Pain assessment.

Pain assessment. CHAPTER-II REVIEW OF LITERATURE Review of literature is traditionally understood as a systematic and critical review of most important scholarly literature on a particular topic. According to Abdullah (1965) review of literature helps the researcher to analyze existing literature to generate research questions to identify what is known and not known about the topic and describe methods of inquiry used in earlier work, including their success and shortcoming. The purpose of review of literature involved in any research study is to become Knowledgeable in that field as much as possible this is the in depth search of the prior research. Research and non research literature were reviewed and organized under the following. Studies and literatures related to pain and pain assessment Studies and literatures related play distraction Techniques on Pain Studies and literatures related to Music distraction on Pain 1. Studies and literatures related to pain and pain assessment. Srouji R, et al., (2010) conducted a study on Pain assessment and non pharmacological management. He concluded that pain perception in children is complex, and is often difficult to assess. The distractions techniques are provided by nurses to manage pain in children is most effective when adapted to the developmental level of the child. Stinson J, et al., (2008) had done the systematic reviews on the effectiveness of pharmacological and non pharmacological management of acute procedure-related pain in children (n=1469) of one to 18 years. The reviewed findings suggested that distraction and hypnosis were effective for management of acute procedure-related pain in hospitalized children. Hockenberry and wilon et al., (2007) reported that brain perceives pain, there is a release of inhibitory neurotransmitters to hinder the transmission of pain and helps to produce on analgesic effect. This inhibition of the pain impulse is the fourth phase of the nociceptive process known as modulation. A protective reflex response also occurs with pain receptions. So while assessing pain intensity in children requires special techniques, therefore assessment requires using word such as owive, boo-boo. There are some unique tools available to measure pain intensity in children. Wongs (2007) stated that pain is often associated with fears, anxiety, and stress and non-pharmacological techniques, such as distraction, relaxation, guided imagery, and cutaneous stimulation provide coping strategies that may help reduce pain perception, make pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. The strategies are safe, non invasive, and inexpensive, and most are independent nursing functions. The strategies that are appropriate for the childs age, pain intensity, interest, and abilities is often necessary to determine the most effective approach. Herr and. et.al., (2006) expressed that the child is unable to communicate the pain perception. So often the child requires special attention during assessment. Children who are developmentally delayed, 15 are psychotic, critically ill, dementia are examined with various pain behaviors assessment tools. Although it is important to understand that the pain is measured by using a pain-behavior scale. These tools identify the presence of pain, but not determine the intensity of pain. Joseph, Zeltzer, (2000) They state that there are three factors to assess pediatric pain: pain sensitivity, coping skills, and cognitive ability. Pain Sensitivity ascertained that pain sensitivity highly depends on childrens temperaments. Studies have shown that children with more pain-sensitive temperaments demonstrate increased reports of pain and anxiety during painful medical procedures. Significant differences in pediatric distress were found when those children received psychological interventions prior to the medical procedure. Their distress levels were significantly lower with the psychological intervention, which suggests that the interventions may benefit most children who are pain sensitive. Lara J. Spagrud.et.al (2003) conducted a study that suggested that the face pain scale revise, is a useful self report tool for assessing pain intensity in preschool and school age children who may not be able to use other pediatric self report pain measurement tools such as visual analog or numeric rating scales. Salantera S, Lauri S, Salmi TT, Aantaa R (1999) had done a survey on nursing activities and outcomes of care in the assessment, management, and documentation of childrens pain.(N=303) and retrospective chart review of 50 consecutive cases of operation of acute appendicitis was carried out. The results showed that nurses assess pain by observation of childs behavior and changes in physiology. The author suggested that development of pain assessment and documentation practices is needed in all settings. Cheryl. A. Gilbert et.al, (1999) conducted videotaped study to determinethe pain level based on facial expression to assess post operative pain in the age group of 13-74 months(N=48).Results demonstrated that face scale serve as a valid tool to assess persistent pain in young children. Carroll et.al., (1998) Reported that the degree of pain to which a child focuses attention can influence pain perception. Increased attention has been associated with increased pain response. So the nurses have to apply the