Assessment of children's distress during painful medical procedures.

Examined the relationship between the distress of 42 pediatric cancer patients (aged 2–20 yrs) in response to medical procedures and a number of psychosocial, medical, and demographic variables. Results indicate that the observation scale used to measure distress was a reliable, valid instrument. The 3 variables most highly predictive of distress included the age of the S, the number of previous medical procedures experienced by the S, and parental anxiety in relation to the medical procedures. The apparent roles of cognitive-developmental factors and habituation in Ss' response to medical procedures are noted. Implications for intervention are reviewed, and it is suggested that effective intervention must include the parents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of child and parent behavior during painful medical procedures.

Examined (1) the impact of demographic, medical, and psychological factors on overall child distress (CD) during an invasive medical procedure required for pediatric cancer treatment and (2) the relationship of individual parent behaviors to CD across phases of the procedure. 70 3–10 yr old pediatric cancer patients receiving outpatient venipuncture and their parents participated. Overall distress was greater in younger children who had fewer previous venipunctures and poorer venous access and whose parents rated them prior to the procedure as less likely to be cooperative. Providing explanations regarding the procedure was the parent behavior most clearly associated with CD. The impact of parent explanation depended on when the explanation was given and on the child's level of distress at the time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral and pharmacologic interventions for childrens' distress during painful medical procedures.

This study evaluated the efficacy of a cognitive–behavioral intervention package and a low-risk pharmacologic intervention (oral Valium), as compared with a minimal treatment-attention control condition, in reducing children's distress during bone marrow aspirations. The subjects were 56 leukemia patients who ranged in age from 3 years to 13 years. The three intervention conditions were delivered in a randomized sequence within a repeated-measures counterbalanced design. Dependent outcome measures included observed behavioral distress scores, self-reported pain scores, pulse rate, and blood pressure scores. Repeated-measures analyses of variance indicated that children in the cognitive-behavior therapy condition had significantly lower behavioral distress, lower pain ratings, and lower pulse rates than when they were in the attention-control condition. When children were in the Valium condition, they exhibited no significant differences from the attention control condition except that they had lower diastolic blood pressure scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress management during noxious medical procedures: An evaluative review of outcome studies.

Presents an evaluative review of outcome studies that have employed information, relaxation, cognitive-behavioral, and modeling interventions for stress management in patients during noxious medical procedures. There was some evidence to support the use of each of these interventions, with cognitive-behavioral and modeling approaches yielding stronger effects over a wider range of measures. Methodological deficiencies were common across all of the approaches reviewed. More research aimed at revealing possible key components common to many of these interventions should be undertaken. Some examples include enhancement of patients' sense of predictability and control over an aversive situation, provision of cognitive-behavioral coping strategies, and nonspecific aspects of intervention such as emotional supportiveness. Pertinent research is presented from the domain of experimental personality and social psychology, bearing on elucidation of situational and individual difference factors mediating successful preparation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Special series: Coping with medical illness and medical procedures.

This Special Series integrates recent progress in coping processes with the challenges of behavioral medicine. The term coping implies a reaction to stress; this series of articles considers stressors such as chronic disease (hypertension, heart disease, and arthritis), disability and death, and medical procedures (radiation therapy, childbirth, surgery, and invasive diagnostic procedures). Each study has derived a unique set of conclusions, with the common theme that preconceived notions about coping effectiveness should be replaced by empirical exploration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alteration of memory in the reduction of children's distress during repeated aversive medical procedures.

The present study sought to reduce children's distress during aversive medical procedures using a brief cost-effective intervention aimed at reframing memory. Fifty children diagnosed with leukemia (25 treatment, 25 attention control, aged 3–18) were observed as they underwent 3 consecutive lumbar punctures (LPs; baseline, postintervention, and follow-up). Self-report, physiological, and observable distress measures were collected before and after each LP. At posttreatment, children in the intervention group showed reductions in anticipatory physiological and self-report ratings relative to the control group. At follow-up, these effects generalized to reductions in procedural distress. These results suggest that (a) a simple memory-based intervention is efficacious at reducing children's distress and (b) benefits from this intervention are maintained over 1 week even without continued intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory in pediatric patients undergoing conscious sedation for aversive medical procedures.

