Comparison of Forward-Leaning and Fowler Position: Effects on Vital Signs, Pain, and Anxiety Scores in Children With Asthma Exacerbations.

BACKGROUND: It is essential to relieve bronchospasm or specific asthma symptoms by administering immediate inhaler treatment during an asthma exacerbation. The present study compared the effect of Fowler position and forward-leaning positions during nebulization on heart rate, SpO2 , breathing frequency, pain, and anxiety levels in children experiencing asthma exacerbations. METHODS: The data originated from a randomized trial that compared 86 participants (study group n = 43, control group n = 43) who presented to the pediatric emergency department with asthma exacerbations between October 2019-February 2020. The subjects were administered nebulization 3 times, during which the study group was placed in the forward-leaning position and the control group in the routine Fowler position. The subjects provided information on chest pain and anxiety levels before and after nebulization, and heart rate, SpO2 , and breathing frequency were measured before and after each nebulization. RESULTS: The difference in the mean SpO2 measured at admission and after the third nebulization was significantly higher (3.2 ± 1.5% vs 2.3 ± 1.9%, P = .01); the difference in the mean breathing frequency was considerably higher (-6.0 ± 1.7 breaths/min vs -3.2 ± 1.8 breaths/min, P < .001), and the difference in the mean pain scores was significantly higher (-3.3 ± 2.5 vs -2.0 ± 2.3, P = .02) in the study group than in the control group. In addition, after the third nebulization, the breathing frequency (22.8 ± 2.8 breaths/min vs 24.2 ± 2.7 breaths/min, P = .02) and pain score of the study group were lower (0.8 ± 1.3 vs 1.5 ± 1.5, P = .01). There was no difference in the mean heart rate (20.6 ± 16.2 beats/min vs 20.0 ± 15.4 beats/min, P = .85) and anxiety levels (-2.0 ± 2.2 vs -1.9 ± 2.2, P = .90) between the groups. CONCLUSIONS: Placing children in a forward-leaning position during nebulization was effective in improving SpO2 and reducing breathing frequency and chest pain. The forward-leaning position implemented during nebulization is a non-pharmacologic method that supports recovery in children with asthma exacerbations.

Effect of Acupressure on Procedural Pain in Children: A Systematic Review.

PURPOSE: Acupressure is a complementary treatment method performed using fingers and hands to maintain the body's energy balance by stimulating acupuncture points. In recent studies, acupressure has been widely used for minimally invasive procedural (venous assess, intravenous (IV) cannulation, intramuscular injection, heel lancing) pain management in children. This study aims to systematically review the studies that evaluate the effectiveness of acupressure on minimally invasive procedural pain in children. DESIGN: This study is a systematic review of literature. METHODS: Studies were obtained by screening literature on this topic using the databases PubMed, EBSCO, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials. The keywords "Acupressure," "Child," "Pain," and "Procedural" were used when screening the literature. The studies selected were those published from January 1, 2000 to January 1, 2022 that met the inclusion and exclusion criteria. The PRISMA checklist was used when performing this systematic review. The Oxford Center for Evidence-Based Medicine Levels of Evidence Working Group (2011) table was used to assess the level of evidence. The procedures for this systematic review were preregistered in the PROSPERO (CRD42022320155) database. FINDINGS: Of the 12,624 records identified, 10 nursing studies that met the research selection criteria were included in the advanced analysis. These papers were further reviewed for their study design, adequacy of randomization and concealment of allocation, blinding of participants, interventions, and outcome measurements. CONCLUSIONS: Acupressure has been shown to be effective in relieving minimally invasive procedural pain in children. This review begins to establish a credible evidence base for the use of acupressure in minimally invasive procedural pain relief in pediatric age groups. The implication for nurses includes incorporating acupressure into their practice as an alternative therapy for children who suffer from minimally invasive procedural pain.

Effect of peppermint-lemon aromatherapy on nausea-vomiting and quality of life in pediatric patients with leukemia: A randomized controlled trial.

