The Child Life Council Evidence-Based Practice Committee has developed this annotated bibliography of research-related literature for use by child life specialists and others interested in the child life profession. The purpose of the bibliography is to promote the integration of research in child life practice to enhance and validate professional interventions.
If you are interested in contributing to the ongoing development and expansion of the annotated bibliography, consider applying to become an Adjunct Annotated Bibliography Reviewer for the EBP Committee! For more information, please review the Annotated Bibliography Submission Guidelines.
|26 , 27 , 28 , 34 , 35 , 37 , 38 , 39 , 45|
|16 , 23 , 24 , 29 , 30 , 33 , 35 , 38 , 41 , 42 , 43, 44 , 45|
|26 , 27 , 34 , 35|
|6 , 7 , 11 , 14 , 18 , 19 , 20 , 31 , 32 , 35|
|4 , 9 , 15 , 20 , 24 , 40|
Research Question: Compared the effectiveness of a party blower (deep breathing distraction procedure) to a pinwheel (simple, more cost effective) in distracting children for routine immunizations.
Methods: Sample size included 80 children, ages three to six. Three different groups of children: control group, party blower group, and pinwheel group. A nurse gave standard immunization instructions for control group. For the party blower and pinwheel groups, a nurse instructed the child how to use them during the shot. The party blower was handed to the child and the pinwheel was kept at a reasonable distance from the child in order for them to blow it. Parents, children, and the administering nurse completed rating scales to assess the effectiveness of the distraction procedures.
Significant Findings: Children in the party blower group reported significant decreased anxiety levels.
Implications for practice: Simple interventions, such as a party blower, can easily distract children during immunizations. This intervention requires minimal training of staff and is cost effective for clinics and pediatricians' offices.
Research Question: Does the use of relaxation, distraction, and imagery reduce pain perception and distress during painful procedures and do these effects remain over time? Is temperament associated with the use of a behavioral pain management intervention? How does practice time and perceived effectiveness of intervention relate to children's/adolescents' pain reports and observed distress?
Methods: 19 children and adolescents, ages 4-18 years, were divided into two groups. One set of baseline measures were obtained from Group 1 and two sets of were obtained from Group 2.
Significant Findings: There was a significant improvement in their pain reports over a 5-month period. The temperament dimensions of a more positive mood, lower activity, less persistence, and lower distractibility related to report of pain. The effectiveness of practice was highly related to a decrease in the child/adolescent's self-report of pain post-treatment.
Implications for practice: Encourage parents and children to learn to work together to use simple distraction and relaxation techniques during painful procedures.
Implications for practice: Encourage parents and children to learn to work together to use simple distraction and relaxation techniques during painful procedures.
Research Question: To assess the effectiveness of community-based, stress-point intervention in decreasing distress and improving child and family functioning.
Methods: 50 parents were divided into two groups. The experimental group had intervention focused on child and family issues, identifying concerns and receiving preparation or assistance with parent's stress points. Parents in the control group received the usual medical care.
Significant Findings: Parents in the intervention group had better coping and family functioning three months after hospitalization. Children in the intervention group showed no developmental regression at 2 weeks post hospitalization and more developmental gains after 3 months than control group.
Implications for practice: Community-based or outpatient based stress-point interventions can improve care for children with repeated hospitalizations.
Research Question: To evaluate the effectiveness of psychosocial intervention on the immunological status and clinical management of children with asthma.
Methods: 35 children with asthma were divided into two groups. Both groups received routine medical care but the experimental group also received a 6-month psychosocial intervention (PSI) consisting of relaxation, guided imagery, and self-esteem workshops.
Significant Findings: Children who participated in PSI group had a reduced number of asthmatic episodes and use of broncho-dilator medication, improvement in pulmonary function, and reduction in the IgE responses to the most prevalent allergen.
Implications for practice: Psychosocial interventions can be useful in improving health status and can possibly create immunological changes.
Category: Coping, Teaching
Research Question: How accurate are children's memories of LPs? How do children's memories compare for event details versus emotional response? How does memory relate to distress?
Methods: 55 patients diagnosed with ALL between the ages of 3 and 18 were participants of this study. Half of the sample received an intervention for LP distress. Children in both groups were combined for memory analysis. Measures included a memory interview and distress measures (i.e. anxiety questions and pain questions).
Significant Findings: Additional factors other than initial child distress may influence the way in which a child remembers a stressful event such as an LP, but once exaggerated memories have developed, they become a strong predictor of levels of distress during future encounters with the same stressful event.
Implications for practice: Emphasizing children's exaggerated negative memories represents a new approach to intervention that has the potential to significantly impact procedural distress.
Research Question: Can a reframing children's memories influence children's distress during painful medical procedures?
Methods: 50 patients diagnosed with leukemia were observed as they underwent lumbar punctures. 25 received the intervention; the other 25 were in the control group.
