Evidence and Practice

Clinical

Nurses’ underuse of non-pharmacological pain relief interventions in preterm infants

Nurses’ underuse of non-pharmacological pain relief interventions in preterm infants

Why you should read this article • To understand the experience of pain in preterm infants • To enhance your knowledge of the factors that make nurses less likely to use non-pharmacological pain relief in preterm infants • To recognise the role of local and national guidelines in providing pain relief for preterm infants The aim of this literature review was to explore nurses’ underuse of non-pharmacological pain relief interventions for minor procedures in preterm infants on neonatal intensive care units (NICUs). A search of the literature using keywords was undertaken using multiple databases. After inclusion and exclusion criteria were applied, three main themes emerged from 11 studies: preterm infant factors; nurse factors; and organisational factors. The literature review found that nurses consistently underused non-pharmacological pain relief interventions for minor procedures in preterm infants. Several contributory factors were identified, including the absence of pain guidelines, the quality of nurses’ training and education, patient acuity, the lower gestational age of patients, and the intensity level of NICUs. Recommendations for future practice include the implementation of pain guidelines and validated pain assessment tools via neonatal clinical networks and local pain champions. Effective dissemination of education and training for nurses in pain affecting preterm infants is also required to overcome barriers such as staff shortages and excessive workloads.

Family members’ perceptions of a Singing Medicine project in a children’s hospital

Family members’ perceptions of a Singing Medicine project in a children’s hospital

Children spending prolonged periods in hospital need to play and express themselves

Enhancing the care of children and young people with mental health issues

Enhancing the care of children and young people with mental health issues

Children’s nurses require education and training in mental health to provide optimal care

Frequency of injection site assessment for lipohypertrophy in children and young people with type 1 diabetes

Injection site assessment for lipohypertrophy in children with type 1 diabetes

It is vital that nurses understand the importance of injection site assessment

Does parental anxiety affect children’s perception of pain during intravenous...

Background Pain associated with invasive medical procedures is a significant cause of anxiety for parents. This may increase children’s anxiety, pain and fear. Aim To determine the anxiety perceived by parents of children undergoing intravenous cannulation and the influence of parental anxiety on the intensity of pain experienced, and to explore the association between selected variables and anxiety perceived by parents. Method A descriptive correlational approach was adopted and a purposive sample of 48 children and their parents was selected. The pilot study was conducted in the children’s wards of a selected hospital in Mumbai, India, between August 2017 and January 2018. Parental anxiety was assessed using the short version of the Depression and Anxiety Stress Scales. Pain experienced by children was assessed using the Faces Pain Scale-Revised. Results Mild anxiety was experienced by 6% (n=6) of parents, while 52% (n=25) had moderate to extreme anxiety. More than one third of the children (35%, n=17) reported moderate pain and 31% (n=15) reported severe pain. A positive correlation was found between pain and parental anxiety and between parental anxiety and age and birth order. Conclusion Parental anxiety influences the perception of pain in children. Parents should be made aware of how their anxiety can affect children’s pain experiences during medical procedures and take measures to reduce anxiety, such as relaxation, distraction and deep breathing. Children’s nurses can help parents manage preprocedural anxiety to reduce the traumatic effect on children.

In the child’s best interests: should life be sustained when further treatment is futile?

In the child’s best interests: should life be sustained when further treatment is...

Why you should read this article: • To understand that medical advances have meant that children with complex diseases are living longer, but in some cases prolonging treatment may be deemed futile • To understand the ethics involved in decisions about withholding or withdrawing treatment and the best interests of the child • To recognise the importance of nurturing partnerships and encouraging parents to be involved in decision-making particularly about end of life care The aim of this article is to explore the concept of medical futility and the withdrawal of care for children in intensive care units. There have been several recent cases where medical staff have considered that there was no possibility of recovery for a child, yet their clinical judgments were challenged by the parents. The private anguish of these families became public, social media heightened emotions and this was followed by political and religious intrusion. Innovations in medical treatment and technological advances raise issues for all those involved in the care of children and young people especially when decisions need to be made about end of life care. Healthcare professionals have a moral and legal obligation to determine when treatment should cease in cases where it is determined to be futile. The aim should be to work collaboratively with parents but all decisions must be made in the best interests of the child. However, medical staff and parents may have differing opinions about care decisions. In part, this may be as a result of their unique relationships with the child and different understanding of the extent to which the child is in discomfort or can endure pain.

