Communication challenges caused by wearing masks and strategies used by pediatric nurses during the COVID-19 pandemic: A qualitative study.

PURPOSE: The COVID-19 pandemic and the use of facemasks have caused many communication challenges for pediatric nurses. The purpose of this study was to investigate these challenges and the strategies that nurses use to overcome them during the nursing care of sick children. DESIGN AND METHODS: This was a qualitative study using conventional content analysis. The nurses were selected by purpose-based sampling and interviewed semi-structurally between April and June 2023 at the Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the data saturation principle. The report of this research followed the COREQ guidelines. RESULTS: Twelve nurses were interviewed. The analysis revealed four main categories: "Disturbances in communication", "Disturbances in trust", "Disturbances in providing care", and "Nurses' strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, nurses used solutions such as removing the mask and mitigating the adverse effects of mask usage they used. The central theme of the study was "Humanistic care requires trust-based communication". CONCLUSIONS: This study highlights the communication challenges faced by pediatric nurses due to mask-wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed innovative strategies to improve communication and build trust with their young patients. Further research is needed to evaluate the effectiveness and feasibility of these strategies. PRACTICAL IMPLICATIONS: These strategies can be useful for other nurses who work with children in similar conditions. Further research is needed to evaluate the effectiveness and feasibility of these strategies in different settings and populations.

Differences in the child, mother, and nurses' pain score measurements during pediatric venipuncture.

BACKGROUND: Self-reporting is the gold standard for measuring pain in adult pain management; however, this issue is unique and different in children. Accurate pain assessment for the appropriate management of children's pain is important. PURPOSE: This study was conducted to assess the pain level by the child, mother, and nurse during intravenous line insertion in preschool children, candidates for surgery in Tabriz Children's Hospital. DESIGN AND METHODS: This is descriptive observational study. A total of 140 eligible children were included in the study using convenience and sequential methods. The intravenous line was inserted by an experienced nurse and pain assessment was performed by the child, mother, and nurse immediately after procedure, using the Wong-Baker face scale (WBFS). The data were analyzed through descriptive statistics and repeated measures ANOVA test using SPSS version 13 software. RESULTS: The difference between child-mother and nurse-mother mean scores was not statistically significant; however, there was a statistically significant difference between the score measured by the child and the nurse (P = 0.017). CONCLUSION: The children's pain assessment score during venipuncture was higher than that of mothers and nurses. The mothers' score was more closely related to the children's score. As a result, a mother's assessment can be considered a reliable estimation of proper pain management in young children and mothers can act as a moderator and actualize the nurses' score. Consequently, establishing a three-way communication between mother, child, and nurses is necessary to precisely estimate the child's actual pain and take appropriate measures to reduce it.

Care providers' experiences regarding barriers to maternal participation in neonatal pain management.

BACKGROUND: Mothers' involvement in the pain management of infants admitted to the intensive care unit can alleviate the infants' pain. Despite International guidelines, maternal involvement in neonatal pain management is low. Hence, investigating the perspectives of care providers (CPs) on barriers to maternal participation can be helpful in developing practice guidelines. AIMS: The purpose of this study was to investigate the experiences of CPs on barriers to maternal involvement in neonatal pain management in the intensive care unit. DESIGN: In this study, a qualitative design based on the content analysis approach was used. METHOD: We included 24 nurses and physicians in the neonatal intensive care unit from February to September 2020. Data were collected through conducting 11 individual interviews and two focus group discussions with eight and five participants, respectively. RESULTS: Three main categories and seven sub-categories were found, including maternal barriers (inadequate emotional readiness and unfamiliarity with role), CPs' barriers (time pressure, fear of family-care provider tension, and insufficient knowledge), and organizational barriers (neglected joint decision-making and restricted organizational participative policies). CONCLUSIONS: The identified barriers could be classified into those related to mothers, care providers, and organizations. The lack of appropriate interaction and cooperation between parents and care-providers can affect the emergence of barriers related to the mothers and staff. RELEVANCE TO CLINICAL PRACTICE: There is a lack of knowledge regarding neonatal pain management in the health care team and mothers. Educating mothers and CPs about the benefits and ways of mothers' participation can increase readiness and capabilities. Providing clear guidelines about family-centred care and promoting parent-CPs' interactions can increase the mothers' participation.

Comparison of the Effect of Massage and EMLA Cream on Children's Physiological Indices During Venipuncture: A Factorial Clinical Trial.