This study investigated preserved memory in 26 pediatric cancer patients (65% boys, 77% Caucasian, mean age = 12.5 years) undergoing midazolam-induced conscious sedation during painful medical procedures to treat hematological or oncological diseases. The sedative midazolam had a significant anterograde amnesic effect on participants' performance on a visual recognition (explicit) memory task but not on a visual perceptual facilitation (implicit) memory task. That implicit memory scores were relatively unaffected while explicit memory scores deteriorated significantly indicates that learning occurred while participants were sedated, even when participants did not recollect the learning event. These findings, which replicate those of M. R. Polster, R. A. McCarthy, G. O'Sullivan, P. A. Gray, and G. R. Park (1993) in a study of adults, have implications for the development and treatment of conditioned anxiety reactions associated with aversive medical procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interruption in the medical interaction

OBJECTIVES: To describe patterns of interruption in the physician-patient interaction; specifically, to determine who interrupts, to determine if a shift in control occurs as a result of interruption, and to characterize the information gained when patients interrupt physicians. DESIGN: Observational. SETTING: Community-based primary care practices in North Carolina. SUBJECTS: Internists and family physicians in private practice in North Carolina (six men and two women) and their patients (13 men and 27 women). INTERVENTIONS: None. MAIN OUTCOME MEASURE: The obtainment of control of the interaction, at least momentarily, as a result of interruption. RESULTS: Analysis of 40 audiotaped interactions revealed 833 interruptions (mean +/- SD, 20.8 +/- 12.2 per interaction): Patients initiated 55% of all interruptions. Physicians and patients each gained control of the conversation after 50% of interruptions. Patients gained control after 74% of patient-initiated interruptions, and physicians gained control after 79% of physician-initiated interruptions. Patients were more likely to gain control by interrupting late in the interaction, and 75% of patient-initiated interruptions resulted in new information (solicited and unsolicited) being contributed to the interaction. CONCLUSION: Interruption by patients can be an informative event.     

Identifying and treating femoral artery pseudoaneurysms following invasive cardiac procedures

Advances in interventional cardiology offer new choices for patients with coronary artery disease. Unfortunately, these new procedures are associated with complications, such as femoral artery pseudoaneurysms. Accurate and timely vascular assessments by adult health nurses can detect this problem and result in prompt treatment, sometimes including ultrasound-guided compression.     

Puppet modeling technique for children undergoing stressful medical procedures: Tips for clinicians.

Films of puppet models have been found effective in reducing anxiety levels in children facing medical stressors. Unfortunately, films that address the specific medical stressors faced by a given child are not always available. The current work describes how individual clinicians can use puppets as models to alleviate children's anxiety when they face medical stressors. The elements of this technique are presented and discussed with an illustrative case history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of hypnosis and distraction in severely ill children undergoing painful medical procedures.

An ethnically diverse sample of high and low hypnotizable children (N?=?27) suffering from cancer or blood disorders and their parents were trained to use both distraction and hypnosis to reduce pain and anxiety. Measures of pain and anxiety were obtained from the children and their parents. Independent raters also judged participants' video-taped distress responses. Data were collected during painful medical procedures, for baseline, distraction, and hypnosis conditions. Supporting E. R. Hilgard's (1977, 1992) neodissociation theory, hypnotizable children showed significantly lower pain, anxiety, and distress scores in response to hypnosis in contrast to low hypnotizable children. Distraction produced significant positive effects for observer-rated distress scores for the low hypnotizable children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analytic procedures for assessing change during organizational entry.

Confirmatory factor analytic procedures that assess changes in the level of work-related constructs (e.g., organizational commitment), and also their reconstitution by individuals as they enter a new organization, are presented and applied to data from 101 doctoral program newcomers. The procedures assessed changes over time in the factor loadings, variances, and covariances of responses as well as changes in the level of common factor means, holding constant the latter changes in factor structure. The present application shows that this approach can yield profitable insights about shifts in the individual's perspective during organizational entry while also enabling researchers to determine the effect of such perceptual reconstitution on inferences about mean changes with repeated measures. Procedures are proposed to further apply this analytical framework to organizational entry and other research areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)