CPD articles

Care and management of children with a totally implanted central venous access device: portacath

Care and management of children with a totally implanted central venous access device:...

Research and advances in technology have enabled children and young people with life-limiting conditions to live longer. To maintain their well-being and quality of life many of these children usually require some form of intravenous access for treatment. Children’s nurses should have the skills and training to ensure they are competent to practise using totally implanted central venous access devices such as portacaths (ports). This article addresses the care and management of these ports in children and the wide variation in practice that exists in the UK, and makes recommendations for practice.

The Me first communication model

The Me first communication model

This article explores communication and decision-making with children and young people in healthcare. Children and young people report that healthcare professionals are good at explaining and helping them to understand what will happen to them, but that they do not feel involved in decision-making about their care or treatment. To improve communication with children and young people, they need to be involved in decision-making about their care and treatment. In partnership with children, young people and healthcare professionals Common Room Consulting, Great Ormond Street Hospital for Children NHS Foundation Trust and Health Education England have co-produced a communication model, Me first, to support decision-making with children and young people in healthcare. This article introduces the Me first model and explores how it can be applied in clinical practice.

Migraine

Diagnosing and managing migraine in children and young people

This article gives an overview of migraine in children. It outlines the epidemiology of the condition and describes presentation with headache and other symptoms and linked conditions. It aims to raise awareness of the diagnosis of migraine and its impact on children and young people, their families and school life. The author also describes methods of diagnosis and management, and the importance of recognising and of avoiding medication overuse.

Complementary feeding

An update on complementary feeding

Complementary feeding is an important developmental milestone in children and occurs at a formative time for the development of healthy eating habits that can continue into later childhood and beyond. The timing of weaning has been a controversial subject and recommendations in the UK differ from those in Europe. In the UK and New Zealand, baby-led weaning is becoming increasingly popular. The importance of responsive feeding is highlighted to make parents aware of a baby’s cues indicating hunger or fullness. There have also been advances in the science of immunology that deem the early introduction of allergens to be a preventive strategy for food allergies. This article discusses the nutritional requirements for infants and reviews the foods that should be introduced and avoided. Guidelines are changing all the time, so nurses must keep up to date with current research to be able to offer advice to parents of infants.

Assessment and treatment of nocturnal enuresis in children and young people

Assessment and treatment of nocturnal enuresis in children and young people

Nocturnal enuresis – or bed-wetting – is one of the most common chronic conditions of childhood. It has a significant effect on the quality of life of affected children and their families and is associated with several comorbidities, some of which resolve on successful treatment. The causes of this troublesome condition are explored and the principles of assessment and treatment are discussed with reference to National Institute for Health and Care Excellence guidance as well as research. Response to treatment resistance is considered and appropriate onward referral discussed.

Suctioning

Principles of suctioning in infants, children and young people

Suctioning to clear airway secretions is an important part of the nursing care for children with respiratory conditions. While the principles of safe suctioning are known widely, they are not closely adhered to. The adverse effects of suctioning can easily be overlooked to the detriment of the patient. Careful risk assessment and patient observation are needed to ensure that suctioning is performed only when necessary and the risks to the patient are minimised.

A to Z of syndromes

Mother and baby

A-Z syndromes: Congenital Zika syndrome

First identified in 2015, there is no vaccine for this virus

Webbed_fingers

A-Z syndromes: Yunis-Varon syndrome

An insight into this rare genetic disorder in which both parents are recessive gene carriers

A-Z of syndromes: X-linked ichthyosis

An insight into this genetic disorder occurring in 1 in 6,000 infant males

Stef Sanjati

A-Z of syndromes: Waardenburg syndrome

Waardenburg syndrome is a genetic disorder that gives people a distinctive appearance

A-Z of syndromes: Usher syndrome

Understanding Usher syndrome which is found in approximately 10,000 people in the UK

Tay-sachs disease

A-Z Syndromes: Tay-Sachs disease

An insight into this genetic disorder which carries a poor prognosis and is often fatal

Jobs