various pain relief interventions such as distraction, relaxation, guided imaginary and massage. etc. MaiklerVE. (1991) conducted a study on effects of a skin refrigerant and age on the pain responses of infants receiving immunizations. The results showed that MANOVA revealed fewer distress behaviors following refrigerant spray and more complex, varied behavioral responses for older infants. The findings provide further evidence that infants perceive pain and that nursing interventions for pain reduction should be tested and extended to the very young. Rice L J. (1989) conducted a study on acute pain management in pediatric patients. Findings indicated that children often do not express pain in terms that are easily understood by adults. Distraction by parents or other factors may address the emotional component of pediatric pain. This review of acute pain management in children examines traditional practices as well as recent developments in acute pain management in infants and children. Schechter NL. (1985) conducted a study on pain control in children. He concluded that pain is not solely a fixed neurophysiologic response to a noxious stimulus but interaction of variables such as age, cognitive set, personality, ethnic background, and emotional state of the child. When approaching to pain in children, a high index of suspicion is necessary to determine the difficulty of verbalizing their discomfort. Play techniques are important in distraction from pain by nursing, medical, or child life personnel should be considered. Preparation of the child for procedures is often helpful as some of the fear of the unknown is eliminated. 2. Studies and literatures related play distraction Techniques Weiss KE, Dahlquist LM, Wohlheiter K. (2011) conducted a descriptive study on the effects of interactive and passive distraction on Cold Presser pain in Preschool-aged Children (N=60).Participants showed significantly higher pain tolerance during both interactive and passive distraction relative to baseline. They concluded that interactive and passive video game distraction appears to be effective for preschool-aged children during laboratory pain exposure. Uman LS, McMurtry CM (2009) had done the randomized control trial (N=1380) to examined the efficacy of seven psychological interventions like suggestion, breathing exercises, child directed distraction, parent-led distraction, nurse-led distraction on infants and children (1 month 11 years) for reducing pain and distress during routine childhood immunizations. The results showed that nurse-led distraction was effective in reducing distress (SMD, -0.40; 95% CI, -0.68 to -0.12; P = 0.005). The study findings suggested that combined cognitive-behavioral interventions, breathing exercises, child-directed distraction, nurse-led distraction, are effective in reducing the pain and distress associated immunizations. Miller K, et al., (2009) conducted a study on multimodal distraction to relieve pain in children undergoing acute medical procedures. They used hand held multimodal distraction device (MMD). Pain and anxiety scores were measured by Modified Faces, Legs, Activity, Cry and Consol ability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. The study findings show MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures. MMD is continuing to be trialed and is continuing to show positive clinical outcomes. Murphy G. (2009) had done a study on the effectiveness of distraction techniques for venepuncture. The findings show that distraction has been shown to reduce procedural distress in children. Further the study revealed that passive distraction is more effective than active distraction during venepuncture and that the effectiveness of a particular technique depends on the attention capacity of the child andtheir engagement in the distraction activity. Windich-BiermeierA (2007) had done a study on children and adolescents (N=50) ages 5 to 18, to evaluate the pain on distraction techniques during venipuncture by using self-selected distracters (i.e., bubbles, virtual reality glasses, or handheld video games, play toys) The design adopted for this study was intervention-comparison group design (n=28) and (n=22). The study participants demonstrated significantly less fear (P Cohen LL, et al., (2006) in their randomized control study on infants (n=136) (range=1-21 months; M=7.6 months, SD=5.0 months) and their parents to investigate the effectiveness of movie distraction in reducing immunization distress during their routine vaccinations. The behaviors were assessed by visual analog scale and a behavioral observation rating scale. The results indicated that parents and infants in the study group engaged in higher rates of distraction than experimental group both prior to and during recovery from the injection. The study findings suggested that a simple and practical distraction intervention can provide some distress relief to infants during routine injections. DAntonio IJ. (2006) conducted a study on use of therapeutic play in hospitals. He stated that play can be a tool to understand and intervene with pediatric patients. They develop a plan for purposeful play programs or play sessions with nurses who are clinical specialists, early childhood educators, and others who have expert knowledge of children and play equipment for the special needs of hospitalized children. For