Susan Fowler-Kerry

Management of injection pain in children

&NA; Researchers have come to understand a great deal about pain mechanisms, especially in the past 30 years. This understanding has spawned the development of a number of psychological pain control strategies which have been extensively assessed for use with adults. Less is known about pain control strategies in children. The purpose of this study was to assess the value of 2 cognitive strategies (suggestion and music distraction) in reducing pain in children. Two hundred children, aged 4.5–6.5 years, receiving routine immunization injections were randomly assigned to one of the intervention groups in this factorial study. The groups were designated as: distraction, distraction with suggestion, suggestion and control. Subjects reported their pain using a 4‐point pain scale. Distraction was found to significantly decrease pain whereas suggestion did not. Combining suggestion and distraction did not further enhance pain relief compared to use of distraction alone. Age was found to be an important determinant of the success of distraction. Furthermore, age was found to be related to amount of pain reported by children regardless of type of treatment. The results of this study support the use of music distraction in the reduction of injection pain in children.

Knowledge of the professional role of others: A key interprofessional competency

In this paper, the authors present the results of a study which delineated six key competencies of interprofessional collaborative practice for patient-centred care: communication; strength in ones professional role; knowledge of professional role of others; leadership; team function; and negotiation for conflict resolution. While all of these competencies are important and require special attention, this paper examines and discusses the competency knowledge of professional role of others and its associated behavioural indicators, especially as these relate to the interprofessional education of nursing students. The identification of these competencies and their behavioural indicators serve two purposes. It forms the basis for the preparation of students, preceptors, and faculty for interprofessional practice, and it develops a tool for assessing student performance in such practice. Consequently, we believe that the utilization of this key competency and its behavioural indicators will contribute to the development of programs that include specific knowledge and skills related to interprofessional nursing education. This will enable educators to support and evaluate students in interprofessional educational experiences more efficiently and effectively. Ultimately, as nursing students practice and become fully functioning practitioners, client care will be optimized.

The use of a topical refrigerant anesthetic to reduce injection pain in children

Early childhood experiences with painful injections may lead to anxiety and fear. These reactions need not develop if steps are taken to reduce the pain associated with injections. The purpose of this study was to assess the efficacy of a refrigerant topical anesthetic in reducing injection pain in preschool children experiencing routine diphtheria-pertussis-tetanus (DPT) immunizations. This double-blind placebo-controlled study was conducted in community health clinics in conjunction with ongoing immunization programs. Ninety subjects, aged 4-5.5 years, were randomly assigned to one of three groups: (a) refrigerant topical anesthetic; (b) placebo topical spray; and (c) no-spray control. Pain was measured subjectively using a four-point visual analogue scale. Both the refrigerant topical anesthetic spray and the placebo spray significantly reduced injection pain. Age was found to be an important factor influencing pain response in this study. Parental anxiety was not a significant factor influencing pain response. In addition, parents were not good at predicting their childs pain. The results of the study support the use of an intervention, such as refrigerant topical anesthetic, as a practical, simple, and effective treatment strategy for reduction of short-term painful procedures like injections.

Assessing Children’s State Anxiety

Anxiety is an important component of childrens pain and is routinely assessed in pain research. Two forms of the State-Trait Anxiety Inventory have been used frequently by researchers investigating childrens pain and state anxiety (form C-1 and Y-1). We were unable to find psychometric information about this tool when used with a population of hospitalized children. Therefore, we undertook to assess reliability and validity, and identify problem items using data from 881 hospitalized children (aged 5-18 years) whom we had tested. Considering results of all analyses together, we concluded that the tools lack validity and reliability, and contain many problem items that are in need of revision.

Pediatric Palliative Care: Global Perspectives

Palliative care has long been a model of care that focuses on both patients with life-limiting illnesses and their family members. This is especially true in pediatrics where parents, siblings, grandparents and others are affected by a child’s illness. Yet, provision of pediatric palliative care around the world is scant. There are of course many reasons for this such as finances, lack of trained professionals, and a lack of general awareness by the public or policymakers. Despite these barriers, and many others, many countries have found ways to provide this care and those countries are both resource-rich and resource-poor. It is important for these countries to share their stories, which include valuable information on how barriers were overcome and programs were developed and implemented. Only through information dissemination will countries with no programs be able to learn from others and to identify strategies that they can use to help advance the pediatric palliative care movement worldwide.