Significant Findings: After the test, children in the intervention group showed reductions in anticipatory physiological and self-report ratings compared to the control group. Overall, these effects led to reduction in procedural distress.
Implications for practice: Memory reframing interventions are effective at reducing children's distress. Even without continued intervention, the benefits are maintained for more than one week
Research Question: To determine if children prepared by their parents prior to having an EGD exhibit decreased anticipatory and procedural anxiety and had more positive attitudes to EGDs.
Methods: One hundred children ages 8-18 participated. Parents were given information sheet about EGDs and discussed procedure with physician. Parents completed questionnaire about any preparation (by parents) provided to children. Children were measured on their knowledge of EGD, anxiety, pain, and observed distress.
Significant Findings: Patients with more knowledge of EGD experienced less anticipatory anxiety, procedural distress, and were more positive of future EGDs. Children who exhibited anxiety or distress with initial IV start exhibited significant levels of anxiety during the rest of the procedure and had negative attitudes about procedure.
Implications for practice: Providing preparation prior to procedure lessens anticipatory anxiety and procedural distress and has a more positive impact on future procedures.
Research Question: To assess the perceptions of health care professionals about child life specialists.
Methods: Health care professionals in a variety of fields were given a questionnaire to indicate how much contact they had with child life specialists, their perceptions of what child life specialists do with their time, how important child life specialists were to patients' psychosocial well-being and how much power they perceived child life specialists to have in the hospital.
Significant Findings: Both child life specialists and hospital administrators rated child life specialists as significantly more important for patients' psychosocial well-being than did physicians and nurses. Although child life professionals were rated highest among professionals in importance for providing psychosocial care of children, they were perceived as having little power in the health care system. Child life specialists were also perceived as serving to amuse and entertain children, although child life professionals did not view their role in such a manner.
Implications for practice: Discrepancies between perceptions of child life specialists and other health team members on the responsibilities of child life professionals demonstrate the need to educate other health team members about the child life role and about the importance of play in decreasing distress and facilitating coping.
Category: Professional Issues
Research Question: To examine how adults issue commands during invasive procedures affects children's distress
Methods: 45 children between the ages of 5-15 being videotaped during an IM injection and an LP. The videotapes were coded for child distress using the Observation Scale of Behavioral Distress, and the adult commands were coded as specific direct, specific softened, specific phrased as a question or vague phrases.
Significant Findings: Vague adult commands were correlated with increased child distress, while specific direct commands by parents during IM injection and specific softened commands by nurses during LPs were correlated with decreased child distress.
Implications for practice: Child Life Specialist can help educate staff and caregiver to the more effective ways to talk to children during procedures in order to minimize distress.
Research Question: To determine the effectiveness of a distraction program with children undergoing needle sticks
Methods: Six children from a hematology, oncology, and immunology clinic participated. The children received intramuscular injections, portacatheter access, or IV starts. Each child and parent met with a therapist who demonstrated a distraction tool and discussed the effectiveness of distraction during painful procedures. The therapist met with each child and parent on several continuous clinic visits to provide distraction and eventually empower a parent to utilize the technique with their child.
Significant Findings: The use of distraction was effective in reducing child and parent anxiety during procedures.
Implications for practice: Distraction appears to be effective even if children have repeated invasive procedures. It is important to utilize distraction items that are appropriate to the developmental level of each child.
Research Question: Assessed the effects of a pre-admission program to prepare children and families for day surgery.
Methods: Seventy-five families comprised a control and experimental group. The experimental group, consisting of children ages 3-12, received preparation throughout daylong program, led by nurses. The program consisted of a slide presentation, rehearsal of procedures, visits to OR, and medical play. Fifty-two families comprised the control group and received no intervention. Parents were interviewed about parent/child anxiety and children's anxiety measured by the FACES Scale.
Significant Findings: Children in the experimental group were less anxious than the children in the control group. Parental and child anxiety were strongly correlated.
Implications for practice: Preparation program for children and families before surgery lowers anxiety and increases their comfort level about the experience.
Research Question: To determine the effectiveness of distraction techniques with the use of EMLA on pain and distress during IV insertion
Methods: One hundred and sixty children ages 2 to 16 were randomized according to four age-based blocks, then divided into two groups. The experimental group received developmentally appropriate distraction by a nurse, and the control group allowed parents to use their typical strategies. Both groups were measured on pain and behavioral distress ratings
Significant Findings: While pain ratings were not affected by age or distraction, children's distress scores were lower for children in the distraction group and older children.
Implications for practice: The study supports the use of pharmacological and psychological intervention in order to decrease behavioral distress.
Research Question: To determine the effectiveness of a pain coping skills intervention in children with sickle cell disease after one month.
