The effects of audiovisual distraction on children's pain during laceration repair

This study aimed to determine the effects of audiovisual distraction on pain in children during laceration repair in emergency room settings. This study was designed as a randomized controlled trial. Eighty‐four children aged 3–10 years were randomized to either the experimental group or the control group. Pain response was assessed by the Faces Pain Rating Scale, a visual analogue scale and the Procedure Behaviour Checklist. We measured salivary cortisol levels as a physiological pain response. The results showed that the sensory and affective pain responses were significantly lower in magnitude in the experimental group than in the control group. There was no statistically significant difference in physiological pain responses between the two groups. Audiovisual distraction might be a helpful method to reduce children's pain during laceration repair in emergency room settings.     

Personal control in pain relief during labour

Personal control is a central feature of women's involvement in their childbirth experiences. To achieve this control tacit rules and guidelines are applied to define how women and the professionals who care for them should behave. This study investigated the extent to which women exercised control in pain relief during the first stage of labour by comparing (a) the rules which they held prior to childbirth (2-3 cm cervical dilatation) with those which they afterwards felt applied to their labour and (b) the rules held by the women before and after childbirth with those held by the midwives. In a quantitative study using a repeated measures design, a questionnaire was administered to 35 midwives and to 100 women prior to and within 24 hours following their delivery. Consistency of the women's scores before and after childbirth, indicated by few statistically significant differences, tended to confirm their rules on control of pain relief. Some of the rules were held even more strongly following childbirth. A surprising finding was the even stronger agreement by midwives with some of the rules. There was a definite trend for many of the rules held by the women prior to childbirth to increase following birth towards those of the midwives. This could be the result of the experience of childbirth per se but the possibility that it was contributed to by the influence of the midwives cannot be ruled out and warrants further research. An interesting hierarchy in the rules for compliance with professional care has been highlighted.     

Improvements in pain relief,handling time and pressure ulcers through internal audits of hip fracture patients

The aim of this project was to improve the outcome of hip fracture patients by optimizing preoperative pain relief, diminishing the time from admission to operation and reducing the occurrence of pressure ulcers. A retrospective study of all medical records of hip fracture patients from the last 4 months in 1998 was compared with prospective registrations during the same period in 1999 and 2000 after the introduction of quality improvements. The number of patients who waited for more than 1 hour to get pain relief was almost halved after improvements. In 1998, close to half of the patients had to wait more than 24 hours for an operation. After attention was given to quality improvements, 36% of the patients in 1999 and 34% of the patients in 2000 had to wait more than 24 hours. In addition, 18% of the patients in 1999 and 24% of the patients in 2000 vs. 11% in 1998 were operated on within 12 had to wait more than 24 hours. Pressure ulcers were considerably reduced. In total, 19% of the patients in 1998, 8% in 1999 and 4.5% in 2000 had pressure ulcers at discharge from the hospital. The outcome for hip fracture patients was improved through attention to quality improvements with all staff involved and focused on these patients.     

注意力转移法在患儿颌面外伤护理中的应用

目的探索注意力转移法在患儿颌面外伤护理中的应用效果。方法选取颌面外伤的患儿88例,按就诊先后顺序分为实验组及对照组,每组各44例。实验组在治疗护理中采用注意力转移法,对照组采用强制束缚的传统方法。比较两组患儿的伤口处理时间和痊愈时间、患儿舒适度和治疗依从性。结果实验组处理时间短于对照组;患儿舒适度和治疗依从性均优于对照组,两组比较,差异具有统计学意义(P0.05)。结论在患儿颌面外伤治疗和护理中实施注意力转移法,提高了患儿舒适度和治疗依从性,缩短了伤口处理时间,值得临床推广应用。     

Epidural analgesia for pain relief in labour and childbirth - a review with a systematic approach

