Use of non‐conventional nurses’ attire in a paediatric hospital: a quasi‐experimental study

Aims:  To test the impact of a multi‐coloured non‐conventional attire on a population of children admitted to a paediatric hospital. Design:  Quasi‐experimental before‐after controlled study. Background:  It has been suggested that non‐conventional nurses’ uniforms in paediatric settings may contribute to lowering children’s distrust towards healthcare providers and reduce fear. Little formal research has investigated on the impact of nursing attire in a paediatric setting. No study has so far analysed the effects in actual use of a non‐conventional, other than the traditional type of uniform, on a paediatric hospitalised population. Design:  A quasi‐experimental study. Methods:  We introduced multi‐coloured nurses’ attire in two wards of a paediatric hospital. Using open questions and semantic differential scales (SDS), we evaluated the effects of this non‐conventional attire on a group of hospitalised children, compared to sex‐and‐age‐matched controls interviewed before the introduction. Parents were also interviewed. Results:  One hundred and twelve hospitalised children and their parents (n = 112) were studied. The percentage of positive words used by children to define their nurse was higher in children interviewed after the introduction of non‐conventional uniforms (96·2% vs. 81·8%, p = 0·01). Children’s perception of nurses was significantly improved by the use of multi‐coloured attire (‘bad’–‘good’ SDS: p = 0·01; ‘disagreeable’–‘nice’ SDS: p = 0·001). Children’s perceptions regarding hospital environment did not change. Parents’ perception of nurses’ uniform adequacy to the role and capability to reassure resulted improved (p < 0·0001, p = 0·0003). Conclusions:  Multi‐coloured non‐conventional attire were preferred by hospitalised children and their parents. Their introduction improved the perception children have of their nurses. Moreover, the coloured uniforms improve the parents perception about the reliability of the nurse. Relevance to clinical practice:  The use of non‐conventional nurses’ attire can contribute to improve the child–nurse relation, which has the potential to ease the discomfort experienced by children due to hospitalisation.     

Longitudinal study on infants’ temperament and physical development in Beijing,China

The objective of this longitudinal study is to explore the relationship between temperament and physical development among infants in Beijing, China. A total of 1117 term, normal and singleton infants were followed regularly for 12 months. Body weight and horizontal length were measured at 42 days and monthly from the third to twelfth month of their lives. Infants’ temperament was assessed using the revised Chinese infants’ temperament scale when the infants were 6 months. There was a significant difference on temperament dimensions between infants’ genders (P < 0.05). Infants’ weight and length were significantly related to their parents’ weight and height. Infants with positive temperaments (easy and intermediate) were heavier than those with negative temperaments (difficult and slow to warm up) (P < 0.05). The horizontal length of boys was related to their temperament categories (P < 0.05). Infants’ weight and length were significantly related to their temperament category and parents’ weight and height.     

Critical evaluation of the ‘heated-hand-technique’ for obtaining ‘arterialized’ venous blood: incomplete arterialization and alterations in glucagon responses

Summary. In order to test the degree of ‘arterialization’ and the occurrence of arterio-(or capillary-) venous differences in glucose concentrations for commonly used blood sampling sites (including the retrogradely cannulated dorsal hand vein with application of dry heat to this hand/arm – the ‘heated-hand-technique’), oxygen partial pressure (oxygen saturation) and plasma glucose was determined in blood drawn from different venous sites before and after an oral glucose load (75 g). Experiments with and without heating (hot air 68°C) were compared in nine healthy volunteers. Basal pO₂ (and oxygen saturation) increased in the order cubital fossa vein < superficial forearm vein < dorsal hand vein. Heating raised pO₂ by ?20 mmHg; P=0.008) and oxygen saturation (P= 0.008–0.02) at all sites, including those on the contralateral arm. Capillary-venous glucose differences after the glucose challenge were significantly related to the sampling site (P< 0.0001). They were reduced by ?50% in response to heat exposure (P=0.008–0.011) and could be correlated to pO₂-values (r=0.92; P= 0.01). The lowest capillary-venous glucose concentration difference was measured with the ‘heated-hand-technique’ (0.4 ± 0.1 mmol l^-1). Heating did not alter integrated incremental glucose (capillary values), insulin, and C-peptide-responses and late, counter-regulatory responses (120–240 min after glucose) of Cortisol, growth hormone, and adrenalin. However, the late glucagon response was enhanced (P=0.011) by heating, concomitant with a significantly reduced ‘reactive’ decrement in glucose concentrations. In conclusion, the ‘heated-hand-technique’ provides blood more similar to arterial blood that can be obtained from other venous sampling sites. However, significant residual differences in pO₂ and glucose concentrations remain. In addition, altered counter-regulatory hormone responses may occur with heating.     

