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      Children’s description of pain through drawings and dialogs: A concept analysis

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          Abstract

          Aim

          To present a concept analysis of pain in children's drawings and dialogs.

          Introduction

          The complexity and subjectivity of the concept of pain in children remain ambiguous. As a result, children are exposed to inappropriate diagnosis and inadequate treatment. Children can describe or draw their painful experiences. Analysing the concept of pain based on children's experiences can help identify, assess and properly manage and treat pain in children.

          Design

          Concept analysis.

          Methods

          Walker and Avant's framework for concept analysis was used in this current study.

          Results

          Major aspects of pain revealed in this concept analysis are affected by children's different concerns about pain. The description of pain in children with chronic diseases or chronic pain is completely different from that in healthy children. Children perceive pain to be internal, external and emotional. Pain in children is associated with poor psychological and emotional conditions, which add new features and aspects to the concept of pain. Children's descriptions and drawings of pain indicate different concepts of pain in their minds. From the perspective of children, pain has an identity that is formed based on reality.

          Conclusion

          When developing pain evaluation tools, it is necessary to address the characteristics of pain. In the case of chronic pain, emotional effects of pain on children's psyche need extra attention. Child‐based pain management guidelines can then be formulated with the results of relevant concept analyses. Pain assessment is a major part of pain management in children. By considering the characteristics of the concept of pain, the efficiency and usefulness of developed tools can be enhanced to create advancement in paediatric pain management.

          Related collections

          Most cited references49

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          The assessment and management of acute pain in infants, children, and adolescents.

          (2001)
          Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness, and necessary medical procedures. It is associated with increased anxiety, avoidance, somatic symptoms, and increased parent distress. Despite the magnitude of effects that acute pain can have on a child, it is often inadequately assessed and treated. Numerous myths, insufficient knowledge among caregivers, and inadequate application of knowledge contribute to the lack of effective management. The pediatric acute pain experience involves the interaction of physiologic, psychologic, behavioral, developmental, and situational factors. Pain is an inherently subjective multifactorial experience and should be assessed and treated as such. Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly, use a multimodal approach to pain management, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.
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            Measuring pain as the 5th vital sign does not improve quality of pain management.

            To improve pain management, the Veterans Health Administration launched the "Pain as the 5th Vital Sign" initiative in 1999, requiring a pain intensity rating (0 to 10) at all clinical encounters. To measure the initiative's impact on the quality of pain management. We retrospectively reviewed medical records at a single medical center to compare providers' pain management before and after implementing the initiative and performed a subgroup analysis of patients reporting substantial pain (> or =4) during a postimplementation visit. Unique patient visits selected from all 15 primary care providers of a general medicine outpatient clinic. We used 7 process indicators of quality pain management, based on appropriately evaluating and treating pain, to assess 300 randomly selected visits before and 300 visits after implementing the pain initiative. The quality of pain care was unchanged between visits before and after the pain initiative (P>.05 for all comparisons): subjective provider assessment (49.3% before, 48.7% after), pain exam (26.3%, 26.0%), orders to assess pain (11.7%, 8.3%), new analgesic (8.7%, 11.0%), change in existing analgesics (6.7%, 4.3%), other pain treatment (11.7%, 13.7%), or follow-up plans (10.0%, 8.7%). Patients (n=79) who reported substantial pain often did not receive recommended care: 22% had no attention to pain documented in the medical record, 27% had no further assessment documented, and 52% received no new therapy for pain at that visit. Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.
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              Concept analysis: resilience.

              This paper will systematically analyze the concept of resilience using an integrated review of literature. The historical perspective, attributes, antecedents, and consequences of resilience will be reviewed. A theoretical and operational definition will be provided. The Walker and Avant method will be used to describe the cases. Finally, the use of concept map will capture the relationships among the attributes, antecedents, consequences, and empirical indicators through clustering and chaining. © 2013.
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                Author and article information

                Contributors
                Ashoseini@Tums.ac.ir
                Journal
                Nurs Open
                Nurs Open
                10.1002/(ISSN)2054-1058
                NOP2
                Nursing Open
                John Wiley and Sons Inc. (Hoboken )
                2054-1058
                14 October 2018
                April 2019
                : 6
                : 2 ( doiID: 10.1002/nop2.2019.6.issue-2 )
                : 301-312
                Affiliations
                [ 1 ] School of Nursing & Midwifery Tehran University of Medical Sciences Tehran Iran
                Author notes
                [*] [* ] Correspondence

                Akram Sadat Sadat Hosseini, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran.

                Email: Ashoseini@ 123456Tums.ac.ir

                Author information
                http://orcid.org/0000-0003-3133-1657
                Article
                NOP2211
                10.1002/nop2.211
                6419297
                cb3c4d73-8aa4-4788-ab61-bc19c9b996bc
                © 2018 The Authors. Nursing Open published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 February 2018
                : 16 August 2018
                : 17 September 2018
                Page count
                Figures: 0, Tables: 2, Pages: 12, Words: 10337
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                nop2211
                April 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.1 mode:remove_FC converted:15.03.2019

                children,concept analysis,nurses,nursing,paediatrics,pain
                children, concept analysis, nurses, nursing, paediatrics, pain

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