Children’s Fear and Pain During Medical Procedures: A Quality Improvement Study With a Humanoid Robot

2019 ◽  
pp. 084456211986274 ◽  
Author(s):  
Christian E. Farrier ◽  
Jacqueline D. R. Pearson ◽  
Tanya N. Beran
Keyword(s):  
Quality Improvement ◽  
Standard Care ◽  
Humanoid Robot ◽  
Pediatric Patients ◽  
Pain Scale ◽  
Medical Procedures ◽  
Deep Breathing ◽  
Before And After ◽  
Painful Medical Procedures ◽  
Children's Pain

Background Pediatric patients undergo a variety of painful medical procedures. Purpose The goal of this quality improvement study was to introduce a humanoid robot (MEDi®) programmed with strategies, such as distraction and deep breathing, at inpatient and outpatient units to determine any preliminary effects on children’s pain and fear during medical procedures. Methods A nonrandomized two-group pre- and posttest design was used to compare pain and fear of children before and after intervention versus standard care. A total of 46 children aged 2–15 years undergoing various medical procedures in a pediatric hospital, and their parents completed the Children’s Fear Scale and the Faces Pain Scale-Revised. The former was used both before and after the procedure, while the latter only after the procedure. Results Children ( n = 18), who interacted with the robot before and during a procedure, and their parents reported significantly lower levels of fear and pain than did children ( n = 28) and their parents in standard care, ps < .05. Conclusions The use of a humanoid robot programmed with psychological strategies to support coping may enhance children’s experiences of care for pain management.

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

2021 ◽  
Vol 67 (9) ◽  
pp. 14-24
Author(s):  
Jordan Jackson ◽  
Holly Kirkland-Kyhn ◽  
Laura Kenny ◽  
Alana Beres ◽  
Stephanie Mateev
Keyword(s):  
Quality Improvement ◽  
Pediatric Patients ◽  
Wound Care ◽  
Occipital Region ◽  
Provider Education ◽  
Before And After ◽  
Prevention Interventions ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
Hospital Acquired

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

The Impact of Parental Presence on Their Children During Painful Medical Procedures: A Systematic Review

Pain Medicine ◽  
2021 ◽  
Author(s):  
Emma Rheel ◽  
Anneleen Malfliet ◽  
Dimitri M L Van Ryckeghem ◽  
Roselien Pas ◽  
Tine Vervoort ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Intensity ◽  
Physiological Parameters ◽  
Medical Procedure ◽  
Medical Procedures ◽  
Parental Presence ◽  
Beneficial Effects ◽  
Painful Medical Procedures ◽  
Children's Pain ◽  
The Impact

Abstract Objective Whether parental presence during their children’s painful medical procedures is advantageous with regard to children’s pain-related outcomes is questionable. Research on this topic is equivocal, and additional questions, such as whether levels of parental involvement may play a role as well, remain to be addressed. The purpose of this systematic review is to summarize and critically appraise the literature on the impact of parental presence vs absence during their children’s painful medical procedures on the child’s pain-related outcomes. Methods The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2,157 participants. Studies were considered eligible if they included children (≤18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure. Results The children’s pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence vs absence with regard to children’s self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children’s self-reported fears, anxiety and distress, and observed pain-related behaviors. Conclusions To provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review.

Children’s Pain During IV Induction: A Randomized-Controlled Trial With the MEDi® Robot

2021 ◽  
Author(s):  
Rachelle C W Lee-Krueger ◽  
Jacqueline R Pearson ◽  
Adam Spencer ◽  
Melanie Noel ◽  
Lisa Bell-Graham ◽  
...  
Keyword(s):  
Humanoid Robot ◽  
Controlled Trial ◽  
Deep Breathing ◽  
Exact Test ◽  
Randomized Controlled ◽  
Line Placement ◽  
Hospital Patients ◽  
Children's Pain ◽  
Changes Over Time ◽  
The Impact

