Pediatric Procedural Pain: How Far Have We Come? An Ethnographic Account

Background:Advancing health literacy is a fundamental step toward achieving population health. To that end, the National Institutes of Health (NIH) funded research to increase scientific understanding of how health literacy can reduce disparities and enhance the health of the United States.Objective:This study identified and evaluated NIH-funded health literacy research focusing on disease prevention.Methods:New R01, R03, and R21 research project grants awarded from fiscal year (FY) 2004 to FY 2017 studying health literacy and disease prevention were identified. Study characteristics, including the role of health literacy, how health literacy was measured, populations studied, and study design, were coded for each grant. Administrative grant data were obtained from the NIH's internal database. Research impact was assessed using the relative citation ratio (RCR).Key Results:There were 192 grants studying health literacy and disease prevention awarded by 18 NIH institutes and centers from FY 2004 to FY 2017, covering a wide variety of health conditions including cancer (26.0%), infectious diseases (13.5%), nutrition (8.3%), drug/alcohol use (7.8%), and cardiovascular disease (6.3%). Most grants studied the health literacy skills of patients (88%), with a few studies assessing the health literacy practices of health care providers (2.1%) or systems (1%). There was good representation of populations with traditionally low levels of health literacy, including Black/African American participants (30.2%), Hispanic/Latinx participants (28.6%), older adults (37%), and people with low income (20.8%). The scientific articles generated by these grants were more than twice (RCR = 2.18) as influential on the field as similar articles.Conclusions:The NIH provided support for a wide array of prevention-focused health literacy research. The value of this research is highlighted by the number of funding institutes and centers, the diversity of populations and health conditions studied, and the effect these grants had on the field. Future research should move beyond patient-level health literacy to health literacy practices of health care systems and providers. [HLRP: Health Literacy Research and Practice. 2020, 4(4):e212–e223.]Plain Language Summary:This study describes health literacy research funded by the National Institutes of Health that focused on disease prevention. These grants sought to prevent a variety of health conditions, but health literacy research over the past 14 years continued to concentrate on the capacity of patients despite increased attention on the health literacy practices of health care providers and systems.

Increasing Nursing Treatment for Pediatric Procedural Pain

BackgroundIn Mozambique, and other low-income countries (LICs), there is little information on the burden of child maltreatment (CM). Emergency care services (ECS) play an important role in recognizing, treating, and intervening in situations of CM. We aim to identify knowledge, attitudes, and practices regarding CM among health care providers in ECS at Mavalane General Hospital in Maputo, Mozambique.MethodsThis exploratory cross-sectional study evaluates the knowledge, attitudes, and practices of health care providers to diagnose and treat cases of CM. A 25 min, pilot-tested verbal interview questionnaire was administered to 49 physicians and nurses working in ECS at Mavalane General Hospital. Interviews were completed between October–November 2010. Data were managed and analyzed in SPSS 14.0 and descriptive statistics were generated.ResultsOf 49 health care providers, 83.6% reporting receiving no, or very little CM education or training. Only 61.2% had knowledge of physical abuse as a main form of child maltreatment and 38.8% were able to identify corresponding symptoms of physical abuse. Sexual abuse as a main form of CM was mentioned by 26.5 and 2% cited its symptoms. While 87.7% of health care providers strongly agreed or agreed that they hold an important role in preventing CM, 51.1% also strongly disagreed or disagreed that they feel confident diagnosing and treating CM cases. In regards to follow-up, 14.3% strongly disagreed or disagreed that they know where to refer victims for further follow-up and an additional 14.3% did not know whether they agreed or disagreed.ConclusionThis study revealed knowledge gaps in emergency health care provider knowledge of the main forms of CM and their symptoms. The fact that a majority of health care providers in our sample did not receive information specific to CM in their medical education and training could explain this gap, as well as their unawareness of where to refer victims. Given that health care providers believe they play an important role in identifying and treating CM, future research should focus on raising physician awareness of CM and developing education and training materials grounded in cultural contexts to build response capacity in Mozambique and other LICs.

