Effects of applications manual pressure and shotblocker to reduce needle-related pain and fear in children with type 1 diabetes mellitus.

BACKGROUND: Pain and fear associated with insulin injections can cause children with type 1 diabetes mellitus to avoid insulin injections and skip doses. OBJECTIVE: To evaluate and compare pain and fear levels in children aged 6-12 years receiving subcutaneous insulin injection using the manual pressure and ShotBlocker methods. METHODS: A randomized controlled study was conducted with 90 children with type 1 diabetes who were allocated using block randomization to the manual pressure, ShotBlocker, and control groups (n = 30 in each group). Fear and pain levels were rated by the children, their parents, and a member of the study team immediately before and after insulin injection using the Children's Fear Scale and Wong-Baker Faces Pain Rating Scale, respectively. RESULTS: All groups had similar self-, parent-, and researcher-reported levels of preprocedural pain and fear (p > 0.05). However, pain and fear scores were lower in the manual pressure and ShotBlocker groups than in the control group after injection (p = 0.0001). There was no significant difference in pain and fear scores between the two intervention groups (p > 0.05). CONCLUSION: Manual pressure and the ShotBlocker both reduced fear and pain associated with insulin injection in 6- to 12-year-old children with type 1 diabetes. IMPLICATIONS FOR PRACTICE: Both the manual pressure and ShotBlocker methods can easily be applied in children receiving insulin injections. As manual pressure is completely cost- and equipment-free, it is a useful option to reduce pain and fear related to insulin injection. CLINICAL TRIAL REGISTRATION NUMBER: National Institutes of Health (NIH), ClinicalTrials.gov, NCT05789810.

Attitudes Toward Neonatal Palliative Care Among Turkish Nurses and Physicians: A Comparative Cross-sectional Study.

Few studies have examined and compared neonatal physicians' and nurses' attitudes toward palliative care. This comparative study sought to evaluate attitudes toward neonatal palliative care in neonatal nurses and physicians and identify associated facilitators and barriers. This comparative, cross-sectional study included 173 neonatal intensive care unit staff (149 neonatal nurses and 24 neonatal physicians) in 2 hospitals in Istanbul, Turkey. Data were collected using the Turkish version of the Neonatal Palliative Care Attitude Scale. The results of the study revealed 8 facilitators and 9 barriers to neonatal palliative care. Nurses were significantly more likely than physicians to agree that parents are informed about palliative care options in their unit ( P = .008), that caring for dying infants is traumatic ( P = .007), and that their willingness to provide palliative care is influenced by their personal attitudes toward death ( P = .015). This study demonstrates the importance of parents' active involvement in the palliative care process, the establishment of standard policies and guidelines, and the provision of vocational and in-service education programs to support palliative care. Initiatives to strengthen facilitators and mitigate barriers are needed to optimize the implementation of palliative care in NICUs.

Effects of two different feeding positions on physiological characteristics and feeding performance of preterm infants: A randomized controlled trial.

PURPOSE: The aim of this randomized controlled study was to determine the effect of semielevated side-lying (ESL) and semielevated supine (ESU) positions, which are used to bottle-feed preterm infants, on their physiological characteristics and feeding performance. DESIGN AND METHODS: The sample consisted of preterm infants who were born in the 31st gestational week and below, and met the inclusion criteria. A randomization was provided in the sample group with a total of 80 infants including 38 infants in the ESL (experimental) group and 42 infants in the ESU (control) group. Both groups were compared in terms of their SpO2 values, heart rates, and feeding performances before, during, and after the feeding. The data were obtained by using a form for infant descriptive characteristics, feeding follow-up form, a Masimo Radical-7 pulse oximeter device, and a video camera. RESULTS: It was determined that the infants in the ESL group had statistically significantly higher SpO2 values (ESL: 96.77 ± 2.51; ESU: 93.48 ± 5.63) and lower heart rates (ESL: 155.87 ± 11.18; ESU: 164.35 ± 6.00) during the feeding compared to the infants in the ESU group (p < .05). Besides, oxygen saturation levels of the infants in the ESU group decreased more (p < .01) and their heart rates increased more (p < .05) during the feeding than those obtained before the feeding compared to the infants in the ESL group. PRACTICE IMPLICATIONS: The ESL position has a more positive effect on oxygen saturation and heart rate of infants and it is more effective in providing a physiological stabilization during the feeding, compared to the ESU position. According to these results, the ESL position can be recommended for preterm feeding.