BACKGROUND: Nausea and vomiting, frequently induced by chemotherapy, can delay treatment protocols and the healing process. PURPOSE: The aim of this study is to determine how aromatherapy inhalation with peppermint and lemon using a diffuser affects nausea-vomiting management and quality of life in 2-12-year-old children undergoing chemotherapy. DESIGN AND METHODS: The study utilized a pretest-posttest control group experimental design with randomized groups. A total of 90 children who met the inclusion criteria were included in the study. The experimental group received Mentha Piperita and Citrus Lemon essential oils through a diffuser, while the placebo group received water through a diffuser. The control group did not receive any intervention. RESULTS: Pulse and respiratory rates of children treated with aromatherapy were found to be significantly lower than the other groups. After aromatherapy application, quality of life of the children in the experimental group was significantly higher than the other groups. The change in the Index of Nausea, Vomiting, and Retching scores of the experimental group on the 4th chemotherapy cycle compared to the 1st chemotherapy cycle was significantly higher than the change in the other groups. CONCLUSIONS: Consequently, it was determined that inhalation aromatherapy with peppermint-lemon was effective in the management of chemotherapy-induced nausea-vomiting symptoms and quality of life compared to the placebo and control groups. PRACTICE IMPLICATIONS: Inhalation aromatherapy with mint-lemon can be used as an alternative method to improve the quality of life in children with leukemia who suffer from chemotherapy-induced nausea and vomiting.

The effect of a video-based COVID-19 paediatric patient education on state anxiety in children with suspected COVID-19 admitted to hospital.

BACKGROUND: Anxiety causes the long-term psychological impacts on children during the pandemic. OBJECTIVE: The aim of this study is to reduce anxiety in paediatric patients and increase their adherence to treatment through a video-based COVID-19 paediatric patient education. METHODS: This quasi-experimental study with pretest-posttest single group was carried out in a research hospital's COVID-19 Paediatric Emergency Area in Turkey between May and August 2020. The sample consisted of 128 children aged between 4 and 12 years. RESULTS: In the study, it was found that 50.8% of the children who came to the COVID- 19 Paediatric Emergency Area due to suspicion of COVID-19 were boys and their mean age was 8.54 ± 2.62. 21.1% of the children were hospitalised before and 73.4% were afraid of the hospital. State stress scores of the participants before the patient education were higher in those, who didn't attend school between ages of 4-10, than those who went to school. State stress mean scores of the children from all age groups decreased significantly after the education. CONCLUSIONS: The video-based paediatric patient education decreases the children's hospital-related anxiety during the pandemic and increased their adherence to treatment.

A tablet game or training booklet? Two methods for evaluating symptom management and quality-of-life of children receiving chemotherapy.

PURPOSE: In chemotherapy process, the innovative and educational roles of nurses come to the forefront so that children can manage the symptoms they will encounter and thus increase their quality-of-life. Therefore, a tablet game was developed by the authors of this study to evaluate the effect of training children aged 10-16 who receive chemotherapy by a tablet game and a booklet on symptom management and quality-of-life. METHODS: This was a non-randomized pre and post-test control group study. The study sample consisted of 50 children (game: 25; booklet: 25) who met the inclusion criteria and hospitalized between February 2017-July 2018 in two hospitals' Paediatric Haematology-Oncology Units. Data collection tools consisted of a child evaluation form, Memorial Symptom Assessment Scale, KINDL-Cancer Module, a tablet game, and booklet. RESULTS: When groups were evaluated within themselves after the intervention, the decrease of disturbance level of symptoms at the game group was higher than the booklet group (p:.004). Before the intervention, there was not any difference in the quality-of-life mean between groups (p < .05). After the intervention quality-of-life total (p:.000), mental (p:.030), and treatment (p:.009) subscale means were statistically significantly less at game group than booklet group. CONCLUSIONS: Both interventions were effective for symptom management, and they were not superior to each other, but the quality-of-life was higher in the game group.

The effect of simulative heartbeat nest used in preterm new-borns on vital signs, pain, and comfort in Turkey: A randomized controlled study.

BACKGROUND: Creating a womb-like environment for the preterm infant is vital to reduce the stress caused by stimuli and facilitate optimal neurological-behavioral development. PURPOSE: This randomized-controlled study aimed to determine the effect of simulative heartbeat nest use on vital signs, pain level, and comfort in preterms. METHODS: The study population consisted of 52 (experiment: 25, control: 27) preterms hospitalized in a university hospital's neonatal intensive care unit between May-November 2018. Before the application, preterms in both groups were evaluated with PIPP and Comfort scales. The experiment group was monitored in the nest with a heart beating device for 15 min. The control group was observed in the nest without the device for 15 min. Their heartbeats and oxygen saturation were recorded. After the application, preterms in both groups were re-evaluated with PIPP and Comfort scale. RESULTS: There was no statistically significant difference between the groups in terms of gestation week, age, birth weight and height, HB, SaO2, PIPP, and Comfort Scale total scores before and after the application (p > .05). However, the mean SaO2 increased significantly during the application (p < .003) in the experiment group; and that the PIPP total score decreased statistically significantly (p: 0.001) after the application. The comfort scale total score averages of the preterms in both groups decreased statistically significantly after the application (experiment:p < .01; control:p < .05). IMPLICATIONS FOR PRACTICE AND RESEARCH: Preterms in both groups had similar indicators. The nests that create heartbeat provide positive outcomes, such as the standard nests'.

