The Effect Of Percussive Therapy On Musculoskeletal Performance And Experiences Of Pain: A Systematic Literature Review.

Background: There is a lack of specific research on the effect of percussive therapy (PT) delivered by massage guns on physiological adaptations. This systematic literature review investigates research conducted on the effects of PT interventions on performance in strength and conditioning settings, and on experiences of musculoskeletal pain. Purpose: To determine the effect of PT delivered by massage guns on physiological adaptations: muscle strength, explosive muscle strength and flexibility, and experiences of musculoskeletal pain. Study Design: Systematic literature review. Methods: Data sources (CINAHL, Cochrane Library, Psychinfo, PubMed, SportDISCUS and OpenGrey) were searched from January 2006 onwards for full text literature in any language involving adult populations receiving PT delivered by massage guns, directly to any muscle belly or tendon, with comparisons to an alternative treatment, placebo or no treatment. Literature with outcomes relating to acute or chronic physiological adaptations in muscle strength, explosive muscle strength, flexibility or experiences of musculoskeletal pain were included. Articles were assessed for quality using the Critical Appraisal Skills Programme and PEDro scores. Results: Thirteen studies met the inclusion criteria. All studies had limitations in methodological quality or reporting of findings but still included contextually-rich details that contributed to the overall narrative synthesis. A significant relationship was found between a single application of PT delivered by massage guns and an acute increase in muscle strength, explosive muscle strength and flexibility, with multiple treatments eliciting a reduction in experiences of musculoskeletal pain. Conclusion: PT delivered by massage guns can help improve acute muscle strength, explosive muscle strength and flexibility, and reduce experiences of musculoskeletal pain. These devices may provide a portable and cost-effective alternative to other forms of vibration and interventions.

Interventions that prevent or reduce obesity in children from birth to five years of age: A systematic review.

Childhood obesity worldwide affects 5.6% or 38.3 million children under five years of age. The longer children are overweight or obese, the more likely they are to become obese adults with all the contingent morbidity involved. An extensive number of preventive interventions to combat childhood obesity have been carried out worldwide. This article reports a systematic review of interventions aimed to reducing or preventing obesity under-fives. The search was performed with six different databases: Web of Science, PsycINFO, Cochrane, PubMed, Medline, and CINAHL. Studies meeting the inclusion criteria were independently assessed using Joanna Briggs Institute methodology. Thirty studies involving 23,185 children across nine countries were included. Twenty-two were randomised controlled trials, and 8 quasi-experimental pretest/post-test design with comparison. These studies fell into four different categories: home-based interventions with family involvement (n = 12), preschool/early childhood settings (n = 9), multicomponent interventions across multiple settings (n = 6) and healthcare setting (n = 3). Future research should focus on increasing the accessibility of education on diet and physical activity for deprived families as well as the cultural acceptability of interventions to prevent childhood obesity.

Developing a Framework to Support the Delivery of Effective Pain Management for Children: An Exploratory Qualitative Study.

Two million children are admitted to hospital every year in the UK and between 59% and 94% will experience pain, with 27-40% of them experiencing moderate to severe pain. Currently, there are a number of well-researched guidelines on children's pain available, yet pain prevalence is high. Despite the guidelines, there is a lack of an overall framework that includes the necessary components to deliver effective pain management. This study was built on previous work about key elements that support children's pain management, by exploring their relevance and practical application with 43 healthcare practitioners. We carried out focus groups with band 5 nurses (n = 6) and advanced nurse practitioners (n = 11) and semistructured interviews with pain nurses (n = 16) and consultants (n = 10). We also presented and discussed our findings with an advisory group. Findings demonstrated that the following elements were considered to be important: delivering pain management with confidence, supporting colleagues with protocols and guidance, empowering parents to be involved in pain management, and adopting an individual approach to a child and family. These elements formed the basis of a framework for children's pain management. Some practitioners indicated that pain management required education and more resources, and that the culture of an area could influence pain management practice. The framework brings together elements that have the potential to improve the management of children's pain through its use as an education tool. Each interrelated element of the framework plays an important part in the overall management of children's pain. The need now is to make the dissemination of the findings accessible to health care practitioners, parents, and educators. Next steps include the development of infographic posters, an animation, and a free online course, which will incorporate the use of Bloom's taxonomy.

Developing a Sense of Knowing and Acquiring the Skills to Manage Pain in Children with Profound Cognitive Impairments: Mothers' Perspectives.

Children with profound cognitive impairment (PCI) are a heterogenous group who often experience frequent and persistent pain. Those people closest to the child are key to assessing their pain. This mixed method study aimed to explore how parents acquire knowledge and skills in assessing and managing their child's pain. Eight mothers completed a weekly pain diary and were interviewed at weeks 1 and 8. Qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics. Mothers talked of learning through a system of trial and error ("learning to get on with it"); this was accomplished through "learning to know without a rule book or guide"; "learning to be a convincing advocate"; and "learning to endure and to get things right." Experiential and reflective learning was evident in the way the mothers developed a "sense of knowing" their child's pain. They drew on embodied knowledge of how their child usually expressed and responded to pain to help make pain-related decisions. Health professionals need to support mothers/parents to develop their knowledge and skills and to gain confidence in pain assessment and they should recognise and act on the mothers' concerns.

