| Sažetak | Istraživanja sugeriraju kako je ublažavanje boli prilikom dijagnostičkih/terapijskih postupaka u pedijatrijskih pacijenata manje od optimalnog. Bolni medicinski postupci u djetinjstvu mogu imati dugoročne negativne efekte na razvoj tolerancije boli. Venska kanulacija vodeći je uzrok proceduralne boli, ekvivalentna postoperativnoj boli. Neke studije pokazuju kako su medicinske sestre sklone ocijeniti razinu boli višom, a primjerenost kontrole boli nižom u usporedbi s drugim medicinskim osobljem. Te ocjene vjerojatno su odraz količine vremena koje medicinske sestre provode s pacijentom, uključujući veću izloženost psihološkim aspektima boli poput straha i tjeskobe, što rasvjetljuje važnost sveobuhvatnom pristupu ublažavanja boli. Važno je pregledati razloge iz kojih se bol podcjenjuje i ne tretira u dovoljnoj mjeri kod djece, te se educirati za njezino optimalno ublažavanje.
Ciljevi: Istraživali smo utjecaj psiholoških čimbenika (strah, nazočnost roditelja), utjecaj sociodemografskih obilježja (dob, spol), te učinkovitost intervencija za ublažavanje boli (distrakcija, EMLA krema) na percepciju boli tijekom dijagnostičkih/terapijskih postupaka u djece dobi 3 – 12 godina.
Metode: Istraživanje predstavlja prospektivno kliničko ispitivanje percepcije bolnosti postupaka koji se na pedijatrijskim odjelima često provode u svrhu dijagnostike i liječenja. Podaci su prikupljeni anketnim upitnikom, a za procjenu intenziteta boli koristili smo Oucherovu skalu.
Rezultati: U istraživanje je uključeno 120 ispitanika srednje dobi 8,07 ± 2,99. Utvrđena je statistički značajna povezanost između straha (P = 0,001), dobi ispitanika (P = 0,001) i nazočnosti roditelja (P = 0,001) na percepciju boli. Nismo utvrdili statistički značajnu povezanost spola ispitanika na percepciju boli (P = 0,820). Pri evaluaciji intervencija za ublažavanje boli postoji trend prijavljivanja manje boli ispitanika kod kojih je primijenjena EMLA krema ili distrakcija, ali rezultati nisu pokazali statistički značajnu razliku u odnosu na kontrolnu skupinu (P = 0,835).
Zaključak: Strah, nazočnost roditelja i dob djeteta imaju značajan utjecaj na percepciju boli. Učinak EMLA kreme i distrakcije na percepciju boli u ovom istraživanju je minimalan. |
| Sažetak (engleski) | Children often experience pain from needle insertion procedures. Painful medical procedures in childhood may have long-term negative effects on development and future tolerance of pain. Significant number of children receive less than optimal management of procedure-related pain. Nurses tended to rate pain levels higher and adequacy of pain control lower compared with the other providers. These ratings perhaps reflect the greater amount of time nurses spent with the patient and family, including greater exposure to the psychological aspects of pain. This highlights the importance of comprehensive pain management and the need to address psychological as well as physical pain.
Objective: The present study aim to investigate psychological aspects (fear, parental presence and previous experiance with procedure), sociodemographic aspects (gender and age) and efficacy of two interventions methods (distraction and aplication of local anestetic EMLA) on perception of pain associated with needle insertion procedures in a group of pediatric patients.
Methods: A prospective clinical trial with children who required needle insertion procedures (venipuncture, intramuscular/subcutaneus injection, lumbar punction and joint puncture) aged 3 to12 years was conducted in a pediatric clinic or day hospital. Data were obtained by conducting interviews with the children and their parents. The pain levels of the children were assessed by self-report using the Oucher pain scale.
Results: One hundred and twenty children (mean age 8.07±2.99 years) were included. We found statistically significant differences in the perception of pain in relation to the presence of the parent (P=0.001) when conducting the procedures, fear (P=0.001) and age on pain perception (P=0.001), but there wasn't statistically significant differences between males and females (P=0.820). For all other pain outcomes there was a trend for lower pain scores for those receiving EMLA or distraction, but these differences were not statistically significant (P=0.835).
Conclusion: The results suggests that fear, age and parental presence have affected but gender and previous experiance with the procedure haven't affected on pain perception in children. Despite only minimal pain reduction achieved using EMLA or distraction in this study, previous research suggest it may have important and long-term effects for future experiences. |
