The preparation of children for day surgery from the parent's viewpoint: A mixed methods study.

AIM: The purpose of the study was to describe the preparation of children for day surgery from the parent's viewpoint. DESIGN: Empirical Research Mixed Method. METHODS: The research applied a mixed-methods study design. The study was conducted at the Paediatric Day Surgical Department of one REDACTED between 2018 and 2020 at the same time as an associated randomised controlled conduct trial. Parents of 41 children (ages 2-6 years) completed measures assessing their preparation for day surgery and satisfaction with the procedure. Semi-structured interviews were conducted with 15 parents to better understand their experiences. RESULTS: According to the results, most of the parents (95%) told their children about the upcoming day surgery procedure. The child was prepared for the surgery with cognitive and sensory information, and the preparation usually started at home well before the surgery. The parents' experiences with the most critical aspects of preparing their child included three main categories: (1) usability of the preparation method; (2) content and timing of the preparation method and (3) consideration of the family perspective.

Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial.

BACKGROUND: Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. OBJECTIVE: This study aims to evaluate the effectiveness of a mobile app intervention on preschool children's fear and pain and parents' anxiety and stress in preparing children for day surgery. METHODS: This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents' and children's outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. RESULTS: Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children's pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children's fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). CONCLUSIONS: The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. TRIAL REGISTRATION: ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303.

Parents' perceptions of their child's pain assessment in hospital care: A cross-sectional study.

PURPOSE: A prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents' perceptions of their child's pain assessment in hospital care. DESIGN AND METHODS: This study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis. RESULTS: Parents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child's pain assessment. Parents were satisfied with their child's pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child's pain and that the parents' and child's views on pain would be taken into account. CONCLUSIONS: Most children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales. PRACTICE IMPLICATIONS: Child's pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.

Women's perceptions of counselling on pain assessment and management during labour in Finland: A cross-sectional survey.

BACKGROUND: The challenge is to identify pain assessment counselling that are effective and reliable to the woman during labour while also supporting appropriate management of labour pain. OBJECTIVE: This study aimed to describe women's perceptions of their counselling on pain assessment and pain management during labour. DESIGN: A descriptive, cross-sectional study. PARTICIPANTS: The sample consisted of women who had given birth (n=204) at a university hospital in Finland; 250 parturients were recruited by convenience sampling. METHODS: Data were collected using a questionnaire (P-PAPM) between November 2018 and February 2019. The statistical significance of observed differences was analysed using the Chi-squared test and Fischer's exact test. RESULTS: Eighty percent of women reported that they had received counselling on pharmacological treatments from midwives, but only 33 % received counselling on pain assessment. The non-pharmacological methods for alleviating labour pain most commonly taught by midwives were proper breathing techniques, cold/heat treatments, and trying different positions and movements. Women were less commonly counselled to try listening to music, thinking about pleasant and positive things, or concentrating their thoughts on something other than pain. The two most commonly used counselling methods were demonstrations and written material and least used Internet-based resources. The personal issue that midwives discussed most frequently during counselling was the women's individual hopes concerning pain management (91%), while the issue discussed least often was previous experiences of pain (58%). The participants' experiences of fear, age, and education were significantly associated with aspects of counselling on pain assessment and management. CONCLUSIONS: Women's counselling on pain assessment and management during labour varied widely. Therefore, to improve its quality, counselling should be routinely integrated into daily midwifery work. In particular, the counselling given on non-pharmacological pain relief methods during labour was inadequate. More varied counselling methods should be used in the future. Finally, the results indicate that midwives' knowledge of counselling should be increased and they should be encouraged to routinely offer counselling on pain assessment and management for parturing women.

Women's perceptions of the pain assessment and non-pharmacological pain relief methods used during labor: A cross-sectional survey.

INTRODUCTION: The use of non-pharmacological pain relief methods and pain assessment scales during labor has received limited research attention. This study aimed to describe women's perceptions of the pain assessment and non-pharmacological pain relief methods used during labor. METHODS: A descriptive, cross-sectional survey was conducted. A convenience sample of women (n=204) from one Finnish maternity ward participated in the study. Women who had given birth were asked to respond to a validated questionnaire between November 2018 and February 2019. The statistical significance of observed differences was analyzed using the chi-squared test. RESULTS: Less than half (46%) of the women who gave birth at the hospital were asked to assess the intensity of their pain on a pain assessment scale. The most commonly used non-pharmacological pain relief methods were encouragement (92%), the presence of a midwife (82%), and proper breathing technique that was taught by a midwife (81%). Aqua blisters (3%), reflexology (e.g. zone magnets, 5%), and music (9%) were the least commonly used non-pharmacological methods during labor. The participants' experiences of fear and pain were significantly associated with the implementation of pain assessment. CONCLUSIONS: Women's pain was rarely evaluated by using a certain pain assessment scale. In addition, non-pharmacological pain relief methods were inadequately used during labor. More specifically, methods that required midwives' own personal contributions were rarely offered to the women.