Introduction Medical, sometimes painful, procedures such as dental care, blood tests, immunizations, and others are ubiquitous experiences. In childhood, procedural pain emerges from common injections or more invasive procedures, such as IVs, that are needed to treat life-threatening illnesses, such as cancer. Pain is a social experience that emerges from both personal history and social context (Craig & Pillai Riddel, 2003). Management of procedural pain in childhood is important because children's perception of pain is influenced by their early pain experiences that can impact their future response to painful events or procedures (Blount, Piira, & Cohen, 2003; Taddio, Katz, Ilersich, & Koren, 1995). Unfortunately, despite the considerable research in the past two decades, pediatric pain is often underestimated and under-treated (Craig & Pillai Riddell) and dissemination of interventions to reduce pediatric pain continues to be lacking (Blount et al., 2003). Consequently, understanding the development and maintaining factors, as well as the interventions that assist these children is imperative. Social learning theory is one perspective from which pediatric procedural pain can be understood. A great deal of the literature examining this model has been conducted with chronic pain patients (Levy, Langer, & Whitehead, 2007). Though some have discussed the social learning contributions to procedural pain (e.g., Chambers, Craig & Bennett, 2002), an examination of the social learning implications across the etiology and treatment of pediatric pain has not occurred. Social learning theory provides a model for understanding the development, maintenance and effective treatments of pediatric procedural pain. The goal of this paper is to examine these contributions of social learning theory to our current understanding of pediatric procedural pain. Key Concepts from Social Learning Theory Self-efficacy is a key mechanism for understanding pain; pain perception is mediated via perceived self-efficacy of one's ability to manage the pain (Bandura, 1997). According to Bandura (1977b; 1997), self-efficacy is the primary cognitive mechanism that facilitates action. The ability of individuals to believe in their own effectiveness determines how well they will cope with difficult situations. Bandura states Perceived self-efficacy not only reduces anticipatory fears and inhibits but, through expectations of eventual success it affects coping efforts once they are initiated (Bandura, 1977a, p. 80). Expectations about one's personal efficacy are based on four sources of experience including performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal, each with its own valance that results from behavioral enactment. Performance accomplishments are the most reliable source of efficacy expectations. These accomplishments are the most influential because they provide the most authentic evidence that one can succeed. Participant modeling is one mode that enhances procedural accomplishments and is one of the most influential tools for raising self-efficacy beliefs. Modeling of threatening activities or joint performance with therapists can reduce the fear of an aversive activity (Bandura, 1977a, 1977b). Of the sources of self efficacy, verbal persuasion, often enacted through suggestion or exhoration, is a weaker source of self efficacy because of its low reliance on behavioral enactment. Procedural pain is especially amenable to a social learning perspective because of the role that anticipatory anxiety and avoidance plays in the pain and distress responses. From a social learning perspective, avoidant or distress behaviors (often seen in procedural pain) are viewed as disruptions in perceived inefficacy in coping that facilitates anticipatory anxiety and avoidant behavior (Bandura, 1986). According to this view, children avoid medical procedures or display anticipatory anxiety because they believe that they will be unable to manage difficult parts of the procedure. …

