An international study on innovations in the management of children’s pain

Background: Children have a right to effective pain management and up to date guidelines are available to promote this. Despite this, many reports state that children’s pain in hospital settings is not managed well, and many children are left to suffer unnecessarily. Nearly a quarter of children surveyed said they were in pain all or most of the time they were in hospital (Picker, 2005). However, this is not the whole picture; many areas deliver effective and innovative pain management for children. Aim: The aim of this travel scholarship was to undertake a study to identify innovations and learn from examples of good practice in the management of children’s pain by visiting three areas of excellence in the UK, Sweden and Australia. Methods: The study took an Appreciative Inquiry approach, focusing on learning from good practice, and follows four stages: • Discovery (the best of what is): this involved visits to the three study areas and meeting practitioners, educators and researchers to explore innovations in their pain management practice • Dream (what might be): this involved meeting with the host at the end of each study week to present to them identified examples of good practice for confirmation • Design (what should be): this involved writing up the findings of the three visits, exploring what innovations could be introduced to improve pain management practice across the UK • Destiny: this is dissemination and implementation of the best practice examples identified Conclusions: In each area visited, confident practitioners identified innovations in their pain management practice that have improved children’s pain experience in hospital. Innovations ranged from environmental adjustments to reduce anxiety related to pain, to standardising children’s observation charts to promote the regular assessment of pain. Effective leadership was apparent at each study site. Implications for practice: • Appreciative Inquiry is about identifying what works so that it can be repeated • Confidence and self-belief underpin the practice of effective pain management teams • An effective leader with a vision is needed to drive continuous improvement in the management of children’s pai

Identifying innovations in children's pain management project: an international perspective

Aim: The aim of the Travel Scholarship was to identify and learn from international examples of good practice in the management of children’s pain by visiting three areas of excellence in pain management in the UK, Sweden and Australia. Background: Children have a right to effective pain management and up to date guidelines are available to promote good pain management. However, many reports state that children’s pain in hospital settings is not managed well, and many children are left to suffer unnecessary pain. Nearly a quarter of children surveyed said they were in pain all or most of the time they were in hospital. However, this is not the whole picture; many areas deliver effective and innovative pain management for the benefit of children. Project structure: The study took an appreciative inquiry approach, focusing on learning from good practice and follows four stages. 1.Discovery: Involved meeting practitioners, educators and researchers in the UK, Sweden and Australia to explore innovations in their pain management practice. 2.Dream: Involved meeting with the host and presenting to them identified examples of good practice for confirmation. 3. Design: Involved writing up the findings of the three visits, exploring what innovations could be introduced to improve pain management practice across the UK. 4. Destiny: Involved dissemination and implementation of the best practice examples identified Findings from site visits: Alder Hey Children’s Hospital, Liverpool, UK Increased use of IV paracetamol; Paediatric Pain Profile for children with cognitive impairment; Hospital Play Specialists using Entonox for painful procedures; Protocols for anticipatory distress and procedural pain; Post-operative tonsillectomy pain regime Queen Silvia Children’s Hospital, Gothenberg, & Linköping University Hospital, Linköping, Sweden The use of Ulrich’s environmental work to reduce anxiety and pain; Use of tactile touch in PICU; Protocol devised to give children in A&E analgesia before they are seen by a doctor; Literature designed to enhance communication with children and parents pre-surgical admission; Use of 70:30 nitrous oxide and air for painful procedures Randwick Children's Hospital & Westmead Children's Hospital, Sydney, Australia One pain team covering acute and chronic pain All pain protocols and analgesic regimes, online and user friendly; Standardised observation charts (all ages) with pain scores; Follow-up pain support for parents from pain nurses, post-discharge for children on long acting opioids; Development of national pain dataset Conclusion: In every area visited confident practitioners identified innovations in their pain management practice that have improved children’s pain experience in hospital. Innovations ranged from environmental adjustments to reduce anxiety related to pain, to standardising children’s observation charts in promoting the regular assessment of children’s pain. Effective leadership was apparent at each study site. Implications for Practice: Dissemination of the findings to each area to share new ideas on the management of children’s pain

