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”Jag är rädd, jag vill till mamma”: Yngre barns, föräldrars och sjuksköterskors levda erfarenheter av nålprocedurer i vården
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
2015 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
“I’m afraid, I want my mommy” : Younger children's, parents', and nurses' lived experiences of needle procedures in health care (English)
Abstract [sv]

Syftet med denna avhandling är att skapa kunskap om vad det innebär för yngre barn att genomgå nålrelaterade medicinska procedurer. Dessutom vad vårdande stöd i samband med dessa procedurer innebär utifrån barns, föräldrars och sjuksköterskors perspektiv. Nålrelaterade medicinska procedurer är undersökningar som barn behöver vara med om i vården för att motverka sjukdom, för att ta reda på varför barnet är sjukt och för att ge barnet behandling. Dessa åtgärder innebär att barn behöver vara med om nålstick.

Med hjälp av deltagande observationer och livsvärldsintervjuer, som har dokumenterats genom videoobservationer, fältanteckningar och ljudinspelningar, har datainsamlingen genomförts i vården med yngre barn, 3-7 år, deras föräldrar och sjuksköterskor. Barnen har berättat om konsekvenser som de har upplevt av nålprocedurer och om att få stöd vid dessa åtgärder. Föräldrar och sjuksköterskor har berättat om sina erfarenheter av att ge stöd till barnen.

Avhandlingens resultat visar att en framträdande konsekvens för barn under nålprocedurer är upplevelse av rädsla. Hur föräldrar och sjuksköterskor svarar an mot detta har en avgörande betydelse för om barnets rädsla ökar eller minskar.

Denna avhandling bidrar med kunskap om barns upplevelser av nålprocedurer och behov av stöd samt hur stödet kan utformas vid dessa åtgärder. Emellertid, forskning inom området ärfortfarande otillräcklig och ytterligare forskning behövs där barns perspektiv lyfts fram i vården.

Abstract [en]

Aim: The overall aim of the thesis is to create knowledge about what it means for younger children to undergo needle-related medical procedures (NRMPs), and what caring support in relation to this means based on nurses’, parents’, and younger children's perspectives.

Methods: The first and second papers used descriptive phenomenological analysis to describe the meanings of supporting younger children during NRMPs from the perspective of nurses (Ι) and parents(ΙΙ). The third and fourth papers used lifeworld hermeneutic analysis to explain and understand the consequences related to NRMPs (ΙΙΙ) and support (ΙV) during these procedures from younger children’s perspectives. Data has been collected by participant observations and lifeworld interviews documented by video-recorded observations, field notes, and audio-recorded interviews. In total 60 people participated, fourteen nurses, twenty-five parents, and twenty-one children.

Main results: The results show that an important consequence for children of procedures with needles is experiences of fear. The child's fear affects how the child is able to manage the procedure and the support the child gets from adults is crucial to whether the child's fear increases or decreases.

The support consists of giving support or receiving support. Parents support the child by safeguarding and protecting the child during the needle-related procedure; they “keep the child under the protection of their wings,” sometimes very close and sometimes a little further out under the wingtips. Nurses support the child by starting from individual child’s experiences and needs; they "balance on a tightrope" in an unpredictable situation. In the meeting between the child, the parents, and the nurses, the adults are guided by the child in what forms of support are provided. This continues until the needle-related medical procedure is completed and the child can walk proud and strong from the procedure with a feeling that "I can handle this.”

Conclusions: Children’s need for support during needle-related medical procedures is primarily tied to children’s experiences of fear. For the child to experience a caring support, adults need to understand children’s experiences of fear as well as children’s need for support and what form the support should take. A caring support develops dialectically between children and adults in a circular movement. In such a dialectic, the child guides the adult and vice versa. That children have the capability of guiding adults during needle-related medical procedures shows that they are active and participating. Here it becomes clear that there is no objective location of the phenomenon of support. Support can therefore only be studied as a lived experience of those who need it.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2015. , 115 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 64
Keyword [en]
Younger children, parents, nurses, needle-related medical procedures, consequences, support, caring, lived experiences, phenomenology, lifeworld hermeneutic
National Category
Pediatrics Nursing
Identifiers
URN: urn:nbn:se:hj:diva-28270ISBN: 978-91-85835-63-8 (print)OAI: oai:DiVA.org:hj-28270DiVA: diva2:867527
Public defence
2015-12-04, Sparbankssalen, Allégatan 1, Borås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-11-05 Created: 2015-11-05 Last updated: 2016-01-21Bibliographically approved
List of papers
1. Nurses' perspectives on supporting children during needle-related medical procedures
Open this publication in new window or tab >>Nurses' perspectives on supporting children during needle-related medical procedures
2014 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, no 23063Article in journal (Refereed) Published
Abstract [en]

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents' ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as "balancing on a tightrope" in an unpredictable situation.

