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

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Presenting Author

Gabriela Ruiz

Poster Authors

Gabriela Ruiz

BNSc

Universidad de Chile. Medical Student, Universidad de Chile

Lead Author

E-mail

Mariela Bustamante

PhD

Universidad de Chile. Master in Health Psychology and Doctoral Candidate in Psychology Pontificia Universidad Católica de Chile

Lead Author

E-mail

Nicole Klein

BS

Universidad de Chile. Psychology Student, Universidad de Chile

Lead Author

E-mail

Jose Ivan Rossel. Psychologist

PhD

Universidad de Chile

Lead Author

E-mail

Scarlett Caroca

BNSc

Universidad de Chile. Bachelor in Medicine, Universidad de Chile

Lead Author

E-mail

Sofía Hidalgo Vilche

BS

Universidad de Chile. Psychology Student, Universidad de Chile

Lead Author

E-mail

Topics

  • Access to Care