Abstract Objective This study examined the impact of a humanoid robot (MEDi®) programmed to teach deep breathing as a coping strategy, on children’s pain and fear as primary and secondary outcomes, respectively, during intravenous (IV) line placement. The completion of IV induction was also examined as an exploratory outcome. Methods In this randomized controlled, two-armed trial, 137 children (4–12 years) were recruited in Short Stay Surgery at a tertiary pediatric hospital. Patients were randomly assigned to standard care (SC) with Ametop© only (N = 60) or SC and robot-facilitated intervention (N = 59) before induction. Pain and fear before, during, and after IV insertion were rated by patients and observers. Results No significant differences were found between groups and there were no changes over time for pain or fear (ps &gt; .05). Exploratory analyses show that patients in the MEDi® group were 5.04 times more likely to complete IV induction, compared to SC, Fisher’s exact test: X2 (1) = 4.85, p = .04, φc = 0.22, odds ratio = 5.04, 95% CI [1.06, 24.00]. Conclusion This study was the first to examine children’s IV induction experience when provided MEDi® support. Reasons for nonsignificance, limitations, and research suggestions were made.

scholarly journals DIFFERENCES IN THE EFFECTIVENESS OF EAR MASSAGE, DEEP BREATH RELAXATION, AND GUIDE IMAGERY IN REDUCING LABOR PAIN

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Moh. Hanafi ◽  
Wiwin Renny R ◽  
Suyanta . ◽  
Ismi Rajiani
Keyword(s):  
Test Group ◽  
Holistic Approach ◽  
Labour Pain ◽  
Pain Scale ◽  
Labor Pain ◽  
P Value ◽  
Deep Breathing ◽  
Before And After ◽  
Post Test ◽  
The Difference

Background: Labor and birth are physiological processes of women. Although it is natural for women, but in general, the process is accompanied by severe pain and sometimes even lead to life-threatening. Childbirth pain is a problem that receives proper attention from nurses. Many alternative and complementary methods besides the use of drugs, can be applied to reduce pain. The methods applied include a holistic approach to ear massage, deep breathing relaxation, and guided imagery. Research method: This research is a quasi experiment. The research design used in this study is the "pre test and post test group design experiment" research by collecting data twice, namely before and after treatment. Results: From the analysis results obtained p value<0.05 indicating the three variables give the effect of the difference in pain between before and after the intervention. The difference in mean between the three interventions, ear massage and guide imagery have the same effect of reducing pain scale. However, if observed from the large value, imagery guide is the most effective in reducing labour pain. This is because the guide imagery can minimise labor pain by up to 12 times, while ear massage reduces labor pain by up to 10 times and breathing relaxation in reducing labor pain by up to 8 times. Conclusion: There is an effect of ear massage, deep breathing relaxation and guide imagery in reducing labor pain. Keywords: ear massage, deep breathing relaxation, and guide imagery, labor pain

Aromatherapy improves nausea, pain, and mood for patients receiving pediatric palliative care symptom-based consults: A pilot design trial

2019 ◽  
Vol 18 (2) ◽  
pp. 158-163
Author(s):  
Meaghann S. Weaver ◽  
Jacob Robinson ◽  
Christopher Wichman
Keyword(s):  
Palliative Care ◽  
Visual Imagery ◽  
Pediatric Patients ◽  
Symptom Burden ◽  
The United States ◽  
Pain Scale ◽  
Deep Breathing ◽  
Post Intervention ◽  
Total N ◽  
The Impact

