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  • 1. Alfvén, Gösta
    et al.
    Caverius, Ulla
    Nilsson, Stefan R
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Smärta hos barn och ungdomar ett eftersatt område2012Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, nr 19, s. 966-967Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    En enkät om organisationen av omhändertagandet av akut och återkommande smärta hos barn har besvarats av 26 av landets 34 barnkliniker. Drygt en tredjedel av dessa har organiserad verksamhet för akut och/eller långvarig smärta. En femtedel av barnklinikerna har en verksamhet som är specifikt organiserad för barn. Flertalet av dessa mottagningar är bemannade med deltidsarbetande personal. Endast två läkare och fyra sjuksköterskor arbetar heltid med dessa frågor, och antalet psykologer och sjukgymnaster är begränsat.

  • 2. Apell, Jeanette
    et al.
    Paradi, Rikard
    Kokinsky, Eva
    Nilsson, Stefan R
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Mätning av barns oro vid undersökning eller behandling på sjukhus: en studie som utvärderar short STAI2011Inngår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 31, nr 1, s. 45-47Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The purpose was to investigate the validity and reliability of short STAI (State-Trait Anxiety Inventory) for measuring children's anxiety in connection with procedures in hospital. Background: The children´s level of anxiety during hospitalization can cause problems and it should be evaluated with a valid and reliable instrument. STAIC-S (STAI for children) has previously been validated in children for this purpose but may be too complex to use. Short STAI has only been evaluated in adults and should be tested in children before it can be used. Methods: Children aged five to 16 filled in both STAIC-S and short STAI before and after an examination or treatment at the hospital. Results: Twenty children were included. Satisfactory internal reliability was found for short STAI with Cronbachs’s alpha 0.82. Correlation coefficients between the instruments were 0.88 before and 0.75 after the procedure. Significantly lower values were found after compared to before demonstrating constructive validity. Short STAI was easy to fill in but seven of 16 participants received help from their parents. Conclusion: Short STAI was shown to be a reliable and valid instrument for measuring anxiety in children, but a larger study is needed to confirm the validity and reliability further

  • 3. Björkman, Berit
    et al.
    Nilsson, Stefan R
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Sigstedt, Bo
    Enskär, Karin
    Children’s pain and distress while undergoing an acute radiographic examination2012Inngår i: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 18, nr 3, s. 191-196Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pain has been highlighted as a main concern for children in conjunction with an acuteradiographicexamination. The aim of this study was to further investigate children’spain and distress while undergoing an acuteradiographicexamination. The study comprised 29 participants with an age range of 5–15 years who were injured and submitted to an acuteradiographicexamination of the upper or lower extremity when the question at issue was fracture. The Coloured Analogue Scale (CAS) and the Facial Affective Scale (FAS) were used as self-reporting scales to measure the children’spain and distress. The Face, Legs, Activity, Cry and Consolability Behavioural scale (FLACC) was used as an observation tool to assess behaviours associated with pain in children. Descriptive statistics were used when analysing the scores, and the results showed that children experience pain and distress in conjunction with a radiographicexamination after an injury. Spearman’s correlation was used to compare variables, and significant correlations were obtained between the self-reported pain and the observed pain behaviour. Fischer’s Exact test was used to compare groups, and when using the cut-off 3.0 on the self-reporting scale no significant correlation was found concerning the pain reported by children diagnosed with and without a fracture. No significant correlations were found concerning the self-reported distress and pain either, regardless of whether it was a first-time visit and whether a parent was near during the examination.

  • 4. Nguyen, Nhan Than
    et al.
    Nilsson, Stefan R
    [external].
    Hellström, Anna-Lena
    Bengtson, Ann
    Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomised clinical trial2010Inngår i: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 27, nr 3, s. 146-155Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A nonpharmacological method can be an alternative or complement to analgesics.The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures. A randomized clinical trial was used in 40 children (aged 7-12 years) with leukemia, followed by interviews in 20 of these participants. The participants were randomly assigned to a music group (n = 20) or control group (n = 20). The primary outcome was pain scores and the secondary was heart rate, blood pressure, respiratory rate, and oxygen saturation measured before, during, and after the procedure. Anxiety scores were measured before and after the procedure. Interviews with open-ended questions were conducted in conjunction with the completed procedures. The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture. The anxiety scores were lower in the music group both before and after the procedure. The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children, including less pain and fear.