Background: Palliative care in the Philippines is categorized as 3A, considered to have localized hospice care provision; however, lack of education and awareness are dismal and accounted as the biggest challenges for the health care providers and for their patients. Other barriers like access and referral to palliative care specialist were not even equitable for all, especially in the Southern Philippines. The pervasive stigma of what palliative care means to the health care provider remains the major problem for accessing palliative programs, particularly in pediatric oncology patients. Objectives: This study aimed to assess the level of knowledge, attitude, and practice of health care providers towards pediatric palliative care. It intended to discover the associated factors that limit the pediatric oncology patients to receive palliative care, and to identify the barriers in providing palliative care by the cancer centers to the pediatric oncology patients. Method: A cross-sectional study design was used to carry out the research study in the 500 respondents (100 oncology doctors, 250 medical nurses, and 150 allied health workers) using a systematic random sampling method at the 13 tertiary care hospitals that offer palliative care to pediatric oncology patients in the Southern Philippines. Structured questionnaire was circulated to identify the barriers of palliative care, and assess the knowledge, attitude, and practices (KAP) of health care providers using a systematic random sampling method. The data were entered, cleaned, and analyzed using Excel and SPSS version 19.0 software. The chi-square test was employed to assess the association between variables. A p-value of less than 0.05 was considered as statistically significant. Results: From the total of 508 health care providers selected, a response rate of 500 (98.4%) was registered. Among the respondents, 287 (57.4%) had good knowledge and 259 (58.1%) had favorable attitude towards pediatric palliative care. In contrast, the level of practice showed that the majority, 384 (76.8%) of health care providers, had poor practice towards palliative care. Results showed that 94% to 99% of health care providers believed that the inadequate research evidence base to guide and measure the quality of life and lack of staff training in pediatric palliative care were the major barriers in providing palliative care by the cancer centers to the pediatric oncology patients. In addition, 100% of health care providers affirmed that the ignorance and lack of awareness about the existing program and resources of palliative care were the major factors that limit the pediatric oncology patients in receiving pediatric palliative care in Southern Philippines. Conclusions: The health care providers had poor training and knowledge aspect of practice, but their attitude towards palliative care was favorable. Recommendations are the need to be incorporated in the Department of Health through Continuing Professional Development to promote regular training for palliative care. Citation Format: Jayson Cagadas Pasaol, Jashin Rosal, Jansen Marcos Cambia, Jin Kyoung Oh. Assessment of knowledge, attitude, and practice and associated factors towards palliative care among health care providers to the pediatric oncology patients in southern Philippines [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A36.

Background: Children malnutrition constitutes one of the major public health problems in Egypt. Healthcare personnel lack adequate nutrition knowledge and they also lack the competence and skills to provide basic nutrition advice to their clients.Aim: To assess the knowledge, attitude and practice (KAP) of health care providers about chronic malnutrition (stunting) in children under-five in primary health care (PHC) centers and to identify the main items in which health care provides are trained including Integrated Management of Childhood Illness (IMCI) supporting the problem of stunting.Subjects and Methods: This is a cross-sectional descriptive study including all healthcare providers (N=51 doctors and 31 nurses), who were involved in the nutrition care of children under-five at PHC centers in Giza Governorate, at the time of the study. Data were collected using a structured question-naire for KAP of healthcare providers regarding chronic malnutrition (stunting) and training of healthcare providers, and using a checklist to record performance of healthcare providers providing nutrition related services to children under- five.Results: Overall, the mean percent knowledge score of healthcare providers about 'main health problems', 'main nutritional problems' and 'nutritional assessment methods' in children under five was below 50. Healthcare providers had overall positive attitude towards characteristics and manage-ment of stunting in children under-five. The mean percent score for 'Reported Practice related to breast feeding' was higher in nurses, where as reported practice related to com-plementary feeding was higher in doctors. More than 64.5% of healthcare providers reported correct practice regarding recommendation of micronutrient supplementation to children and mothers. Overall healthcare providers' performance re-garding communication and nutrition related services to children under five was suboptimal, but the nurses performing better than doctors. More than 70% of healthcare providers were trained in IMCI but there was a deficiency in nutritional training.Conclusion: The healthcare providers had optimal knowl-edge regarding some aspects of stunting. There was no signif-icant difference between doctors' and nurses' KAP in most of the items. Although they had overall positive attitude towards stunting and the majority were trained in IMCI, they showed suboptimal performance during care of children under five at PHC. The results of the study directed us to some of the recommendations as, preservice, on job and continuous prac-tical training of the health care providers on comprehensive management of malnutrition, improving the quality of health care services in PHCs and prioritizing key 1000 days window concepts in nutrition counseling for future trainings.

