Journal of Pediatric Nursing (2015) 30, 283–284
Experienced Nurses' Use of Non-Pharmacological Approaches Comprise More Than Relief From Pain: Letter to the Editor Dear Editor, The article, “Experienced Nurses Use of Non-Pharmacological Approaches Comprise More Than Relief From Pain” by Svendsen et al. (2014, Vol. 29, pp. e19–e28) sought to explore an important topic that markedly effects all pediatric healthcare facilities. I recently began working with children with various developmental disabilities such as severe autism spectrum disorder and Down syndrome. I now have a clearer understanding of the importance of non-pharmacological approaches and the effect it has on client cooperation. This article claims that it is the first document to share the goal of non-pharmacological approaches as establishing and maintaining cooperation; this intrigued me to learn more. Establishing and maintaining cooperation in adolescents can be a near impossible task. Failure to do so may result in painful procedural experiences that can impact their future reactions to pain. Adolescent children have a difficult time trusting unfamiliar people, which could result in uncooperative behavior. The authors of this article believe they are the first people to consider the relationship between cooperation and the reduced chance of using a restraint. I applaud them for making this comparison, as it is a breakthrough for the nursing profession. According to Svendsen et al. the most significant way to achieve adolescent cooperation is through “giving control over the situation” (Svendsen, 2014, e. 24). To reiterate, the nurses preferred method of obtaining cooperation, was to “let the child take the lead, let the child decide when to take breaks during the procedure or let the child decide between different alternatives” (Svendsen, 2014, e. 25). Evidence from several sources suggest that there are an array of non-pharmacological approaches that can be made when attempting to gain an adolescents cooperation. For example cooperation can be linked to levels of anxiety, distress, fear, and pain in an individual undergoing needle related surgeries (Svendsen, 2014). It is a common consensus
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that non-pharmacological methods are superior to that of drug induced treatment. The study implies that fear, distress, pain and anxiety are immune to pharmacological medicines when performing these needle procedures in adolescents (Svendsen, 2014). The Svendsen et al. article emphasizes the use of humor by implying that it has positive effects on adolescents' cooperation. Further evidence supports this, but in an abstract way. It is known that laughter is the ultimate stress reliever; evidence shows that laughter increases levels of endorphins, which are directly related to an increased tolerance to pain (Comicrelief, 2012). Perhaps it is not actually “keeping up the spirit of a room” (Svendsen, 2014, e. 23) that benefits the child undergoing painful procedures, but it is the chemical response to increased endorphin levels. This article gives great insight to a topic that has only just begun to unfold. There is a substantial amount of research needed to investigate the relationship between the use of non-pharmacological interventions and cooperation. On that note, I believe it would be beneficial to have a larger sample of nurses, perhaps internationally, as these non-pharmacological interventions are better compared when using evidence gathered from various countries (Yip, Middleton, Cyna, & Carlyle, 2009). Also, I believe that further research is indicated to see the effects of parental influence regarding non-pharmacological interventions especially in those who are developmentally disabled. Several studies have stated that there is little evidence to support the positive effects of parent-based non-pharmacological intervention (Svendsen, 2014; Yip et al., 2009). However, there has been a substantial number of studies that have shown positive effects of integrating parent-directed interventions (Beattie, 2011). As for future healthcare clinicians, the importance for utilizing these non-pharmacological interventions is paramount. It is critically important to ensure that academic institutions reinforce the importance of learning nonpharmocological interventions. It would be advantageous to implement classes that teach those who lack the “natural” ability to practice these intervention methods. Also, it may be beneficial to further explore the effects of non-pharmacological parent-based interventions.
Correspondence Aaron Knapp Health Studies Student, Utica College, Utica, NY E-mail address: [email protected]
References Beattie, T. L. (2011). Non-pharmacological treatment of problem behaviors in children with autism spectrum disorder. Child & Adolescent Psycho pharmacology News, 16, 9–11, http://dx.doi.org/10.1521/capn. 20111639 (16).
Comic relief (2012). Laughter is a natural painkiller. Retrieved November 4, 2014, from http://bodyodd.nbcnews.com/_news/2012/ 11/18/15114626-comic-relief-laughter-is-a-natural-painkiller?lite Svendsen, E. J. (2014). Experienced nurses' use of non-pharmacological approaches Comprise more than relief from pain. Journal of Pediatric Nursing, 29, e19–e28, http://dx.doi.org/10.1016/j.pedn. 2014.01.015. Yip, P., Middleton, P., Cyna, A. M., & Carlyle, A. V. (2009). Nonpharmacological interventions for assisting the induction of anesthesia in children. Cochrane Database of Systematic Review, http://dx.doi.org/10.1002/14651858.CD006447.pub2 (Article #: CD006447).