  • 5.
    Nilsson, Stefan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Björkman, Berit
    Almqvist, Anna-Lena
    Almqvist, Lena
    Björk-Willén, Polly
    Dnohue, Dana
    Enskär, Karin
    Granlund, Mats
    Huus, Karina
    Hvit, Sara
    Children's Voices: Differentiating a Child Perspective from a Child's Perspective.2015Inngår i: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 18, nr 3, s. 162-168Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this paper was to discuss differences between having a child perspective and taking the child’s perspective based on the problem being investigated. Methods: Conceptual paper based on narrative review. Results: The child’s perspective in research concerning children that need additional support are important. The difference between having a child perspective and taking the child’s perspective in conjunction with the need to know children’s opinions has been discussed in the literature. From an ideological perspective the difference between the two perspectives seems self-evident, but the perspectives might be better seen as different ends on a continuum solely from an adult’s view of children to solely the perspective of children themselves. Depending on the research question, the design of the study may benefit from taking either perspective. In this article, we discuss the difference between the perspectives based on the problem being investigated, children’s capacity to express opinions, environmental adaptations and the degree of interpretation needed to understand children’s opinions. Conclusion: The examples provided indicate that children’s opinions can be regarded in most research, although to different degrees. Read More: http://informahealthcare.com/doi/abs/10.3109/17518423.2013.801529

  • 6.
    Nilsson, Stefan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Finnström, Berit
    Mörelius, Evalotte
    Forsner, Maria
    The facial affective scale as a predictor for pain unpleasantness when children undergo immunizations2014Inngår i: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, nr 628198Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Needle fear is a common problem in children undergoing immunization. To ensure that the individual child’s needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions.

  • 7.
    Nilsson, Stefan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gustafsson, Lisa
    Jenholt Nolbris, Margaretha
    Young adults' childhood experiences of support when living with a parent with a mental illness2015Inngår i: Journal of child health care, ISSN 1367-4935, Vol. 19, nr 4, s. 444-453Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There are several concerns in relation to children living with a parent suffering from a mental illness. In such circumstances, the health-care professionals need to involve the whole family, offering help to the parents on parenting as well as support for their children. These children are often helped by participating in meetings that provide them with contact with others with similar experiences. The aim of this study was to investigate young adults' childhood experiences of support groups when living with a mentally ill parent. Seven young women were chosen to participate in this study. A qualitative descriptive method was chosen. The main category emerged as 'the influence of life outside the home because of a parent's mental illness' from the two generic categories: 'a different world' and 'an emotion-filled life'. The participants' friends did not know that their parent was ill and they 'always had to…take responsibility for what happened at home'. These young adults appreciated the support group activities they participated in during their childhood, stating that the meetings had influenced their everyday life as young adults. Despite this, they associated their everyday life with feelings of being different. This study highlights the need for support groups for children whose parents suffer from mental illness.

  • 8.
    Nilsson, Stefan R
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Does music therapy reduces pain and anxiety in children with cancer2011Inngår i: Focus on Alternative and Complementary Therapies, ISSN 1465-3753, E-ISSN 2042-7166, Vol. 16, nr 1, s. 67-Artikkel, omtale (Annet vitenskapelig)
    Abstract [en]

    Review of: Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial.

  • 9.
    Nilsson, Stefan R
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Procedural and postoperative pain management in children: experiences, assessments and possibilities to reduce pain, distress and anxiety2010Rapport (Annet vitenskapelig)
    Abstract [en]

    Children’s visits to hospital are often connected with painfulexaminations and treatments. If these situations are associated withunsuccessful alleviation of pain, the children may develop distress, anxiety and even pain sensitization. Effective pain management including pharmacological treatment and coping methods that support the children when undergoing examinations or treatments could reduce these harmful effects. Distraction methods such as serious games and music medicine are techniques to deviate attention away from procedural or postoperative pain, and these may help children create positive experiences. There is a need to examine these interventions among children in hospital.