Methods: 46 children with sickle cell disease ages of 8 to 17 were divided into two groups. The experimental group was asked to practice daily with an audiotape of relaxation and imagery activities. The control group received routine medical care. Both groups were measured on pain sensitivity, coping strategies, depression, anxiety, and daily pain.
Significant Findings: Children who were in the intervention group were more active in managing their own pain, and, when they practiced their coping strategies, they had fewer health visits and school absences than when they did not practice.
Implications for practice: The coping skills training can increase participation of patients in managing the pain and health care, as well reduce their utilization of health care and reduce disruption in their daily life
Research Question: Does psychological preparation reduce anxiety of children undergoing ENT surgery?
Methods: 160 children and parents studied in two groups – the control group with tour only and the experimental group with medical play. Questionnaires were given to patients/parents to rate anxiety and satisfaction before and after surgery.
Significant Findings: Children in experimental group were less anxious than control group. Parents/patient were more satisfied with care.
Implications for practice: Medical play adds value by reducing anxiety and increasing satisfaction.
Research Question: To determine the effectiveness of a videotape and picture book on the prevention and management of acute episodes of asthma in young children.
Methods: 80 children diagnosed with asthma between the ages of 2 and 5. The children were divided into four groups (three experimental and one control). The three experimental groups were a) videotape alone; b) book alone, c) both videotape and book. The control group had no interventions. Children were measured on the knowledge of asthma, compliance with medication, and health status.
Significant Findings: Children in the experimental group had increased knowledge over the control group, with the greater increase in knowledge in the group that saw the videotape and the book. Children in the experimental groups also had greater compliance than patients in the control group
Implications for practice: Developmentally appropriate learning material can help even the youngest children increase knowledge and compliance with medical conditions.
Research Question: Research Question: To determine the effectiveness of a community-based support program on the anxiety, depression, and other secondary mental problems of mothers who have chronically ill children.
Methods: 193 mothers of chronically ill children (diabetes, sickle cell anemia, cystic fibrosis, or moderate to severe asthma) between the ages of 7 and 11 were enrolled either into the experimental community-based support program or a control group. The community- based program provided support through veteran, trained mothers who had kids with the same illness and a child life specialists. The program included telephone calls, face–to face visits, and special events.
Significant Findings: Mothers who participated in the experimental group had decreased anxiety scores during the intervention across all diagnoses with the greatest effect seen in mother who had high baseline anxiety and/or poor health ratings
Implications for practice: Psychosocial support program can positively effect maternal functioning
Category: Family-Centered Care
Research Question: Does a combination of pharmacological and psychological interventions help reduce procedural distress more than a pharmacological-only intervention?
Methods: 45 patients received the pharmacological-only intervention and 47 received the combination of pharmacological and psychological interventions. A cross-sectional control group consisted of parents of 70 patients in first remission before the study.
Significant Findings: Lower levels of child distress were reported in the combined intervention than the pharmacological-only intervention. The two intervention groups showed lower levels of child and parent distress than the control group. Younger children had more distress.
Implications for practice: The two interventions are effective in reducing procedural distress for the child and the parent. There is a need to develop more interventions for young children and their families.
Research Question: To assess the effectiveness of the combined use of local anesthesia to the skin, sensory preparation and parental involvement on the reduction of distress in children undergoing venepuncture.
Methods: 31 children between the age of 3 and 8 were two divided in two groups. The experimental group was provided EMLA, a short sensory preparation read by parents, and parental involvement in venepuncture. The control group received no preparation or EMLA but parents were present for venepuncture. Children were rated on behavior distress.
Significant Findings: Children in the preparation group showed less distress before and during venepuncture.
Implications for practice: The combination of sensory preparation and local anesthesia cream can reduce or prevent distress in children under going venepuncture.
Category: Coping, Preparation
Research Question: To determine effects of psychological intervention in reducing anxiety of hospitalized children.
Methods: Control group received no program, and experimental group received a preparation program prior to or on admission. Interventions in the hospital included relaxation, cognitive approaches, and social behavioral training. Difference in the groups' anxiety was measured at the beginning and end of the hospital stay.
Significant Findings: Experimental group showed a decrease in anxiety during hospitalization as compared with the control group.
Implications for practice: Psychological preparation can reduce anxiety in children admitted to the hospital.
Category: Coping, Preparation
Research Question: To determine the effect of using developmentally appropriate games in dental health education, the best presentation order for the games, and the long-term effectiveness of the games.
Methods: One hundred and eighty preschool aged children (3.0 to 5.7 years of age) were divided into three groups. The control group received the standard verbal dental health education. The first experimental group (analytic group) watched a puppet show about dental health before playing games about dental health, including a food-matching game, a role-playing game with healthy and unhealthy food, and role-playing with toothbrushes. The second experimental group (synthetic group) played the games first and then watched the puppet show. All of the groups were pre-tested and assessed on several measures of dental health knowledge and tooth brushing skill.
