Effect Of Tailor Made Technique Nursing Essay

Effect Of Tailor Made Technique Nursing screenChildren are members of families, comm unit of measurementies, populations and over all(prenominal) society, which shape the context, consumes, and op wayunities of their lives. Thus, their well creation is inextricably linked to the well-being of their families, communities and the society in which they live.Hospitalization of children is for subacute or chronic conditions. M some(prenominal) f make upors sum to the distress of young children during hospitalization, and existing fears and emotions may be intensified with prolonged hospitalization. Children become anxious and normal fears are exacerbated when they think ab let on being in injure, harmed, or mutilated in almost way or being separated from parents (Nicki and Barbara, 2007). Cannulation causes moderate or severe disquietfulness and fear in a substantial number of children and adults.Pain is an unpleasant sensory and emotional experience associated with actual or pot ential tissue damage (Merskey and Bogduk, 1994). Pain mitigation is a human right, yet fuss in children is an under-recognized problem around the world. Children not only seduce annoyance from injuries, surgery, burns, infections, and the piths of war, terrorism, and violence, just also undergo wo(e) from some actions and investigations utilize by doctors and nurses to investi gateway and treat disease.Fear quite a little be explained as a state of dread, apprehension or misgiving related to the future. Fear is a major stressor among hospitalized children. Ac heaping to children, insertion of needle is one of the most fearful experiences. For many battalion, the needle washbowl only be a source of fear to the extent that a needle is a necessary part of the procedure that initiates a terrifying involuntary reaction of ones body. For some the fear may extend up to needle phobia,who has thought nigh the nature and origin of their condition, they actually have no fear of needles at all, but may have an extreme fear of suffering the physical effects of a needle phobia reaction.Thus, these problems of a hospitalized child can be sticking(p) by the nurse who is directly responsible for their protection and guidance. Nurses are at high risk for liability with regard to the under treatment of distract and fear. Of all the members of the health care team, nurses spend most of the clipping with patients and are recognized as the patients primary bother managers. The nurse is concerned not only with providing breast feeding interventions to children, but also with obtaining cooperation of children to the procedures to them. This is possible for a nurse with the skill in wide variety of interventions such as therapeutic play and the use of the humanistic discipline and humanities as music, drama, television etc.Some institutions have procedures for minimizing the predictable pain and fear of cannulation, e in particular in children. Current advances ar e being make to experience pain by integrating two the science of pain medications and the science of the human mind. According to Brunner and Suddharth (2004), misdirection is thought to reduce the perception of pain by stimulating the descending control system, resulting in fewer painful stimuli being transmitted to brain. Distraction techniques may range from simple activities, such as watching TV or listening to music, to highly complex physical and mental exercises.Topical analgesics have been one important tool in reduction and preventing pain during minor procedures. As elicited by Potter and Perry (2005), the anesthetic cream which is thickly applied is placed on the skin 15 minutes before local anesthetic percolation or minor procedures, e.g., IV start. The Lidocaine patch is a topical analgesic effective in cutaneous pain. triplet patches are placed on and around the pain site victimization a 12-hour on, 12-hour off schedule to avoid Lidocaine toxicity.According to Sr. Nancy (2005), intent applications can be dry catch fire applications or moist oestrus applications which may be applied either locally or generally. Hot applications have many local physiological effects on the body. One among the many local physiological effects of hot application is vasodilatation. Dilatation of nervure aids in reducing the number of phlebotomy attempts. Also, the chief therapeutic use of local hot application is that it decreases pain due to ischemia, local congestion and muscle spasm.Injections of any kind can hurt Children do it this pain is predictable. How they respond to an injection depends in part of their developmental age and their previous experience. Intravenous and intramuscular injections should be given in such a manner that the children do not have time to build up their anxiety about the