some children, hospitalization is a challenging experience that promotes a sense of competence and for others hospitalization is an experience that results in a negative outcome. Nurses can use play to provide pediatric patients with emotional and cognitive growth-promoting activities which facilitate a more positive hospital experience and long-term outcome. Cohen LL. (2002) had done the randomized trial (N=90) on reducing infant immunization distress through nurse directed distraction. Infants and their parents were randomly assigned to a distraction condition (i.e., nurses used stimuli to divert infants attention) or a typical care condition. The research outcome was measured by observational scale, parent and nurse ratings, and infant heart rate. Results indicated that infants engaged in distraction showed reduced behavioral distress. ThitipornUdomkittti(2001) investigated the effect of distraction on acute pain in infants. Results revealed that acute pain in infants who were distracted by a toy during receiving immunization had significantly lower mean of behavioral pain scores (p Sparks (2001) examined the effect of two forms of distraction on injection pain in a convenience sample of 105 preschool children. The results showed that both forms of distraction, bubble blower and touch, significantly reduced pain perceptions (P Bowen AM, (1999) had done the study to compare two brief, inexpensive distraction techniques for children receiving immunizations. Preschool children (n = 80) were assigned to a party blower intervention, a pinwheel intervention, or a control group. Nurses were instructed to use standard instructions for the control group, and to simply provide the distracter and encourage use, but not to spend time trying to train the child or force them to use it, for the other groups. Results of planned comparisons indicated significant party blower results in the childrens ratings of reduced distress (P Megal, Houser, Gleaves (1998) examined the effects of audio taped lullabies on physiological and behavioral distress and perceived pain among children during routine immunization. The samples were 99 healthy children age 3-6 years old. Half of them received the musical intervention during the immunization, while the other half did not. Children in each group were assessed pain and distress during five phases: baseline, pre immunization, during the immunization, after Band-Aid application, and 2 minutes after phase 4. Physiological methods included heart rate and blood pressure and self-report pain assessment by using the Oucher Scale were used to measure pain intensity. Besides, they were also assessed behavioral distress. Results indicated that no significant differences were found between experimental and control groups for heart rate, blood pressure, or Oucher scores. It may be possible that the reflective of the ages of children in the studies, 3-6 years, may not be able to focu s their attention on distraction devices. However, total distress scores of the experimental group were significantly less than the control group. French, Painter, Coury (1994) studied the effect of distraction technique on pain in preschool children receiving diphtheria, pertussis, and tetanus immunization. The samples were 149 children aged 4 to 7 years old who received the injection, one with and one without taught to blow out air repeatedly during the injection, as if they were blowing bubbles. Although self-report measures by parents, children, and nurses were not different between control and experiment Conditions, children who were taught to blow out air repeatedly during the injection had significantly fewer pain behaviors (P 2.Studies and literatures related to Music distraction on Pain Balan R, (2009) had done the comparative study on Indian classical instrumental music and local anesthetic cream on children aged 5-12 yrs in terms of in reducing pain during venepuncture was conducted at a tertiary care center. They were randomly assigned to 3 groups: local anesthetic (LA), music or placebo (control) group. The study findings showed that, using EMLA or Indian classical instrumental music can be significantly reduced pain in children. The difference between VAS scores with LA and music is not always significant. Bufalini A. (2009) conducted a study on pediatric patients undergoing painful procedures (lumbar injection, bone marrow aspiration, and arterial catheter) to assess the role of interactive music. Data significance was accepted with values of P Evans S (2008) conducted a study on complementary and alternative medicine for acute procedural pain in children. He suggested that music therapy also has gained some attention and for the most part shows promise in the pediatric acute pain setting. Noguchi LK. (2006) had done the study on the effect of music versus non music on behavioral signs of distress and self-report of pain in pediatric injection patients. Music has been examined as a potential distraction during pediatric medical procedures, but research findings have been mixed, due, in part, to the fact that children were primarily instructed to merely listen to the music. (n=64) The children 4- to 6(1/2) -years receiving routine immunizations were randomly assigned to one of three conditions: musical story, spoken story, or standard care/control. Participants in the musical story condition tended to be