Keyword
Lived experience, caring science, younger children, phenomenology, reflective lifeworld research
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-23676 (URN)10.3402/qhw.v9.23063 (DOI)000332846200001 ()24646473 (PubMedID)2-s2.0-84897000232 (Scopus ID)
Available from: 2014-04-05 Created: 2014-04-05 Last updated: 2017-12-05Bibliographically approved
2. Consequences of needle-related medical procedures: A hermeneutic study with young children (3–7 years)
Open this publication in new window or tab >>Consequences of needle-related medical procedures: A hermeneutic study with young children (3–7 years)
Show others...
2016 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 31, no 2, e109-e118 p.Article in journal (Refereed) Published
Abstract [en]

Background

Needle-related medical procedures (NRMPs) are often frightening and cause children anxiety and pain. Only a few studies have examined the perspectives of younger children. More knowledge is needed about younger children's experiences in caring situations such as NRMPs.

Aim

The aim of this study was to explain and understand the consequences related to NRMPs from younger children's perspectives.

Methods

Participant observations and interviews with younger children who had experienced NRMPs were analysed using a lifeworld hermeneutic approach.

Results

Experiencing fear is central for younger children during an NRMP and interpretation of its consequences formed the basis for the following themes: seeking security, realizing the adult's power, struggling for control, feeling ashamed, and surrendering. A comprehensive understanding is presented wherein younger children's experiences of NRMPs vary across time and space related to weakening and strengthening their feelings of fear.

Conclusions

Awareness is needed that adults' power becomes more obvious for children during an NRMP. Children's surrender does not necessarily imply acceptance of the procedure. Providing children with opportunities to control elements of the procedure creates a foundation for active participation, and vice versa.

Keyword
Younger children; Lived experiences; Consequences; Needle-related medical procedures; Caring science; Reflective lifeworld research; Lifeworld hermeneutic
National Category
Pediatrics Nursing
Identifiers
urn:nbn:se:hj:diva-28268 (URN)10.1016/j.pedn.2015.09.008 (DOI)000370808800005 ()26603292 (PubMedID)2-s2.0-84958927460 (Scopus ID)
Available from: 2015-11-05 Created: 2015-11-05 Last updated: 2017-12-01Bibliographically approved
3. Experiencing support during needle-related medical procedures: a hermeneutic study with young children (3–7 years)
Open this publication in new window or tab >>Experiencing support during needle-related medical procedures: a hermeneutic study with young children (3–7 years)
Show others...
2016 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 31, no 6, 667-677 p.Article in journal (Refereed) Published
Abstract [en]

Background Needle-related medical procedures (NRMPs) are something that all young children need to undergo at some point. These procedures may involve feelings of fear, pain and anxiety, which can cause problems later in life either when seeking healthcare in general or when seeking care specifically involving needles. More knowledge is needed about supporting children during these procedures.

Aim: This study aims to explain and understand the meaning of the research phenomenon: support duringNRMPs. The lived experiences of the phenomenon are interpreted from the perspective of younger children.

Method: The analysis uses a lifeworld hermeneutic approach based on participant observations and interviews with children between 3 and 7 years of age who have experienced NRMPs.

Results: The research phenomenon, support for younger children during NRMPs, is understood through the following themes: being the centre of attention, getting help with distractions, being pampered, becoming involved, entrusting oneself to the safety of adults and being rewarded. A comprehensive understanding is presented wherein younger children experience support from adults during NRMPs in order to establish resources and/or strengthen existing resources.

Conclusions: The manner in which the child will be guided through the procedure is developed based on the child's reactions. This approach demonstrates that children are actively participating during NRMPs. Supporting younger children during NRMPs consists of guiding them through a shared situation that is mutually beneficial to the child, the parent and the nurse. Play during NRMP is an important tool that enables the support to be perceived as positive.

Keyword
Caring science; Lifeworld hermeneutic; Needle-related medical procedures; Reflective lifeworld research; Support; Younger children
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-28269 (URN)10.1016/j.pedn.2016.06.004 (DOI)000389587500015 ()2-s2.0-84996483982 (Scopus ID)
Available from: 2015-11-05 Created: 2015-11-05 Last updated: 2017-12-01Bibliographically approved

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