The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study.

BACKGROUND: Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children. OBJECTIVE: The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan. METHODS: We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test. RESULTS: A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=-3.551, P<.001 and Z=-3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=-2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=-3.643, P<.001). CONCLUSIONS: The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

[Improvement Project Introducing the Hospital Environment to New Patients in Pediatric Wards].

BACKGROUND & PROBLEMS: The pediatric ward in our hospital has an average occupancy rate of ten patients per day. An investigation found that nurses had a low (51.9%) rate of completing the required introduction to the hospital environment for pediatric ward patients. The main reasons for this low rate were found to be: 1) the large number of items to be introduced, 2) interruptions of staffs during the introduction process, 3) the lack of sufficient introduction tools, and 4) patient family members and new caregivers not being given the introduction. PURPOSE: To increase the rate of completeness of nursing staffs introducing the hospital environment from 51.9% to over 91.0%. RESOLUTION: The project team proposed the following solutions. First, make a video introducing the general hospital environment and make it accessible via QR (quick response) code; second, provide multiple introduction video tools; third, make the environment more friendly using ward-mascot-themed décor; fourth, install fixtures in the rooms that complement the ward-mascot theme; fifth, revise the contents of the environment introduction; and sixth, make an environment introduction checklist. RESULTS: The completeness rate of environment introduction increased from 51.9% to 97.6%. CONCLUSIONS: The pediatric ward not only increased the environment introduction completion rate but also created a more friendly environment. Using the video and QR code and providing multiple video players and a checklist has efficiently increased the environment introduction completion rate and, in creating a more friendly environment, has successfully maintained nursing quality.

Effectiveness of Cognitive-behavioral Program on Pain and Fear in School-aged Children Undergoing Intravenous Placement.

PURPOSE: This study aimed to evaluate the effects of cognitive-behavioral program on pain and medical fear in hospitalized school-aged children receiving intravenous (IV) placement. METHODS: This study used an quasi-experimental design. Thirty-five participants were assigned to the experimental group and 33 to the control group in the acute internal medicine ward of a children's hospital. The cognitive-behavioral program entailed having the patients read an educational photo book about IV placement before the procedure and having them watch their favorite music video during the procedure. The outcome measures were numeric rating scales for pain intensity and fear during the procedure. RESULTS: After applying the cognitive-behavioral program, the mean scores on pain and fear decreased in the experimental group. However, the difference in pain intensity between these two groups was nonsignificant. The intensity of fear in the experimental group was significantly lower than that in the control group. CONCLUSION: In this study, the cognitive-behavioral program used with school-aged hospitalized children promoted less fear during IV placement. The results of this study can serve as a reference for empirical nursing care and as care guidance for clinical IV injections involving children.

[Reducing the Incidence of Phlebitis Related to Intravenous Injection in Pediatric Patients].

BACKGROUND & PROBLEMS: Peripheral venous catheter (PVC) is commonly used to provide nutrition and medicine to pediatric inpatients. Phlebitis is a common side effect of PVC insertion. Over 90% of pediatric patients in the paedi-atric medical ward at the Chang Gung Memorial Hospital (CGMH) receive PVC insertion, with an incident rate of phlebitis of 5.07%. Common cause factors of phlebitis are: insufficient sterilization time, inappropriate methods used to fix the PVC, the use of fixtures that loosen easily, high re-fix rates, and inadequate wound care after catheter removal. PURPOSE: The purpose of this project was to reduce the incidence rate of PVC-insertion-related phlebitis in children from 5.07% to 2.5%. RESOLUTION: A one-week clinical observation identified the re-inserting / re-fixing of existing PVCs as the principal cause of phlebitis in the CGMH paediatric ward. Therefore, the researchers modified the catheter care bundle based on a review of the literature and the suggestions of clinical pediatric experts. Modifications included applying 2% chlorhexidine to sterilize the insertion site; using a new, non-woven fabric splint to fix the PVC site; providing cartoon-themed waterproof dressings for the first bath after the removal of the PVC; and setting standard operating procedures (SOPs) for PVC insertion and catheter removal. RESULTS: After applying these modifications, the incident rate of phlebitis in children with PVC insertions decreased from 5.07% to 2.08%. CONCLUSIONS: The application of 2% chlorhexidine reduces the waiting time for sterilization; the purpose-designed splint strengthens the fixation of the PVC; and the development of the SOPs for PVC insertion and post-removal catheter care reduces the risk of phlebitis. The combination of these strategies effectively reduces the incidence of phlebitis and improves the nursing care quality.

[Effectiveness evaluation of healthy lifestyle interventions in childhood obesity prevention: a systematic review].

BACKGROUND: There is significant reporting on evidence-based research in the literature regarding lifestyle modification programs. There is a need to review and synthesize results in order to develop childhood obesity prevention and intervention strategy recommendations. PURPOSE: Main purposes of the present review were to update the systematic review and critical appraisal of recent evidence in this area and assess the efficacy and quality of published research studies. METHODS: Studies included in this review incorporated the following inclusion criteria: obese children participants 5 to 14 years of age; a face-to-face randomized-controlled study with a 4-week intervention period; and anthropometry, physical activity, sedentary behavior evaluated as primary outcomes after > 6 months. Eleven studies met the 3 inclusion criteria. All were found using the following key word string: RCT or CCT interventional study researches, childhood obesity, overweight, preventive intervention, healthy lifestyle". RESULTS: Evidence from these studies showed that all interventions varied in terms of approach and settings. Most provided a healthy lifestyle program duration of more than 15 minutes per week. Those that included culturally sensitive diet education and 30-60 minutes of moderate-intensity exercise everyday significantly enhanced childhood obesity prevention in terms of both anthropometry and dietary habits and decreased sedentary behavior. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Results suggest that effective healthy lifestyle programs for childhood obesity prevention in Taiwan should provide dietary guidance sensitive to Taiwanese dietary habits, encourage daily physical activities, and decrease sedentary behavior.

[Reducing fear in preschool children receiving intravenous injections].

BACKGROUND & PROBLEM: Our pediatric medical ward administers an average of 80 intravenous injections to preschool children. We found that 91.1% exhibit behavior indicative of fear and anxiety. Over three-quarters (77.8%) of this number suffer severe fear and actively resist receiving injections. Such behavior places a greater than normal burden on human and material resources and often gives family members negative impressions that lower their trust in the healthcare service while raising nurse-patient tensions. Using observation and interviews, we found primary factors in injection fear to be: Past negative experiences, lack of adequate prior communication, measures taken to preemptively control child resistance, and default cognitive behavioral strategies from nursing staff. PURPOSES: This project worked to develop a strategy to reduce cases of severe injection fear in preschool children from 77.8% to 38.9% and achieve a capacity improvement target for members of 50%. RESOLUTIONS: Our team identified several potential strategy solutions from research papers and books between August 1st, 2009 and April 30th, 2010. Our proposed method included therapeutic games, self-selection of injection position, and cognitive behavioral strategies to divert attention. Other measures were also specified as standard operating procedures for administering pediatric intravenous injections. RESULT: We applied the strategy on 45 preschool children and identified a post-injection "severe fear" level of 37.8%. CONCLUSIONS: This project was designed to reduce fear in children to make them more accepting of vaccinations and to enhance children's positive treatment experience in order to raise nursing care quality.