AbstractObjectiveThe role of aromatherapy in supportive symptom management for pediatric patients receiving palliative care has been underexplored. This pilot study aimed to measure the impact of aromatherapy using validated child-reported nausea, pain, and mood scales 5 minutes and 60 minutes after aromatherapy exposure.MethodsThe 3 intervention arms included use of a symptom-specific aromatherapy sachet scent involving deep breathing. The parallel default control arm (for those children with medical exclusion criteria to aromatherapy) included use of a visual imagery picture envelope and deep breathing. Symptom burden was sequentially assessed at 5 and 60 minutes using the Baxter Retching Faces scale for nausea, the Wong-Baker FACES scale for pain, and the Children's Anxiety and Pain Scale (CAPS) for anxious mood. Ninety children or adolescents (mean age 9.4 years) at a free-standing children's hospital in the United States were included in each arm (total n = 180).ResultsAt 5 minutes, there was a mean improvement of 3/10 (standard deviation [SD] 2.21) on the nausea scale; 2.6/10 (SD 1.83) on the pain scale; and 1.6/5 (SD 0.93) on the mood scale for the aromatherapy cohort (p < 0.0001). Symptom burden remained improved at 60 minutes post-intervention (<0.0001). Visual imagery with deep breathing improved self-reports of symptoms but was not as consistently sustained at 60 minutes.Significance of resultsAromatherapy represents an implementable supportive care intervention for pediatric patients receiving palliative care consults for symptom burden. The high number of children disqualified from the aromatherapy arm because of pulmonary or allergy indications warrants further attention to outcomes for additional breathing-based integrative modalities.

Using an App to monitor postoperative pain at home in pediatric patients

2021 ◽  
pp. 136749352091931
Author(s):  
Emanuela Tiozzo ◽  
Valentina Biagioli ◽  
Matilde Brancaccio ◽  
Riccardo Ricci ◽  
Anna Marchetti ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Health Professionals ◽  
Pediatric Patients ◽  
Pain Scale ◽  
Factors Associated ◽  
Prospective Comparative Study ◽  
Paper And Pencil ◽  
The Impact ◽  
At Home

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

scholarly journals Spinal Muscular Atrophy after Nusinersen Therapy: Improved Physiology in Pediatric Patients with No Significant Change in Urine, Serum, and Liquor 1H-NMR Metabolomes in Comparison to an Age-Matched, Healthy Cohort

Metabolites ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 206
Author(s):  
Leon Deutsch ◽  
Damjan Osredkar ◽  
Janez Plavec ◽  
Blaž Stres
Keyword(s):  
Machine Learning ◽  
Spinal Muscular Atrophy ◽  
1H Nmr ◽  
Pediatric Patients ◽  
Muscular Atrophy ◽  
Male And Female ◽  
Before And After ◽  
Healthy Cohort ◽  
Males And Females ◽  
Urine Serum

Spinal muscular atrophy (SMA) is a genetically heterogeneous group of rare neuromuscular diseases and was until recently the most common genetic cause of death in children. The effects of 2-month nusinersen therapy on urine, serum, and liquor 1H-NMR metabolomes in SMA males and females were not explored yet, especially not in comparison to the urine 1H-NMR metabolomes of matching male and female cohorts. In this prospective, single-centered study, urine, serum, and liquor samples were collected from 25 male and female pediatric patients with SMA before and after 2 months of nusinersen therapy and urine samples from a matching healthy cohort (n = 125). Nusinersen intrathecal application was the first therapy for the treatment of SMA by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Metabolomes were analyzed using targeted metabolomics utilizing 600 MHz 1H-NMR, parametric and nonparametric multivariate statistical analyses, machine learning, and modeling. Medical assessment before and after nusinersen therapy showed significant improvements of movement, posture, and strength according to various medical tests. No significant differences were found in metabolomes before and after nusinersen therapy in urine, serum, and liquor samples using an ensemble of statistical and machine learning approaches. In comparison to a healthy cohort, 1H-NMR metabolomes of SMA patients contained a reduced number and concentration of urine metabolites and differed significantly between males and females as well. Significantly larger data scatter was observed for SMA patients in comparison to matched healthy controls. Machine learning confirmed urinary creatinine as the most significant, distinguishing SMA patients from the healthy cohort. The positive effects of nusinersen therapy clearly preceded or took place devoid of significant rearrangements in the 1H-NMR metabolomic makeup of serum, urine, and liquor. Urine creatinine was successful at distinguishing SMA patients from the matched healthy cohort, which is a simple systemic novelty linking creatinine and SMA to the physiology of inactivity and diabetes, and it facilitates the monitoring of SMA disease in pediatric patients through non-invasive urine collection.

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