Children's venipuncture pain : influence of technical factors

Several aspects of venipuncture technique were evaluated to assess their relationship to reported pain. Subjects were 514 children aged 5-17 who had venipuncture performed by a technician in a hospital outpatient laboratory. A research assistant timed the duration of venipuncture and then obtained visual analogue pain scores from the children following venipuncture. Blood volume obtained from venipuncture was also measured. The technician who performed the procedure, amount of blood drawn, and time required to complete the venipuncture did not contribute to the prediction of childrens pain. Age and anxiety, which were treated as covariates, were significant predictors of pain. The distribution of pain experienced by children was positively skewed and about one-third of children were above the mean pain score. From the results of this study, venipuncture pain can be recommended for the study of issues in childrens pain. Further, the findings recommend the development and utilization of interventions to reduce childrens venipuncture pain.

Pediatric Palliative Care and the Medical Home

An estimated 7 million children globally would benefit from pediatric palliative care services. Pediatric palliative care is both a philosophy and a model of care where the fundamental concepts are to provide whole-person care, meaning physical, psychosocial, and spiritual care, to the child, parent, and siblings. While there is no standardized list of diagnoses appropriate for pediatric palliative care currently available, many advocates and health care workers promote and utilize categories established for use by Together for Short Lives in the United Kingdom (formerly ACT, the Association for Children’s Palliative Care) to describe the types of illnesses that could benefit from pediatric palliative care. Today, programs throughout the globe provide services in a variety of settings including academic, tertiary care hospitals, homes, and hospices. The pediatric palliative care movement began to expand rapidly in the 1980s and since then many changes have occurred. Programs across the globe continue to be developed, most impressively in countries with limited development and resources, such as Uganda and Costa Rica. Educational programs are key to the success of pediatric palliative care programs and over the last decade there has been significant growth in this area globally. A significant change in the evolution of pediatric palliative care over the past 30 years is the modification to the definition of pediatric palliative care by the World Health Organization in the late 1990s. The definition was changed to state that pediatric palliative care should be delivered alongside, and not in place of, curative care. This change reinforced the fact that palliative care is complementary to curative treatments and not an intervention delivered only as death becomes inevitable. Thus, pediatric palliative care services should be made available and delivered from the point of diagnosis onward. This integrative approach to pediatric palliative care continues to be misunderstood, denying children and their families the right to these specialized services. This confusion is also seen between primary and palliative care for children.

How Can We Improve Pain Control in Children over the World? Results of International Multiprofessional ICPCN Survey

Dear Editor: Pain control is the most prominent problem in childrens palliative care, especially in developing countries. Many attempts have been made to improve this situation by different organisations including the World Health Organization (WHO) in 2012 (“WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses.”) While the intent of the WHO guidelines is clear, there are many local country-specified barriers to successful implementation of the recommendations. How can we improve pain control in children all over the world? In order to gain some understanding of different perspectives, the International Childrens Palliative Care Network (ICPCN) initiated an International Multiprofessional Survey in 2012. The aim of the survey was to evaluate how ICPCN could help to improve pain control in children around the world. The ICPCN Scientific Committee convened a task force of 25 childrens palliative care professionals from 15 countries representing all continents. This task force created a list of eight possible roles the ICPCN could play in improving pain management in children and these roles were described in the survey. Survey participants were …

An Overview of Pediatric Palliative Care

Palliative care has long been a model of care that focuses on both patients with life-limiting illnesses and their family members. This is especially true in pediatrics where parents, siblings, grandparents and others are affected by a child’s illness. Yet, provision of pediatric palliative care around the world is scant. There are of course many reasons for this such as finances, lack of trained professionals, and a lack of general awareness by the public or policymakers. Despite these barriers, and many others, many countries have found ways to provide this care and those countries are both resource-rich and resource-poor. It is important for these countries to share their stories, which include valuable information on how barriers were overcome and programs were developed and implemented. Only through information dissemination will countries with no programs be able to learn from others and to identify strategies that they can use to help advance the pediatric palliative care movement worldwide.

Pediatric Palliative Care: A New and Emerging Paradigm

As demonstrated in the chapters of this book, countries are as diverse as they are similar in regard to pediatric palliative care. Central to every barrier, enabler, program, policy, and organization is a child with a life-limiting illness and a family struggling to survive and accept that they may lose that child. What rights do these children and families have? Is pediatric palliative care a right or a need? These questions continue to be posed by many around the world who fight for these children every day in their roles as researchers, clinicians, advocates, and policymakers. As the global community comes together to initiate change the lessons learned in sources such as this book will be invaluable.