Significant Findings: Children in both experimental groups showed greater knowledge and dental health skills than the control group after the intervention and at follow-up. Children in the analytic experimental group showed more knowledge than the synthetic group.
Implications for practice: The use of developmentally appropriate games and activities is more effective than using only didactic information with young children. Also, it is more effective to teach children why they should do something before teaching them what to do.
Research Question: Effectiveness of psychological preparation program for children undergoing endoscopy.
Methods: Control group received no psychological preparation, and experimental group received psychological preparation. Groups were measured on anxiety, behavioral distress, cooperation, vital signs, and parent/patient questionnaires.
Significant Findings: Experimental group was less anxious, required less sedation, was more cooperative, had less autonomic nervous system stimulation, and had less change in blood pressure.
Implications for practice: Psychological preparation is effective in reducing anxiety, increasing cooperation, decreasing sedation medicine needed, and improving parental/ patient satisfaction.
Category: Preparation, Coping
Research Question: To explore the knowledge of healthy preschoolers concerning what happens in the hospital, what it means to be sick, their knowledge of and reactions to medical equipment, and their understanding of leukemia, in order to achieve a better of the impact of leukemia on preschoolers.
Methods: Twenty-seven children between the ages of 3 and 5 participated in a free play session that included medical equipment and developmentally appropriate toys. During the session, children were asked questions about being sick, cancer, and the hospital situations. The play sessions were recorded with a Child Life Specialist, and the verbatim transcripts of the session were assessed into themes, using the QSDR NUD*IST computer program.
Significant Findings: Most children spent only a small amount of time engaged in medical play. Some of the children with previous hospital experience were fearful of medical play. Seventy-three percent of the children did not have detailed knowledge about the medical equipment. Sixty percent of the children who talked about experiences with sickness used simple statements, and some children who had more medical experience had more sophisticated answers. None of the children had heard of leukemia, and the children who knew about cancer had personal experience with it. The children could not identify the use of medical equipment, IVs, and anesthesia masks when shown a picture of them in use, and the children used their imagination and inventiveness in order to determine a use for the equipment.
Implications for practice: Preschool children have both misconceptions about medical equipment and use their imagination readily in order to invent uses for equipment. This highlights need for therapeutic play to correct misconceptions and reduces anxiety upon exposure to medical experiences.
Category: Therapeutic Play
Research Question: To identify aspects of PICU care and parental coping that have a favorable effect on parental bereavement outcome.
Methods: Parent participants completed two standardized questionnaires, the Coping Resources Inventory and the Texas Revised Inventory of Grief that quantifies the intensity of grief both near the time of death and in the present (TRIG 1 and TRIG 2).
Significant Findings: Parents whose children died of acute illness had higher intensity of grief scores than parents whose children died of chronic disease. Parents who felt that staff were uncaring, nervous or unresponsive had higher intensity of grief scores, as did those who felt the staff was evasive, which demonstrates that the outcome of parental bereavement after death of a child in the PICU is influenced by intrinsic parental factors (coping resources and strategies) and extrinsic factors (emotional attitudes of staff and adequacy of information provided).
Implications for practice: Demonstrates the importance of responsiveness to parental presence. Unobtrusive assistance such as that be provided by child life specialists can support the link of communication between the larger health care team and family members. These become particularly critical with those families whose children die of acute illness, when there is no time to develop long-term relationships of trust and support.
Category: Coping, Family-Centered Care
Research Question: To determine the effects of a child behavioral informational intervention on children's post hospital negative behavioral changes and the mediating effects of maternal anxiety and participation in their child's hospital stay.
Methods: 49 mothers of children between 24 and 68 months of age were divided into two groups. The experimental group received Child Behavior Information about the common behaviors and emotions of children during and after hospitalization, and they received interventions in order to promote the children's adaptation. The control group received information about hospital services. Both groups were measured on maternal anxiety, parental participation, child behavior, and knowledge of hospitalized children's behaviors.
Significant Findings: Mothers who participated in the Child Behavior Intervention had more knowledge of children's behaviors due to hospitalization, and their children had fewer negative behavior changes. The intervention was found to lessen maternal anxiety and increase maternal participation in their child's care.
Implications for practice: This study demonstrates how an informational intervention with a parent is able to affect the behavior of her child by improving maternal coping, especially with young children.
Category: Family-Centered Care, Teaching/Education
Research Question: To evaluate the efficacy of non-pharmacological intervention, specifically music and guided imagery in relaxing children undergoing MRI enough to eliminate the need for routine sedation.
Methods: Experimental group listened to the music through headphones, and the control group had no music through the headphones. Children responded by pre-and-post MRI questionnaires, measuring the child's responses on a behavior scale, and physical observations of the children were made before, during, and after testing.
Significant Findings: The experimental group was calmer, more alert, less agitated, and less distressed than the control group.
Implications for practice: Music and guided imagery are effective in reducing the number of children requiring sedation for an MRI test.
