Kristensen Helle Nygaard, Sørensen Erik Elgaard, Stinson Jennifer, Haslund-Thomsen Helle
Department of Pediatrics Aalborg University Hospital Aalborg Denmark.
Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark.
Paediatr Neonatal Pain. 2019 Aug 22;1(1):5-14. doi: 10.1002/pne2.12005. eCollection 2019 Sep.
This study explored the interaction between child and hospital clown during recurrent hospitalizations for repeated pain-related procedures and conditions.
Despite improvements in the management of pain in hospitalized children, procedural pain in particular is a common experience for hospitalized children, and they continue to report undertreated pain. Hospital clowns are widely used as a nonpharmacological intervention in hospitalized children. Little research has examined the influence of hospital clowns during recurrent hospitalizations on repeated painful procedures.
Ethnographic fieldwork using focused ethnography was conducted. Data were collected during October-December 2017 using participant observation and informal interviews with children at one pediatric unit at a Danish university hospital. Data include 61 interactions between children aged 4-14 years and hospital clowns. The participants comprised 13 children undergoing recurrent hospitalizations. The data were coded using thematic analysis, and the research team verified the resulting themes.
The overarching theme was defined as , based on two identified themes, that is, and . The WE was characterized by a responsive interaction between the child and clown, which evolved over the course of an ongoing relationship.
This study demonstrates how an ongoing WE was constructed with children during repeated painful procedures and conditions. Specifically, the study emphasizes the importance of developing a trusting relationship on the child's terms. Children seemed to experience enhanced coping with painful procedures during the recurring hospital clown encounters, thus reinforcing their competence and hope for coping with future painful procedures. These findings may improve psychosocial care for hospitalized children undergoing repeated painful procedures and conditions and may facilitate multidisciplinary initiatives, such as nurses' advocacy for the inclusion of hospital clowns during recurrent hospitalizations for repeated painful procedures to ensure optimal pain management.
本研究探讨了在因反复进行与疼痛相关的程序和病症而多次住院期间儿童与医院小丑之间的互动。
尽管住院儿童疼痛管理有所改善，但程序性疼痛尤其是住院儿童的常见经历，他们仍报告疼痛治疗不足。医院小丑被广泛用作住院儿童的非药物干预措施。很少有研究考察多次住院期间医院小丑对反复进行的痛苦程序的影响。
采用聚焦民族志进行民族志实地研究。2017年10月至12月期间，在丹麦一家大学医院的一个儿科病房，通过参与观察和与儿童进行非正式访谈收集数据。数据包括4至14岁儿童与医院小丑之间的61次互动。参与者包括13名多次住院的儿童。使用主题分析对数据进行编码，研究团队对得出的主题进行了验证。
基于两个确定的主题，总体主题被定义为 ，即 和 。WE的特点是儿童与小丑之间的反应性互动，这种互动在持续的关系过程中不断发展。
本研究展示了在反复进行的痛苦程序和病症期间如何与儿童构建持续的WE。具体而言，该研究强调了按照儿童的条件建立信任关系的重要性。在与医院小丑反复接触的过程中,儿童似乎在应对痛苦程序方面表现得更好，从而增强了他们应对未来痛苦程序的能力和希望。这些发现可能会改善对反复经历痛苦程序和病症的住院儿童的心理社会护理，并可能促进多学科倡议，例如护士倡导在因反复痛苦程序而多次住院期间纳入医院小丑，以确保最佳的疼痛管理。