procedure. tailored stiffs, it has been specially designed for a particular purpose. Thus the researcher uses tailor-made technique for preschool and s chool-aged children who enjoy active play, during the injection the nurse can suggest distraction activities along with local analgesics agent and hot application.NEED FOR THE STUDYThe leading health indicators, the healthy people 2010 provides a framework for identifying essential components of child health procession programs, designed to prevent future health problems in our nations children (Department of health and human service, 2007). The present total population of children in the world is 2.2 billion where in India, 13.1 portion of the population that is 15, 87, 89,287 are children (Census, 2011).The paediatric ward of Sri Ramakrishna hospital receives an average of 1414 admissions per year. Almost all of them ought to have venipuncture since it is an integral part of performing diagnostic procedures and administering therapy during a patients hospitalization. apiece hospitalized child has to undergo at to the lowest degree a single venipuncture within every threesome days of hospital life. Thus, attention in relieving such pain and fear is a must.Pain is the primary complaint for which people seek medical treatments. Sr. Callista Roy (1991), defined pain within the psychological mode, as a sensory experience of acute and chronic nature, coded into the somatosensory pain pathways. Acute pain, according to Sr Callista Roy, refers to Discomfort which is profound but relatively short and reversible. utilize principles from neuropsychology Roy stated that a sensory experience such as pain involves the transmission of information from sensory pathways to the cerebral cortex.The theoretical explanation for the persuasiveness of distraction lies in its ability to divert attention away from the painful stimulus. McCaul and Malott (1984) hypothesize that the brain has a limited capacity to focus attention on stimuli. Therefore, using up attentional resources dapple engaging in a distracting task leaves little capacity for attending to painful stimuli. The Gate Control hypothesis of Pain proposed by Melzack and Wall (1965, 1995) offers a physiological explanation of the effectiveness of attention diversion. In brief, the Gate Control Theory explains that pain perception can be affected by factors other than the stimulus itself. This possible action suggests that pain perception is controlled by a neural mechanism or gate in the spinal cord. Depending on how the mechanism is activated, the gate can be opened or closed. When the gate is open, 8 pain signals are transmitted to the brain, and when the gate is closed, they are not. Melzack originally proposed this theory to explain why physically stimulating an area can lead to reduced pain perception, but later modified his theory to suggest that cognitive factors can also open or close the gate. Cognitive and behavioral processes, such as distraction, Lamaze, and self hypnosis, cartoons can close the gate to subsequent pain perception by diverting attention away from the painful s timulus and toward focal points.Neglected pain erodes a patients trust in the health care system. In 1995, the American pain society challenged all health care systems to make pain as the fifth vital sign. crowd Campbell, the societys President noted that, if pain were assessed with the same zeal as other vital signs, at that place would be a much better chance of its being treated properly .Failure to appropriately assess and treat pain is a liability issue for facilities and members of the health care team .Pain is always a source of anxiety, as well as a constant companion. Furthermore about 10% of adults in the United States have needle phobia, as intense fear of needle that triggers immediate anxiety in the most severe cases, vasovagal response can lead to shock. The phobia may intensify for most people with the stripped pain of venipuncture. The fear usually begins in childhood and it may lead to avoidance of medical care.According to Journal of anxiousness Disorders (2006 ), the tendency to experience pain, disgust, andfearof fainting during injections was associated with anxious responding to the venipuncture and a probable diagnosis ofneedlephobia. A local anesthetic, Lidocaine blocks the conduction of pain impulses and stabilizes the neuronal membranes, thereby relieving pain. The drug penetrates the skin to act locally on the damaged or dysfunctional nerves and soft tissues, underlying the site. The benefit of local mechanism of action is that, with appropriate use, there is minimal systemic absorption of Lidocaine and adverse effects such as central nervous system depression or excitation are averted .Local absorption, also results in fewer drug interactions , an important