Interventions that prevent or reduce obesity in children from birth to five years of age: A systematic review

Childhood obesity worldwide affects 5.6% or 38.3 million children under five years of age. The longer children are overweight or obese, the more likely they are to become obese adults with all the contingent morbidity involved. An extensive number of preventive interventions to combat childhood obesity have been carried out worldwide. This article reports a systematic review of interventions aimed to reducing or preventing obesity under-fives. The search was performed with six different databases: Web of Science, PsycINFO, Cochrane, PubMed, Medline, and CINAHL. Studies meeting the inclusion criteria were independently assessed using Joanna Briggs Institute methodology. Thirty studies involving 23,185 children across nine countries were included. Twenty-two were randomised controlled trials, and 8 quasi-experimental pretest/post-test design with comparison. These studies fell into four different categories: home-based interventions with family involvement (n = 12), preschool/early childhood settings (n = 9), multicomponent interventions across multiple settings (n = 6) and healthcare setting (n = 3). Future research should focus on increasing the accessibility of education on diet and physical activity for deprived families as well as the cultural acceptability of interventions to prevent childhood obesity

Developing a framework to support the delivery of effective pain management for children: an exploratory qualitative study

Two million children are admitted to hospital every year in the UK and between 59 and 94% will experience pain, with 27-40% of them experiencing moderate to severe pain. Currently there are a number of well researched guidelines on children’s pain available, yet pain prevalence is high. Despite the guidelines there is a lack of an overall framework that includes the necessary components to deliver effective pain management. This study built on previous work about key elements that support children’s pain management, by exploring their relevance and practical application with 43 health care practitioners. We carried out focus groups with Band 5 nurses (n=6), Advanced Nurse Practitioners (n=11), and semi structured interviews with Pain Nurses (n=16), and Consultants (n=10). We also presented and discussed our findings with an Advisory Group. Findings demonstrated that the following elements were considered to be important: delivering pain management with confidence, supporting colleagues with protocols and guidance, empowering parents to be involved in pain management and adopting an individual approach to a child and family. These elements formed the basis of a framework for children’s pain management. Some practitioners indicated that pain management required education as well as more resources and that the culture of an area could influence pain management practice. The framework brings together elements that have the potential to improve the management of children’s pain through its use as an education tool in facilitating the development of skilled confident pain practitioners, who empower parents to engage in their child’s pain care. Each interrelated element of the framework plays an important part in the overall management of children’s pain. Information sheets, posters and an animation have been developed to support the dissemination of the findings to health care practitioners, parents and educators

Developing a Sense of Knowing and Acquiring the Skills to Manage Pain in Children with Profound Cognitive Impairments: Mothers' Perspectives

Children with profound cognitive impairment (PCI) are a heterogenous group who often experience frequent and persistent pain. Those people closest to the child are key to assessing their pain. This mixed method study aimed to explore how parents acquire knowledge and skills in assessing and managing their child's pain. Eight mothers completed a weekly pain diary and were interviewed at weeks 1 and 8. Qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics. Mothers talked of learning through a system of trial and error ("learning to get on with it"); this was accomplished through "learning to know without a rule book or guide"; "learning to be a convincing advocate"; and "learning to endure and to get things right." Experiential and reflective learning was evident in the way the mothers developed a "sense of knowing" their child's pain. They drew on embodied knowledge of how their child usually expressed and responded to pain to help make pain-related decisions. Health professionals need to support mothers/parents to develop their knowledge and skills and to gain confidence in pain assessment and they should recognise and act on the mothers' concerns

Navigating Uncertainty: Health Professionals' Knowledge, Skill and Confidence in Assessing and Managing Pain in Children with Profound Cognitive Impairment