Background. Clinical ambiguity concerning effects of epidural analgesia for pain relief in labour seems to reflect a need for evidence‐based knowledge for midwives. Aims. This study aimed to review, with a systematic approach, the literature about effects and risks associated with the use of epidural analgesia for pain relief in labour and childbirth. Design. A structured question was formulated and used for deriving search terms, establishing the inclusion of certain criteria and retrieving articles, i.e. what are the effects of epidural analgesia for pain relief in labour and childbirth? References were obtained through searches using MeSH‐terms in Medline and Subheadings (SH) in CINAHL (e.g. Obstetrical Analgesia combined either with psychology or adverse effects and together with, Dystocia, Caesarean Section, Infant Newborn and Breastfeeding). The articles were divided into prospective randomized trials (C), non‐randomized prospective studies (P) and retrospective studies (R). Scientific quality of the studies was assessed on a three‐grade scale: high scientific quality (I), moderate scientific quality (II) or low scientific quality (III). Results. Twenty‐four articles were retrieved and systematically assessed. Seven studies were judged as high quality, 15 as moderate quality and two as low quality. The majority of studies appraised in this review failed to obtain or establish a cause and effect relationship. According to the data, it seems clear that the use of epidural analgesia is considered to be an effective method of pain relief during labour and childbirth from the perspective of women giving birth. Relevance to clinical practice. Midwives and doctors can recommend this form of pain relief. However, information about possible associations with adverse effects in mothers and infants must be provided to expectant couples.     

Satisfaction in childbirth and perceptions of personal control in pain relief during labour

Satisfaction in childbirth is influenced by individual and environmental factors. Of specific interest in this study is the extent to which women feel that they have been able to control what happened to them during labour. The main purpose of this study was to examine the influence of personal control on women's satisfaction with pain relief during labour. A questionnaire-based retrospective study of women's pain experiences within 48 hours of delivery was carried out on the postnatal ward of one teaching hospital in Northern Ireland. One hundred women who had had a vaginal delivery consented to take part in the study. Two main measures were used in the study; personal control in and satisfaction with pain relief during labour. The key finding of this study indicates that feelings of personal control influenced positively the women's satisfaction with pain relief during labour. Demographic and other psycho-social variables had little impact on the women's satisfaction scores. These findings have implications for clinical practice and for the management of maternity services and are discussed.     

Laughter, humor and pain perception in children: a pilot study

Although there are many clinical programs designed to bring humor into pediatric hospitals, there has been very little research with children or adolescents concerning the specific utility of humor for children undergoing stressful or painful procedures. Rx Laughter, a non-profit organization interested in the use of humor for healing, collaborated with UCLA to collect preliminary data on a sample of 18 children aged 7-16 years. Participants watched humorous video-tapes before, during and after a standardized pain task that involved placing a hand in cold water. Pain appraisal (ratings of pain severity) and pain tolerance (submersion time) were recorded and examined in relation to humor indicators (number of laughs/smiles during each video and child ratings of how funny the video was). Whereas humor indicators were not significantly associated with pain appraisal or tolerance, the group demonstrated significantly greater pain tolerance while viewing funny videos than when viewing the videos immediately before or after the cold-water task. The results suggest that humorous distraction is useful to help children and adolescents tolerate painful procedures. Further study is indicated to explore the specific mechanism of this benefit.     

Chinese parent's use of nonpharmacological methods in children's postoperative pain relief

Parental participation in paediatric postoperative care is common in China. However, the knowledge is limited on what methods parents use to relieve their children's postoperative pain in hospital. The purpose of this study was to describe what nonpharmacological methods parents use to relieve their children's postoperative pain and factors related to this. A previously validated Scandinavian questionnaire survey was conducted in five provincial hospitals in Fujian, China, in 2004. Parents (n = 206) whose children had undergone operation were asked to complete questionnaires concerning nonpharmacological methods for children's pain relief. The response rate was 88%. Results show that the most commonly used methods by parents were emotional support strategies, helping with daily activities, distraction and imagery. Breathing technique was the method used least frequently. Fathers and parents who were older, more educated, employed and with earlier hospitalization experience with their children used pain alleviation methods more frequently than mothers and parents without these characteristics. Moreover, parents used some methods more frequently with boys, younger children, as well as children admitted for selective operations, with longer duration of hospitalization and with moderate or severe pain. Parents utilized various nonpharmacological methods for children's pain relief, especially those easy to use. This study may serve to focus healthcare providers' efforts on educating parents with respect to various nonpharmacological pain alleviation methods available for postoperative pain. Furthermore, this study provides parents an opportunity to be aware of their role in their children's pain management.     