consideration ,because many people with chronic pain requires opioids, nonopioids or adjuvant analgesics.A playing area was conducted by C V Bellieni et al., in 2006 conducted to the children, the results of is reported in the November 28 issue of the Archives of Disease in C hildhood.In this study, 69 children aged 7 to 12 age undergoing medical procedure were randomized to receive no distraction procedure (controls), active distraction by their mother, or supine distraction by a television cartoon. both(prenominal) the mothers and childrens rating scores suggested that procedures performed during television watching were perceived as being less painful than procedures performed during active or no distraction.Many studies have well-tried the effectiveness of Eutectic Mixture of Local Analgesics (EMLA) and Lidocaine gel .Since the application of Lidocaine is one quarter the cost of EMLA cream, significant saving can be obtained if it is proven to be effective as a topical anesthetic agent. It was seen in earlier studies that, IV cannulation was easier with Lidocaine gel as compared to EMLA cream.A randomized, double-blinded, placebo-controlled study by J.B.Rose et al., (2002) of Lidocaine Iontophoresis for pediatric venipuncture among 59 children a ged 6-17 years suggested that lidocaine iontophoresis is safe in children, reduces discomfort associated with venipuncture, and increases satisfaction when compared with the placebo.Hot applications promote vasodilation. A study was conducted on effect of EMLA choice and Application of Heat to Facilitate Peripheral Venous Cannulation in Children by Lori Huff et al., (2009). There was a significant increase in vein visualization from pre-application of heat to post application of heat with a success rate of 80% with the first time attempt of IV insertion. Therefore, application of heat counteracts the adverse effect of vasoconstriction that occurs with EMLA cream application, potentially increasing peripheral venous cannulation success rates.The Joint Commission on Accreditation of Healthcare Organizations (JCAHO, 2003) has approved revise standards for pain assessment and management in hospital ambulatory and home care settings .The American pain Societys Quality improvement recomm endation provides excellent foundations for get together JCAHOs expectations which includes recognizing and treating pain properly and promising patients attentive analgesic care.On the investigators personal experience, it is observed that children are having increased pain and fear during needle-related procedures performing in Paediatric ward. This motivated the researcher to conduct a study to make venipuncture a total painless procedure. Hence Tailor-made technique was selected for the research.1.2 STATEMENT OF THE PROBLEM burden OF TAILOR-MADE TECHNIQUE ON PAIN PERCEPTION AND FEAR AMONG CHILDREN UNDERGOING VENIPUNCTURE AT SRI RAMAKRISHNA HOSPITAL, COIMBATORE.1.3. OBJECTIVESTo administer Tailor-made technique among children before venipuncture.To assess the pain perception among children by and by administering Tailor-made technique in experimental and control classify.To assess the fear among children after administering Tailor-made technique in experimental and control multitude.1.4. OPERATIONAL translation1.4.1. EffectEffect refers to the change in the direct of pain perception and fear during venipuncture among children after Tailor-made technique.1.4.2. Tailor-made TechniqueTailor-made technique refers to the cabal of three interventions, such as exposure of the child to cartoon animations, application of 2 % Xylocaine gel for 10 to 15 minutes and application of local heat for 2 minutes over the planned site, before venipuncture.1.4.3. Pain PerceptionPain perception means the level of pain experienced by a child during venipuncture, denotative in terms of behavioral responses in face, legs, activity, cry and consolability.1.4.4. FearFear is an unpleasant feeling due to frightened situation during venipuncture among children expressed as responses in face.1.4.5. ChildrenChildren refer to those who are between the age concourse of 4-12 years, who need to undergo venipuncture at the Paediatric ward of Sri Ramakrishna hospital.1.4.6. Venipunct ureVenipuncture is a needle-related procedure, in which a vein is punctured for medication administration, fluid infusion or blood sampling among children between 4 to 12 years of age at Sri Ramakrishna hospital.1.5. conceptual FRAME WORKModified Weidenbachs Helping Art of Clinical Nursing TheoryModified Weidenbachs Helping Art of Clinical Nursing Theory (1964) was espouse for developing conceptual framework. The theory views nurse as an act, based on goal oriented care and closely parallels the assessment, implementation and evaluation steps of nursing process. This theory is composed of three