Objectives. To determine the knowledge, attitudes and practices (KAP) of health care providers at the Philippine General Hospital towards hypoglycemia among non-critically ill patients using a validated, self-administered survey tool.
 Methods. This study covered two phases out of a three-phased project: (1) development and validation of a 43- item KAP survey tool and (2) assessment of KAP among nurses and residents using the tool. Phases 1 and 2 are analytic cross-sectional studies. Data for the KAP survey was collected using the developed tool and focused group discussions (FGDs). Results of this study will be the framework for Phase 3, which is the development of an in-patient hypoglycemia protocol.
 Results. The validated KAP survey tool yielded a low overall mean score of 12.56 ± 2.11 in the knowledge domain although high scores (4.88 ± 1) were noted for knowledge on management of hypoglycemia. In terms of attitude, majority (99.31%) of respondents believed that fewer hypoglycemia events correlates to better clinical outcomes and are willing to adopt a nurse-driven protocol. Most respondents (52.8%) employed correct practices in hypoglycemia management. The FGDs identified the perceived facilitators and barriers to hypoglycemia management.
 Conclusion. There is a gap in knowledge and practices in managing hypoglycemia among health care providers which needs to be addressed further with education and training. Nevertheless, health care providers have a positive attitude towards having a standard hypoglycemia protocol that will contribute greatly to its implementation in the clinical area.

Background:Influenza viruses cause annual epidemics and occasional pandemics that have claimed the lives of millions. Understanding the role of specific perceptions in motivating people to engage in precautionary behavior may help health communicators to improve their messages about outbreaks of new infectious disease generally and swine flu specifically.Objectives:To study the knowledge and practices of health care providers regarding swine flu and to study the attitudes and practices of health care providers toward the prevention of the swine flu epidemic.Materials and Methods:The present study was a cross-sectional (descriptive) study and was conducted in the month of September, 2009, among doctors and nurses. A maximum of 40% of the total health care providers of GTB Hospital were covered because of feasibility and logistics, and, therefore, the sample size was 334.Results:Around 75% of the health care providers were aware about the symptoms of swine flu. Mostly, all study subjects were aware that it is transmitted through droplet infection. Correct knowledge of the incubation period of swine flu was known to 80% of the doctors and 69% of the nurses. Knowledge about high-risk groups (contacts, travelers, health care providers) was observed among 88% of the doctors and 78.8% of the nurses. Practice of wearing mask during duty hours was observed among 82.6% of doctors and 85% of nurses, whereas of the total study population, only 40% were correctly using mask during duty hours.Conclusions:Significant gaps observed between knowledge and actual practice of the Health Care Provider regarding swine flu need to be filled by appropriate training. Data indicate that the health care providers are very intellectual, but they do not themselves practice what they preach.

Background A lack of knowledge and inadequate practices of health care providers (HCPs) are the main obstacles to effective cancer pain management (CPM). The main objective of the study was to evaluate the CPM knowledge, CPM practice, and attitudes towards pharmacists' participation and advanced methods in CPM of physicians, nurses, and pharmacists in China. Methods An open online survey was adopted using social media software (WeChat) as the platform to conduct a nationwide survey of HCPs involved in CPM in public medical institutions at all levels in China from March to June 2019. Results A total of 1279 physicians, 2267 nurses, and 1466 pharmacists participated in the survey. Among the three types of professionals, nurses had the highest level of practical ability (61.63 ± 28.99) and best attitudes towards pharmacists' participation and advanced methods in CPM (72.05 ± 33.71) and physicians had the best mastery of CPM-related knowledge (69.60 ± 28.45), while pharmacists performed the worst in these three aspects (50.04 ± 26.69, 61.49 ± 28.95, and 62.07 ± 36.46, respectively). Only 19.69% of the hospitals had a pharmacist to tumor patient ratio ≥1 : 50. Hierarchical analysis showed that passing a good pain management (GPM) ward program and participating in advanced training had positive impacts on the scores of all three parts in the three professions (ptrend <0.05). Conclusions HCPs' levels of practice, knowledge, and attitudes towards pharmacists and advanced methods of CPM were average in China; however, pharmacists had the worst performance, which demonstrates a need for further improvement. Furthermore, GPM ward programs and advanced trainings are helpful for improving CPM levels.

