[Restraint in paediatric care]. / La contention lors des soins en pédiatrie.

Restraint in general, and particularly when giving paediatric care, is a sensitive subject. This practice continues to appear often as a solution when children are disorientated or struggle during care. However, it is generally traumatic for the different care agents: the child, the parent and the care-giver. Reflection on this subject has been carried out after exchanges with professionals about the use of restraint with children aged 2-4 during paediatric emergency care.

HEDEN Pain Scale: A Shortened Behavioral Scale for Assessment of Prolonged Cancer or Postsurgical Pain in Children Aged 2 to 6 Years.

Few observational scales are available for assessing chronic or recurrent pain in children with cancer because overt behavioral signs of chronic pain dissipate as time passes, making them difficult to detect reliably. The Douleur Enfant Gustave Roussy (DEGR) scale developed by Gauvain-Piquard to monitor prolonged pain in children with cancer aged 2-6 years is currently the only validated tool available for this purpose, but is time consuming and difficult to use in daily clinical practice. To shorten composite measurement scales, we developed the Hétero Evaluation Douleur Enfant (HEDEN) scale from the DEGR scale. We present here the process and validation of this scale. Expert consensus was used for the elaboration of HEDEN: 5/10 DEGR items were chosen with three rating levels. Concurrent validity was tested in a first cohort with correlation analysis between HEDEN and DEGR. The HEDEN scale was then validated in a second cohort. In the first step, the study (59 children) showed acceptable correlation between DEGR and HEDEN (r = 0.5), with good reliability (α = 0.61), and interrater agreement (r = 0.62). Subsequent validation in 48 children showed a significant correlation between DEGR and HEDEN (r = 0.6). Reliability was good (α = 0.75), with excellent interrater agreement [r = 0.67 (95% CI: 0.48-0.79)]. On average, the evaluation took 23 minutes (SD = 10.4) for DEGR versus 4.42 minutes (SD = 5.9) for HEDEN. This study shows a good correlation between HEDEN and DEGR scales. HEDEN allows accurate assessment of prolonged pain in young children with cancer.

[Chronic pain in children]. / La douleur chronique de L'Enfant.

Chronic pain affects 10 to 20% of children and teenagers. Apart from the physical consequences, it leads to psychological and social difficulties. These notions, still not well known, are often overlooked. It is essential to raise the awareness of professionals in order to identify these young patients as early as possible and offer them adapted multimodal treatment. The main aim is to develop their autonomy to enable them to gain better understanding of this pain and to treat the cause when it can be identified.

[Painful and anxiety-producing situations in pediatrics, progress to be made]. / Situations douloureuses et anxiogènes en pédiatrie, des progrès à réaliser.

Today there are still difficulties in ensuring that good practice guidelines are adhered to in relation to the prevention of pain and anxiety generated by care procedures carried out oh hospitalised children. Two studies were made in 2012 by pediatric nurses students to question that care situations the conditions in which these procedures are carried out and improve.

[Pain within the healthcare team, a source of dyscommunication]. / La douleur au sein de l'équipe soignante, source de dyscommunication.

The subjective nature and complexity of the pain phenomenon make it a difficult symptom to take into consideration, regardless of where the patient is being cared for, leading to multiple sources of dyscommunication between professionals. Despite the undeniable progress that has been made, this recurring theme has received little attention in the professional literature. It is therefore worthwhile analyzing the causes of these relational problems and proposing avenues of reflection and work that could help remedy them.

[Pain in children, using the right words]. / Douleur de l'enfant, utiliser les mots justes.

Verbal communication is an essential element in the prevention and treatment of pain in children and adolescents. It is essential to take into account existing knowledge and recommendations relating to verbal communication in the caregiver's relationship with a child in pain. Developing the nurse's ability to adapt to diverse situations and carrying out research concerning the effects of speech on the child are priorities.

[Pain in children: some progress, continuity to be monitored]. / Douleur de l'enfant: des avancées, une pérennisation à surveiller.

The fight against pain in children has progressed significantly since the 1980s. The setting up of pain prevention plans, the issuing of good practice recommendations, the development of new treatments as well as the training of professionals in particular account for this progress. However, caregivers must remain vigilant in order that the quality of care provided to a child in pain remains a priority.

[The ethics of compassionate care]. / L'éthique de la bientraitance.

Compassionate care in the nursing relationship maintains awareness of the risks of mistreatment and reiterates that intention is not enough. It aims for the intention, the emotion and the organisation to be articulated. Beyond the risks of control and protocolization, compassionate care enables the framework for action to be redefined and gives meaning to nursing practices.

[The principle of spirituality in healthcare establishments, the role of healthcare supervisors]. / Le principe de laïcité en établissement de santé, rôle du cadre de santé.

Healthcare teams are sometimes questioned by patients and their loved ones concerning respect for their desires or performing rites, whether religious or part of their own personal beliefs. While caregivers are convinced that it is part of their job to meet these needs, this is sometimes contrary to the requirements of neutrality and laïcité--the French concept of secularity--on healthcare premises. Nonetheless, each can contribute to the evolution of the general reflections undertaken by a team or an organization.

[Using touch to prevent pain during the removal of a drain]. / Le toucher pour prévenir la douleur lors de l'ablation d'un drain.

A study was carried out in 2010-2011 to assess the effectiveness of "conscious touch" in preventing the pain caused by the removal of the Redon drain in patients having undergone a hip replacement. The results show that the pain rating is significantly lower in patients having received this touch. This study opens the way for further research work on the prevention of pain during nursing procedures.