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Spinal fusion for idiopathic scoliosis is one of the most painful surgeries experienced by adolescents. Music therapy, utilizing music-assisted relaxation with controlled breathing and imagery, is a promising intervention for reducing pain and anxiety for these patients. It can be challenging to teach new coping strategies to post-operative patients who are already in pain. This study evaluated the effects of introducing music-assisted relaxation training to adolescents before surgery. Outcome measures were self-reported pain and anxiety, recorded on 0-10 numeric rating scale, and observed behavioral indicators of pain and relaxation. The training intervention was a 12-minute video about music-assisted relaxation with opportunities to practice before surgery. Forty-four participants between the ages of 10 and 19 were enrolled. Participants were randomly assigned to the experimental group that watched the video at the preoperative visit or to the control group that did not watch the video. All subjects received a music therapy session with a board certified music therapist on post-operative day 2 while out of bed for the first time. Pain and anxiety were significantly reduced from immediately pre-therapy to post-therapy (paired t-test; p).

Evidence-based pediatric pain management (EBPPM) has been identified as a practice too often overlooked in Emergency Departments (EDs). Studies show EBPPM is practiced inconsistently in urban EDs, and even less is known about the practice in rural EDs. The objectives of this study were: A) Determine the frequencies with which specific EBPPM practices are used in EDs of a primarily rural state; and B) Explore the differences in EBPPM practice in Critical Access, rural, and urban hospital EDs. A web-based survey, measuring the use of 14 EBPPM practices, was offered to all licensed independent providers (Medical Doctors, Doctors of Osteopathy, Physicians’ Assistants, and Advanced Registered Nurse Practitioners) and nurses from the 118 hospital EDs in a rural state. Responses from 259 providers and 1,177 nurses revealed that the majority of respondents infrequently used any type of topical analgesic before venipuncture or IV insertion in children, or oral sucrose for infant procedures. Tests for group differences show that providers from urban EDs more frequently used a topical analgesic for suturing lacerations, provided analgesics for blood draws, and gave pain medication to children with abdominal pain. Nurses from urban hospitals used significantly more EBPPM practices than nurses from Critical Access and rural hospitals (P Perspective In hospitals of all types, ED providers and nurses fail to take advantage of EBPPM practices. This study reveals that health professionals in rural settings are particularly in need of improving the use of recommended pediatric pain management practices.

Some children report significant pain with peripheral intravenous catheter (IV) insertion, despite the appropriate use of topical lidocaine anesthetics. This analysis of data from an existing study identified factors related to variation in topical anesthetic effectiveness used for IV insertion. The children (n = 218) in this investigation were 4 to 10 years old and undergoing a scheduled IV insertion. Inclusion criteria were (1) topical anesthetic was used according to manufacturer's recommendations, (2) DNA material was available, and (3) child completed a self-report measure of pain intensity (Oucher scale). Low pain phenotype was defined as a pain intensity score of 0 to 3, and high pain phenotype was an intensity score of 4 to 10. Potential predictor variables included child age, gender, number of previous painful procedures, state and trait anxiety, temperament characteristics, and alleles in 3 candidate genes in a pain pathway influenced by topical anesthetics (endothelin-1 [ EDN1 ], endothelin receptor A [ EDNRA ], endothelin receptor B [ EDNRB ]). All subjects were genotyped for a single-nucleotide polymorphism in each gene. Children in the high pain group (n = 89) were significantly younger ( P P = .0029), scored higher for trait ( P = .0009) and state anxiety ( P = .0312), and had the EDNRA TT genotype (high pain group, TT 67.35%; low pain group, TT 39.47%; P = .026). Perspective The identification of factors that influence peripheral pain sensation aids in selecting the most appropriate pharmacologic and nonpharmacologic interventions. Until genotyping is available at a clinically prescriptive level, other predictors (eg, age and activity level) can be used to tailor pain-relieving strategies for children undergoing needle sticks.

