‘If I knew what was going to happen, it wouldn’t worry me so much’: Children’s, parents’ and health professionals’ perspectives on information for children undergoing a procedure

Bray, Lucy; Appleton, Victoria; Sharpe, Ashley

doi:10.1177/1367493519870654

Cited by 40 publications

(60 citation statements)

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“…This sense of credibility also provided the foundation for tailored information‐sharing practices including providing hope to parents and children by vocalizing the different options/solutions available to manage pain and creating opportunities for shared decision‐making 29 . Other research advocates the importance of supporting children's literacy through providing clear information tailored to their needs and available in a timely manner before their procedure 26 . Generic reassurance was also used to increase credibility.…”

Section: Discussionmentioning

confidence: 99%

How nurses use reassurance to support the management of acute and chronic pain in children and young people: An exploratory, interpretative qualitative study

Carter

Harris

Jordan

2021

Paediatric and Neonatal Pain

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Reassurance in the context of pediatric pain is regarded to promote distress. Typically, spoken reassurance is reported as short, generic statements (“it's ok,” “don't worry”); little research has considered wider reassuring behaviors and actions undertaken by nurses. Most studies focus on unidirectional, dyadic relationships between reassurance and pain (parent‐to‐child, professional‐to‐child) failing to capture the inherent complexities. Adopting an exploratory, interpretative, and qualitative approach, this paper reports on findings from the qualitative interview component of a mixed‐methods study, concerning how nurses actively use reassurance when talking to children and their parents about pain. Eighteen nurses with experience of managing children's pain were recruited on completion of an international online survey (distributed by pain and children's nursing networks and via newsletter, email, and social media). All 18 nurses completed a semi‐structured interview concerning their experiences of managing children's pain working in the UK (n = 14), Canada (n = 3), and Australia (n = 1) in primary, secondary, and tertiary settings with nursing experience ranging from pre‐qualification to >20 years. Thematic analysis generated three themes which reflect the main ways in which nurses focus their reassurance within encounters with children and their parent(s): (a) on child and parent(s), (b) on the child, and (c) on the parent. Nurses generated reassurance using language, gesture, relationship building, individualizing approaches, education, and preparation. The study highlights the diversity of reassurance provided by nurses in relation to children's pain. Our study finds that when nurses reassure children about pain, they focus their reassurance in three distinct directions (child, parents, and children and parents in partnership); this has not been specifically acknowledged by previous research. We highlight the wide range of implicit and explicit reassurance actions undertaken by nurses and propose that reassurance that extends beyond limited vocalizations is part of a complex package of care that can support children's current and future pain experiences.

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Section: Discussionmentioning

confidence: 99%

How nurses use reassurance to support the management of acute and chronic pain in children and young people: An exploratory, interpretative qualitative study

Carter

Harris

Jordan

2021

Paediatric and Neonatal Pain

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“…Children particularly valued that the Xploro intervention enabled them to customize and individualize their learning experiences; they could access different components of Xploro based on their individual preferences and information needs. Previous research indicates that children wish to receive information specific to them and are more likely to engage with and understand information delivered in a child-centered way [ 10 ]. It is increasingly recognized within the literature, particularly in relation to children, that health literacy is facilitated when an individual can tailor information to their needs and have the opportunity to process, question, and apply information to their individual circumstances [ 9 ] and actively construct knowledge and understanding [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Children’s distress and noncooperation during procedures can also result in longer appointments, delays to appointments, and referrals to psychological services, all of which have cost implications for health service providers. Children and their parents identify an unmet need for information about hospital procedures and interventions [ 8 , 9 ] and that such information would be valuable to help them know what to expect and how best to prepare themselves for a procedure [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Acceptability and Impact of the Xploro Digital Therapeutic Platform to Inform and Prepare Children for Planned Procedures in a Hospital: Before and After Evaluation Study

