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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.

Nurses must strive for increased cultural competence and explore ways to make healthcare services sensitive to culturally diverse groups. Nurses have an educational role in educating parents and children about pain and the importance of sufficient pain relief. All healthcare providers should be aware of their own cultural values and the risk of stereotyping people.

Relaxation and guided imagery do not reduce stress, pain and unpleasantness for 11-to 12-year-old girls during vaccinations, 2015, Acta Paediatrica, (104) Abstract AimRelaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. We examined whether its use decreased the stress experienced by 11 to 12-year-old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain. MethodA randomised crossover trial was conducted with 37 girls. During the first vaccination, each girl was randomised to receive either relaxation and guided imagery or standard care. They then received the other form of care during the second vaccination. Salivary cortisol was measured before each vaccination and 30 minutes after it was administered. The girls reported pain intensity and pain unpleasantness before and directly after each vaccination and stress after each vaccination. ResultsOn a group level, relaxation and guided imagery did not decrease cortisol levels, selfreported stress, pain intensity and pain unpleasantness. Salivary cortisol levels decreased significantly in both groups during the second vaccination. ConclusionRelaxation and guided imagery did not prove beneficial during the vaccination of 11 to 12-year-old girls and is not recommended as a regular nursing intervention. However, further research is needed into effective techniques to help children who experience pain unpleasantness in connection with needle procedures. Key notes Relaxation and guided imagery is a distraction technique known to reduce discomfort during paediatric medical procedures. 3 We found that its use did not decrease the stress experienced by a group of 11 to 12-year-old girls receiving the human papilloma virus vaccination, as well as the intensity and unpleasantness of any pain. However, further research is needed into effective techniques to help children who experience pain unpleasantness with needle procedures. BACKGROUND

Patients with asthma-like symptoms benefit from taking part in a problem-based learning health education programme. It helps them to reflect upon themselves and the disorder and to use new strategies to cope with it.