Effects of pain management on sleep in preterm infants

Background: This study was conducted to gain better understanding of the prolonged effects of pain and pain management on preterm infants’ sleep. Aim: The hypothesis was that the sleep structure in very preterm infants is different after painful procedures with pain management (facilitated tucking by parents (FTP), oral glucose, and oxycodone) than without pain management (oral water as placebo). Methods: A prospective randomized placebo‐controlled cross‐over trial design was used. Thirteen‐hour polysomnographic recordings were conducted when the study infants (n = 18) were at a post‐conceptional age of 28–32 weeks. During the recordings, the standardized nursing care periods were carried out with different forms of pain management administered at 3‐h intervals. Sleep structure was analyzed before and after the interventions. The main hypothesis was analyzed using mixed models. Results: During the first post‐intervention hour, the amount of rapid eye movement (REM) sleep decreased after all interventions regardless of pain management (p < 0.001). However, the oxycodone treatment further reduced the amount of REM sleep to 48.0% (SD 14.9) compared to other interventions: oral glucose to 64.4% (SD 12.8), (p < 0.001); placebo to 62.9% (SD 16.1), (p < 0.001); and FTP to 61.6% (SD 1.9), (p = 0.004). In addition, sleep onset comprised non‐rapid eye movement (NREM) sleep more frequently after oxycodone (50%) compared to placebo (6%, p = 0.006), oral glucose (11%, p = 0.019) or FTP (17%, p = 0.056). Conclusion: Pain management with oxycodone markedly altered the structure of the subsequent sleep period. This reduced amount of REM sleep may have consequences for brain development in preterm infants.     

Longitudinal Study of Parents’ Impact on Quality of Life of Children and Young Adults with Intellectual Disabilities

Background Earlier research has distinguished five domains of Quality of life (QoL) for people with ID: material well‐being, development and activity, physical well‐being, social well‐being, and emotional well‐being. We investigated parents’ perspectives on these domains and QoL for children and young adults with ID and hypothesized that parents’ well‐being would be a predictive factor in QoL of their children with ID. Methods Our longitudinal study administered questionnaires to parents at T₀ (n = 147) and T₁ (n = 108). The inclusion criteria were: (i) the child’s age 0–24 years and (ii) the child’s intellectual disability (IQ < 70 or IQ < 85 in combination with behavioural problems). Results Social well‐being of parents (P ≤ 0.001), changes in parents’ social well‐being (P ≤ 0.01) and changes in children’s social well‐being (P ≤ 0.05) were strong predictors of QoL for children with ID. Emotional well‐being of children with ID (P ≤ 0.01), changes in children’s emotional well‐being (P ≤ 0.01) and changes in emotional well‐being of parents (P ≤0.05) also predicted QoL of children with ID. Material well‐being of parents, and health, development and activity of the children were not predictors. Conclusion Our study revealed that predictors of QoL in children and young adults with ID occurred in the following domains: physical well‐being (children), social well‐being (parents and children) and emotional well‐being (parents and children).     

EMLA cream and oral glucose for immunization pain in 3-month-old infants

The objective of this study is to determine whether use of lidocaine-prilocaine 5% cream (EMLA) and oral glucose decreases pain associated with diphteria-pertussis-tetanus (DPT) immunization in 3-month-old infants. DESIGN: randomized, double-blind, controlled trial in outpatient paediatric practice in northern Sweden. EMLA or placebo was applied to the infant's lateral region of the right thigh and covered with an occlusive dressing 1h before the immunization. In addition, 1 ml of glucose (300 mg/ml) or placebo (water) was instilled on the baby's tongue within 2 min before the DPT-injection. Forty-five infants received EMLA and glucose and 45 infants placebo cream and water. ECG was recorded and stored in a computer and the procedure was videotaped. The parents and the nurse assessed the infants' pain on a visual analogue scale (VAS) after the immunization. Heart rate and heart rate variability pre- and post-injection were calculated. From the videotapes, the modified behavioural pain scale (MBPS) was used to assess pain scores during baseline and after immunization. The latency of the first cry and total crying time were measured. The parents and the nurse scored the infants' pain on the VAS significantly lower in the treatment group than in the placebo group. The infants' responses to the immunization measured as the difference in MBPS scores pre- and post-injection were significantly lower in the EMLA-glucose group compared with the placebo group. More infants cried after the immunization in the placebo group compared with the EMLA-glucose group and the latency of the first cry after the injection was shorter in the placebo group. A biphasic transient heart rate response with a marked deceleration followed by a subsequent acceleration was seen more frequently in the placebo group compared to the EMLA-glucose group. EMLA and glucose alleviate immunization pain in 3-month-old infants.     

