Tarja Pölkki

Hospitalized children's descriptions of their experiences with postsurgical pain relieving methods

The purpose of this study was to describe childrens (aged 8-12 yr) experiences with postsurgical pain relieving methods, and their suggestions to nurses and parents concerning the implementation of pain relief measures in the hospital. The data were collected by interviewing children (N = 52) who were inpatients on a pediatric surgical ward in the university hospital of Finland. Content analysis was used to analyze the data. The children rated the intensity of pain on a visual analogue scale. The results indicated that all of the children used at least one self-initiated pain relieving method (e.g. distraction, resting/sleeping), in addition to receiving assistance in pain relief from nurses (e.g. giving pain killers, helping with daily activities) and parents (e.g. distraction, presence). The children also provided suggestions, especially as it relates to nurses (e.g. creating a more comfortable environment), regarding the implementation of effective surgical pain relief. However, some cognitive-behavioral and physical methods were identified that should be implemented more frequently in clinical practice. Furthermore, most children reported their worst pain to be severe or moderate, which indicates that pain management in hospitalized children should be more aggressive.

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

BACKGROUND Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries. METHODS EUROPAIN (EUROpean Pain Audit In Neonates) was a prospective cohort study of the management of sedation and analgesia in patients in NICUs. All neonates admitted to NICUs during 1 month were included in this study. Data on demographics, methods of respiration, use of continuous or intermittent sedation, analgesia, or neuromuscular blockers, pain assessments, and drug withdrawal syndromes were gathered during the first 28 days of admission to NICUs. Multivariable linear regression models and propensity scores were used to assess the association between duration of tracheal ventilation (TV) and exposure to opioids, sedatives-hypnotics, or general anaesthetics in neonates (O-SH-GA). This study is registered with ClinicalTrials.gov, number NCT01694745. FINDINGS From Oct 1, 2012, to June 30, 2013, 6680 neonates were enrolled in 243 NICUs in 18 European countries. Mean gestational age of these neonates was 35.0 weeks (SD 4.6) and birthweight was 2384 g (1007). 2142 (32%) neonates were given TV, 1496 (22%) non-invasive ventilation (NIV), and 3042 (46%) were kept on spontaneous ventilation (SV). 1746 (82%), 266 (18%), and 282 (9%) neonates in the TV, NIV, and SV groups, respectively, were given sedation or analgesia as a continuous infusion, intermittent doses, or both (p<0.0001). In the participating NICUs, the median use of sedation or analgesia was 89.3% (70.0-100) for neonates in the TV group. Opioids were given to 1764 (26%) of 6680 neonates and to 1589 (74%) of 2142 neonates in the TV group. Midazolam was given to 576 (9%) of 6680 neonates and 536 (25%) neonates of 2142 neonates in the TV group. 542 (25%) neonates in the TV group were given neuromuscular blockers, which were administered as continuous infusions to 146 (7%) of these neonates. Pain assessments were recorded in 1250 (58%) of 2138, 672 (45%) of 1493, and 916 (30%) of 3017 neonates in the TV, NIV, and SV groups, respectively (p<0.0001). In the univariate analysis, neonates given O-SH-GA in the TV group needed a longer duration of TV than did those who were not given O-SH-GA (mean 136.2 h [SD 173.1] vs 39.8 h [94.7] h; p<0.0001). Multivariable and propensity score analyses confirmed this association (p<0.0001). INTERPRETATION Wide variations in sedation and analgesia practices occur between NICUs and countries. Widespread use of O-SH-GA in intubated neonates might prolong their need for mechanical ventilation, but further research is needed to investigate the therapeutic and adverse effects of O-SH-GA in neonates, and to develop new and safe approaches for sedation and analgesia. FUNDING European Communitys Seventh Framework Programme.

Imagery-Induced Relaxation in Children's Postoperative Pain Relief: A Randomized Pilot Study

This study aimed to test the efficacy of imagery and relaxation in hospitalized childrens postoperative pain relief. Sixty children aged 8-12 years who had undergone appendectomy or upper/lower limb surgery and had been randomly assigned to the experimental group (n(1) = 30) listened to an imagery trip CD, whereas those in the control group (n(2) = 30) received standard care. An investigator-developed questionnaire was used, and the intensity of pain was assessed using a visual analogue scale: before (Phase 1), immediately after (Phase 2), and 1 hour after (Phase 3) intervention or standard care. The children in the experimental group reported having significantly less pain (p < .001) than the control children based on a comparison of VAS pain scores in Phases 1 and 2. There were no significant differences in nurse-assessed pain scores. The type and time of operation were related to pain intensity in children. The nurses underestimated the pain of pediatric patients. The imagery trip CD can be used to reduce childrens postoperative pain in a hospital setting, although its effect is short-lasting.

Testing and verifying nursing theory by confirmatory factor analysis

AIM This paper presents a discussion of the use of confirmatory factor analysis to test nursing theory. BACKGROUND Theory testing is an important phase in nursing theory development. Testing of theory is intended to give more information about concepts and their usefulness in nursing practice. Confirmatory factor analysis is commonly used in instrument development in nursing science studies, but also in theory testing. However, there has been little discussion of its use in theory testing in nursing science research. DATA SOURCES Multidisciplinary methodological and research publications from 1990 to 2009 were used. DISCUSSION The aim of confirmatory factor analysis is to test nursing theory that has already been established, i.e. researchers have an a priori hypothesis based on theoretical knowledge or empirical indications. Analysis is represented as three phases: preparation, model testing and reporting the results. Preparation involves data screening and preliminary analyses. Model testing is divided into model specification, model identification, model estimation, model evaluation and model modification. The results are reported with standardized regression coefficients of the items related to the latent variables, squared multiple correlations (R²) related to error terms and the models goodness of fit indexes. Implications for nursing. Testing of theory is intended to give more valid information about the concepts and their usefulness in nursing practice. CONCLUSION Confirmatory factor analysis is a good method to test the structure of theory, for example to test the concepts built by concept synthesis or analysis. Tested theories are needed to develop nursing science itself.

