| Background:The pain management of wound dressing change in children is a clinical problem,which often appears in the practice of wound care.From the perspective of medical ethics and humanitarianism,the pain of wound dressing change in children needs to be alleviated urgently.Epidemiological data show that the incidence of trauma in children in China is 10.8% ～ 47.9%,and the overall trend is on the rise,suggesting that the need for wound dressing change and pain management in children will further expand.Pain stimulation can cause long-term physical,psychological and behavioral effects on children,can also cause acute psychological distress on parents,and can also cause certain economic and medical burden on society.Although specialized wound nursing develops rapidly,medical staff often pay more attention to wound healing rather than the pain.Therefore,it is necessary to strengthen pain management.There are two ways to relieve pain,drug therapy and non-drug therapy.Non-drug therapy can reduce the dosage of analgesic drugs,improve the compliance of children,and the cost is low.Besides,wound specialist nurses can independently implement non-drug therapy.Compared with drug therapy alone,non-drug assisted analgesia showed great superiority in wound dressing change in children.There are many kinds of non-drug therapy,and the evidence-based evidence is scattered,so it is difficult to provide reference for clinical nursing practice directly.Among them,virtual reality assisted analgesia is both interesting and practical,and has been highly praised in recent years.However,the period of wound dressing change in children with infected wounds is long and the pain degree is high.Whether virtual reality is suitable for wound dressing change in children with infected wounds remains to be further explored.Therefore,This study carried out an empirical study on the application of virtual reality in children analgesia with infected wound,in order to improve pain management.Objective:1.To investigate the current situation of pain management of wound dressing change in children.2.To summarize the best evidence for common non-drug therapy of procedural pain in children.3.To evaluate the effects of virtual reality on wound dressing change in children with infected wounds.Methods:1.Through literature review,qualitative interviews and expert meetings,questionnaires were formed.The current situation of pain management of wound dressing change in outpatient and emergency children was investigate in secondary and tertiary hospitals in 31 provinces in China.The survey contents included the general information of the participants,the organizational system,specific measures and obstacles of wound dressing pain management.2.The clinical practice guidelines,evidence summaries,clinical decisions and systematic reviews for common non-drug therapy of procedural pain in children were retrieved by computer from databases and related guideline websites in the past 10 years.Two researchers evaluated the literature quality independently according to the unified standard and extracted the best evidence.3.From November 2019 to January 2020,Children with infected wounds who visited the specialty wound clinics in our hospital were conveniently selected as study subjects,they were divided into the control group(48 patients)and the observation group(48 patients)by visited time.During the wound dressing change,the control group was intervened by mobile phone video,while the experimental group was intervened by virtual video.Repeated measures anova was used to compare the pain score,heart rate,duration of dressing change and adverse reactions in the two groups before and on the 1st to 3rd day of intervention.Results:1.A total of 109 hospitals were investigated,Totally 91.7% of hospitals had wound care teams and 41.3% of the hospitals had specialist nurses to provide wound care.The proportion of hospitals without pain assessment,pain recording or pain health education was 33.0%,34.9% and26.6%,respectively.Ibuprofen(52.3%)and lidocaine(50.5%)were the main analgesics.Distraction(86.2%)were the mainly non-drug analgesic methods.In 77.1% of the hospitals,analgesia measures was insufficient.The main impediments to pain management include: insufficient knowledge of pain management in wound dressing changers,imperfect system of pain management in dressing changing room,and poor medication compliance of the family members.2.A total of 15 literatures were extracted,including 4 clinical practice guidelines,2 evidence summaries,1 recommended practice and 8systematic reviews.Finally,21 pieces of evidence were summarized,involving 7 aspects: breastfeeding,kangaroo nursing,sweetener,non-nutritive sucking,facilitated tucking and swaddling,distraction and combined non-drug therapy.Breastfeeding,kangaroo nursing,sweetener are good for younger infants,non-nutritive sucking,facilitated tucking and swaddling are not known for their analgesic effects,and distraction is good for older children.For newborns,breastfeeding and kangaroo care,sweeteners and non-nutritive sucking have synergistic analgesic effects.3.For elderly children,distraction is an appropriate non-drug therapy,and virtual reality is a new and highly respected distraction therapy,so virtual reality was chosen as an intervention.Due to the difficulty of operating virtual reality devices,pre-test found that children under 5 years old had limited cognitive ability and low compliance,which made it difficult to use VR glasses.Therefore,children aged 5 to 18 years old were selected for the intervention.Before intervention,there was no statistical difference in the baseline between the two groups.The pain score,heart rate of wound debridement,and duration of dressing change in the experimental group were all lower than those in the control group on the1 st to 3rd day of intervention,with statistically significant differences(P<0.05).There were inter-group effect,time effect and interaction between the two groups in pain scores,heart rate of wound debridement and dressing,and duration of dressing change(P<0.05).No adverse reactions were reported in the two group.Conclusion:1.The organizational system of wound dressing pain management in children is relatively perfect,the specific measures need to be standardized,and the analgesic effect was poor.It is suggested to standardize the procedure of pain management,improve the effectiveness of analgesia measures,overcome the obstacle factors of pain management,and thus improve the wound dressing experience.2.Non-drug therapy is safe and can be operated independently by nurses.Clinical nurses can promote the transformation and application of evidence according to the age of children and department environment,and timely pay attention to the update of evidence to alleviate procedural pain in children.3.Virtual reality can reduce the pain and shorten the time of wound dressing change in children with infected wounds.In addition,virtual reality is safe and reliable.It is worthy of popularization and application in clinical practice. |
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