  • 10.
    Nilsson, Stefan R
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Buchholz, Margret
    Thunberg, Gunilla
    Assessing children’s anxiety using the modified short State-Trait Anxiety Inventory (STAI) and Talking Mats: A pilot study2012Inngår i: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Preoperative anxiety complicates treatment and requires assessment by nurses in children. Children, with or without disability, are helped when pictures are used to support communication. The purpose of this pilot study was to test the reliability and validity of the modified short State-Trait Anxiety Inventory (STAI) using a modified Talking Mats method in children undergoing day surgeries. Method. A modified short STAI with pictorial support along the lines of the Talking Mats method was pre- and postoperatively administered to 42 typically developing children aged three to nine years. The parents assessed the children's anxiety, simultaneously and independently, by scoring the short STAI by proxy. Results. The modified short STAI showed moderate internal consistency and good construct validity in the age group seven to nine years. Conclusions. The results of this study support the use of the instrument for self-reports in children aged seven to nine years. Future research will explore the possibilities of also using this instrument for children with cognitive and communicative difficulties.

  • 11.
    Nilsson, Stefan R
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Enskär, Karin
    Hallqvist, Carina
    Kokinsky, Eva
    Active and Passive Distraction in Children Undergoing Wound Dressings2013Inngår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 28, nr 2, s. 158-166Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to test how distraction influences pain, distress and anxiety in children during wound care. Sixty participants aged 5-12years were randomized to three groups: serious gaming, the use of lollipops and a control group. Self-reported pain, distress, anxiety and observed pain behaviour were recorded in conjunction with wound care. Serious gaming, an active distraction, reduced the observed pain behaviour and self-reported distress compared with the other groups. A sense of control and engagement in the distraction, together, may be the explanation for the different pain behaviours when children use serious gaming.

  • 12.
    Nilsson, Stefan R
    et al.
    [external].
    Finnström, Berit
    Kokinsky, Eva
    The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years2008Inngår i: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 18, nr 8, s. 767-774Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives:  To evaluate the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural pain in children aged 5–16 years. Background:  Self-reporting of pain is considered to be the primary source of information on pain intensity for older children but a validated observational tool will provide augment information to self-reports during painful procedures. Methods:  Eighty children scheduled for peripheral venous cannulation or percutaneous puncture of a venous port were included. In 40 cases two nurses simultaneously and independently assessed pain by using the FLACC scale and in 40 cases one of these nurses assessed the child. All children scored the intensity of pain by using the Coloured Analogue Scale (CAS) and distress by the Facial Affective Scale (FAS). Results:  Concurrent validity was supported by the correlation between FLACC scores and the children’s self-reported CAS scores during the procedure (r = 0.59, P < 0.05). A weaker correlation was found between the FLACC scores and children’s self-reported FAS (r = 0.35, P < 0.05). Construct validity was demonstrated by the increase in median FLACC score to 1 during the procedure compared with 0 before and after the procedure (P < 0.001). Interrater reliability during the procedure was supported by adequate kappa statistics for all items and for the total FLACC scores (κ = 0.85, P < 0.001). Conclusions:  The findings of this study support the use of FLACC as a valid and reliable tool for assessing procedural pain in children aged 5–16 years.

  • 13.
    Nilsson, Stefan R
    et al.
    [external].
    Finnström, Berit
    Kokinsky, Eva
    Enskär, Karin
    The use of Virtual Reality for needle-related procedural pain and distress in children and adolescents in a paediatric oncology unit2009Inngår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 13, nr 2, s. 102-109Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: It is essential to minimize pain and distress during painful procedures in children. This study examined the effect of using non-immersive Virtual Reality (VR) during a needle-related procedure on reported pain or distress of children and adolescents in a paediatric oncology unit and surveyed their response to the use of VR-equipment during the procedure. METHOD: Twenty-one children and adolescents were included in an intervention group with non-immersive VR and another 21 children and adolescents in a control group where they underwent either venous punctures or subcutaneous venous port devices. Self-reported pain and distress, heart rate and observational pain scores were collected before, during and after the procedures. Semi-structured qualitative interviews were conducted in conjunction with the completed intervention. RESULTS: Self-reported and observed pain and distress scores were low and few significant differences of quantitative data between the groups were found. Two themes emerged in the analysis of the interviews; the VR game should correspond to the child and the medical procedure and children enjoyed the VR game and found that it did distract them during the procedure. CONCLUSION: The interviews showed that non-immersive VR is a positive experience for children undergoing a minor procedure such as venous puncture or a subcutaneous venous port access.