Salivary cortisol has emerged in pediatric research as an easy-to-collect, relatively inexpensive, biologic marker of stress. Cortisol is highly variable and is responsive to a wide range of factors that should be considered when incorporating this measure into research with children. Strategies for sample collection include: (1) standardizing the time for sample collection, including baseline samples; (2) using consistent collection materials and methods; (3) controlling for certain drinks, foods, medications, and diagnoses; and (4) establishing procedures and protocols. Other strategies for laboratory analyses include: (1) selecting the appropriate assay and laboratory; (2) identifying units of measure and norms; and (3) establishing quality controls. These strategies control extraneous variables and produce reliable and valid salivary cortisol results.

The purpose of this article is to present a model of factors that may influence a child's response to a painful procedure when parents are distraction coaches during the procedure. Nonpharmacological interventions, in particular, distraction, and parents as coaches for their children during procedures are discussed. A conceptual model is presented that illustrates the multiple factors and their possible relationships. A selected review of studies is provided that supports the inclusion of these factors in the model. The model and literature review focus on three major areas: characteristics of the child, characteristics of the parent, and procedural variables. The model presented is currently being tested in a large multisite study on the use of distraction during intravenous line insertion.

The purpose of this study was to provide a viable alternative to routine postpartum hematocrit measurement, by a determination of the clinical risk factors that identify patients with anemia and an examination of the resulting cost savings.In this retrospective review, cases (postpartum hematocrit level,26%; subgroup hematocrit level,23%) and control subjects were culled from the records of all vaginal deliveries from February 1997 to July 1998. Charts were reviewed for demographic characteristics, medical history, nursing assessments, and postpartum hematocrit measurements. Logistic regression modeling determined the best set of risk factors for the identification of low postpartum hematocrit levels.From 1484 vaginal deliveries, 117 of the women (8%) had postpartum hematocrit levels of26%. Estimated blood loss of500 mL, Hispanic ethnicity, dizziness, or third- or fourth-degree laceration were the factors that identified 82.9% of the women with hematocrit levels of26% and identified 97.4% of the women with hematocrit levels of23%. Only 39.3% of the women would have required postpartum hematocrit measurement to obtain these detection rates.Four risk factors (estimated blood loss of500 mL, Hispanic ethnicity, dizziness, and third- or fourth-degree laceration) can safely determine the necessity of a postpartum hematocrit measurement.

The UIHC Department of Nursing is nationally known for its work on use of research to improve patient care. This reputation is attributable to staff members who continue to question "how can we improve practice?" or "what does the latest evidence tell us about this patient problem?" and to administrators who support, value, and reward EBP. The revisions made in the original Iowa Model are based on suggestions from staff at UIHC and other practitioners across the country who have implemented the model. We value their feedback and have set forth this revised model for evaluation and adoption by others.

This study investigated the effectiveness of a brief Distraction Education intervention for parents prior to their preschool children's medical procedures. Forty-four preschool children with chronic non-life-threatening conditions were having intravenous catheters (IVs) placed for medical tests. Parent-child dyads were randomized into two groups. The experimental group received Distraction Education prior to IV insertion; the control group received standard care. Data were analyzed for two phases of the IV procedure. Phase 1 was the preparation for needle insertion; Phase 2 began with needle insertion. Experimental group parents used significantly more distraction than did control group parents during both phases (P < 0.001). There were no group differences for child behavioral distress or self-report of pain. There was a trend toward a group by phase interaction for behavioral distress (P = 0.07); more experimental group children showed decreased behavioral distress over time (from phase 1 to phase 2) than did control group children (P = 0.02).

A recently developed intraoral device is being used for infants who require orotracheal and orogastric intubation. The purpose of the appliance is to prevent complications associated with long-term intubation, such as palatal groove formation, acquired cleft palate, defective primary dentition, and chronic irritation of the airway. The nursing care required for an infant with this intraoral appliance is described. The procedure for daily removal of the appliance, oral hygiene, and assessment of the oral cavity is presented. Other nursing interventions addressed include provision of non-nutritive sucking, initiation of oral feedings, and parent teaching and support.