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"Jag är rädd, jag vill till mamma": Yngre barns, föräldrars och sjuksköterskors levda erfarenheter av nålprocedurer ivården
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Jönköping University.
2015 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of the thesis is to create knowledge about what it means for younger children toundergo needle-related medical procedures (NRMPs), and what caring support in relation to this meansbased on nurses’, parents’, and younger children's perspectives.

Methods: The first and second papers used descriptive phenomenological analysis to describe themeanings of supporting younger children during NRMPs from the perspective of nurses (Ι) and parents(ΙΙ). The third and fourth papers used lifeworld hermeneutic analysis to explain and understand theconsequences related to NRMPs (ΙΙΙ) and support (ΙV) during these procedures from younger children’sperspectives. Data has been collected by participant observations and lifeworld interviews documented byvideo-recorded observations, field notes, and audio-recorded interviews. In total 60 people participated,fourteen nurses, twenty-five parents, and twenty-one children.

Main results: The results show that an important consequence for children of procedures with needles isexperiences of fear. The child's fear affects how the child is able to manage the procedure and the supportthe child gets from adults is crucial to whether the child's fear increases or decreases.

The support consists of giving support or receiving support. Parents support the child by safeguarding andprotecting the child during the needle-related procedure; they “keep the child under the protection of theirwings,” sometimes very close and sometimes a little further out under the wingtips. Nurses support thechild by starting from individual child’s experiences and needs; they "balance on a tightrope" in anunpredictable situation. In the meeting between the child, the parents, and the nurses, the adults areguided by the child in what forms of support are provided. This continues until the needle-related medicalprocedure is completed and the child can walk proud and strong from the procedure with a feeling that "Ican handle this.”

Conclusions: Children’s need for support during needle-related medical procedures is primarily tied tochildren’s experiences of fear. For the child to experience a caring support, adults need to understandchildren’s experiences of fear as well as children’s need for support and what form the support shouldtake. A caring support develops dialectically between children and adults in a circular movement. In such adialectic, the child guides the adult and vice versa. That children have the capability of guiding adultsduring needle-related medical procedures shows that they are active and participating. Here it becomesclear that there is no objective location of the phenomenon of support. Support can therefore only bestudied as a lived experience of those who need it.

Place, publisher, year, edition, pages
Jönköping: School of Health and Welfare , 2015. , 186 p.
Keyword [en]
Younger children, parents, nurses, needle-related medical procedures, consequences, support, caring, lived experiences, phenomenology, lifeworld hermeneutic
National Category
Nursing
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-3295ISBN: 978-91-85835-63-8 (print)OAI: oai:DiVA.org:hb-3295DiVA: diva2:872594
Public defence
2015-12-04, Sparbankssalen, Allegatan 1, Borås, 13:00 (Swedish)
Available from: 2015-11-19 Created: 2015-11-19 Last updated: 2015-12-18Bibliographically approved
List of papers
1. Consequences of Needle-Related Medical Procedures: A Hermeneutic Study With Young Children (3–7 Years)
Open this publication in new window or tab >>Consequences of Needle-Related Medical Procedures: A Hermeneutic Study With Young Children (3–7 Years)
Show others...
2015 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449Article in journal (Refereed) Published
Abstract [en]

Background Needle-related medical procedures (NRMPs) are often frightening and cause children anxiety and pain. Only a few studies have examined the perspectives of younger children. More knowledge is needed about younger children's experiences in caring situations such as NRMPs. Aim The aim of this study was to explain and understand the consequences related to NRMPs from younger children's perspectives. Methods Participant observations and interviews with younger children who had experienced NRMPs were analysed using a lifeworld hermeneutic approach. Results Experiencing fear is central for younger children during an NRMP and interpretation of its consequences formed the basis for the following themes: seeking security, realizing the adult's power, struggling for control, feeling ashamed, and surrendering. A comprehensive understanding is presented wherein younger children's experiences of NRMPs vary across time and space related to weakening and strengthening their feelings of fear. Conclusions Awareness is needed that adults' power becomes more obvious for children during an NRMP. Children's surrender does not necessarily imply acceptance of the procedure. Providing children with opportunities to control elements of the procedure creates a foundation for active participation, and vice versa.

Keyword
Younger children, Lived experiences, Consequences, Needle-related medical procedures, Caring science, Reflective lifeworld research, Lifeworld hermeneutic
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-997 (URN)10.1016/j.pedn.2015.09.008 (DOI)
Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2015-11-23
2. Nurses' perspectives on supporting children during needle-related medical procedures.
Open this publication in new window or tab >>Nurses' perspectives on supporting children during needle-related medical procedures.
2014 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9Article in journal (Refereed)
Abstract [en]

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents' ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as "balancing on a tightrope" in an unpredictable situation.

Place, publisher, year, edition, pages
Co-Action Publishing, 2014
Keyword
Lived experience, caring science, phenomenology, reflective lifeworld research, younger children
National Category
Nursing
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-1908 (URN)10.3402/qhw.v9.23063 (DOI)000332846200001 ()24646473 (PubMedID)2320/14206 (Local ID)2320/14206 (Archive number)2320/14206 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2015-11-23
3. Parents' perspectives on supporting children during needle-related medical procedures
Open this publication in new window or tab >>Parents' perspectives on supporting children during needle-related medical procedures
2014 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9Article in journal (Refereed)
Abstract [en]

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child’s horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child’s advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents’ ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as ‘‘balancing on a tightrope’’ in an unpredictable situation.

Place, publisher, year, edition, pages
Co-Action Publishing, 2014
Keyword
Lived experience, Caring science, Younger children, Phenomenology, Reflective lifeworld research
National Category
Nursing
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-1907 (URN)10.3402/qhw.v9.23759 (DOI)PMC4090367 (PubMedID)2320/14204 (Local ID)2320/14204 (Archive number)2320/14204 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2015-11-23

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