Research Question: The ability to assess chronic pain in non-communicative children by developing an observational measure based on caregiver reports.
Methods: 29 caregivers of children with a chronic or life-limiting condition underwent semi-structured interviews where they were asked to list specific pain cues.
Significant Findings: 90% of the caregivers used six cues from five different categories to identify severe pain in their children.
Implications for practice: The development of a reliable measure to assess pain in non-communicative children will allow medical staff to provide better pain control for those children.
Category: Assessment, Pain
Research Question: This study explores the perception of pain in children with sickle cell disease and how it affects their lives in areas such as mental age and emotions.
Methods: Thirty children (between the ages of 5 and 13) with sickle cell anemia and their parents were interviewed. The children were asked to draw a picture of themselves and a picture of themselves in pain. After each picture, the interviewer conducted a semi-structured interview, and the results were analyzed with the Goodenough draw-a-person test, IQ, and the Koppitz test for emotional indicators.
Significant Findings: The mental age of the same child calculated twice from each of two self-drawings and a difference was found between those calculated mental ages when compared. The self-drawings of the child with no pain showed a higher mental age than the self-drawing of the same child recalling pain. Children who had more control over their pain showed a smaller drop in cognitive level between the two self-drawings.
Implications for practice: This study highlights the need to help children with sickle cell develop ways to feel they have more control over their pain. Also, this study shows the usefulness of using a self-drawing technique to assess to effects of sickle cell disease and its possible use as an intervention.
Category: Assessment, Pain
Research Question: To examine the behavioral responses of infants with non-organic failure to thrive (NOFTT) during play interactions with their mothers.
Methods: The sample consisted of 31 infants: 17 with NOFTT and 16 healthy controls with normal patterns of growth matched for age, sex and race. Infants and their mothers were videotaped in the home environment during a 5-minute free-play interaction, and the infants' behavioral responsiveness during the play session were subsequently assessed, using the Parent-Child Early Relational Assessment. Variables measured included expressed affect and characteristic mood, behavior/adaptive abilities, activity level, and communication.
Significant Findings: Infants with NOFTT displayed more difficult behaviors during play interactions than their healthy peers. Infants with NOFTT demonstrated numerous negative behaviors during play, including negative affect, gaze aversion, less vocalization and ambiguous cues, and were less socially responsive to attempts by the mother to engage them in play.
Implications for practice: Assessment of the infant-mother interaction during play may provide health care professionals with insight into interactions that take place during other care taking activities, whereby interventions could be developed to assist the mother with interacting with her difficult infant.
Research Question: To assess levels of stress in parents of children undergoing bone marrow transplantation (BMT) over the course of hospitalization of their children and to determine the effectiveness of psychological intervention program that teaches parents stress management techniques.
Methods: Twenty-two mothers of children (ages 2-16) were divided into two groups. Both groups were followed from before admission to BMT until three weeks post transplant. The mothers in the experimental group were trained in stress management techniques.
Significant Findings: Significant changes in stress level were found over time with the most stress reported before admission. Mothers in the intervention group used more stress management techniques than mothers in the control group, but there were no differences found in the level of stress.
Implications for practice: Increased levels of parenting distress may occur pre-transplant, suggesting the need for additional psychological intervention at that time.
Category: Coping, Family-Centered Care
Research Question: To investigate the needs of parents with critically ill infants in the neonatal intensive care unit (NICU).
Methods: The NICU Family Needs Inventory was administered to 52 parents (42 female, 10 male, mean age of 26.19 years) of critically ill infants in a NICU.
Significant Findings: The parents in this study chose assurance needs as being of the greatest importance, while support needs were ranked as least important by parents. There were significant differences in the need statements as reported by mothers and fathers, in that the fathers ranked assurance, information and support needs as significantly less important than the mothers ranked them.
Implications for practice: The results of this study support the notion that, in order to meet parental needs, family centered care must be consistently incorporated in the NICU.
Category: Family-Centered Care
Research Question: To assess the effectiveness of an interactive therapeutic puppet show on preschool children before surgery.
Methods: 50 children participated in a puppet show before surgery, while the control group of 50 received usual care. Children were measured at admission, time of stressful procedure, after surgery, and after discharge on physiological and behavioral measures.
Significant Findings: Children in the experimental group showed less anxiety, more cooperation, lower blood pressure and lower pulse rate during injection. They also voided bladders more quickly after surgery, and had lower scores on a post-hospitalization behavioral questionnaire.
Implications for practice: This study shows the effectiveness of therapeutic play on reducing anxiety and stressful responses for children undergoing surgery and hospitalization.
Research Question: Do cognitive behavioral interventions help young children cope with voiding cystourethrograms?
Methods: 40 children were studied in two groups – the intervention group receiving procedural information, coping skills training, and parent coaching, and the control group receiving standard care. Groups were assessed by patient report, parent and technician ratings, and behavioral observation.