basic elementsIdentification.Ministration.Validation.1.5.1. Identification.It involves individualization of the patient, his experiences and recognition of the patients perception of his condition. The researcher identifies the children who need to undergo venipuncture from the medical records, collects the demographic data and then plans for Tailor-made technique.1.5.2. Ministration.It is providing the needed help. It requires the identification of the need-for-help, the selection of a helping measure appropriate to the need, and the acceptability of the help to the patient. In this study, the researcher administers the Tailor-made technique before venipuncture to the experimental group, whereas no intervention is given to the control group.1.5.3. Validation.It is the evidence that the patients functional ability was restored as a result of the help given. In post test, the researcher assesses the level of pain and fear after the administration of Tailor-made technique and compares the effect of Tailor-made technique on pain perception and fear during venipuncture in experimental group with the level of pain perception and fear during venipuncture without Tailor-made technique in control group.1.6. PROJECTED OUTCOMEApplication of Tailor-made technique reduces the pain perception and fear among children undergoing venipuncture.Review of literatureLiterature review a rticle refers to the activities involved in identifying or searching for information on the topic (Polit and Hungler, 1999). Literature review is an essential component to the researcher for the greater understanding of the research problem and its aspects. It provides the researcher with an opportunity to respect many different approaches to the problem. Thus the literature review has organised and presented under three headings.2.1. Literature related to pain and fear during venipuncture.Cavender et al., (2004) done a study to determine the effectiveness of parental berth and distraction on the pain,fear, and distress of pediatric patients undergoingvenipuncture. An experimental-comparison group design was used to evaluate 43 patients (20 experimental and 23 comparisons) who were 4 to 11 years old. Experimental participants used parental positioning and distraction. totally participants rated their pain andfear parents andchildlife specialists (CLS) rated thechildsfear, and CLS rated thechilds distress. Self-reported pain andfearwere highly correlated (p Anil Agarwal et al., (2005) conducted a study to evaluate the dexterity of the valsalva maneuver on pain during venous cannulation among children. In this study 75 samples were randomly assigned to 3 groups respectively. root word I was control group without intervention, group II was instructed to blow into a sphygmomanometer tubing and raise the mercury column up to 30 mm of Hg for 20 seconds and group III was instructed to press a rubber ball. After 20 seconds peripheral venous cannulation was performed. Venous cannulation pain was graded by a 4 point scale. Results showed a significant reduction in the incidence of pain in group II (72 %), whereas other two groups experienced coke % pain. Researcher concluded that, the valsalva maneuver performed at the time of venous cannulation greatly decreases venipuncture pain.Gupta et al., (2005) carried out a prospective, randomized controlled study to evalu ate the efficacy of aviate inflation on venous cannulation pain among children by Devendra. The study was conducted among 75 children aged 6-12 years who were randomly divided into three equal groups. Group I was control group with no intervention, group II was provided with distraction like pressing a ball and group III with balloon inflation. optical analogue scale was used to assess the venipuncture pain and there was a significant reduction observed in group II and group III, when compared with group I. Visual analogue score in group III was decreased when compared with group II (p Farion et al., (2006) conducted a randomized control study to determine the effect of vapocoolant spray on pain during intravenous cannulation by among 80 children between 6-12 years. The children received either vapocoolant spray or placebo before cannulation. Children rated their pain using a 100-mm colour visual analogue scale. Parents (p = 0.04), nurses (p = 0.01) and child life specialists (p Mo vahedi et al., (2006) conducted a study to examine the effect of local refrigeration prior to venipuncture on pain related responses among school age children. 