Kangaroo Care (Skin Contact) Reduces Crying Response to Pain in Preterm Neonates: Pilot Results

Crying commonly occurs in response to heel stick and adversely affects the infant's physiologic stability. Minimal crying in response to pain is desired. “Kangaroo Care,” skin contact between mother and infant, reduces pain and may reduce crying in response to pain. The purpose of this pilot study was to test Kangaroo Care's effect on the preterm infant's audible and inaudible crying response to heel stick. Inaudible crying has not been previously studied. A prospective randomized cross-over study with 10 preterm infants 2-9 days old (30-32 weeks' postmenstrual age) was conducted. Infants were randomly assigned to two sequences (sequence A: day 1 heel stick in Kangaroo Care [after 30 min of prone skin contact upright between maternal breasts] and day 2 heel stick in incubator [inclined, nested and prone]; or sequence B: opposite of sequence A) was conducted. Videotapes of baseline, heel warming, heel stick, and recovery phases were scored for audible and inaudible crying times. Audible and inaudible crying times for each subject in each phase were summed and analyzed by repeated-measures analysis of variance. Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p ≤ .001). When in Kangaroo Care compared with the incubator, crying time was less during the heel stick (p = .001) and recovery (p = .01) phases, regardless of sequence. Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants, a definitive study is merited before making recommendations.     

Effects of prenatal yoga on women’s stress and immune function across pregnancy: A randomized controlled trial

ObjectiveThe effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks’ gestation between women receiving prenatal yoga and those receiving routine prenatal care.DesignFor this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks’ gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n = 48) or control (n = 46) groups using Clinstat block randomization.InterventionThe 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care.Main outcome measuresIn both groups, participants’ salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks’ gestation.ResultsThe intervention group had lower salivary cortisol (p < 0.001) and higher immunoglobulin A (p < 0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p = 0.018), and infants born to women in the intervention group weighed more than those born to the control group (p < 0.001).ConclusionPrenatal yoga significantly reduced pregnant women’s stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.     

The effects of skin‐to‐skin contact during acute pain in preterm newborns

Background and purpose: Several promising non‐pharmacological interventions have been developed to reduce acute pain in preterm infants including skin‐to‐skin contact between a mother and her infant. However, variability in physiological outcomes of existing studies on skin‐to‐skin makes it difficult to determine treatment effects of this naturalistic approach for the preterm infant. The aim of this study was to test the efficacy of mother and infant skin‐to‐skin contact during heel prick in premature infants. Method: Fifty nine stable preterm infants (born at least 30 weeks gestational age) who were undergoing routine heel lance were randomly assigned to either 15min of skin‐to‐skin contact before, during and following heel prick (n=31, treatment group), or to regular care (n=28, control group). Throughout the heel lance procedure, all infants were assessed for change in facial action (NFCS), behavioral state, crying, and heart rate. Results: Statistically significant differences were noted between the treatment and control groups during the puncture, heel squeeze and the post phases of heel prick. Infants who received skin‐to‐skin contact were more likely to show lower NFCS scores throughout the procedure. Both groups of infants cried and showed increased heart rate during puncture and heel squeeze although changes in these measures were less for the treated infants. Conclusions: Skin‐to‐skin contact promoted reduction in behavioral measures and less physiological increase during procedure. It is recommended that skin‐to‐skin contact be used as a non‐pharmacologic intervention to relieve acute pain in stable premature infants born 30 weeks gestational age or older.     

Parallel assessment of prolonged neonatal distress by empathy‐based and item‐based scales

Objective: To evaluate the association between the empathy‐based Faces Pain Scale‐Revised (FPS‐R) and the item‐based Neonatal Pain, Agitation and Sedation Scale (N‐PASS) when used to assess prolonged distress in term and preterm infants. Method: Sequential prospective psychometric evaluations of distress, at 4‐h intervals during a 48‐h time period. FPS‐R and N‐PASS were employed in parallel by the nurses in charge in 44 term and preterm newborn infants. Results: During the overall 48‐h observation period, median FPS‐R declined from 6/10 to 2/10 (p < 0.001) while N‐PASS did not change significantly. FPS‐R and N‐PASS showed strong correlation during the first 12 h of observation (R_s = 0.786, p < 0.001). During each of the following 12‐h observation periods, the strength of this association decreased (12–24 h: R_s = 0.781; 24–36 h: R_s = 0.675; 36–48 h: R_s = 0.658) while remaining significant (p < 0.001). However, when used to categorize infants as being in distress or not, the rate of agreement between FPS‐R and N‐PASS showed little variation (0–12 h: 79.6%, 12–24 h: 88.6%; 24–36 h: 89.4%, 36–48 h: 84.9%). Conclusions: In newborn infants serially assessed over 48 h, there is a progressive divergence between FPS‐R and N‐PASS. There is, however, reason to extend the use of the FPS‐R also to the neonatal arena, as the rate of agreement between N‐PASS and FPS‐R to categorize an infant as being in distress or not remains stable. Preference of item‐ or empathy‐based assessment may be a question of personal philosophy rather than medical science.     