Significant Findings: Children who received the intervention were more cooperative than the children who received standard care by generally displaying less distress behavior and more coping behavior, although they still had some emotional distress and fear related to this procedure.
Implications for practice: This study demonstrates the importance of preparation and coping for children undergoing VCUG's.
Category: Coping, Preparation
Research Question: To examine the process and outcome of a time-limited, manual-based group therapy intervention program with regards to symptoms of depression, anxiety, and behavior problems in siblings of pediatric cancer patients.
Methods: 17 siblings, ages six to seventeen, and one parent of each child. The siblings participated in eight weekly two-hour sessions of a manualized group intervention program (Siblings Coping Together) addressing emotional and behavioral problems in siblings of children with cancer. Siblings also participated in pre- and post group evaluations. Evaluation data was collected from the siblings and parent.
Significant Findings: Siblings had significant findings of lower symptoms of depression and anxiety, fear of the disease, and improvement of intra-personal skills (thoughts and feelings) related to cancer. Parents had a significant finding of increased cancer related communication with the siblings.
Implications for practice: This program supports the movement towards family-centered care in pediatric hospitals. Findings also suggest that such interventions can release some familial stresses surrounding childhood cancer, for both the siblings and parents. Child Life staff should know of pre-existing sibling/parent support groups to refer families to, or create sibling/parent support groups to give siblings and parents the opportunity to share experiences.
Category: Coping, Family-Centered Care
Research Question: To evaluate the psychometric properties of the Non-communicating Children's Pain Checklist – Postoperative Version (NCCPC-PV) when used with children with severe intellectual disabilities.
Methods: Sample size included caregivers of 24 children with severe intellectual disabilities (aged 3-19). Before and after surgery, each child was observed by one of their caregivers and one of the researchers for 10 minutes. They independently completed the NCCPC-PV and made a visual analog scale rating of the child's pain intensity for those times. A nurse also completed the scale for the same observations.
Significant Findings: Post-operative pain of non-verbal children who have severe intellectual disabilities can be assessed using a formal pain tool. Adults who were unfamiliar with these children were able to detect signs of pain using the NCCPC-PV. Facial expressions were used by all observers and may be the most useful consistent cues to pain shown by the children.
Implications for practice: The NCCPC-PV has the potential to be a useful tool used by health care professionals to assess children's pain.
Category: Pain, Assessment
Research Question: To examine whether parental assessment of a child's usual behavioral reaction to common painful events predicts the child's ratings of needle pain intensity from routine venipuncture.
Methods: Sample size included children, ages three to twelve. Equal number of boys and girls were sampled into two age brackets (3-7 and 8-12 years of age). The Faces Pain Scale and a behavioral checklist were used in the study. Three ratings of pain responses were obtained from the children, parents and independent observer.
Significant Findings: Parental estimates of reactions to other painful events proved to be a useful predictor of self reported needle pain. For those parents who indicated having relied on what their child physically did rather than what the child verbalized, the parent and child ratings of pain agreed more closely. Facial responses to pain was the most useful indicator of needle pain severity.
Implications for practice: Preparation of children by Child Life Specialists for venipuncture may be enhanced by asking a parent beforehand how the child usually responds to everyday pain.
Category: Assessment, Family-Centered Care, Pain, Preparation
Research Question: To study the mean effect across studies for the effects of distraction on young children's distress behavior and self-reported pain during medical procedures.
Methods: 16 studies (total n = 491) on children's distress behavior and 10 studies (total n = 535) on children's pain were examined using the Hunter and Schmidt (1990) method for meta-analysis.
Significant Findings: Across the populations represented in this study distraction had a positive effect on children's distress behavior.
Implications for practice: Using distraction with children during medical procedures will reduce the amount of observed distress behavior for most children.
Research Question: To investigate the validity and reliability of the "Child Drawing: Hospital" as a measure of anxiety for hospitalized children.
Methods: The study sample consisted of 139 children (ages 5 to 11). These children were randomly divided into two groups, the control group and the experimental group. The experimental group received half an hour of therapeutic play daily from a nurse play therapist. The Child Drawing: Hospital and the Missouri Children's Picture Series with parental information was presented to children within 24 hours of admission and within 24 hours before discharge. Research assistants who were blind to the group assignments scored the drawings using the Child Drawing: Hospital Scoring Manual.
Significant Findings: The study reports that The Child Drawing: Hospital is a valid and reliable tool to measure anxiety of hospitalized school-aged children (ages 5 to 11).
Implications for practice: The Child Drawing: Hospital instrument is an assessment tool that can be used by health care professionals to obtain information regarding the child's emotional status, as well as their physiological status. This would allow the health care professional to monitor the emotional well being of the hospitalized child.
