Procedural pain and patient-reported side effects with weekly injections of subcutaneous Methotrexate in children with rheumatic disorders

Bechard, Melanie; Lemieux, Julie; Roth, Johannes; Duffy, Karen Watanabe; Duffy, Ciarán M.; Aglipay, Mary; Juřenčák, Roman

doi:10.1186/1546-0096-12-54

Cited by 19 publications

(23 citation statements)

References 30 publications

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“…Even when the disease-related symptoms were under control, JIA treatments made their child sick in other ways. This finding is consistent with previous studies that also reported children with JIA experienced difficulty and side effects with some medications such as Methotrexate (Bechard et al, 2014; Mulligan et al, 2013; Mulligan, Wedderburn, & Newman, 2015). Parents struggled with administering injectable medications due to the pain and discomfort it caused the child.…”

Section: Discussionsupporting

confidence: 93%

Struggling in the Dark to Help My Child: Parents' Experience in Caring for a Young Child with Juvenile Idiopathic Arthritis

Yuwen

Lewis

Walker

et al. 2017

Journal of Pediatric Nursing

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Purpose The purpose of this study is to describe parents’ experiences in caring for 2–5-year-old children with juvenile idiopathic arthritis (JIA). Design and methods A qualitative study using single-occasion in-depth interviews was conducted. Nine parents (eight mothers and one father) were interviewed in-person or via telephone. Data were analyzed using inductive content analysis. Methods used to protect the trustworthiness of study results included maintenance of an audit trail, peer debriefing, and member checks. Results The core construct Struggling in the Dark to Help My Child explained parents’ experience in six domains: not knowing, trying to reach out in the dark, feeling my child’s pain, working out the kinks to stay on top to manage, feeling drained by the whole process, and being hard on the entire household. Parents struggled with the unknown, searched for resources, witnessed their child’s suffering without knowing how to help, and tried every possible way to stay on top of the child’s illness and treatment, even when they felt drained physically and emotionally. JIA not only consumed their lives, but also affected the entire family, including the siblings and spouse, and the relationships among family members. Conclusion and implications Findings highlight the day-to-day lived challenges parents face when caring for a young child with JIA. Healthcare providers including nurses need to assess the particular needs of an ill child and parents as well as the impact of the illness on the physical and psychosocial health of the entire family so that proper resources can be provided.

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Section: Discussionsupporting

confidence: 93%

Struggling in the Dark to Help My Child: Parents' Experience in Caring for a Young Child with Juvenile Idiopathic Arthritis

Yuwen

Lewis

Walker

et al. 2017

Journal of Pediatric Nursing

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“…Methotrexate intolerance may be particularly evident among children with JIA (49), and there seems to be a strong positive association between side effects of methotrexate and needle pain (50,51). This intolerance was not the main topic in this study, but ndings indicated that intolerance played an important role in children's experiences with needle injections.…”

Section: Building Con Dence In Everyday Lifementioning

confidence: 61%

I don’t want to think about it: a qualitative study of children (6 -18 years) with rheumatic diseases and parents' experiences with regular needle injections at home

Sørensen

Skirbekk

Kvarstein³

et al. 2020

Preprint

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Background Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living.Methods This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16 years (n = 7) and their parents (n = 8) were interviewed individually 4 to 6 months after the onset of needle injection treatment. The focus groups included children aged 11 to 17 years (n = 9) and parents (n = 8) with a minimum of 6 months of experience with injection treatment. Data were analyzed using thematic analysis. Results The main themes; “challenges,” “motivational factors,” and “routines” captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The children’s experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet. Conclusions Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.

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“…A (17) Todos D (20) Participaram do estudo crianças em uso de injeções (SC) de metotrexato. Avaliada a dor por escalas de dores, os participantes e os responsáveis foram treinados para aplicação das escalas.…”

Section: Metodologia Resultados Principaisunclassified

“…Os resultados dos estudos incluídos demonstraram que a tecnologia da HDC é um procedimento alternativo para a administração de medicamentos de diversas classes e tipos de tratamentos, para outras patologias e situações não restritas à diabetes e alergia infantil. Resultados significativos para as crianças que participaram dos estudos desta revisão são relativos à rápida melhora hemodinâmica e sintomática, com menor desconforto e ausência de eventos adversos graves (17)(18)(19)(20)(21)(22) .…”

Section: Discussionunclassified

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Hipodermóclise Para Tratamentos Não Convencionais Em Pediatria: Revisão Integrativa

et al. 2019

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Objetivo: descrever o uso da hipodermóclise em tratamentos pediátricos não convencionais.Método: revisão integrativa, com período amostral de 2010 a 2018, em cinco bases de dados.Dois revisores independentes procederam à seleção dos artigos. Após foi realizada avaliação pelonível de evidência, segundo Instituto Joanna Briggs.Resultados: foram selecionados seis artigos internacionais, com evidência de nível 1 e 3. As doençase situações não-convencionais para o tratamento via hipodermóclise foram: artrite idiopáticajuvenil poliarticular; prevenção de hiponatremia na restrição de fluidos; sedação em tratamentoodontológico; desordens reumáticas; antibioticoterapia e hipertensão arterial pulmonar refratária.Conclusão: o procedimento constitui-se como opcional efetivo e seguro para administração demedicamentos em crianças, justificada devido à minimização da intensidade da dor e proteçãodo estresse da criança, família e equipe de enfermagem. Contudo, são necessárias mais pesquisaspara fundamentá-lo cientificamente, e para implementação na prática profissional.

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Procedural pain and patient-reported side effects with weekly injections of subcutaneous Methotrexate in children with rheumatic disorders

Cited by 19 publications

References 30 publications

Struggling in the Dark to Help My Child: Parents' Experience in Caring for a Young Child with Juvenile Idiopathic Arthritis

Struggling in the Dark to Help My Child: Parents' Experience in Caring for a Young Child with Juvenile Idiopathic Arthritis

I don’t want to think about it: a qualitative study of children (6 -18 years) with rheumatic diseases and parents' experiences with regular needle injections at home

Hipodermóclise Para Tratamentos Não Convencionais Em Pediatria: Revisão Integrativa

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