing an increase in their stress levels (see Appendix). Validity of a scale is best evaluated by comparing it with a validated scale measuring the same parameter. But such a scale could not be found, so we measured the agreement between the VRSS and a visual analogue scale (VAS) measuring the same phenomenon. This was done in both groups. The child was asked to choose one of six alternatives on the VRSS to report how strong the latest experienced stress (VRSS1) was and to report the same experience on a visual analogue scale (VAS1) with the written anchors ‘no stress’ and ‘the worst known stress.’

Massage therapy in post-operative rehabilitation of children and adolescents with cerebral palsy - a pilot study.

AIM The purpose of this pilot study was to explore the use of massage therapy in children with cerebral palsy undergoing post-operative rehabilitation. MATERIAL AND METHOD Three participants were randomized to massage therapy and another three participants to rest. All children had undergone surgery in one or two lower limbs. Pain, wellbeing, sleep quality, heart rate and qualitative data were collected for each child. RESULTS The scores of pain intensity and discomfort were low in all participants. Heart rate decreased in participants who were randomized to rest, but no change was found in the massage therapy group. CONCLUSIONS The lack of decrease in heart rate in the study group of massage therapy may imply an increased sensitivity to touch in the post-operative setting. Further research with larger study populations are needed to evaluate how and when massage therapy is useful for children with cerebral palsy.

Mätning av barns oro vid undersökning eller behandling på sjukhus : en studie som utvärderar short STAI

Purpose: The purpose was to investigate the validity and reliability of short STAI (State-Trait Anxiety Inventory) for measuring childrens anxiety in connection with procedures in hospital. Background: The childrens level of anxiety during hospitalization can cause problems and it should be evaluated with a valid and reliable instrument. STAIC-S (STAI for children) has previously been validated in children for this purpose but may be too complex to use. Short STAI has only been evaluated in adults and should be tested in children before it can be used. Methods: Children aged five to 16 filled in both STAIC-S and short STAI before and after an examination or treatment at the hospital. Results: Twenty children were included. Satisfactory internal reliability was found for short STAI with Cronbachss alpha 0.82. Correlation coefficients between the instruments were 0.88 before and 0.75 after the procedure. Significantly lower values were found after compared to before demonstrating constructive validity. Short STAI was easy to fill in but seven of 16 participants received help from their parents. Conclusion: Short STAI was shown to be a reliable and valid instrument for measuring anxiety in children, but a larger study is needed to confirm the validity and reliability further.