Maternity ward staff perceptions of exclusive breastfeeding in Finnish maternity hospitals: A cross-sectional study.

INTRODUCTION: This study aimed to describe exclusive breastfeeding (EBF, Step 6 of the Baby-Friendly Hospital Initiative) in Finnish maternity hospitals and identify factors that promote or limit EBF. METHODS: A cross-sectional study design was used, and data were collected from eight maternity hospitals in Finland during a 10-day period in May 2014. The staff completed questionnaires (n=1554) from separate work shifts. The data were analyzed using descriptive statistics, and chi-squared and Fisher's tests. Responses to open-ended questions were analyzed using content analysis. RESULTS: Maternity ward staff reported that 72% (n=1105) of the infants were exclusively breastfed during their work shift. The strongest promoting factors of exclusive breastfeeding were: maternity ward staffs' profession and education in breastfeeding counselling; multiparity; vaginal delivery; early skin-to-skin contact between mother and infant; initial breastfeeding after birth; rooming-in; and initial success of breastfeeding. The use of a nipple shield, the need for additional breastfeeding counselling, and infants' blood tests were limiting factors to exclusive breastfeeding. Open-ended answers revealed that exclusive breastfeeding was mainly delayed because of medical issues for the mother or infant. CONCLUSIONS: Finnish maternity hospitals could improve exclusive breastfeeding rates by focusing attention and resources on breastfeeding counselling and evidence-based maternity care practices related to immediate care after birth, promoting vaginal delivery, rooming-in and availability of skilled counselling.

Implementation of Step 7 of the Baby-Friendly Hospital Initiative (BFHI) in Finland: Rooming-in according to mothers and maternity-ward staff.

INTRODUCTION: Rooming-in is an evidence-based practice during which postpartum mothers and infants stay together. Rooming-in benefits both the mother and infant, and is especially important for breastfeeding. This study aims to describe rooming-in (Step 7 of the BFHI), according to mothers and maternity-ward staff in Finnish maternity hospitals, as well as the factors associated with its implementation. METHODS: The presented research adopted a cross-sectional study approach. Questionnaires were used to collect data from mothers (n=111) who had given birth and the attending maternity-ward staff (f=1554 reported events) at 8 Finnish maternity hospitals. The data were analysed using descriptive statistics, as well as chi-squared, t-test, and Fisher, Mann-Whitney, Kruskal-Wallis tests. Answers to the open-ended questions were analysed using content specifications. RESULTS: Rooming-in was utilised to a satisfactory extent, especially after vaginal birth. Most of the mothers regarded it as a very positive experience. Rooming-in was delayed mainly because of a mother's tiredness and the infant's condition. Factors such as a staff member's age, work experience, and completion of breastfeeding counselling training (WHO 20-h), a mother's parity, need for supplementation, and mode of childbirth, were found to be associated with the decision to implement rooming-in. CONCLUSIONS: Rooming-in should be used more with infants born by caesarean section and primiparous mothers. The need for supplementation clearly increased when roomingin was not employed. The presented information could be crucial for effectively allocating maternity ward resources and demonstrating the importance of rooming-in to a diverse audience of health care professionals.

The realization of BFHI Step 4 in Finland - Initial breastfeeding and skin-to-skin contact according to mothers and midwives.

BACKGROUND: Breastfeeding and skin-to-skin contact are the best start for infant life. Breastfeeding ensures the best trajectory for development and growth while preventing many diseases later in life. It is recommended that initial breastfeeding occur during the first hour and that generally exclusive breastfeeding is adopted during the first six months. OBJECTIVE: The aim of this study is to describe how initial breastfeeding and skin-to-skin contact (Step 4 of the BFHI) is implemented in Finnish maternity hospitals as well as to explain the factors connected to it. The information can be used to develop maternity care during the immediate postpartum period. DESIGN: Cross-sectional study. METHODS: The data were collected from mothers who had given birth as well as their midwives via questionnaire during the spring of 2014 during one week at eight maternity hospitals in Finland. The response rate was 59% for the new mothers (n=111), while it was 57% for the midwives (n=272). The data were analysed statistically and the open-ended questions in the questionnaire using content specifications. FINDINGS: On the basis of the results, initial breastfeeding succeeded well after vaginal birth. Initial breastfeeding began, on average, at 41minutes of age and lasted for 51minutes. Of mothers, 87% regarded it a very positive experience. Initial breastfeeding was delayed mainly because of caesarean section and for reasons related to an infant's condition. Many background factors such as midwives' age, mothers' parity and the mode of childbirth were statistically significant in respect to the success of initial breastfeeding. CONCLUSIONS: More attention should be placed on the initial breastfeeding of infants born by caesarean section and primiparous mothers.