A descriptive qualitative review of the barriers relating to breast-feeding counselling

The purpose of this review was to describe barriers in breast-feeding counselling considering it from the viewpoint of health professionals. CINAHL, MEDLINE and Cochrane databases were searched from 1950 to 2008. In total, 40 scientific research articles in English, Swedish or Finnish related to breast-feeding counselling were included and analysed using thematic analysis. The quality of the studies was also assessed. The main barriers were deficits in knowledge, resources, counselling skills and the counsellors negative attitude. Conflicting advice, lack of guidelines, sufficiency of counselling and perceiving of the personal education needs were examples of the indicated barriers. The most commonly described barriers in breast-feeding counselling were limitations in breast-feeding knowledge. Developing of the measurements to assess the barriers in breast-feeding counselling is needed.

Assessment of continuous pain in newborns admitted to NICUs in 18 European countries

Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.

Knowledge of breastfeeding among pregnant mothers and fathers.

Purpose: The purpose of this study was to describe breastfeeding knowledge of childbearing parents as well as to discover the demographic variables related to it, and evaluate the use of a web-based survey. Subjects and methods: The electronic Breastfeeding Knowledge, Attitude and Confidence scale was developed, and the data were collected at eight maternity healthcare clinics in Finland. All the families who visited those clinics between March 2 and April 3, 2009 were invited to the study, and 123 pregnant mothers and 49 fathers completed the survey. Findings and conclusions: The respondents correctly answered 68% of the items related to breastfeeding knowledge. The most usual lack of knowledge concerned how to increase lactation, sufficiency of breast milk in hot weather, sufficiency of breast milk for 4 months after birth, and the need to pump the breasts after alcohol consumption. Differences in the breastfeeding scores existed when gender, parity, age, living with spouse, educational level, smoking, time of pregnancy and breastfeeding history were considered. The web-based survey was well suited to the data collection, but the weak response rate requires attention. Parents need more information about ways to increase lactation and reasons to start complementary feeding.

Confidence in Breastfeeding Among Pregnant Women

Little is known about prenatal breastfeeding confidence, although such knowledge is necessary for developing the content of counseling and tailoring it for individuals. The purpose of this study was to describe women’s prenatal breastfeeding confidence and how their sociodemographic characteristics, breastfeeding knowledge, and attitudes relate to it. The electronic confidence scale was used in data collection, and 123 Finnish women filled in the questionnaire. The mean confidence score was 83.88 when the maximum possible score was 120. Confidence scores varied when parity, breastfeeding knowledge, and attitudes were involved. Variables regarding breastfeeding as difficult, regarding breastfeeding as exhausting, and parity explained 38.1% of the variation of the breastfeeding confidence scores. Pregnant women need information about managing potential breastfeeding problems and the physiology of breastfeeding. Interventions designed to promote breastfeeding confidence need to be focused on primiparas and women with a lack of breastfeeding knowledge.

A descriptive qualitative study of adolescent girls' well-being in Northern Finland

Background Previous studies have shown that girls present welfare-related symptoms differently than boys and that the severity of their symptoms increases with age. Girls living in Northern Finland experience reduced well-being in some aspects of their lives. However, the opinions of girls on these matters have not previously been studied. Objective The aim of this study was to describe girls’ well-being in Northern Finland. Method This is a descriptive qualitative study. The participants were 117 girls aged between 13 and 16 who were living in the province of Lapland in Finland and attending primary school. Data were collected electronically; the girls were asked to respond to a set of open-ended questions using a computer during a school day. The responses were evaluated by using inductive content analysis. Results Four main categories of girls’ well-being were identified: health as a resource, a beneficial lifestyle, positive experience of life course, and favourable social relationships. Health as a resource was about feeling healthy and the ability to enjoy life. A beneficial lifestyle was about healthy habits and meaningful hobbies. Positive experience of life course is related to high self-esteem and feeling good, safe, and optimistic. Favourable social relationships meant having good relationships with family and friends. Conclusions To the participating girls, well-being was a positive experience and feeling which was revealed when they interact between their relationships, living conditions, lifestyle, and environment. Knowledge about girls’ description of their well-being can be used to understand how the girls themselves and their environment influence their well-being and what can be done to promote it.

The Cultural Meaning of Children Sleeping Outdoors in Finnish Winter: A Qualitative Study From the Viewpoint of Mothers

Purpose: Little is known about children sleeping outdoors in a northern winter climate, although it is a common practice in northern countries. The article describes the cultural meaning of this child care practice from the viewpoint of mothers. Design: Explorative descriptive study design was adopted and unstructured interviews were processed by qualitative content analysis. Participants: Twenty-one mothers of families in northern Finland participated. Results: Family, cultural outdoor sleeping practice and northern winter environment constituted compatibility, which consisted of four generic categories: strengthening family well-being through outdoor sleeping, taking notice of security perspectives, adaptation to the northern winter environment, and cultural knowledge-building processes. Conclusions: Family well-being was strengthened through outdoor sleeping of children when all security perspectives were first taken into account. Families were adapted to the northern winter environment and cultural knowledge was built. A fit was found between families, cultural child care practice, and northern winter environment constituting a coherent whole.