PURPOSE: The aim of this study was to identify the effect of massage, EMLA cream, and the combination of these two methods on changes in physiological indices because of pain caused by intravenous line insertion in preschool children. DESIGN: A four-group randomized nonblinded clinical trial with factorial design. METHODS: In total, 140 eligible 3- to 6-year-old children entered the study in Tabriz Children's Hospital in 2017 and were randomly allocated to four groups (EMLA cream, massage, combination of the two, and control). Physiological responses were measured before and immediately after interventions in all groups. Data were collected and analyzed using SPSS version 19. FINDINGS: Comparison of the physiological indices changes caused by pain between groups showed that changes in children's heart rate (HR) and respiratory rate (RR) in the EMLA group and in the combined-method group were statistically significant (P < .05). No significant differences were found in systolic blood pressure and oxygen saturation (SPo2) between the four groups. CONCLUSIONS: Results indicated that EMLA cream was more effective than massage and a combination of EMLA and massage in reducing an increase in the HR and RR caused by pain in children. Massage alone was not effective in significantly lowering the children's increased physiological indices such as the HR and RR, and it seems the effectiveness of massage is more noticeable in conjunction with EMLA cream.

Organisational challenges of pain management in neonatal intensive care unit: a qualitative study.

OBJECTIVES: Despite credible evidence, optimal neonates' pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing challenges vary depending on the context, and investigating them can help to improve the quality of care. The study aimed to explore organisational challenges to neonates' pain management in the NICU. METHODS: This qualitative study included 31 nurses and physicians in the NICU of Children's Hospital, Tabriz, Iran. Data collection was done through individual and focus group interviews. For data analysis, we used conventional content analysis. RESULTS: The identified challenges included organisational culture (poor interprofessional collaboration and low parental participation), organisational structure (lack of unified approach in relieving pain and limited supervision for pain management) and organisational resources (lack of time due to high workload and inadequate educational programmes). CONCLUSIONS: Many organisational factors consistently affect neonatal pain management. Adopting some approaches to enhance the cooperation of treatment team members, holding educational programmes, proper organisational supervision and implementing a unified neonatal-based pain management programme could improve neonatal pain management.

Challenges of human resources management in nursing in Iran: A qualitative content analysis.

Aim: Health service providers are appreciated among the vital components in a society wherein nurses are also considered as the main human resources. Thus, examining the existing challenges in managing these human resources through taking correct measures can contribute to identifying the priorities and consequently influence the quality of services provided. This study aims to investigate the challenges of human resources management in nursing from the perspective of professionals in Iran. Design: Qualitative content analyses. Methods: Present study is carried out using purposive sampling conducted on 12 nurses involved in different professional nursing positions. To this end, the participants' perceptions, opinions, beliefs and attitudes were collected via two focus group sessions. Data were collected during Febuary and March 2018. Results: From the perspective of the professionals, the challenges could be observed in a wide variety of human resources management dimensions in nursing such as job analysis, recruitment, as well as development and retention of workforce.

Effects of Breast Milk and Vanilla Odors on Premature Neonate's Heart Rate and Blood Oxygen Saturation During and After Venipuncture.

BACKGROUND: Different studies have shown that the use of olfactory stimuli during painful medical procedures reduces infants' response to pain. The main purpose of the current study was to investigate the effect of breast milk odor and vanilla odor on premature infants' vital signs including heart rate and blood oxygen saturation during and after venipuncture. METHODS: A total of 135 preterm infants were randomly selected and divided into three groups of control, vanilla odor, and breast milk odor. Infants in the breast milk group and the vanilla group were exposed to breast milk odor and vanilla odor from 5 minutes prior to sampling until 30 seconds after sampling. RESULTS: The results showed that breast milk odor has a significant effect on the changes of neonatal heart rate and blood oxygen saturation during and after venipuncture and decreased the variability of premature infants' heart rate and blood oxygen saturation. Vanilla odor has no significant effect on premature infants' heart rate and blood oxygen saturation. CONCLUSION: Breast milk odor can decrease the variability of premature infants' heart rate and blood oxygen saturation during and after venipuncture.

Comparison of Breastmilk Odor and Vanilla Odor on Mitigating Premature Infants' Response to Pain During and After Venipuncture.

OBJECTIVE: The main purpose of this study was to investigate the calming effects of breastmilk odor and vanilla odor on preterm infants during and after venipuncture. SUBJECTS AND METHODS: One hundred thirty-five preterm infants were randomly selected and divided into three groups: control, vanilla odor, and breastmilk odor. Infants in the breastmilk group were exposed to breastmilk odor, and infants in the vanilla group were exposed to vanilla odor from 5 minutes before the start of sampling until 30 seconds after sampling. The Premature Infant Pain Profile was used for calculating quality of pain in infants during and after sampling. RESULTS: Statistical analyses showed that both vanilla and breastmilk odors had calming effects on premature infants during sampling, but just breastmilk odor had calming effects on infants after the end of sampling. Compared with vanilla odor, breastmilk odor has more calming effects on premature infants. CONCLUSIONS: Breastmilk odor can be used for calming premature infants during and after venipuncture.