How to prepare conference abstracts and poster presentations.

An effective way of disseminating nursing research is to present it at a national or international conference.

Navigating Uncertainty: Health Professionals' Knowledge, Skill, and Confidence in Assessing and Managing Pain in Children with Profound Cognitive Impairment.

There is limited evidence to underpin the assessment and management of pain in children with profound cognitive impairment and these children are vulnerable to poor pain assessment and management. Health professionals working with children with profound cognitive impairment from a single paediatric tertiary referral centre in England were interviewed to explore how they develop and acquire knowledge and skills to assess and manage pain in children with cognitive impairment. The interviews were transcribed and subjected to thematic analysis. Nineteen health professionals representing different professional groups and different levels of experience participated in the study. A metatheme "navigating uncertainty; deficits in knowledge and skills" and two core themes "framing as different and teasing things out" and "the settling and unsettling presence of parents" were identified. Uncertainty about aspects of assessing and managing the pain of children with cognitive impairment tended to erode professional confidence and many discussed deficits in their skill and knowledge set. Uncertainty was managed through engaging with other health professionals and the child's parents. Most health professionals stated they would welcome more education and training although many felt that this input should be clinical and not classroom oriented.

A Proposed Model of the Effective Management of Children's Pain.

The aim of this study was to understand the various factors that contribute to the delivery of effective pain management. The current picture of pain management is complex and contradictory, with children in the hospital still experiencing unnecessary pain, nurses reporting better pain care than is evidenced, and parents who are reluctant to report their child's pain. There is a real need to focus on areas of excellence where pain management innovations have been successfully implemented. Five hospitals were visited in three countries: the United Kingdom, Sweden, and Australia, spending a week in each country. In all, 28 health care professionals were interviewed exploring innovations in pain management; the effect of improvements on children, parents, and nurses; and what helped and hindered the delivery of effective pain management. Better pain management provides nurses with confidence, which in turn gives children and parents confidence in their care and reduces anxiety for nurses. Resources, on the other hand, were a common issue in relation to obstacles to innovation. A recurring theme in all areas visited was the issue of culture and how it affected both negatively and positively on the management of children's pain. Strong leadership was integral to moving practice forward and to introducing the innovations that led to effective pain management. The key findings identified that underpin the effective management of children's pain are effective leadership, resources, and confidence; the consequences are less stress for children and nurses, more trusting relationships, and greater job satisfaction. A model of effective pain management is proposed.

Research essentials: How to find funds to support projects.

IF YOU HAVE an idea for a research project, whether it is an investigation or a literature review, it can be difficult to know where to start looking for financial support. Finding colleagues to work with will provide you with a sounding board for your idea, as well as support and encouragement.

Preceptorship: ensuring the best possible start for new nurses.

The impending change to nurse education with the move to an all-degree profession in the UK from 2013 and the increasing demands made on nurses working in the NHS make successful transition from student to staff nurse a high priority. The stress of this move can be minimised by efficient preceptorship for the first six months of practice. As part of a practice-based project two focus groups were formed to discover the views of preceptors and preceptees in children's nursing on what their programme should include and achieve. The knowledge gained from this exercise informed a preceptorship model for one NHS trust.

An introduction to Q methodology.

AIM: To explain Q methodology, an untraditional approach to nursing research, by exploring the various stages involved in it and using two studies. BACKGROUND: Q has some of the advantages of qualitative and quantitative, methodologies. A defining principle of Q is its assumption that subjective viewpoints are amenable to systematic analysis. Q aims to identify shared views across a population. The orientation of the uncovered perspectives differs significantly from qualitative research and there is no researcher bias. DATA SOURCES: Studies on living with chronic pain and the therapeutic relationship in mental health nursing. REVIEW METHODS: A review of the advantages and disadvantages of Q. DISCUSSION: In areas where there are many contradictions and contrasting views, for example nursing practice, such a methodology could bring clarity in identifying subjective views of different groups. This article will first present the methodology followed by two examples of studies that have been carried out. CONCLUSION: This article demonstrates that Q has much to offer nurse researchers, because the identification of patients' viewpoints in a reliable way has the potential to help nurses to deliver evidence-based practice in response to patients' needs. IMPLICATIONS FOR RESEARCH/PRACTICE: Q methodology has much to offer nursing research because the identification of patients' viewpoints has the potential to enhance nurses' abilities to deliver responsive evidence-based practice.

Identifying medication errors in surgical prescription charts.

