Medical staff:child interaction during a painful therapeutic procedure

Abstract

The purpose of this dissertation was to examine the effects of medical staff's behaviors on children's levels of distress and coping during a painful medical procedure. To accomplish this objective 30 children diagnosed with cerebral palsy and recovering from surgery (selective posterior rhizotomy) were videotaped during stretching, the most painful part of their physical therapy regiment. Children's ages ranged from 2.6 to 9.1 years (M = 4.5, SD = 1.51). The procedure was recorded at three time points: on admission to an inpatient rehabilitation unit one week post surgery), five weeks post surgery and on discharge. Two raters recorded the behaviors of physical therapists and children at 15-second intervals using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). Results confirmed the hypotheses that children exhibit more coping behaviors, F(2, 58) = 17.3, p {dollar}<{dollar}.001, and fewer distress behaviors, F(2, 58) = 14.4, p {dollar}<{dollar}.001, over time. Hypotheses that positive relationships exist between coping-promoting behaviors in physical therapists and coping in children (r =.72, p {dollar}<{dollar}.001), and distress-promoting behaviors in physical therapists and distress in children (r =.61, p{dollar}<{dollar}.001) were also supported by the data. Stepwise multiple regression analyses showed that prompts to use a coping strategy (CECS), reassuring comments (REAS) and non-procedural talk (NPTA) by adults explained a total of 67% of the variance in children's coping. While CECS and NPTA were associated with better coping, REAS was associated with fewer coping behaviors. Criticism (CRIT), reassurance (REAS), checking child's status (CCS), praise (PRA) and empathic statements (EMPA) by adults explained a total of 65% of the variance in children's distress. While CRIT and REAS were associated with more distress, CCS, PRA and EMPA were associated with fewer distress behaviors. Correlational analyses revealed that older children and children with higher IQs exhibited more coping behaviors. This study demonstrated that children accommodate to pain and exhibit more coping and fewer distress behaviors when faced with repeated painful procedures. Frequent distractions and prompts to use coping strategies (combined with coaching and modeling) were found to be most effective in increasing children's coping, while criticism, and reassuring statements resulted in distress behaviors in children.