YouTube as a source of information about COVID-19 for children: Content quality, reliability, and audience participation analysis.

PURPOSE: This study aimed to evaluate the content quality, reliability, and audience participation analysis of YouTube videos as a source of information about COVID-19 for children. DESIGN AND METHODS: This study was conducted in a descriptive design. The keywords "COVID-19, explain, children" were searched on the YouTube platform on March 17, 2021, and 294 videos were reviewed. The content of the selected videos was analyzed by 2 independent reviewers. Meet the inclusion criteria, 57 videos were evaluated according to the presenter source and the presented audience with the COVID-19 for Children Checklist (CCC), DISCERN score and the Global Quality Score (GQS). RESULTS: When the contents of 57 videos included in the study were reviewed, it was determined that 56.1% (n = 32) were informative and 43.9% (n = 25) were misleading. Kappa value among the two independent observers was 0.89. 17.5% (n = 10) of the videos scored 5 points from DISCERN and 31.6% (n = 18) scored 4 points from GQS. The mean scores of GQS, DISCERN and CCC of videos with the grouped as informative were found to be statistically higher. There was a significant difference between the DISCERN mean score of ministry/academic/hospital/physician channel videos was higher than the mean score of entertainment/individual channel videos. CONCLUSIONS: This study has shown that videos explaining COVID-19 to children have high viewing rates, but also videos that are low in terms of quality and reliability. PRACTICE IMPLICATIONS: It is thought that this study will reduce the rates of hospitalization by protecting children from COVID-19 by providing them access to healthier and more reliable sources.

FoxO1 is required for physiological cardiac hypertrophy induced by exercise but not by constitutively active PI3K.

The insulin-like growth factor 1 receptor (IGF1R) and phosphoinositide 3-kinase p110α (PI3K) are critical regulators of exercise-induced physiological cardiac hypertrophy and provide protection in experimental models of pathological remodeling and heart failure. Forkhead box class O1 (FoxO1) is a transcription factor that regulates cardiomyocyte hypertrophy downstream of IGF1R/PI3K activation in vitro, but its role in physiological hypertrophy in vivo was unknown. We generated cardiomyocyte-specific FoxO1 knockout (cKO) mice and assessed the phenotype under basal conditions and settings of physiological hypertrophy induced by 1) swim training or 2) cardiac-specific transgenic expression of constitutively active PI3K (caPI3KTg+). Under basal conditions, male and female cKO mice displayed mild interstitial fibrosis compared with control (CON) littermates, but no other signs of cardiac pathology were present. In response to exercise training, female CON mice displayed an increase (∼21%) in heart weight normalized to tibia length vs. untrained mice. Exercise-induced hypertrophy was blunted in cKO mice. Exercise increased cardiac Akt phosphorylation and IGF1R expression but was comparable between genotypes. However, differences in Foxo3a, Hsp70, and autophagy markers were identified in hearts of exercised cKO mice. Deletion of FoxO1 did not reduce cardiac hypertrophy in male or female caPI3KTg+ mice. Cardiac Akt and FoxO1 protein expressions were significantly reduced in hearts of caPI3KTg+ mice, which may represent a negative feedback mechanism from chronic caPI3K, and negate any further effect of reducing FoxO1 in the cKO. In summary, FoxO1 contributes to exercise-induced hypertrophy. This has important implications when one is considering FoxO1 as a target for treating the diseased heart.NEW & NOTEWORTHY Regulators of exercise-induced physiological cardiac hypertrophy and protection are considered promising targets for the treatment of heart failure. Unlike pathological hypertrophy, the transcriptional regulation of physiological hypertrophy has remained largely elusive. To our knowledge, this is the first study to show that the transcription factor FoxO1 is a critical mediator of exercise-induced cardiac hypertrophy. Given that exercise-induced hypertrophy is protective, this finding has important implications when one is considering FoxO1 as a target for treating the diseased heart.

Motivational support programme to enhance health and well-being and promote weight loss in overweight and obese adolescents: A randomized controlled trial in Turkey.