Research Question: Which variable in early social environment (father-child and mother-child interactions, perceptions of parenting stress, socioeconomic status, pre-maturity) was most predictive of the child's development at four years of age in healthy pre-term and full-term children.
Methods: 44 healthy pre-term and 49 full-term Canadian children were matched. At 3 and 12 months, the Nursing Child Assessment Teaching Scale, Parenting Stress Index, and Dyadic Adjustment Scale were administered to the child and/or parents. At four years the McCarthy Scales of Children's Abilities and the Clinical Evaluation Language Fundamentals-Preschool were administered to the child to assess developmental outcomes. Parents completed a general information questionnaire.
Significant Findings: Whether the child was born pre-term or full-term was a significant predictor of the child's receptive language, cognitive and motor skills, but not expressive language at 4 years of age. Mother's perceptions of stress associated with the child's distractibility, and mother's and fathers interactions with their 12-month-old child all predicted the child's later expressive language development.
Implications for practice: Mothers and fathers should be encouraged to interact with their infant to encourage expressive language development. Programs should help mothers understand their child's age appropriate attention span to decrease feelings of stress.
Category: Family Centered Care, Assessment
Research Question: Analyzed the reliability and validity of a new questionnaire specifically designed to measure children's worries concerning a surgical procedure.
Methods: Sample size included 1,311 children between 7 and 10 years of age. The random sampling was carried out in the cities of Murcia and Elche, Spain. The questionnaire was administered to groups of 4 to 5 children in their classroom. The researcher remained in the room to offer help when necessary; otherwise the children filled out the 17-item questionnaire independently. The questionnaire used a 3-point Likert-type scale including 0 ( not at all worried ), 1 ( quite worried ), and 2 ( very worried ). It related to statements such as, “I'm worried about what I'll feel during the operation.”
Significant Findings: The Children's Surgical Worries Questionnaire (CSWQ) has a satisfactory internal consistency, a high temporal stability, and unidimensional structure.
Implications for practice: Reliable and valid questionnaires can provide a quick and affordable way to determine more accurately the nature of the child's experience as well as to assess the effects of interventions such as surgical preparations.
Methods: This descriptive pilot study used a one-group pretest-posttest design. The sample size of 34 subjects, ages six to twelve years, represented a typical clinical population of children with asthma. Children's asthma knowledge, symptoms, behavior, mastery, and peak-flow technique were measured two to three weeks before camp and, again, on the last day of a five-day camp. Baseline measures of parents' asthma knowledge and family stress related to asthma were obtained. Outcomes specific to asthma management, such as missed school days, emergency room visits, and hospitalizations, were evaluated by parent report the year before and after the intervention.
Significant Findings: The children demonstrated a significant improvement in peak-flow technique. Parents reported a reduction in emergency room visits and missed school days after camp.
Implications for practice: Child Life Specialists may use an applied teaching format for school-age children in an asthma day camp or other setting in order to help children achieve a sense of mastery, empowerment and improvement in asthma self-management skills.
Category: Coping, Teaching
Methods: Concept analysis method includes (1) selecting a concept of interest (social support), (2) establishing a purpose of analysis (to educate pediatric nurses), (3) identify uses of concept (social support) as documented in previous research, (4) determining defining attributes (emotional support, instrumental support, informational support, appraisal support, (5) developing model case (fictitious case of Jennifer), (6) building additional cases (a contrary case and a borderline case), (7) identifying antecedents (social network, social embeddedness, social climate) and consequences (self-esteem, coping skills, understanding), and (8) establishing empirical referents (instruments for social support).
Significant Findings: Social support to siblings of cancer patients is critical in their social health. More research is needed.
Implications for practice: Supporting siblings of cancer patients in the healthcare setting can be crucial to the effect the illness has on the sibling. Nurses could benefit from an understanding of simple interventions that are socially supportive; CLS could impart such knowledge at brief in-service opportunities.
Category: Family Centered Care
Research Question: Which social support interventions (emotional, informational, instrumental, appraisal support) siblings of children with cancer currently receive from pediatric oncology nurses are perceived as being helpful?
Methods: The 50 healthy siblings for this study ranged in age from 7 years to 12 years. Fifty-four percent of the siblings were male and forty-six percent were female. There were 50 parents ranging in age from 27 years to 48 years. The majority of the participating parents were mothers who were married (70%), separated (22%), or divorced (8%). All parents completed high school, and 76% had some college education. The sibling version is a self-report as is as the parent version.
Significant Findings: Highlight the need for pediatric health care professionals to recognize that healthy siblings' perceptions of their own need for social support may not be congruent with those of their parents and health care professionals.
Implications for practice: Child Life specialists have an opportunity to effect change in clinical practice that supports not only the needs of the child with cancer and his/her parents, but also to advocate for the well siblings' psychosocial needs.