持续静脉输注吗啡用于腹部手术后的镇痛效果

应用微量输液泵持续静脉输注吗啡（ＣＩＭ）进行腹部手术后镇痛的前瞻性临床研究，４０例腹部大中手术患者随机分入两组，实验组接受ＣＩＭ法镇痛，对照组采用常规间断肌注哌啶镇痛（ＩＭＰ）。实验组２０例术后２４ｈ内镇痛效果均达Ⅰ～Ⅱ级，而对照组肌注哌啶后２ｈ内有７０％患者达Ⅰ～Ⅱ级，仅１０％患者在肌注２ｈ后仍保持Ⅰ～Ⅱ级的镇痛效果。实验、对照组患者术后２４ｈ睡眠时间分别为６．２±１．９ｈ和４．０±１．２ｈ（Ｐ＜０．０１）。ＣＩＭ法术后肠道通气时间短于ＩＭＰ法，分别为５４±１３ｈ和６６±１１ｈ（Ｐ＜０．０１）。两组呼吸频率、心率、血压、ＳｐＯ＿２等无明显差别。结果表明，微量泵持续静脉输注吗啡法镇痛效果优于常规方法，是一种简便、安全、有效的术后镇痛方法。     

The use of nonpharmacological methods for children's postoperative pain relief: Singapore nurses' perspectives

Purpose. The purpose of this study was to examine nurses' use of nonpharmacological methods for school‐age children's postoperative pain relief. Design and Methods. A survey was conducted in 2008 with a convenience sample of 134 registered nurses from 7 pediatric wards in Singapore. Results. Nurses who were younger, had less education, lower designation, less working experience, and no children of their own used nonpharmacological methods less frequently. Practice Implications. Nurses need training and education on nonpharmacological pain relief methods, particularly on methods that have been shown to be effective in prior research but that were less often used by nurses in this study: massage, thermal regulation, imagery, and positive reinforcement.     

A survey of Chinese nurses' guidance to parents in children's postoperative pain relief

Aims and objectives. The aim of the study was to describe parental guidance provided by Chinese nurses regarding non‐pharmacological methods in children's surgical pain relief as well as factors related to this. Background. Parental involvement in children's pain management has been acknowledged and encouraged in recent years. However, parents’ lack of related information has been pointed out and little is known about how parents are guided to use non‐pharmacological methods to relieve the pain. Methods. A previously validated European questionnaire survey was conducted in 2002. Structured questionnaires were distributed to all 187 nurses working at 12 surgical wards in five hospitals of Fujian Province, China. The average response rate was 98%. Results. The results show that nurses informed parents of the majority of cognitive information. The most commonly guided non‐pharmacological methods were distraction, positive reinforcement, comforting/reassurance, positioning and relaxation. Nurses’ background factors, including age, education, nursing position, professional work experience, number of their own children and experiences of earlier hospitalizations of their children, were significantly related to their perceptions regarding parental guidance. Conclusions. Chinese nurses provided much guidance to parents on non‐pharmacological methods. However, the results show that sensory information and physical methods were poorly conveyed to parents, which needs future attention to reinforce parents’ active role in pain management. Relevance to clinical practice. This study provides new information on Chinese nurses’ guiding parents to use non‐pharmacological methods in pain alleviation, thereby contributing to the body of knowledge on this subject. Furthermore, the study makes the respondents aware of the importance of involving parents in their child's pain management.     

Continuous flow 50:50 nitrous oxide:oxygen is effective for relief of procedural pain in the pediatric emergency department

Objectives: To determine applicability of continuous flow 50:50 N₂O:oxygen during painful procedures in our university-hospital pediatric emergency department (ED). Methods: Children scheduled to undergo a painful procedure were enrolled consecutively. 50:50 N₂O:oxygen was provided throughout the procedure. Pain was evaluated using a numerical pain scale (0: no pain to 10: unbearable pain) by children ≥6 years old, medical providers and parent. Duration of N₂O inhalation, recovery time, side effects, provision and type of supplementary analgesics were recorded. Results: Fifty-nine children, 0.5–15 years enrolled and 55 comprised the final study cohort. Pain scores, as reported by the different observers, were low. N₂O administration was more beneficial in children >3 versus <3. Under N₂O, pain during infiltration of the skin with lidocaine was higher than during suturing. Children returned to pre-inhalation behavior by a mean of 2.7±1.6 min. Vomiting, the most common side effect, occurred in five (9.0%) children. All parents reported that they would be willing for their child to use N₂O again, if necessary. Conclusions: Continuous flow 50:50 N₂O:oxygen is effective for procedural pain in the pediatric ED. It is agreeable to children, particularly >3 years old, medical providers and parents, provides short recovery times and bears minor adverse effects.