  • 14.
    Nilsson, Stefan R
    et al.
    [external].
    Hallqvist, Carina
    Sidenvall, Birgitta
    Enskär, Karin
    Children’s experiences of procedural pain management in conjunction with trauma wound dressings2011Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, nr 7, s. 1449-1457Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim.  This paper is a report of the experiences of children (5–10 years) of procedural pain when they underwent a trauma wound care session. Background.  Procedural pain in conjunction with trauma wound care often induces anxiety and distress in children. Children need to alleviate pain and avoid the development of fear in conjunction with examinations and treatments. The nurse could help children to reach this goal by using the comfort theory, which describes holistic nursing in four contexts: physical, psychospiritual, environmental and sociocultural. Few studies have focused on children’s experiences of comforting activities in conjunction with trauma wound dressings. Methods.  This study was conducted between May 2008 and January 2010. Thirty-nine participants aged 5–10 were consecutively included in this study. The wound care session was standardized for all the participants, and semi-structured qualitative interviews with open-ended questions were conducted with all the children in conjunction with the procedure. All the interviews were transcribed verbatim and analysed with qualitative content analysis. Findings.  Four themes were identified: clinical competence, distraction, participation and security. The children were helped to reach comforting activities to enhance pain management. Conclusion.  Children require more than just analgesics in wound care. They also need to experience security and participation in this context. When children feel clinical competence in wound care, they trust the nurse to carry out the wound dressing and instead can focus on the distraction that increases their positive outcomes.

  • 15.
    Nilsson, Stefan R
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Johansson, Gunilla
    Enskär, Karin
    Himmelmann, Kate
    Massage therapy in postoperative rehabilitation of children and adolescents with cerebral palsy: a pilot study2012Inngår i: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 17, nr 3, s. 127-131Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim The purpose of this pilot study was to explore the use of massage therapy in children with cerebral palsy undergoing post-operative rehabilitation. Material and method Three participants were randomized to massage therapy and another three participants to rest. All children had undergone surgery in one or two lower limbs. Pain, wellbeing, sleep quality, heart rate and qualitative data were collected for each child. Results The scores of pain intensity and discomfort were low in all participants. Heart rate decreased in participants who were randomized to rest, but no change was found in the massage therapy group. Conclusions The lack of decrease in heart rate in the study group of massage therapy may imply an increased sensitivity to touch in the post-operative setting. Further research with larger study populations are needed to evaluate how and when massage therapy is useful for children with cerebral palsy.

  • 16.
    Nilsson, Stefan R
    et al.
    [external].
    Kokinsky, Eva
    Sidenvall, Birgitta
    Enskär, Karin
    School-aged children’s experiences of postoperative music medicine on pain, distress and anxiety2009Inngår i: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 19, nr 12, s. 1184-1190Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim:  To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school-aged children who had undergone day surgery. Background:  Music medicine has been proposed to reduce distress, anxiety, and pain. There has been no other study that evaluates effects of music medicine (MusiCure®) in children after minor surgery. Methods:  Numbers of participants who required analgesics, individual doses, objective pain scores (Face, Legs, Activity, Cry, Consolability [FLACC]), vital signs, and administration of anti-emetics were documented during postoperative recovery stay. Self-reported pain (Coloured Analogue Scale [CAS]), distress (Facial Affective Scale [FAS]), and anxiety (short State-Trait Anxiety Inventory [STAI]) were recorded before and after surgery. In conjunction with the completed intervention semi-structured qualitative interviews were conducted. Results:  Data were recorded from 80 children aged 7–16. Forty participants were randomized to music medicine and another 40 participants to a control group. We found evidence that children in the music group received less morphine in the postoperative care unit, 1/40 compared to 9/40 in the control group. Children’s individual FAS scores were reduced but no other significant differences between the two groups concerning FAS, CAS, FLACC, short STAI, and vital signs were shown. Children experienced the music as ‘calming and relaxing.’ Conclusions:  Music medicine reduced the requirement of morphine and decreased the distress after minor surgery but did not else influence the postoperative care.

  • 17.
    Nilsson, Stefan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Renning, Ann-Christine
    Pain management during wound dressing in children2012Inngår i: Nursing Standard, ISSN 0029-6570, E-ISSN 2047-9018, Vol. 26, nr 32, s. 50-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article reviews the literature describing pharmacological and non-pharmacological strategies that nurses can use to manage pain during wound dressing in children aged between one and 18 years in cases where general anaesthesia is not required. The article discusses the assessment of wound pain and anxiety in children and describes the choices available to nurses when managing pain and anxiety during wound dressings.

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