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Children's individual voices are required for adequate management of fear and pain during hospital care and treatment
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (LIV)ORCID iD: 0000-0001-6614-0493
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (LIV)ORCID iD: 0000-0001-7067-2687
(LIV)ORCID iD: 0000-0003-4080-6677
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (LIV)ORCID iD: 0000-0002-9194-3244
Show others and affiliations
2021 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 35, no 2, p. 530-537Article in journal (Refereed) Published
Sustainable development
According to the author(s), the content of this publication falls within the area of sustainable development.
Abstract [en]

Background: Children often report both fear and pain in conjunction with clinical care and treatment. Interventions developed in the field have still not been sufficient to prevent and relieve children’s fear and pain. More knowledge, from children’s own perspectives, is needed about how they deal with their experiences.

Aim: To explore child-identified strategies that children use to manage fear and pain during needle-related medical procedures in hospital.

Methods: Interviews with children, age 4–12 years, with experience of hospital care were analysed qualitatively using content analysis.

Results: Children have self-identified strategies for dealing with fear and pain during hospital care and treatment. The strategies vary depending on examination or treatment and on how the child felt at that particular day. Children describe what they can do themselves, how adults can empower them and support from surroundings as strategies that give them a choice and a voice. Children wished to have influence, decide when and how information should be given, scream out loud or squeeze something hard, to deal with fear and pain. The results also show that children tried to be brave, gain control and think positively. Something nice to look at and opportunities to play with others also contributed.

Conclusions: Strategies vary between children and are used differently on different occasions. Healthcare professionals pose a threat to the child’s needs and ability to use their strategies due to lack of knowledge of the child’s chosen strategies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021. Vol. 35, no 2, p. 530-537
Keywords [en]
child perspective, fear, pain, strategies, young children
National Category
Medical and Health Sciences
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-23166DOI: 10.1111/scs.12865ISI: 000530409300001PubMedID: 32363693Scopus ID: 2-s2.0-85085128864OAI: oai:DiVA.org:hb-23166DiVA, id: diva2:1428388
Projects
LIVAvailable from: 2020-05-05 Created: 2020-05-05 Last updated: 2023-10-19Bibliographically approved
In thesis
1. Barncentrerad vård vid nålprocedurer: Betydelsen av att möta barns rädsla och smärta
Open this publication in new window or tab >>Barncentrerad vård vid nålprocedurer: Betydelsen av att möta barns rädsla och smärta
2023 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Children report needle procedures as the worst source of fear and pain during hospital care and treatment. How children communicate their fear and pain varies, which can be challenging for nurses to understand and meet. Nurses need to be able to recognize and acknowledge children’s emotions for needle procedures to be child centered. 

Aim: To explore the effects of a child centered intervention on fear and pain during needle procedures. 

Methods: Four studies combining qualitative and quantitative approaches, with boys and girls aged 4 – 12 years old undergoing a needle procedure, were conducted. Study I explored child-identified strategies used to manage fear and pain in hospital, with data collected through semi-structured interviews. Data through observations from video recordings were used in Study II to explore children’s expressions of emotional cues and concerns, and nurses’ response to these expressions. To examine whether children experience less fear and pain when receiving standard care with the addition of the intervention iCC compared with the experience of standard care only, self-reported fear and pain before and immediately after a needle procedure were conducted in study III. To further evaluate the effect of the intervention, time required for the procedure, heart rate, success rate for the procedure, behavioral observations, and patient preference to undergo the needle procedure in the same way again, were collected. Study IV evaluated child-nurse emotional communication when using a child centered intervention versus a control group. Data collection consisted of video-observations. 

Main results: The opportunity to choose strategy themselves was particularly supportive to children. Unpleasant emotions were commonly expressed through non-verbal communication, but seldom acknowledged by nurses. Less fear and pain were observed in the intervention group and less time required performing the needle procedure. Most children using iCC intervention were positive to the possibility of undergoing a needle procedure in the same way again in the future. Nurses using the intervention acknowledged the child’s expressed unpleasant emotions to a greater extent. 

Conclusion: Approaching children as active and competent actors during needle procedures contributes positively to nurses’ involvement, to the time a needle procedure takes, and to children’s experiences and emotional state.

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2023
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 141
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29843 (URN)978-91-89833-09-8 (ISBN)978-91-89833-10-4 (ISBN)
Public defence
2023-11-17, Sparbankssalen, Järnvägsgatan 5, Borås, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-10-20 Created: 2023-05-29 Last updated: 2023-10-19Bibliographically approved

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Kleye, IdaHedén, Lena EKarlsson, KatarinaSundler, Annelie JohanssonDarcy, Laura

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