80 children aged 6-12 years were selected by purposive sampling. In experimental group the injection site was refrigerated for three minutes using an ice bag before venipuncture and in control group venipuncture was performed according to routine procedure. Physiological responses, behavioral responses, and personal responses were assessed in both groups. Results showed no significant difference between two groups for physiological responses, whereas behavioral responses (p = 0.0011) and subjective responses (p = 0.0097) showed that, the test group had lower score in behavioral and subjective responses compared to the control group. The researcher concluded that the use of local refrigeration prior to venipuncture can be considered as an easy and effective intervention for reducing pain related to venipuncture.Kennedy et al. , (2008) reported in an article that painduring venipuncture and intravenous cannulation is an important source of paediatricpainand has a lasting impact. Older children have reported greaterpainduring follow-up and cancer-relatedprocedures,if the painof the initial procedure was poorly controlled. Fortunately, both pharmacologic and non pharmacologic techniques have been found to reduce childrens acutepainand distress and subsequent blackball behaviours during venipuncture. This review gives the evidence for the importance of managing paediatric proceduralpainand methodsfor reducing venous accesspain.Nilsson et al., (2008) evaluated the concurrent and defecate validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during proceduralpainamong 80 children of 5-16 years age. Children scheduled for peripheral venous cannulation of a venous port were included in this study. In 40 cases, two nurses simultaneously and independently assess edpainby using the FLACC scale and in 40 cases one of these nurses assessed the child. All children scored the intensity ofpainby using the Coloured Analogue Scale (CAS) and distress by the Facial Affective Scale (FAS). Concurrent validity was back up by the correlation between FLACC scores and the childrens self-reported CAS scores during the procedure (r = 0.59, P Hess and Hall (2009) conducted a prospective study to evaluate the effect of a near-infrared loose vein viewing device on the success rate of venipuncture performed by staff nurses on a paediatric surgical unit. The number of attempts, age of the patient, and time required to establish successful vascular access were recorded for 91 children and this data was compared to baseline data (n=150) previously collected on the same unit prior to the implementation of the device. The first attempt success rate for the control group was 49.3%, and for the experimental group 80.2% (p Harrison et al., (2011) conducted a randomize d controlled study to assess the efficacy of sweet tasting solutions or substances for reducing needle-related procedural pain inchildrenbeyond one year of age. A sweet tasting solution or substance was given to 330 childrenbetween 1 to 16 years of age randomly in experimental group. Control conditions included water, non-sweet tasting substances, pacifier,distraction, no treatment, positioning or breastfeeding. Results for the toddlers or pre-schoolchildrenshow that in the sucrose group in one study had significantly lower cry duration and behavioral pain scores, compared with the no intervention group, while crying time did not differ between the sucrose and the no intervention group in the other study. For school-agedchildren, sacramental manduction sweet gum either before, or during the procedure, did not significantly reduce pain scores.2.2 Literature related to distraction strategy, local anesthetics and local heat.Halperin et al., (1989) conducted a double-blind, placebo-con trolled study was conducted by to evaluate the effect of topicalskin anesthesia (EMLA, eutectic mixture of prilocaine andlidocaine) for venous, subcutaneous drug reservoir and lumbar punctures in children. Venipunctures were performed on 18children(6.1 to 12.2 years of age) equally divided in the study and control groups. . Pain intensity was scored by thechildrenthemselves, using a visual analogue scale. EMLA cream was associated with lesser pain scores than those with placebo (means +/- SD 2.8 +/- 2.4 versus 6.8 +/- 2.1, P less than .01). A crossover trial was used in the studies of subcutaneous drug reservoir and lumbar punctures, eightchildren(6.1 to 15.1 years of age) were well-tried for subcutaneous drug reservoir punctures. Pain induced by this procedure was rated at 3.9 +/- 2.2 with placebo compared with 1.2 +/- 1.8 with EMLA cream (P Peretz et al., (2002) conducted a random crossover study to assesschildrens reactions while receiving a warmedlocalanesthetic solution for de ntal procedures (37o C W) and to compare with one at room temperature (21o C RT). 