AIM: The aim of this study is to investigate the effect on health, well-being and weight loss of a motivational support programme provided for adolescents who were overweight and obese. METHODS: This was a randomized controlled trial. Sixty-four adolescents (39 girls and 25 boys) who were overweight and obese and consulted at our polyclinic from January 2015 to February 2016 comprised the study population. The sociodemographic characteristics, well-being levels and physical parameters of the adolescents were evaluated. Routine follow-ups were practiced for both groups. The adolescents in the experimental group had motivational interviews and were sent reminder messages over a 6-month period, and education programmes were conducted with the parents. RESULTS: After 6 months, the body mass index values had decreased in the experimental group compared with baseline, with no decrease in the controls. Scores for the Paediatric Quality of Life total scale and physical health and psychosocial health subscale points were increased in experimental and control groups, but the quality of life scale points of the experimental group were higher than the control group. In the experimental group, aspartate aminotransferase, alanine aminotransferase, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and total cholesterol were decreased. CONCLUSION: The motivational support programme affected the adolescents' health positively and can be recommended as a routine nursing intervention.

Pain Management with ROP Position in Turkish Preterm Infants During Eye Examinations: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to evaluate the effects of infant positioning on pain, heart rate, oxygen saturation and crying time during examination. DESIGN & METHODS: The randomized controlled experimental study was carried out on 70 preterm infants. ROP position + pacifier was used in the experimental group (n = 35) while only the pacifier was used in the control group. Heart rates, oxygen saturation, crying duration and pain score (Premature Infant Pain Profile-PIPP) were evaluated before, during and after the screening. RESULTS: The preterm infants in the experimental group recorded lower pain scores at the beginning of the screening (p = 0.01), at the end of the screening (p = 0.01) and after screening (p = 0.01) than those in the control group. The heart rate was higher in the control group during screening (p = 0.010) and after screening (p = 0.008) than in the preterm infants in the experimental group. Oxygen saturation was not significantly different between the groups before, during or after screening. Crying duration was lower in the experimental group than in the control group (p = 0.010). CONCLUSIONS: Positioning of the infant to support behavioral organization was found to be effective in reducing pain and shortening crying time during eye examination, and had favorable effects on physiological variables with ROP position during eye examinations. PRACTICE IMPLICATIONS: ROP position is a practical and effective non-pharmacological method during eye examinations by neonatal nurses.

Turkish Validation of the Infiltration Scale in Infants.

PURPOSE: To test the validity and reliability of an infiltration scale in infants that was adapted for the pediatric population. DESIGN AND METHODS: The present study is an observational prospective study. The study was conducted in a NICU of a training and research hospital in Istanbul. Data were obtained from131 infants who were <4 kg. Language validity of the scale was tested by expert linguists. The comments of fourteen experts were taken for content validity. For reliability testing, three observers independently evaluated the scale. RESULTS: Infiltration developed in 28.72% of infants who were examined and grade 2 infiltration was detected at rate of 58%. The content validity index of the scale was 0.93. The Cronbach's alpha was calculated as 0.96 in the agreement of the three observer nurses' evaluations. A highly significant association was detected between the coherence of Cohen's kappa values and Intra-Class Correlation coefficient (ICC) (p < 0.01). CONCLUSIONS: The infiltration scale is a valid and reliable scale in infants. The validity and reliability of the scale has been verified and may be used in the identification of infiltration in infant gestational age between 24 and 39 weeks and weighing <4 kg. PRACTICE IMPLICATIONS: The infiltration scale for infants is a valid and reliable tool for monitoring catheter sites in the prevention of complications such as infiltration due to PIV therapy practices in neonatal intensive care units.

The Effect of Swaddling on Pain, Vital Signs, and Crying Duration during Heel Lance in Newborns.

