Barn som besöker sjukhuset förknippar ofta vistelsen med undersökningar och behandlingar. Om dessa procedurer också är förknippade med smärta kan barnen riskera att utveckla stress och rädsla inför kommande procedurer. För att undvika detta behöver barnen hitta strategier för att kunna hantera smärtan och för att minska stressnivån (coping). En effektiv smärtbehandling stödjer barnen till att genomgå medicinska eller kirurgiska procedurer utan att utveckla kvarstående problem med smärta och behandlingsrädsla. Serious games (dataspel utvecklat för detta ändamål) och musikmedicin är två interventioner som skulle kunna hjälpa barnen i dessa situationer. Syftena med avhandlingen var att undersöka barns upplevelser av medicinska och kirurgiska procedurer och att validera en observationsskala som ett komplement till självskattning hos barn som genomgår procedursmärta. Syftet med avhandlingen var också att hitta coping strategier för att minska smärta, stress och rädsla.
I avhandlingen deltog sammanlagt 212 barn som genomick en medicinsk eller kirurgisk procedur.
I avhandlingen validerades observationsskalan FLACC (Face, Legs, Activity, Cry och Consolability) som ett komplement till självskattning. Avhandlingen visade att barnen önskade att den behandlande sjuksköterskan hade en god klinisk kompetens. Barnen
54
ville kunna välja distraktionsmetod och den valda distraktionsmetoden hjälpte dem att genomgå den smärtsamma medicinska eller kirurgiska proceduren. Serious games och musikmedicin distraherade barnen och ökade deras välbefinnande.
Slutsatser
FLACC är en användbar skala för att utvärdera procedursmärta hos barn i åldrarna 5-16 år
Serious games och musikmedicin bör finnas som komplement till annan smärtbehandling för barn
När barnen känner en känsla av kontroll i sin smärthantering är de också beredda att delta i beslutsprocessen
Barn vill välja distraktionsmetod själva
För barn är det viktigt att hitta coping strategier som engagerar dem
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Acknowledgements
I am grateful for the invaluable support of my main supervisor, Karin Enskär, throughout the process of this thesis.
I am also grateful for the encouraging support of my co-supervisors Eva Kokinsky, Birgitta Sidenvall, and Ingemar Brunsson. They helped me understand how to carry out research in children.
I also thank all the children who participated in the studies, generously gave of their time and shared their experiences.
I thank Ann-Christine Renning for sharing her knowledge on wound dressings.
I thank Berit Finnström for her help with data collection and analysis. I would also like to thank Nils Andersson, Jurgen Broeren, Carina Hallqvist, Mathias von Knorring and Martin Rydmark for sharing their knowledge on Virtual Reality and serious games.
I thank Birgitta Lannering and the nurses in the paediatric oncology unit in Gothenburg.
Per Thorgaard and Ulrica Nilsson gave me invaluable knowledge about postoperative music.
I am grateful for the help with data collection from Britt-Marie Karlsson and Eva Norling.
I thank Krister Nilsson and Rune Simeonsson for their review of my manuscripts.
I thank Margareta Adolfsson, Gregor Maxwell and Ylva Ståhl for their advice about the ICF-CY.
56
I thank Ulla Nathorst Westfelt for giving me this opportunity to conduct this research.
I will not forget to thank Marga Brisman whose belief in my research was a condition of this thesis.
Finally, without the full support of my wife Katarina and my children Max and Nelly, the work on this thesis would not have been feasible. This thesis was supported by grants from the Federation of Swedish County Councils (VG-region), the Cancer and Traffic Injury Fund, the Sigurd and Elsa Goljes Foundation, the Children’s Cancer Foundation at the Queen Silvia Children’s Hospital, the Ebba Danelius Foundation, the Queen Silvia Children’s Hospital Foundation, the Wilhelm and Martina Lundgrens Foundation, and Mölnlycke healthcare.
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