less distressed and report less pain than participants in the other two conditions, although these differences were not statistically significant. Subsequent analysis indicated that children who received more injections tended to benefit more from the music intervention, in terms of their perceived pain. Loewy,J.V(1997) states that music distraction using live, familiar music with unusual instruments can be effective in capturing and holding the childs attention during painful procedure, such as needle punctures. Malone (1996) conducted a study that focused on studying the effects of live music on the distress of pediatric patients receiving venipunctures, intravenous starts, and heel sticks. The study results indicated that all age groups appear to benefit from the live music as an effective method of distraction. The patients that demonstrated the most significant difference were children under the age of one. The distraction techniques were less cognitively advanced than the music therapy approaches for older children; rather, they attempt to soothe and relax the infant in order to distract him from his surroundings. Fowler-Kerry S, (1987) Conducted the study to assess the value of two cognitive strategies (suggestion and music distraction) in reducing pain in children. Two hundred children, aged 4.5-6.5 years, receiving routine immunization injections were randomly assigned to one of the intervention groups in this factorial study. The groups were designated as: distraction, distraction with suggestion, suggestion and control. Subjects reported their pain using a 4-point pain scale. Distraction was found to significantly decrease pain whereas suggestion did not. The results of this study support the use of music distraction in the reduction of injection pain in children.

Encouraging Students to Be Literate

It is important for teachers to motivate students to develop literate lives both in the classroom and in society. For some children the desire and importance of literacy is not instilled within the home so teachers need to be prepared to handle this job on their own. In my opinion students need to understand the importance of being literate. They need to understand that reading, writing, listening and speaking are essential to functioning in society. Everyday our lives revolve around our literacy. It seems nearly impossible to live a functional and successful life as an illiterate individual.If students do not understand the significance of literacy they may not aspire to become literate. In my classroom I stress the importance of literacy and try to make my students think about the future. Aside from stressing the importance of literacy, I also use strategies to help motivate my students to literate. Many of these strategies and ideas were discussed in our textbook and I feel they a re beneficial in motivating students to become literate citizens. One way I motivate my students is through modeling. I try to modeling that literacy can be pleasurable and it does not have to be a painful and forced activity.Students need to see that I enjoy reading and writing. I also model good reading and writing strategies. It only makes sense that the more my students see and hear me read the more they will want to try it themselves. I can model literacy through read-alouds and other activities. It is also important that students are given real-life experiences. I try to find real reasons for students to write. Sometimes students need to feel a significance to their reading and writing. Are they just constantly writing just to write or is there a purpose?I ask myself that question frequently. I try to create writing assignments that are meaningful; Students can write thank you cards, Christmas cards and etc. I also feel that technology can be an important piece in motivating s tudents. Some reluctant writers can type out their papers rather then write it out. For some students this is a huge motivator. Using the computer and not worrying about hand-writing can be exciting and relieving for some children. I have used this within my classroom and found it helpful for many students. It is also important to tress here that technology is large part of society today so students should be given the opportunity to express their abilities through technology. Last but not least, Id like to stress the importance to selecting activities that are meaningful, engaging and challenging. Too many times I hear and see students listening to a teacher explain something and then students complete endless worksheets. In my opinion this does not motivate and encourage students to become literate individuals. This tells students that literacy is boring in irrelevant. Teachers need to design lessons that have meaning to the students.There needs to be some background knowledge and relationship to the student. Lessons should also be engaging and interactive. Students should be able to participate through discussions, think-pair-share, concept maps and other activities that promote thinking and learning. Activities should be challenging but not too challenging. They should require thinking but not too stressful. I like my students to feel success when doing activities. The feeling of success builds confidence. It just seems that when one is confident in their literacy abilities they will be more willing to practice and grow to become better.