To determine the effect of swaddling on pain, vital signs, and crying duration during heel lance in the newborn. This was a randomized controlled study of 74 (control: 37, experiment: 37) newborns born between December 2013 and February 2014 at the Ministry of Health Bagcilar Training and Research Hospital. An information form, observation form, and Neonatal Infant Pain Scale were used as data collection tools. Data from the pain scores, peak heart rates, oxygen saturation, total crying time, and duration of the procedure were collected using a video camera. Newborns in the control group underwent routine heel lance, whereas newborns in the experimental group underwent routine heel lance while being swaddled by the researcher. The newborns' pain scores, peak heart rates, oxygen saturation values, and crying durations were evaluated using video recordings made before, during, and 1, 2, and 3 minutes after the procedure. Pain was assessed by a nurse and the researcher. No statistically significant difference was found in the characteristics of the two groups (p > .05). The mean pain scores of swaddled newborns during and after the procedure were lower than the nonswaddled newborns (p < .05). In addition, crying duration of swaddled newborns was found to be shorter than the nonswaddled newborns (p < .05). The average preprocedure peak heart rates of swaddled newborns were higher (p < .05); however, the difference was not significant during and after the procedure (p > .05). Although there was no significant difference in oxygen saturation values before and during the procedure (p > .05), oxygen saturation values of swaddled newborns were higher afterward (p < .05). For this study sample, swaddling was an effective nonpharmacologic method to help reduce pain and crying in an effort to soothe newborns. Although pharmacologic pain management is the gold standard, swaddling can be recommended as a complementary therapy for newborns during painful procedures. Swaddling is a quick and simple nonpharmacologic method that can be used by nurses to help reduce heel stick pain in newborns.

Effect of two different feeding methods on preventing ventilator associated pneumonia in the paediatric intensive care unit (PICU): A randomised controlled study.

BACKGROUND: For infants and children who require intubation in the paediatric intensive care unit (PICU), ventilator-associated pneumonia (VAP) is a significant cause of secondary morbidity and mortality linked with extended use of intubation. Nurses are primarily responsible for the prevention of VAP and there are a number of procedures that contribute towards this end. Although enteral nutrition has been reported to be effective in the prevention of VAP, this remains controversial. OBJECTIVE: To compare and evaluate the effects of intermittent feeding through a nasogastric catheter with those of continuous feeding through a nasoduodenal catheter in preventing VAP in the PICU. DESIGN: The research design was a randomised, controlled experimental study. METHODS: Forty paediatric patients were randomised and divided into two groups of 20: one group for nasoduodenal (ND) feeding and the other for nasogastric (NG) feeding. Patients were assessed for the development of VAP using the clinical pulmonary infection score and Centers for Disease Control and Prevention criteria while working in accordance with the VAP prevention bundles introduced within the unit. RESULTS: The incidence of paediatric VAP was 15%. The rate of VAP in patients who were ND fed was 10%, whereas the rate of VAP in patients who had NG feeding was 20%. No statistically significant difference was observed between the ND- and NG-fed patients (p=0.661). CONCLUSION: Although the results of our study were not statistically significant, nasoduodenal feeding helped to reduce the incidence of VAP.

Effects of Open and Closed Suctioning Systems on Pain in Newborns Treated with Mechanical Ventilation.

This experimental study was conducted to compare the effects of open and closed suctioning systems on pain in newborns receiving ventilation support. The study sample consisted of 42 babies (23 female, 16 male) hospitalized in the unit between December 2010 and December 2011 who met the selection criteria established for the study. Using the random sampling method, 20 of the babies were included in the closed suctioning system group and the remaining 22 were analyzed in the open suctioning system group. The data collection tools of the study were intervention monitoring form, data collection form, and documentation of the personal information on the babies; and the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) evaluated the babies' pain responses. The data were evaluated using SPSS 15 software. Most neonates were born preterm (≤37 weeks' gestation at birth; 69% [n = 29]). The mean (SD) birth weight, gestational age, and intensive care unit stay were 1.82 kg (1.1 kg), 31.9 (5.3) weeks, and 25.3 (2.9) calendar days, respectively. Results of the study revealed no statistically significant difference between the open suctioning and closed suctioning groups (p = .194). However, the N-PASS pain scores obtained before and during the suctioning processes were significantly different (p < .001). In conclusion, babies seem to experience pain during the suctioning process, according to N-PASS scores, and although not significant statistically, the level of pain felt during open suctioning was observed to be slightly higher compared with closed suctioning.

Observation results of handwashing by health-care workers in a neonatal intensive care unit.

This research was conducted as a descriptive study to determine the status of handwashing, which is important and an effective method of preventing and controlling hospital infections, by health-care workers in a neonatal intensive care unit and to make recommendations based on the results. The research sample included 28 health-care workers (physicians and nurses) who agreed to participate voluntarily in the study. A total of 344 observations were made of situations requiring handwashing. The health-care workers' handwashing compliance rate was 58.14% and no statistically significant difference between physicians and nurses was found in whether or not handwashing was done. However the percentage of handwashing compliance was higher for the nurses (62.50%) than for the physicians (52.63%). In the analysis of handwashing technique and duration, the physicians (23.75%) had a higher percentage of correct technique and duration than the nurses (13.33%), but the difference was not statistically significant.