Our clinical nursing articles aim to inform and educate nurse practitioners and students. This is achieved through the publication of peer-reviewed, evidence-based, relevant and topical articles.
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.
Children spending prolonged periods in hospital need to play and express themselves
Children’s nurses require education and training in mental health to provide optimal care
It is vital that nurses understand the importance of injection site assessment
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.
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.
Exploring the evidence for and against the practice of family-witnessed resuscitation
Genetic testing of children to predict the future risk of illness remains controversial
Developing a tool to measure competence in the decision-making process in children aged 8-12
The complex issues involved in the care of children who receive life-sustaining treatment
Meeting the needs of children with palliative conditions and those of their families
Key themes are identified: adolescent life course, risk and vulnerability, and safeguarding