Background & Aims
Research in psychology within pediatric emergency departments (PED) is essential for improving experiences for children, caregivers, and healthcare staff. However, the challenging environment creates obstacles for forming and managing research teams. Most studies on psychological factors in PEDs are limited by being cross-sectional, focused on a single facility, and mainly using self-report measures, which can limit validity and reliability. There is a lack of research addressing specific barriers in the research process within PEDs, such as adapting to each PED’s unique characteristics and overall stressors for users and staff. This is especially important in psychology, where studying effective stress management is crucial. One practical approach is to explore coping mechanisms and co-regulation involving children, caregivers, and staff. Therefore, this study aims to describe adapting a psychology research protocol in PEDs, focusing on coping strategies and adult co-regulation.
Methods
A scoping review of the literature was conducted until June 2023 in the electronic databases: PsycINFO, Scopus, Web of Science, PubMed and CINAHL. The primary eligibility criterion for the study selection was to focus on research on psychological variables in pediatric patients treated in children’s emergencies. Barriers and facilitators of emergency research, along with methodological quality indicators, were examined for the design and implementation of a multicenter cross-sectional pilot research protocol in 4 PEDs focused on studying stress, fear, pain, coping and co-regulation variables with triads of preschoolers, caregivers and health personnel. Subsequently, an adapted longitudinal protocol was developed based on the barriers and facilitators identified in the pilot study to conduct an effective investigation on psychological variables in PEDs, and their impact on quality of life and long-term mental health.
Results
Based on the results of the systematic review and pilot study, specific contextual, functional and individual barriers and facilitators related to the care experience, as well as pre-existing ones, were identified. Ethically, the child’s consent was deemed crucial. Methodologically, a comprehensive evaluation of children’s pain and fear experiences through multiple reports was necessary, both before, during, and after health care. It is advised to use video recording of the attention and procedures with facial and written blurring to complement the measures of pain and fear assessments with a detailed behavioral analysis of child coping and co-regulation processes. The video recording devices should be portable and discreet. Strategies for preparing healthcare personnel in shifts are recommended to foster a positive attitude towards researchers’ presence. Online extensive self-report assessments by caregivers are suggested due to the high stress levels associated with childhood illness processes.
Conclusions
Investigation of psychological factors in pediatric emergencies is crucial for generating scientific evidence aiding in managing stress, pain, and fear in children and caregivers, as well as the stress experienced by healthcare providers. However, the structure and functioning of EDs present a unique set of characteristics, barriers, and facilitators that must be considered when adapting research protocols. While some factors can be altered (such as coping strategies and adult co-regulation, staff readiness strategies), there are also external factors beyond the researcher’s control, where steps can only be taken to minimize their impact on the research protocol. Ongoing efforts are necessary to educate healthcare providers on the importance of their involvement in research processes, to enhance the experience of children, parents, and themselves during each emergency situation. Additionally, training a research team that is adaptable and capable of handling frustration is essential.
References
Afzal, N., Ye, S., Page, A. C., Trickey, D., Lyttle, M. D., Hiller, R. M., & Halligan, S. L. (2022). A systematic literature review of the relationship between parenting responses and child post-traumatic stress symptoms. European Journal Of Psychotraumatology, 14(1). https://doi.org/10.1080/20008066.2022.2156053