The Good, the Bad and Argument Essay Samples with Citations

The Good, the Bad and Argument Essay Samples with Citations Even though it's common, student has to find right to become superior grades. Using Google Slides, students may analyze different segments. Whether a worldwide student think her or his English level is good enough to take regular college class, he or she is able to register the normal college writing class. Many foreign students believe they have strong accent, so they are scared to speak in class, he explained. Recent argumentative essay topics that are related to society is going to do. You can also see concept essays. Your essay should consist of recent statistics and data from reliable sources. Argument essays can be organized in an assortment of means. Inspiration to make your own advertising or media argumentative essay topics isn't tricky to discover. The research was done. Embracing all technology results in a broader knowledge of the issue. Sexist advertising needs to be banned 11. There's no limit concerning how high humanity can build homes. A lifetime of handling your family members has helped you determine which arguments work best to persuade every one of them. Annually, people are becoming sicker. There are scores and scores of other nations. Finding the most suitable arguments will allow you to prove your point and win. The additional points together with the arguments are tied together and in the end, the conclusion presents an acceptable details. When you are requested to select a great topic for your argument, start with something you're acquainted with. Argumentative essay topics are so important since they are debatableand it's vital to at all times be critically considering the world around us. The most significant thing you want to understand is that my opinion simply doesn't matter. So following is a great solution for this problem. Be certain that your reply is consistent with your initial argument. Present each argument fairly and objectively, rather than attempting to make it seem foolish. What's more, a verbal argument often focuses on who's right regarding a particular issue, even though a well-written, researched argument essay focuses on what's the most suitable side of a specific matter. Persuasive essay is also called the argument essay. In a nutshell, an argument essay has to be logical from starting to end. Writing an argumentative essay can occasionally be confusing since you don't necessarily understand how to compose a convincing argument. When it has to do with writing an argumentative essay, the main point to do is to select a topic and an argument that you may really get behind. The art of persuasion in a written argument is dependent on whether it is possible to prove to the reader which you are credible enough to chat about something debatable. You could be surprised to hear that the word argument does not need to be written anywhere in your assignment in order for it to be a significant part your task. If you wish to compose a productive argument you must pick the point you wish to make and the audience that you want to make it to.

The Purpose Of This Paper Seeks To Analyze The Effects

The purpose of this paper seeks to analyze the effects of prescription drug abuse. In the first article identified the author seeks to identify the differences between peer and parent influence on the misuse of prescription drug as it relates to ethnicity. The second article to be investigation into prescription drug use misuse and drug problems as it pertains to motivational context. The third and final article seeks to education young adults on medical prescription drug use. A parent’s attitudes regarding substance use may help to clarify practical racial/ethnic deviations in prescription drug misuse among teens. The findings add provision to the growing evidence that parents continue to endure a critical part of adolescents †¦show more content†¦Strong parental disapproval of alcohol use was linked to lower rates of prescription drug misuse in African American teens, while parental disapproval of marijuana use was a stronger factor for Hispanic teens. Regardless , of the ethnic/racial background both parents and family members are against misusing substances in general and play a strong role in protecting their adolescents from misusing prescription medicine, whether it be alcohol, marijuana, or tobacco. This illustrates a positive step in moving forward to understanding specific culture factors of substance abuse. Some Caucasian teens having close friends that reject substance use have a lesser rates of prescription drug misuse, though their peer opinions had little influence for African American or Hispanic teens. Parents can help their adolescents navigate towards friends with shared substance use disapproval attitudes .The article confirms racial/ethnic disparities in substance use by adolescents, provides preliminary evidence that disapproval by important socialization factors especially parents has a substantial effect on prescription drug misuse. Those results offer indications how the racial/ethnic deviations are arrived. 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