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Children in the Radiology Department: a study of anxiety, pain, distress and verbal interaction
Jönköping University, School of Health Science, HHJ. CHILD.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This dissertation focuses on children’s experiences of going through an acute radiographic examination due to a suspected fracture. The findings from interviews with children aged 3-15 years showed anxiety, pain and distress to be a concern in conjunction with an examination (Paper I). These initial findings entailed empirical studies being undertaken in order to further study children’s pain and distress in conjunction with an examination (Paper II) as well as children’s anxiety, pain and distress related to the perception of care in the periradiographic process (Paper III). Finally, the verbal interaction between the child and radiographer during the examination was studied (Paper IV).

The research was conducted through qualitative, quantitative and mixed method studies. The data collection methods comprised interviews (Paper I), children’s self-reports (Papers II and III), drawings (Paper III), questionnaire (Paper III) and video recordings (Papers I, II and IV). Altogether, 142 children (3-15 years) and 20 female radiographers participated in the studies.

Children aged 5-15 years were observed and they completed selfreports on pain and distress. The children were also provided with an opportunity to express their perceptions of the peri-radiographic process and to make a drawing that was analysed with regard to their level of anxiety. Finally, the verbal interaction between the child and radiographer during the examination was analysed.

Qualitative content analysis was used to analyse the interviews and the written comments in the questionnaire (Papers I and III). The Child Drawing: Hospital Manual (CD:H) was used when analysing the children’s drawings (Paper III), and the Roter Interaction Analysis System (RIAS) was used when analysing the verbal interaction derived from the video recordings (Paper IV). Non-parametric statistics were applied when analysing the quantitative data (Papers II, III and IV). The findings showed that children aged 5-15 years reported pain on the Coloured Analogue Scale (CAS) and distress on the Facial Affective Scale (FAS) above levels at which treatment or further intervention is recommended. These findings corresponded to the observed pain behaviour measured on the Face, Legs, Activity, Cry and Consolability Scale (FLACC) and anxiety expressed through drawings (CD:H). The children’s perception of the care being provided in the peri-radiographic process, was not related to the experience of anxiety, pain and distress however. The children were confident in the radiographers, who they perceived to be skilled in the task and sensitive to their needs. These findings are supported by the analysis of the verbal interaction (RIAS), which showed that the radiographer adjusted the communication when balancing the task-focused and socio-emotional interaction according to the child’s age.

The findings point to the conclusion that children going through an acute radiographic examination should be assessed regarding the anxiety, pain and distress they experience. This is a prerequisite for the radiographer to provide care according to the child’s ability and preferences when interacting with children in the peri-radiographic process.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2014. , 94 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 51
Keyword [en]
Children, radiography, experiences, anxiety, pain, distress, verbal interaction, examination
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-23732ISBN: 978-91-85835-50-8 (print)OAI: oai:DiVA.org:hj-23732DiVA: diva2:714746
Public defence
2014-06-05, Forum Humanum, HHJ, 10:00
Opponent
Supervisors
Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2014-04-29Bibliographically approved
List of papers
1. Children's experience of going through an acute radiographic examination.
Open this publication in new window or tab >>Children's experience of going through an acute radiographic examination.
2012 (English)In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 18, no 2, 84-89 p.Article in journal (Refereed) Published
Abstract [en]

Children’s experience of radiographic examinations remains largely unexplored, although most radiog- raphers examine children on a daily basis. In order to provide the high quality care that meets the needs of patients it was considered important to undertake research focused upon the patients’ experience of radiographic practice.

The aim of the study was to investigate children’s experiences undergoing a radiographic examination for a suspected fracture.

Inclusion criteria were Swedish-speaking children between 3 and 15 years of age who were submitted for a radiographic examination with an acute condition of the upper or lower extremity. Patients were informed of the study and together with the escorting parent or relative asked for consent to participate.

During the examination the child was videotaped and immediately after, the child was interviewed in a nearby facility. The interview contained open-ended questions and was conducted while watching the videotape together with the child and their parent or relative and the researcher.

Qualitative content analysis was used in analyzing the collected data. The analysis resulted in two categories e “feeling uncomfortable” and “feeling confident”. The subcategories contained in these categories were “pain in relation to injury and examination”, “the waiting time is strenuous”, “worries for the future and consequences of the injury”, “confidence in parental presence”, “confidence in radio- graphic staff and examination procedure”, and finally “recognition entails familiarity”.

The results revealed that for the younger children, the experience of undergoing an acute radiographic examination was associated with pain and anxiety, but for the older children, the anxiety was more connected to whether the injury had caused a fracture and any anticipated future consequences or complications.