Azak, M., Aksucu, G., & Ça?lar, S. (2022). The Effect of Parental Presence on Pain Levels of Children During Invasive Procedures: A Systematic Review. Pain Management Nursing, 23(5), 682-688. https://doi.org/10.1016/j.pmn.2022.03.011
Butt, M., Kabariti, S., Likourezos, A., Drapkin, J., Hossain, R., Brazg, J., & Motov, S. (2021). Take?Pause: Efficacy of mindfulness?based virtual reality as an intervention in the pediatric emergency department. Academic Emergency Medicine, 29(3), 270-277. https://doi.org/10.1111/acem.14412
Felluga, M., Rabach, I., Minute, M., Montico, M., Giorgi, R., Lonciari, I., Taddio, A., & Barbi, E. (2016). A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children’s anxiety and pain levels in the emergency department. European Journal Of Pediatrics, 175(5), 645-650. https://doi.org/10.1007/s00431-015-2688-0
Karaca, T. N., & Guner, U. C. (2022). The Effect of Music-Moving Toys to Reduce Fear and Anxiety in Preschool Children Undergoing Intravenous Insertion in a Pediatric Emergency Department: A Randomized Clinical Trial. Journal Of Emergency Nursing, 48(1), 32-44. https://doi.org/10.1016/j.jen.2021.10.004
Lee, H. N., Park, J. W., Hwang, S., Jung, J. Y., Kim, D. K., Kwak, Y. H., & Lee, E. J. (2023). Effect of a Virtual Reality Environment Using a Domed Ceiling Screen on Procedural Pain During Intravenous Placement in Young Children. JAMA Pediatrics, 177(1), 25. https://doi.org/10.1001/jamapediatrics.2022.4426
Litwin, S. P., Nguyen, C., Hundert, A., Stuart, S., Liu, D., Maguire, B., Matava, C., & Stinson, J. (2020). Virtual Reality to Reduce Procedural Pain During IV Insertion in the Pediatric Emergency Department. The Clinical Journal Of Pain/The Clinical Journal Of Pain, 37(2), 94-101. https://doi.org/10.1097/ajp.0000000000000894
Pancekauskait?, G., & Jankauskait?, L. (2018). Paediatric Pain Medicine: Pain Differences, Recognition and Coping Acute Procedural Pain in Paediatric Emergency Room. Medicina, 54(6), 94. https://doi.org/10.3390/medicina54060094
Riddell, R. R. P., Bucsea, O., Shiff, I., Chow, C., Gennis, H. G., Badovinac, S., DiLorenzo-Klas, M., Racine, N. M., Kohut, S. A., Lisi, D., Turcotte, K., Stevens, B., & Uman, L. S. (2023). Non-pharmacological management of infant and young child procedural pain. Cochrane Library, 2023(6). https://doi.org/10.1002/14651858.cd006275.pub4
Rimon, A., Shalom, S., Wolyniez, I., Gruber, A., Schachter-Davidov, A., & Glatstein, M. (2016). Medical Clowns and Cortisol levels in Children Undergoing Venipuncture in the Emergency Department: A Pilot Study. PubMed, 18(11), 680-683. https://pubmed.ncbi.nlm.nih.gov/28466619
Robinson, N., Delorenzo, A., Howell, S., Smith, K., Cameron, P., Stock, A., & Eastwood, K. (2023). Pediatric Distraction Tools for Prehospital Care of Pain and Distress: A Systematic Review. Pediatrics, 152(1). https://doi.org/10.1542/peds.2022-059910
Sobol-Kwapi?ska, M., Sobol, M., & Wo?nica-Niesobska, E. (2020). Parental behavior and child distress and pain during pediatric medical procedures: Systematic review and meta-analysis. Health Psychology, 39(7), 558-572. https://doi.org/10.1037/hea0000864
Wente, S. J. (2013). Nonpharmacologic Pediatric Pain Management in Emergency Departments: A Systematic Review of the Literature. Journal Of Emergency Nursing, 39(2), 140-150. https://doi.org/10.1016/j.jen.2012.09.011
Wolyniez, I., Rimon, A., Scolnik, D., Gruber, A., Tavor, O., Haviv, E., & Glatstein, M. (2013). The Effect of a Medical Clown on Pain During Intravenous Access in the Pediatric Emergency Department. Clinical Pediatrics, 52(12), 1168-1172. https://doi.org/10.1177/0009922813502257
Presenting Author
Gabriela Ruiz
Poster Authors
Gabriela Ruiz
BNSc
Universidad de Chile. Medical Student, Universidad de Chile
Lead Author
Mariela Bustamante
PhD
Universidad de Chile. Master in Health Psychology and Doctoral Candidate in Psychology Pontificia Universidad Católica de Chile
Lead Author
Nicole Klein
BS
Universidad de Chile. Psychology Student, Universidad de Chile
Lead Author
Jose Ivan Rossel. Psychologist
PhD
Universidad de Chile
Lead Author
Scarlett Caroca
BNSc
Universidad de Chile. Bachelor in Medicine, Universidad de Chile
Lead Author
Sofía Hidalgo Vilche
BS
Universidad de Chile. Psychology Student, Universidad de Chile
Lead Author
Topics
- Access to Care