Pacifier and swaddling effective in impeding premature infant's pain score and heart rate

Objective

To assess the effectiveness of pacifier and swaddling on premature infant's pain score, hearthrate, and oxygen saturation during an invasive procedure.

Is foot reflexology effective in reducing colic symptoms in infants: A randomized placebo-controlled trial

ObjectivesInfantile colic and its accompanying crying represent a major source of stress and have negative physiological, emotional and psychological effects on infants and parents. The aim of this study was to examine the efficacy of foot reflexology for reducing symptoms of infantile colic.DesignThe study was conducted as a single-blind, randomized, placebo-controlled trial with a sample population of 45 infants diagnosed with infantile colic.MethodsSimple randomization was used to select a reflexology (study) group (n = 20) and a placebo group of infants with colic (n = 25). The parents and biostatistician were blinded to group assessment. Foot reflexology, or stimulating reflex points on the foot, was implemented with the reflexology group. Placebo foot reflexology, or noneffective touch, was used with the placebo group. Over a two-week period, both interventions were performed four times for 20 min each time by the researcher. The researcher collected data using the information form, the Infant Colic Scale (ICS), and a diary of daily crying duration.ResultsThe trial ended with the completion of the data. In each group, 20 infants were studied. The means of the Infant Colic Scale scores and daily crying duration were significantly lower in the foot-reflexology group than in the placebo foot-reflexology group (p < .001). Infants with colic in the reflexology group cried less and experienced fewer symptoms than before treatment.ConclusionsFoot reflexology is a non-invasive and safe nursing intervention that is effective for reducing crying duration and symptoms in infants with colic.     

The effect of immersion cryotherapy on medial‐lateral postural sway variability in individuals with a lateral ankle sprain

Background and Purpose . Postural stability has been shown to be impaired after a lateral ankle sprain (LAS) and after immersion cryotherapy in healthy ankles. This study was performed to determine the effects of cryotherapy on postural stability after LAS. Method . A single‐session, repeated measures design was used. Fifteen 18‐ to 29‐year‐old males (mean age 21.33 ± 3.54, height 71.23 ± 2.50 cm, mass 170.33 ± 19.77 kg) with relatively recent grade I LAS volunteered. Medial‐lateral postural sway variability was assessed during single‐leg barefoot stance using a Bertec force platform. Sway was tested before cryotherapy (‘Pre’), immediately after 20 minutes of lower‐leg immersion cryotherapy (‘Post₀’), and 10 and 20 minutes after cryotherapy (‘Post₁₀’ and ‘Post₂₀’). Both legs were tested (individually) before cryotherapy; the involved leg was tested alone after cryotherapy. The uninvolved leg served as a control. Results . Postural sway variability of the involved le was significantly greater than the uninvolved le before cryotherapy (p = 0.001). Postural sway variability of the involved le was also significantly greater than the uninvolved LE during Post₀ (p = 0.000), Post₁₀ (p = 0.000) and Post₂₀ testing (p = 0.003) with the largest increase in sway variability occurring at Post₀. Conclusions . Medial‐lateral postural sway variability was greater after LAS. This effect was augmented by immersion cryotherapy. Copyright © 2008 John Wiley & Sons, Ltd.     

