Communication and Control: Parent, Child, and Health Care Professional Interactions During Painful Procedures

Abstract

Through use of a qualitative ethological approach, observations of 17 children who were undergoing 44 painful procedures during cancer diagnosis or treatment were videotaped and analyzed. The children, aged 4 to 18 years, were part of a larger study testing the effectiveness of nonpharmacologic pain management techniques. Analysis of the videotaped observations revealed that several distinct patterns of conversation between caregivers, parents, and children varied greatly among situations. Both child-centered and nonchild-centered communications were demonstrated. During periods of quiet, nonchild-centered behaviors increased. As a child's distress increased, parents actively changed behaviors to redirect verbal support back to the child and to the pain control interventions. Nurses' encouraging parents to be actively involved and physically close during painful treatments may results in less distress and discomfort for the child. In addition, health care professionals need to be aware of the various patterns of child-parent-caregiver interactions and the need to stay focused on the child during painful procedures to enhance the child's ability to cope.

Parents’ Positioning and Distracting Children During Venipuncture

“…Our findings are consistent with the results of other studies indicating that parents need to be given a clear role, guidance, and coaching to maximize their presence in facilitating a child's coping (Bauchner, 1991;Broome, 1990Broome, , 2000Cohen et al, 1997;Colaizzo & Tesler, 1994;Fanurik, Koh, Schmitz, & Brown, 1997;Goldberger et al 1990;Kristensson-Hallstron, 1999;Manne et al, 1994;Rusy & Weisman, 2000). Moreover, children's distress (Naber, Broome, & Rehwaldt, 1995) and parents' anxiety (Bauchner et al, 1996) have been found to be reduced when parents receive guidance on providing positive parental attention and physical closeness with their child.…”

Pediatric nurses view about parental presence during children's painful procedures

“…[16] Ağrılı işlemler sırasında ebeveynin çocuğunun yanında olması çocuğu için yapılan uygulamayı görmesini sağ-lar ve aile üyeleri ile sağlık personeli arasında güçlü bir bağ kurulmasına da yardımcı olur ve çocuğun stresi azalıp işleme uyumunu artırır. [17,18] Ebeveynlerin ağrılı işlemler sırasında çocuklarıyla birlikte olmasının yararları yapılan çalışmalarla ortaya konmuş olmasına karşın sağlık personeli ağrılı işlemler sıra-sında ebeveynlerin çocuklarıyla birlikte olması konusunda bazı tereddütler yaşamaktadırlar. [6] Hastanelerde oluşturulacak politika ve prosedürle-rin aile merkezli olabilmesi ve ağrılı işlemlerde ço-cukların yanında kalabilmeleri için gerekli politika ve prosedürlerin geliştirilebilmesi için öncelikle sağlık personelinin konu ile ilgili görüşlerinin belirlenmesi gerekmektedir.…”

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

“…In the literature reviewed, an extensive amount has been written on adult communication during painful procedures and child behavioral distress (Blount et al, 1989;Blount, Sturges, & Power, 1990;Blount et al, 2000;Cline et al, 2006;Cohen et al, 2002;Dahlquist et al, 2001;Fanurik, Koh, & Schmitz, 2000;Frank, Blount, Smith, Manimala, & Martin, 1995;Gelfand & Dahlquist, 2003;Jay, 1988;Manimala, Blount, & Cohen, 2000;Manne et al, 1992;McCarthy et al, 2010;Naber, Halstead, Broome, & Rehwaldt, 1995;Slifer et al, 2011;Sweet & McGrath, 1998;Vessey, Carlson, & McGill, 1994). Pediatric procedural distress has been a topic of focus mainly in the area of pediatric oncology specific to lumbar punctures, bone marrow aspirations (Blount et al, 1989;Blount et al, 1990;Blount et al, 2000;Cline et al, 2006;Dahlquist et al, 2001;Gelfand & Dalquist, 2003;Naber et al, 1995) and needle procedures that include venipuncture, immunizations, and intravenous catheter insertion in the inpatient and outpatient setting (Cohen et al, 2002;Fanurik et al, 2000;Frank et al, 1995;Manimala et al, 2000;Manne et al, 1992;McCarthy et al, 2010;Slifer et al, 2011;Sweet & McGrath, 1998;Vessey et al, 1994).…”

“…Pediatric procedural distress has been a topic of focus mainly in the area of pediatric oncology specific to lumbar punctures, bone marrow aspirations (Blount et al, 1989;Blount et al, 1990;Blount et al, 2000;Cline et al, 2006;Dahlquist et al, 2001;Gelfand & Dalquist, 2003;Naber et al, 1995) and needle procedures that include venipuncture, immunizations, and intravenous catheter insertion in the inpatient and outpatient setting (Cohen et al, 2002;Fanurik et al, 2000;Frank et al, 1995;Manimala et al, 2000;Manne et al, 1992;McCarthy et al, 2010;Slifer et al, 2011;Sweet & McGrath, 1998;Vessey et al, 1994).…”

“…Two qualitative studies were located that examined communication patterns during painful pediatric cancer procedures (Cline et al, 2006;Naber et al, 1995). Cline et al Only a few studies were located that examined child life services in the ED during routine peripheral venous angiocatheter insertion, venipuncture (Cavender et al, 2004;Stevenson, Bivins, O'Brien, & Gonzalez del Rey, 2005), suturing , environment and waiting behaviors (Alcock, Goodman, Feldman, McGrath, Park, & Cappelli, 1985), and availability of child life programs in pediatric emergency departments (Krebel, Clayton, and Graham, 1996).…”