ObjectiveTo obtain in-depth insight into the perceptions of parents and paediatricians in China regarding current procedural pain management on bone marrow aspirations and lumbar punctures in paediatric haemato-oncology department.Design, setting...

Objective Health care providers (HCPs) may serve as facilitators or barriers to access. We explore the knowledge, attitudes and practices of HCPs in Jamaica to identify gaps which may lead to unmet contraceptive needs for adolescents. Methods A cross-sectional study design was utilized to collect data from urban-based HCPs through a self-administered questionnaire regarding knowledge of, attitudes towards and practices in adolescent contraception. Summative knowledge and attitude scores were generated. Descriptive and inferential statistical analyses were performed. Results One hundred and forty-four HCPs participated with a female predominance (n=127; 88.2%) and median (IQR) age of 36 (20) years old. HCPs mean (SD) knowledge score 1.95 (0.81) negatively correlated with age (r= -0.279; p&lt;0.01) and length of time working as an HCP (r= -0.287; p&lt;0.01). Pharmacy staff had lowest mean (SD) scores, 13.4 (4.48); p&lt;0.05. Mean attitude score did not differ significantly by marital status or religion. As HCPs’ length of time in practice increased there was a decrease in the attitude scores (β= -0.380; p&lt;0.05). Conclusion There is need for capacity-building of HCPs to deliver active contraceptive counselling and provide modern, effective, evidence-based contraceptive services to adolescents in Jamaica. Review and revision of guidelines, policies and laws governing delivery of sexual and reproductive health services is recommended. Key words: adolescents, contraception, providers, Latin America and the Caribbean

Invasive procedures are major sources of pain and distress for children. Hence, it is imperative that it is properly managed to prevent short- and long-term effects of unmanaged acute pain. Despite the wealth of evidence on paediatric procedural pain management, it still remains sub-optimal in Nigeria and other developing countries.This paper is a narrative review which seeks to analyse existing theories and research studies to provide an in-depth understanding about procedural pain and its management. Five databases were searched to identify relevant theories and studies.While there is no model/theory that entirely explains the biopsychological aspects of procedural pain, existing models have emphasized that the parents/caregivers play a significant role in the effectiveness of procedural pain interventions. Also, there is a wide-range of pharmacological and non-pharmacological interventions that can be used to improve procedural pain management in Nigeria. A major barrier to the implementation of procedural pain interventions is cost. Hence, nurses and other health professionals should be educated on the use of cheap interventions such as music and toys. There is a need for more research on the effectiveness of non-pharmacological interventions, such as distraction.Keywords: Paediatric pain, Procedural pain management, Theories of pain

According to WHO, Biomedical waste is defined as ?any solid or liquid waste generated during the diagnosis, testing, treatment, research and production of biological product for humans and animals? The different location of waste generation in hospital are operation theatres, wards, labor room, laboratory and nursing homes. The knowledge and practices for handling of biomedical waste is generally restricted to waste handlers (sweepers), that causes main obstruction in biomedical waste management. So, to assess the level of knowledge and practices regarding disposal of biomedical waste by health care providers involved in health care unit, researchers decided to conduct this study. The research study was conducted with an objective to assess the level of knowledge and practices regarding disposal of biomedical waste by healthcare providers. A descriptive research design was used to assess the level of knowledge and practices regarding disposal of biomedical waste in 40 health care providers selected by convenience sampling technique at Regional Hospital in District Hamirpur, Himachal Pradesh. Data was collected by using observation method and self (interview) method. Result revealed that the calculated chi-square (?2) values were less than the table value at the 0.05 level of significance. There was non-significant association in level of knowledge and practices with their selected demographic variables and also revealed that there was a significant correlation between the level of knowledge and practices of health care providers regarding disposal of biomedical waste. The study concluded that there was significant correlation (0.506) with Table Value (0.312) and P value (0.001) between the knowledge and practices of health care providers.

Cognitive Dissonance and Pediatric Procedural Pain Management: A Concept Clarification

Evaluation of knowledge, attitude and practice of healthcare providers towards life-threatening drug-drug interactions in Penang General Hospital, Malaysia