Keyword
Children, experience, radiographic examination, content analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-17996 (URN)10.1016/j.radi.2011.10.003 (DOI)
Available from: 2012-04-26 Created: 2012-04-26 Last updated: 2017-12-07Bibliographically approved
2. Children’s pain and distress while undergoing an acute radiographic examination
Open this publication in new window or tab >>Children’s pain and distress while undergoing an acute radiographic examination
2012 (English)In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 18, no 3, 191-196 p.Article in journal (Refereed) Published
Abstract [en]

Pain has been highlighted as a main concern for children in conjunction with an acute radiographic examination. The aim of this study was to further investigate children’s pain and distress while undergoing an acute radiographic examination.

The study comprised 29 participants with an age range of 5–15 years who were injured and submitted to an acute radiographic examination of the upper or lower extremity when the question at issue was fracture. The Coloured Analogue Scale (CAS) and the Facial Affective Scale (FAS) were used as self-reporting scales to measure the children’s pain and distress. The Face, Legs, Activity, Cry and Consolability Behavioural scale (FLACC) was used as an observation tool to assess behaviours associated with pain in children.

Descriptive statistics were used when analysing the scores, and the results showed that children experience pain and distress in conjunction with a radiographic examination after an injury. Spearman’s correlation was used to compare variables, and significant correlations were obtained between the self-reported pain and the observed pain behaviour. Fischer’s Exact test was used to compare groups, and when using the cut-off 3.0 on the self-reporting scale no significant correlation was found concerning the pain reported by children diagnosed with and without a fracture. No significant correlations were found concerning the self-reported distress and pain either, regardless of whether it was a first-time visit and whether a parent was near during the examination.

Place, publisher, year, edition, pages
Elsevier: , 2012
Keyword
Children, pain, distress, radiographic examination
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-19140 (URN)10.1016/j.radi.2012.02.002 (DOI)
Available from: 2012-08-09 Created: 2012-08-09 Last updated: 2017-12-07Bibliographically approved
3. Children's Anxiety, Pain, and Distress Related to the Perception of Care While Undergoing an Acute Radiographic Examination
Open this publication in new window or tab >>Children's Anxiety, Pain, and Distress Related to the Perception of Care While Undergoing an Acute Radiographic Examination
2014 (English)In: Journal of Radiology Nursing, ISSN 1546-0843, Vol. 33, no 2, 69-78 p.Article in journal (Refereed) Published
Abstract [en]

Visiting the hospital is likely a frightening experience for a child, and going through a radiographic examination has been reported as both distressing and painful. More knowledge from the children's perspective is needed on this subject, however, and thus, the aim of this study was to investigate children's anxiety, pain, and distress in conjunction with an acute radiographic procedure and whether these factors can be related to the perception of care. A mixed method design was used to analyze data from 110 participants between 5 and 15 years of age, who were examined in a Swedish radiology department. The quantitative findings showed anxiety, pain, and distress to be a concern during a radiographic examination. Significant correlations were obtained between anxiety and pain as well as between anxiety and distress. In addition, also the qualitative findings showed pain and the waiting time to be concerns. Regardless of the quantitative findings, however, children of all ages were satisfied with the care performed in the periradiographic process, perceiving the examination as supportive and geared to their needs. Robust assessment of anxiety, pain, and distress is imperative when interacting with children in acute examination situations to avoid both negative short-term and long-term consequences.

Keyword
Radiographic examination, Children, Anxiety, Pain, Distress, Care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-23730 (URN)10.1016/j.jradnu.2013.12.003 (DOI)2-s2.0-84901832249 (Scopus ID)
Available from: 2014-04-28 Created: 2014-04-28 Last updated: 2016-10-18Bibliographically approved
4. Will it Hurt? Verbal Interaction between Child and Radiographer during Radiographic Examination
Open this publication in new window or tab >>Will it Hurt? Verbal Interaction between Child and Radiographer during Radiographic Examination
2013 (English)In: Journal of Pediatric Nursing, ISSN 0882-5963, Vol. 28, no 6, e10-e18 p.Article in journal (Refereed) Published
Abstract [en]

This study investigated the nature of verbal interactions between child, parent and radiographer and theextent to which it varied as a function of the child's age. The participants were 20 female radiographersand 32 children (3–15 years) examined for acute injuries. The verbal interactions during theexamination were video recorded and analyzed using the Roter Interaction Analysis System (RIAS).Results indicated that 80% of the verbal interaction was accounted for by the radiographer, 17% by thechild and 3% by the parent. The distribution of utterances varied with regard to children's age.

Keyword
Children, Verbal interaction, Radiographic examination, RIAS
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-22651 (URN)10.1016/j.pedn.2013.03.007 (DOI)000326937600002 ()HHJCHILDIS, HLKCHILDIS (Local ID)HHJCHILDIS, HLKCHILDIS (Archive number)HHJCHILDIS, HLKCHILDIS (OAI)
Available from: 2013-12-09 Created: 2013-12-09 Last updated: 2016-09-21Bibliographically approved

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