Category: Family-Centered Care
Research Question: To enhance understandings of what social support interventions healthy siblings of children with cancer perceive as being helpful. These interventions are emotional, informational, instrumental, and appraisal social supports.
Methods: The 50 healthy siblings ranged in age from seven years to twelve years and were asked to respond to two open ended-ended questions related to the childhood cancer experience such as “write about things they wish nurses or parents would do to help children who have a brother or sister with cancer”, or “discuss things that nurses or their parents have done that have been helpful in adjusting to the childhood cancer experience”. Content analysis was used to address the responses to the open-ended questions.
Significant Findings: The majority of healthy siblings of children with cancer perceive emotional and instrumental support to be helpful in adjusting to having a brother or sister with cancer.
Implications for practice: Understanding the psychosocial needs of healthy siblings, in addition to the needs of the ill child and the parents, must be an integral part of delivering comprehensive family-centered care in the field of Child Life.
Category: Family Centered Care.
Research Question: Compared the frequency of problem behaviors in adolescents of parents with chronic health conditions and adolescents with healthy parents.
Methods: Participants were 82 middle school adolescents and their families in rural south central Florida. Packets containing a cover letter and instructions, consent forms, and questionnaires were sent to families who had expressed interest in participating. Questionnaires included a health history form, the SF-36 Health Survey, the Child Behavior Checklist and the Youth Self-Report.
Significant Findings: Adolescents with a parent who is suffering from a chronic illness, especially when quality of life is affected, tend to exhibit more behavior problems than adolescents with healthy parents who report a higher quality of life. A stronger correlation between adolescent behavior problems and parent health was found when the father is the affected parent. No interaction was found between child sex and parental health status nor in the same sex or opposite sex correlations.
Implications for practice: It is important to consider parental health status in the evaluation and treatment of adolescent behavior problems. A proactive approach may be to introduce and involve a Child Life professional with children and adolescents at the onset of parental diagnosis.
Category: Family Centered Care
Research Question: Can family-centered care practices of pediatric caregivers be reliably analyzed via a self-assessment questionnaire?
Methods: The Measure of Processes of Care for Service Providers (MPOC-SP) is a 27-item self-assessment questionnaire for health professionals (working with chronically ill or developmentally delayed children) designed to measure the reported implementation of family-centered services (FCS). Two phases of measurement design and field tests were conducted to develop the four categories of: Showing interpersonal sensitivity; Providing general information; Communicating Specific information about the child; Treating people respectfully. Participants were recruited from 16 rehabilitation centers in Ontario, with a total sample size of 324. Disciplines represented in the sample were: occupational therapists; speech-language pathologists; physiotherapists; service coordinators/case managers; nurses and social workers.
Significant Findings: This study indicates that the MPOC-SP is a valid and reliable self-assessment tool within the health profession.
Implications for practice: The MPOC-SP appears to provide a reliable, valid, in-depth measure of the family-centered care practices among a range of health professionals in pediatric settings, including Child Life Specialists.
Category: Family-Centered Care, Assessment
Research Question: Describe and trace children’s attachment to stories from different sources (books, videos, stories of personal experience and make-believe stories).
Methods: Interviews. 32 mothers of middle-class, European American families with preschoolers were interviewed and six of the thirty-two came back for diary-observation. The mothers discussed past and current emotional attachments to stories.
Significant Findings: Explore how child and caregiver interact with books through story attachments. Mothers said story attachments help to relax the child. Children used stories to moderate their emotional states. Questions to consider: The place and value of story attachments when managing emotions? One boy took a book home with him from the hospital and returned months later with book.
Implications for practice: Knowledge about preschoolers' strong attachments to stories. Helping parents understand their child’s attachment to characters in stories that may assist in their coping and learning new skills.
Research Question: How to help children and families cope with illness and or hospitalization of an adult family member
Methods: Case study. Mother with breast cancer and her 3 schoolaged children.
Significant Findings: Coping for a parent in the hospital might include; denial of the child’s needs, and guilt or sadness because the parent feels incapable of caring for their children. Benefits for the parent, child, and family when child visits.
Implications for practice: Talk to children and parents about emotions. Prepare children for the hospital setting and for mother’s surgery to reduce stress. Focus on family-centered care. Inform parent of post visit stress.
Research Question: How do parents experience the care their child received while hospitalized?
Methods: Qualitative descriptive design using grounded theory. Interviewed parents of various ethnicity, ranging in age from 19 to 65, whose child was hospitalized within the last twelve months, were present with their child part of the hospitalization and willing to talk about child cared for in the hospital.
Significant Findings: Findings prove that relationships with family, staff, and other caregivers are equally important. Further research could include looking into parent’s economic status and researching other qualitative studies. Parents focused on four main categories: facing boundaries, attempting to understand, coping with uncertainty, and seeking reassurance from caregivers.
Implications for practice: Intervention to provide quality care for children and advocate importance of family involvement