There is limited evidence to underpin the assessment and management of pain in children with profound cognitive impairment and these children are vulnerable to poor pain assessment and management. Health professionals working with children with profound cognitive impairment from a single paediatric tertiary referral centre in England were interviewed to explore how they develop and acquire knowledge and skills to assess and manage pain in children with cognitive impairment. The interviews were transcribed and subjected to thematic analysis. Nineteen health professionals representing different professional groups and different levels of experience participated in the study. A metatheme “navigating uncertainty; deficits in knowledge and skills” and two core themes “framing as different and teasing things out” and “the settling and unsettling presence of parents” were identified. Uncertainty about aspects of assessing and managing the pain of children with cognitive impairment tended to erode professional confidence and many discussed deficits in their skill and knowledge set. Uncertainty was managed through engaging with other health professionals and the child’s parents. Most health professionals stated they would welcome more education and training although many felt that this input should be clinical and not classroom oriented

A qualitative study exploring the perceptions of part time distance learning students learning gain using the ‘Three Gains’ Employability model

This qualitative project set out to identify if Open University (OU) students who were studying a level three (FHEQ level 6) module had achieved, as a consequence of their study enhancement in three key areas of an employability framework: learning, working and personal gains. Findings from 27 interviews demonstrated that learning gains appeared to arise from specific module material that was relevant to the student’s employment, but also, on study skills and transferrable skills that contribute to the students’ confidence and ability to carry out their employment. Working and personal gains appeared to be closely linked because of the students’ developing confidence, self-esteem and sense of achievement as a result of their studies, as well as their practical skills such as self-management. The key personal gain that emerged was confidence, which had a positive impact on the interviewees’ personal and working life. The increased self-esteem and sense of achievement indicated that ‘study has enhanced an individual’s sense of self’. The study also reports unexpected gains: the impact of their studies was apparent in how others view of them changed over time. Colleagues admired and respected them for their achievement with their studies and sought advice from them at work. Their families had pride in them and for some were seen as a role model for their children. This study is unique: The Three Gains model of employability used as a conceptual framework offers a perspective on the employability gains part-time distance learning students achieved through study

Nowhere to Run; Nowhere to Hide: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges

This is an edited version of remarks presented at \u27Nowhere to Run, Nowhere to Hide\u27: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges, January 5, 2015, at the Association of American Law Schools Annual Meeting, Washington, D.C

The Effect Of Percussive Therapy On Musculoskeletal Performance And Experiences Of Pain: A Systematic Literature Review

Background There is a lack of specific research on the effect of percussive therapy (PT) delivered by massage guns on physiological adaptations. This systematic literature review investigates research conducted on the effects of PT interventions on performance in strength and conditioning settings, and on experiences of musculoskeletal pain. Purpose To determine the effect of PT delivered by massage guns on physiological adaptations: muscle strength, explosive muscle strength and flexibility, and experiences of musculoskeletal pain. Study Design Systematic literature review. Methods Data sources (CINAHL, Cochrane Library, Psychinfo, PubMed, SportDISCUS and OpenGrey) were searched from January 2006 onwards for full text literature in any language involving adult populations receiving PT delivered by massage guns, directly to any muscle belly or tendon, with comparisons to an alternative treatment, placebo or no treatment. Literature with outcomes relating to acute or chronic physiological adaptations in muscle strength, explosive muscle strength, flexibility or experiences of musculoskeletal pain were included. Articles were assessed for quality using the Critical Appraisal Skills Programme and PEDro scores. Results Thirteen studies met the inclusion criteria. All studies had limitations in methodological quality or reporting of findings but still included contextually-rich details that contributed to the overall narrative synthesis. A significant relationship was found between a single application of PT delivered by massage guns and an acute increase in muscle strength, explosive muscle strength and flexibility, with multiple treatments eliciting a reduction in experiences of musculoskeletal pain. Conclusion PT delivered by massage guns can help improve acute muscle strength, explosive muscle strength and flexibility, and reduce experiences of musculoskeletal pain. These devices may provide a portable and cost-effective alternative to other forms of vibration and interventions