BACKGROUND: Each year 200 million prescriptions for children and adolescents are issued in the UK, with a 1.5 per cent prevalence of errors. AIM: To identify and quantify medication errors on surgical children's prescription charts over a four-month period at two hospital sites. METHOD: Retrospective review of the prescription charts of 175 children at a children's hospital and a children's unit. RESULTS: Errors totalled 301, the most common was overwriting of a prescription, the least common was incorrect dates. No resulting adverse events were recorded. CONCLUSION: The prevalence of errors needs to be reduced to avoid serious adverse incidents. Computerised physician order entry systems are discussed as a potential solution.

Influences on nurses' scoring of children's post-operative pain.

There is a lack of clarity as to why some nurses are not delivering optimal pain management to children post-operatively. This retrospective chart review study examined nurses' pain scoring on 175 children during the first 24 hours post-operatively. Data were analysed on the amount of assessments made, assessment scores recorded, as well as the age, gender and type of surgery performed. One-quarter of children had no assessment record of their pain in the first 24 hours post-operatively. When the pain tool was part of an observation chart, nurses recorded more pain scores. Nurses' scoring of children's pain is influenced positively by children under five years of age and those who undergo abdominal surgery. Nurses who had access to one document for recording vital signs as well as pain scores were more likely to assess and record a child's pain score than nurses who had to use a separate chart.

Post-operative pain: the impact of prescribing patterns on nurses' administration of analgesia.

UNLABELLED: In the past 30 years, significant improvements have been made in the management of children's pain, with most children receiving analgesia post-operatively. However, the amount of analgesia administered to children after surgery varies depending on a number of factors. AIMS: To measure the difference between what children are prescribed for analgesia post-operatively and what they are administered in the first 24 hours following surgery and to explore the influence of the analgesic being prescribed 'as required' or regularly. METHOD: A retrospective chart review of 175 children was carried out at a children's hospital and a paediatric unit in a large teaching hospital. The analgesics that were administered in the first 24 hours post-surgery were morphine, codeine, diclofenac, ibuprofen and paracetamol. RESULTS: Each analgesic that was prescribed was administered in decreasing amounts relative to the strength of the analgesic. The highest percentage given was of paracetamol. When the prescription was for regular paracetamol, it was administered by nurses 88 per cent of the time, whereas when it was prescribed on a pro re nata (prn) or as required basis, 77 per cent of prescribed paracetamol was given. When analgesics were prescribed regularly, children had a considerably greater chance of receiving the analgesic. CONCLUSION: Nurses need to be more responsive to children in pain and acknowledge the value of prn prescribing of analgesics for children post-operatively. There is a need to increase nurses' confidence in assessing and responding to children's pain.

Changing practice: implementing validated paediatric pain assessment tools.

This study attempted to address a lack of evidence-based pain management by implementing validated pain assessment tools across a children's hospital. The method used was action research. The first part of this study where nurses' views of pain tools was elicited has already been reported (Simons and Macdonald, 2004). An action research cycle of negotiation, assessment, diagnosing, planning, action, evaluation and withdrawal was utilized. Data collection occurred at two points in time. Three age-appropriate tools were implemented hospital-wide supported by education and clinical input. A survey of nurses was carried out six months and 12 months post implementation of the tools. At the same time evaluation of the use of the tool was performed. Six months after education and implementation 23 percent of children on 10 wards had a pain tool in use. This had increased to 40 percent six months later. There were many inconsistencies between the replies the nurses gave in relation to their reported use of the tools and the actual use of the tools.

Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain.

AIM OF THE STUDY: To explore the perceptions of nurses and parents of the management of postoperative pain in children. This paper focuses on issues of knowledge and communication. BACKGROUND: Nurses are the key health care professionals with responsibility for managing children's pain, however, nurses are not well supported educationally to manage the level of responsibility. RESULTS: Using matched interviews between 20 parents and 20 nurses many issues arose relating to the nurse/parent communication process. It was also clear that despite nurses' knowledge of pain management being deficient, they had expectations that required parents to have a level of knowledge they did not possess. CONCLUSIONS: The findings suggest that nurses' poor communication with parents and nurses' knowledge deficits in relation to children's pain management create obstacles to effective pain management. These obstacles need to be addressed in order to improve the management of children's pain through better education of nurses and two way communication with parents.

An action research study exploring how education may enhance pain management in children.

The aim of this study was to explore and address the views of children's nurses in relation to their educational needs on pain management. Action research was the methodology used: focus groups were run to identify the problem of nurses' educational needs; action planning was used to develop a short programme of study for nurses to address identified needs. Evaluation was by questionnaire and semi-structured interviews. Ten children's nurses attended the study day. All the nurses said they gained knowledge on the day--in particular assessment of pain and the individuality of the pain experience. The nurses felt that their new knowledge increased their confidence and contributed to them feeling assertive when managing children's pain. The study findings suggest that the current provision in relation to education programmes for children's nurses needs to be improved, in order to provide them with the knowledge and confidence to manage children's pain more effectively.