Bray¹,

Sharpe²,

Gichuru³

et al. 2020

J Med Internet Res

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Background There is increasing interest in finding novel approaches to improve the preparation of children for hospital procedures such as surgery, x-rays, and blood tests. Well-prepared and informed children have better outcomes (less procedural anxiety and higher satisfaction). A digital therapeutic (DTx) platform (Xploro) was developed with children to provide health information through gamification, serious games, a chatbot, and an augmented reality avatar. Objective This before and after evaluation study aims to assess the acceptability of the Xploro DTx and examine its impact on children and their parent’s procedural knowledge, procedural anxiety, and reported experiences when attending a hospital for a planned procedure. Methods We used a mixed methods design with quantitative measures and qualitative data collected sequentially from a group of children who received standard hospital information (before group) and a group of children who received the DTx intervention (after group). Participants were children aged between 8 and 14 years and their parents who attended a hospital for a planned clinical procedure at a children’s hospital in North West England. Children and their parents completed self-report measures (perceived knowledge, procedural anxiety, procedural satisfaction, and procedural involvement) at baseline, preprocedure, and postprocedure. Results A total of 80 children (n=40 standard care group and n=40 intervention group) and their parents participated in the study; the children were aged between 8 and 14 years (average 10.4, SD 2.27 years) and were attending a hospital for a range of procedures. The children in the intervention group reported significantly lower levels of procedural anxiety before the procedure than those in the standard group (two-tailed t63.64=2.740; P=.008). The children in the intervention group also felt more involved in their procedure than those in the standard group (t75=−2.238; P=.03). The children in the intervention group also reported significantly higher levels of perceived procedural knowledge preprocedure (t59.98=−4.892; P=.001) than those in the standard group. As for parents, those with access to the Xploro intervention reported significantly lower levels of procedural anxiety preprocedure than those who did not (t68.51=1.985; P=.05). During the semistructured write and tell interviews, children stated that they enjoyed using the intervention, it was fun and easy to use, and they felt that it had positively influenced their experiences of coming to the hospital for a procedure. Conclusions This study has shown that the DTx platform, Xploro, has a positive impact on children attending a hospital for a procedure by reducing levels of procedural anxiety. The children and parents in the intervention group described Xploro as improving their experiences and being easy and fun to use.

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“…In attempting to ameliorate some of hospitalisation’s insecurities, Bray et al (2019) explore an important aspect of information giving. Improving health literacy in children should be an integral aspect of a planned procedure.…”

mentioning

confidence: 99%

“…A coping strategy available to children in studies reviewed by Jepsen et al (2019), but not to an illegitimate child in the 18th century, was comforting from a parent. The importance of having a parent as interpreter is also highlighted by Bray et al (2019) as children are reliant on their parents for access to information. In absence of a parent, Jepsen et al’s (2019) finding emphasises that this important gap is often filled by healthcare professionals.…”

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confidence: 99%

Caring for more than ‘our bastard children’ in hospitals

McKeever

2019

J Child Health Care

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All countries tell stories of how their inpatient children's hospital services were established. Often contemporary children's hospitals have collated histories of their organisation. Many start with exploring care, and provision, for abandoned children. These histories tell of institutions being established for 'foundling' children. However, these institutions might not be as altruistic as it first appears. Apart from being a moneymaking avenue for wet nurses, foundlings had other potential economic benefits. This included, that once at an appropriate age foundlings could be a commodity to be sold off as part of a workforce or an army (Panter-Brick and Smith, 2000). Despite being a potential investment opportunity, public opinion for a foundling institution was not on Thomas Coram's side when he attempted to establish London's first foundling hospital (McClure, 1981). Early 18th-century English society commonly considered abandoned children as illegitimate, threatening, villainous and amoral (Zunshine, 2005). Thus, foundling equated with bastard; and its repercussion, that bastard equalled a disgrace (McClure, 1981). After a 17-year campaign, and a Royal Charter from King George II, Thomas Coram did establish a Foundling Hospital in Bloomsbury, London. Near to Coram's Foundling Hospital, in 1852, with 10 beds, the United Kingdom's first hospital to offer dedicated inpatient care to children opened. Great Ormond Street Hospital is now just one of hundreds of global children's hospitals, delivering care to millions of children and their families worldwide. Global data on numbers of paediatric hospitals and dedicated paediatric beds are not available. However, in Europe, for the past two decades, there has been an average reduction in hospital beds per person by almost 20% (OECD/EU, 2018). This has been coupled with a fall in average hospital length of stay from 10 days in 2000 to less than 8 days in 2016 (OECD/EU, 2018). In part this reduction can be attributed to improvements in inpatient care delivery. For many countries though, there has also been intentional reduction in hospital bed numbers as community care services are developed. While developments in community care services are important, it is clear that in-hospital improvements are also key to improving healthcare. As our Journal of Child Health Care aims to explore a broad range of health topics from a diverse range of settings for this edition of JCHC, we are focusing on hospital-based care. Jepsen and colleagues (2019) found that hospitalised children face a variety of challenges during admission to the hospital due to acute and/or critical illness. A pressing challenge, which surely would have also faced children admitted to Coram's Foundling Hospital, was that of coping with 'the unfamiliar'. Insecurities and unfamiliar noises abounded, and routines would be as foreign then as they are today. While Coram's children would not have experienced intubation, as

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‘If I knew what was going to happen, it wouldn’t worry me so much’: Children’s, parents’ and health professionals’ perspectives on information for children undergoing a procedure

Cited by 40 publications

References 43 publications

How nurses use reassurance to support the management of acute and chronic pain in children and young people: An exploratory, interpretative qualitative study

How nurses use reassurance to support the management of acute and chronic pain in children and young people: An exploratory, interpretative qualitative study

The Acceptability and Impact of the Xploro Digital Therapeutic Platform to Inform and Prepare Children for Planned Procedures in a Hospital: Before and After Evaluation Study

Caring for more than ‘our bastard children’ in hospitals

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