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Published on: July 4, 2018
Discomfort of the critically ill paediatric patient and correlated variables
Alejandro Bosch-Alcaraz1, Iolanda Jordan2, Llúcia Benito-Aracil3
1Pediatric Nurse, Hospital Sant Joan de Déu, Barcelona, Spain; Department of Public Health, Mental Health, and Maternity/Childhood Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Insights
Nearly half of critically ill children in the pediatric intensive care unit experience discomfort. Older age and lack of analgosedation are linked to increased discomfort, highlighting the need for targeted interventions.
Area of Science:
- Pediatric Critical Care Medicine
- Nursing Research
- Pain Management
Background:
- Critically ill children often undergo invasive procedures causing fear, pain, and discomfort.
- Assessing and managing discomfort is crucial in pediatric intensive care settings.
Purpose of the Study:
- To analyze the level of discomfort in pediatric intensive care unit (PICU) patients.
- To identify sociodemographic and clinical factors influencing discomfort in critically ill children.
Main Methods:
- A descriptive, observational, cross-sectional study involving 311 children.
- The COMFORT Behavior Scale-Spanish version was used by critical care nurses to assess discomfort over two days.
- Data were collected on patient age, length of stay, and analgosedation use.
Main Results:
- 50.2% of patients experienced discomfort (COMFORT score >10).
- Older age correlated positively with higher discomfort levels (Rho=0.230, p<0.001).
- Patients not receiving analgosedation had significantly higher discomfort levels (11.96 ± 2.80) compared to those who did (10.77 ± 2.94).
Conclusions:
- Half of PICU patients experience discomfort, with age and analgosedation being key influencing factors.
- Clinical practices should incorporate strategies to alleviate discomfort in critically ill children.
- Further research into pain and discomfort management in pediatric critical care is warranted.
Introduction:
The care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort.
Objectives:
The aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients.
Methods:
We performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range = 0.9-11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior Scale-Spanish version.
Results:
In total, 49.8% (n = 155) of the patients were free of discomfort (score ≤10 points) vs. 50.2% (n = 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho = 0.16; p = 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho = 0.230, p < 0.001); the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n = 205), with discomfort levels of 10.77 ± 2.94, with those who did not receive analgosedation (n = 106), with discomfort levels of 11.96 ± 2.80, we did find a statistically significant difference (χ2 = -4.05; p < 0.001).
Conclusions:
Half of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients.
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