Effect of nursing interventions on stressors of parents of premature infants in neonatal intensive care unit

Aim. This study was planned for the purpose of determining the effect of stress‐reducing nursing interventions on the stress levels of mothers and fathers of premature infants in a Neonatal Intensive Care Unit (NICU). Design. Randomised intervention. Background. The physical and psychosocial environment of the NICU is a major factor in the stress experienced by the family. Method. Interviews were conducted with the parents of premature infants who agreed to participate in the research. An approximately 30‐minute educational programme about their infant and the intensive care unit was held for the mothers and fathers in the intervention group within the first week after their infant was admitted to the intensive care unit. Then they were introduced to the unit and personnel. They were given the information they requested and their questions were responded to. The parents in the control group received nothing in addition to the routine unit procedures. The mothers and fathers’ stress scores were measured for both groups after their infants’ 10th day in the NICU with the Parental Stress Scale: NICU (PSS:NICU). Results. The difference between the intervention group and the control group mothers’ mean stress score was found to be statistically significant (t = 4·05, p < 0·05). It was determined that the stress scores for the fathers in the treatment group in this research were lower, but the difference between the two groups was not found to be statistically significant (p > 0·05). Conclusion. It has been determined that parents experience very high stress levels when their infants are admitted to an NICU and that there are nursing interventions which can be implemented to decrease their levels of stress. Relevance to clinical practice. Determining the sources of stress experienced by parents can help NICU nurses use appropriate interventions in cooperation with other members of the team to decrease the stress that parents experience.     

Maternally administered tactile,auditory, visual,and vestibular stimulation: Relationship to later interactions between mothers and premature infants

Thirty-three mother-infant pairs were randomly assigned to one of three groups: control, talking, or interactive (RISS). The later treatment included massage, talking, eye contact and rocking. The intervention (RISS) was administered to determine whether mothers and their preterm infants who actively interacted with each other would differ on later maternal and infant behaviors. The talking and RISS treatments were administered at specified time intervals 24 hours after delivery. Prior to hospital discharge, mother-infant interaction was assessed during a feeding. Significant differences were identified among the three groups for maternal (p <.03) and infant (p <.05) behaviors. These results suggest that active maternal interaction with the premature infant may enhance specific components of mother-infant interaction.     

Heritability of chronic pain in 2195 extended families

Chronic pain is pathological, persisting beyond normal tissue healing time. Previous work has suggested ～50% variation in chronic pain development is heritable. No data are currently available on the heritability of pain categorized using the Chronic Pain Grade (CPG). Furthermore, few existing studies have accounted for potential confounders that may themselves be under genetic control or indeed ‘heritable’ non‐genetic traits. This study aimed to determine the relative contributions of genetic, measured and shared environmental and lifestyle factors to chronic pain. Chronic pain status was determined and CPG measured in participants from Generation Scotland: the Scottish Family Health Study, a large cohort of well‐characterized, extended families from throughout Scotland, UK. Heritability estimates (h ²) for ‘any chronic pain’ and ‘severe’ chronic pain (CPG 3 or 4) were generated using SOLAR software, with and without adjustment for shared household effects and measured covariates age, body mass index, gender, household income, occupation and physical activity. Data were available for 7644 individuals in 2195 extended families. Without adjustment, h ² for ‘any chronic pain’ was 29% [standard errors (SE) 6%; p < 0.001], and for ‘severe’ chronic pain was 44% (SE 3%; p <0.001). After adjustment, ‘any chronic pain’ h ² = 16% (SE 7%; p = 0.02) and ‘severe’ chronic pain h ² = 30% (SE 13%; p = 0.007). Co‐heritability of both traits was 11% (SE 76%). This study supports the use of chronic pain as a phenotype in genetic studies, with adequate correction for confounders to specifically identify genetic risk factors for chronic pain.     

A double-blind randomised controlled trial of 25% oral glucose for pain relief in 2-month old infants undergoing immunisation

BackgroundInfant immunisation is the most commonly performed health procedure in developed countries. Associated pain may be harmful because we do not know what painful experiences the infant has already had and whether it might contribute to a cumulative pain experience. Healthy infants undergo immunisation with minimal pain relief. However, immunisation pain can be managed using oral sweet solutions.ObjectiveTo determine the effectiveness of 25% oral glucose solution in reducing immunisation pain in 2-month old infants.Trial design and methodsA double-blind, randomised controlled trial conducted in Jordan. A total of 120 healthy full-term infants who met the eligibility criteria and were attending immunisation clinics for routine 2-month immunisation were randomised to receive either 2 mL of 25% oral glucose solution immediately prior to their immunisation or 2 mL of oral sterile water. Researchers, nurses and parents were blind to the solution. Primary outcome was behavioural pain measured using the Modified Behavioural Pain Scale (MBPS). Secondary outcomes were crying time and duration of full-lung cry. Crying was registered from onset of the immunisation injection and for up to 120 s after completion of the injection procedure.ResultsInfants in the intervention group experienced statistically and clinically significant reduction in behavioural pain responses (p < 0.001), and spent less time crying up to 2 min after the procedure (mean difference 38 vs. 77.9 s).ConclusionA 2 mL oral dose of 25% glucose given immediately before an immunisation procedure reduces pain in 2-month old infants.