Automated Training for Pediatric Pain Management

描述(由申请人提供)：儿童经历了许多痛苦的医疗程序，这可能会导致一系列短期和长期的负面影响。此外，患者的父母和医务人员也遭受了不必要的附带痛苦。令人振奋的是，一些干预措施已被证明可以减少儿童、父母和工作人员经历的程序性痛苦。然而，这些干预措施还没有很好地传播到儿科实践中，这可能是因为它们的成本高和可行性低。该提案的目的是评估一套儿科疼痛管理方案，该方案具有在卫生保健设施中广泛使用的高潜力。参与者将包括150名接受学龄前疫苗接种的4至6岁儿童及其父母。家庭将被随机分配到三种条件中的一种：训练和分心、单独分心或典型护理。通过一个互动的计算机培训计划，被分配到培训和分心条件下的家庭将学习父母指导和儿童应对技能，以便在有害事件中使用。在免疫期间，这些儿童还将观看一部令人分心的电影。单独处于分心状态的儿童将不会接受手术前的训练，但将观看电影。典型护理参与者既不会接受培训，也不会接受电影。家长和护士的辅导行为将用行为观察量表进行量化。儿童焦虑和疼痛将通过自我报告、父母报告、护士报告、行为观察惊吓和心率进行评估。父母报告、护士报告和心率将评估父母的焦虑；护士将评估自己的痛苦。家长和护士将对这三种情况进行满意度评分。一项在手术时和3个月后使用的知识测试将评估父母对指导行为的理解和保留情况，研究表明，在痛苦的事件中，指导行为对孩子有帮助和没有帮助。结果可能支持一种创新的干预措施，可以用来培训父母和孩子在侵入性医疗程序中使用经过验证的疼痛管理技能。

DESCRIPTION (provided by applicant): Children undergo numerous painful medical procedures, which can result in a host of short- and long-term negative repercussions. In addition, the patients' parents and the medical staff experience undue collateral distress. It is heartening that a number of interventions have been shown to reduce the procedural distress experienced by the child, parent, and staff. However, these interventions have not been well disseminated into pediatric practice, which is likely due to their high costs and low feasibility. The purpose of the proposal is to evaluate a pediatric pain management package, which has a high potential for widespread use in health care facilities. Participants will include 150 4- to 6-year-olds receiving preschool vaccinations and their parents. Families will be randomly assigned to one of three conditions: Training and Distraction, Distraction Alone, or Typical Care. Via an interactive computer training program, families assigned to the Training and Distraction condition will learn parent coaching and child coping skills to use during the noxious event. These children will also be shown a distracting movie during the immunization. Children in the Distraction Alone condition will not receive the pre-procedure training but will be shown the movie. Typical Care participants will neither receive training nor the movie. Parent and nurse coaching behavior will be quantified with a behavior observation scale. Child anxiety and pain will be assessed with self-report, parent-report, nurse report, a behavior observation scare, and heart rate. Parent-report, nurse-report, and heart rate will estimate parent anxiety; and nurses will rate their own distress. Parents and nurses will provide satisfaction ratings for the three conditions. A knowledge test, used at the time of the procedure and 3-months later, will evaluate parents' understanding and retention of coaching behaviors shown in research to be helpful and not helpful to children during painful events. Results might support an innovative intervention that can be used to train parents and children in proven pain management skills to use during an invasive medical procedure.