44 childrenbetween the ages of 6 to 11 years were randomly assigned to receive either a W or a RTlocalanesthesia on the first confer and the alternatelocalanesthesia on the second visit. The modified Behavioral Pain Scale (BPS) was used during the injection. For subjective evaluation, the Wong-Baker FACES Pain Rating Scale (FPS) was used. apply the FPS, 19 boys ranked the experience oflocalanesthesia as a positive experience , 4 boys and all 21 girls ranked it as negative for both types (W and RT). No significant difference was found in the mean VAS scores between the room-temperature group and the warm group (23.4 +/- 21.8 and 20.8 +/- 18.9, respectively). Thus there is no advantage towarminglocalanesthetic solution prior to injection.Biswas, D. (2005) conducted a study on effectiveness of four modalities (hot abetment, glycerine Magnesium sulfate application, and Ichthamol Magnesium Sulphate and I chthamol Belladonna) of nursing interventions on phlebitis pain was evaluated. Ichthamol Belladonna along with hot fomentation was effective in reducing pain, erythema, swelling, induration, palpable venous cord at 0.01 as compared to Ichthamol Belladonna dressing, glycerine Magnesium Sulphate dressing and glycerine Magnesium dressing with hot fomentation. Tools included the demographic data to know the sample characteristics, phlebitis measurement chart, observation check list and visual analogue scale. The pre test mean pain score related to peripheral IV infiltration were 61.23 and post test mean pain scores were 13.27 in treatment with Ichthamol Belladonna dressing with fomentation which was found to be the most effective out of all the 4 interventions. Thus the study concluded that Ichthamol Belladonna dressing with fomentation was effective.Vangoli et al., (2005) conducted a study to investigate the presence of clown doctors on achilds preoperative anxiety during the induction of anaesthesia and on the parent who accompanies them until he/she is asleep. There were 40 samples of 5-12 years of age who were assigned randomly to the clown group in which thechildrenwere accompanied in the preoperative room with the clown doctors and a parent and to the control group in which thechildrenwere accompanied by only 1 of his/her parents. The anxiety of thechildrenin the preoperative period was measured through the Modified Yale Preoperative Anxiety Scale instrument and the anxiety of the parents was measured using State-Trait Anxiety Inventory. Also, a questionnaire was developed for health professionals to obtain their opinion about the presence of clowns and a self-evaluation form was developed to be filled out by the clowns themselves about their interactions with thechild. This study shows that the presence of clowns during the induction of anaesthesia with thechilds parents was an effective intervention for managingchildrens and parents anxiety during the preo perative period.Anjum. S (2007) conducted a study on hot fomentation versus low temperature compress, to reveal that the pre-treatment mean score of degree of infiltration was 7.1667 and it was decreased to 0.7071 on the third day of treatment with hot fomentation. In cold compress group, pre-treatment mean score of degree of infiltration was reduced from 6.9333 to 0.7571 on the third day of cold compress treatment. The intensity of pain was reduced from severe 56.66% to no pain 93.4% in hot fomentation group. In cold compress group, the intensity of pain was reduced from moderate 60.0% to no pain 86.6%. The mean score of hot fomentation group was 6.5067 in reducing the degree of infiltration while cold compress the mean score was 6.6. The study concluded that hot fomentation better than that of cold compress.Lee (2008) done a randomized cross-over study to determine the effect ofheatand duration of stretching on the extensibility of hamstring muscles and their electromyographic re sponses to passive stretch inchildrenwith hypertonia and severe mental retardation. There were 29 participants with ages from 4 to 13 years who randomly received 4 treatment sessions as (A)10-second stretching, (B)30-second stretching, (C) hotpack followed by 10-second stretching, and(D) hotpack followed by 30-second stretching each consisting of 5 repetitions of stretching and successive treatments were separated by at least 24 hours. The distance between greater trochanter and lateral malleolus and hamstring electromyographic (EMG) activity during passive knee extension stretching were measured. Two-way ANOVA showed a big increase in hamstring extensibility in conditions C and D (1.3 +/- 1.1 cm) than conditions A and B (0.7 +/- 0.9 cm) (PWarminglocalanesthetics has been proposed as a cost-free intervention that reduces injection pain. Hogan et al., (2011) conducted a study to determine the effectiveness of warminglocalanesthetics to reduce pain in adults andchildrenundergoingloca lanesthetic infiltration into intradermal or subcutaneous tissue. 29 studies were retrieved for close examination and 19 studies met inclusion criteria. A total of 18 studies with 831 patients were included in a meta-analysis. 17 studies had