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UI Researchers Seek To Ease Children's Pain During Medical Procedures

A new system under development by a team of researchers at the University of Iowa will help children better cope with pain during difficult medical procedures.

The system works by using a Web-based software to advise nurses on the best way to distract children from the procedures that cause the pain. The distractions could be anything from having a book read to them, watching a video, talking, or playing a game.

The research team, led by professors Ann Marie McCarthy and Charmaine Kleiber in the College of Nursing and Nick Street in the Tippie College of Business, developed the software after analyzing data from a multi-site research study that observed parents distracting their children, who were undergoing painful procedures.

The study helped the researchers determine how children cope with pain and what distractions worked best to keep their minds off the pain.

Children between the ages of 4 and 10 at the University of Iowa Children's Hospital participated in this study. Data were collected from 542 subjects, all of whom were having an IV line inserted while a video camera recorded the event.

The data was collected by having parents and children complete questionnaires and by analyzing videotapes of the procedures. Members of the research team reviewed the video and graded the children's distress. Children who experienced more pain and had more difficulty coping received higher scores. Children were also able to report how painful the procedure was by using a scale with happy and sad faces on it.

"We're now using that data to build software that will determine the best strategy for distracting a child from the procedure, based on what we know about the child and the type of procedure," said Street, a Tippie professor of management sciences who mined the data and is developing the software.

The software will also determine the parent's capacity for providing the distraction.

"Not all parents are equally cut out for helping their children through medical procedures," said McCarthy, a professor of nursing and chair of the nursing school's Parent, Child and Family Area. "Sometimes, it might be best to bring in a distraction coach who has special training to keep children occupied."

The distractions, she said, are anything that takes captures the attention of the child so that they focus on the distraction and not the procedure; reading a book, talking about school, coloring, drawing.

"In pain management, one size doesn't fit all," McCarthy said. "Some children need intensive distraction, some might need none at all. This software will tell the nurse what group each child should be in and what type of intervention to provide."

McCarthy said the long-term health effects of making it easier for children to cope with pain could be profound.

"This is important because more than 4 million children require painful medical procedures, and we know undergoing those procedures can affect health care decisions later in life," said McCarthy. "If we can provide a distraction, then the children are more likely to find the event to be less traumatic and are less likely to undergo serious psychological trauma."

The next step in the research will begin in January, when researchers will pilot the software to determine what types of distractions work best with different parents and children. Street said the software asks a brief series of questions of the children and their parents about such things as previous experiences with procedures and pain, parenting styles, and anxiety issues.

Based on the answers and the type of procedure, the software will suggest a distraction strategy to the nurse and recommend whether the parents should do the distracting, or a coach should be brought in.

McCarthy said researchers will observe 580 subjects over 30 months during the next phase of research. The children will be patients at the University of Iowa Children's Hospital in Iowa City, Blank Children's Hospital in Des Moines and Cardinal Glennon Children's Hospital in St. Louis.

Other members of the research team include Kaan Ataman, a doctoral student in the Tippie College of Business, and Nick Woike, a Tippie College undergraduate student. Project director Kirsten Hanrahan of the College of Nursing provided nursing clinical experience to the software development.


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