uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Hedén, Lena
Alternative names
Publications (10 of 10) Show all publications
Hedén, L. & Ahlström, L. (2016). Individual response technology to promote active learning within the caring sciences: An experimental research study. Nurse Education Today, 36, 202-206
Open this publication in new window or tab >>Individual response technology to promote active learning within the caring sciences: An experimental research study
2016 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 36, p. 202-206Article in journal (Refereed) Published
Abstract [en]

Background: One major challenge in delivering lectures to large and diverse classes is the maintenance of a high standard of lecturing in order to engage students and increase their participation and involvement. The lecturer's assignment is to arrange and prepare the lecture before teaching, hence enabling students' enhanced learning. Individual response technology could encourage Students' active learning and activate higher cognitive levels. Objectives: The aim of this study was to evaluate individual response technology as a complement during lectures for students in higher education, in terms of the students' experiences of participation, engagement, and active learning. Also of interest was whether this technology can be considered a supportive technical system. Design: Data were collected through a questionnaire where levels of each condition were reported on a numeric rating scale (0-10) at baseline and after the introduction of individual response technology. To get a broader perspective, two types of lectures (pediatric and statistical) were included, giving a total of four assessment times. Participants: The participants comprised 59 students in Bachelor of Nursing program at a Swedish metropolitan university. Results: Overall, when individual response technology was used, students reported increased experience of engagement (n = 82, mean 6.1 vs. is = 65, mean 7.3, p < 0.001), participation (n = 92, mean 6.1 vs. n = 79, mean 7.7, p < 0.001), and active learning (n = 92, mean 73 vs. n = 79, mean 8.2 p < 0.001). Additionally, the students experienced this technology as a supportive technical system during lectures (mean 6.6 vs. mean 8.1, p < 0.001). Conclusions: The use of individual response technology during teaching is one way to enhance students' experiences of engagement, participation, and learning within the caring sciences.

Keywords
Active learning, Nursing education, Clicker, Teaching, Participation in education
National Category
Nursing Pediatrics
Identifiers
urn:nbn:se:uu:diva-274430 (URN)10.1016/j.nedt.2015.10.010 (DOI)000367117000034 ()
Available from: 2016-01-21 Created: 2016-01-21 Last updated: 2017-11-30Bibliographically approved
Hedén, L., von Essen, L. & Ljungman, G. (2016). The relationship between fear and pain levels during needle procedures in children from the parents’ perspective. European Journal of Pain, 20(2), 223-230
Open this publication in new window or tab >>The relationship between fear and pain levels during needle procedures in children from the parents’ perspective
2016 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 2, p. 223-230Article in journal (Refereed) Published
Abstract [en]

Background: The primary objective was to determine the levels of and potential relationships between procedure-related fear and pain in children. Secondary objectives were to determine if there are associations between the child’s age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol levels and the parent’s fear level in relation to fear and pain.

Methods: The child’s level of pain and fear was reported by parents on 0–100 mm visual analogue scales (VAS). One hundred and fifty-one children were included consecutively when undergoing routine needle insertion into a subcutaneously implanted intravenous port. All children were subjected to one needle insertion following topical anaesthesia (EMLA) application. The effect of the child’s age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol change levels and the parent’s fear level, on fear and pain levels was investigated with multiple regression analysis.

Results: The needle-related fear level (VAS mean 28 mm) was higher than the needle-related pain level (VAS mean 17 mm) when topical anaesthesia is used according to parents’ reports (n = 151, p < 0.001). With fear as the dependent variable, age and pain were significantly associated and explained 33% of the variance, and with pain as the dependent variable, fear, parents’ fear and change in cortisol level were significantly associated and explained 38% of the variance.

Conclusions: According to parents, children experienced more fear than pain during needle insertion when topical anaesthesia is used. Therefore, in addition to pain management, an extended focus on fearreducing interventions is suggested for needle procedures.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-251342 (URN)10.1002/ejp.711 (DOI)000368819500008 ()24219618 (PubMedID)
External cooperation:
Funder
Swedish Childhood Cancer FoundationSwedish Cancer Society
Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2017-12-04Bibliographically approved
Hedén, L., von Essen, L. & Ljungman, G. (2014). Effect of high-dose paracetamol on needle procedures in children with cancer - a RCT. Acta Paediatrica, 103(3), 314-319
Open this publication in new window or tab >>Effect of high-dose paracetamol on needle procedures in children with cancer - a RCT
2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, p. 314-319Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to investigate whether children experience less pain, fear and/or distress when they receive high-dose paracetamol compared with placebo, using a needle insertion in a subcutaneously implanted intravenous port as a model.

METHODS: Fifty-one children ranging from 1 to 18 years of age being treated in a paediatric oncology setting were included consecutively when undergoing routine needle insertion into a subcutaneously implanted intravenous port. All children were subjected to one needle insertion following topical anaesthetic (EMLA) application in this double-blind, placebo-controlled RCT, comparing orally administered paracetamol (n = 24) 40 mg/kg body weight (max 2000 mg) with placebo (n = 27). The patients' pain, fear and distress were reported by parents, nurses and children (≥7 years of age) using 0- to 100-mm visual analogue scales (VAS). In addition, pain observation, procedure time and cortisol reduction were assessed.

RESULTS: No differences between the paracetamol and the placebo group were found with respect to demographic characteristics. According to VAS reports, paracetamol did not reduce pain, fear and distress compared with placebo. Pain observation, cortisol reduction and procedure time did not differ between the study groups.

CONCLUSION: Paracetamol provides no additive effect in reducing pain, fear and distress when combined with topical anaesthesia in children undergoing port needle insertion.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-220058 (URN)10.1111/apa.12509 (DOI)000331270000028 ()24219618 (PubMedID)
Available from: 2014-03-10 Created: 2014-03-10 Last updated: 2017-12-05Bibliographically approved
Hedén, L., Pöder, U., von Essen, L. & Ljungman, G. (2013). Parents' Perceptions of Their Child's Symptom Burden During and After Cancer Treatment. Paper presented at 45th Congress Of The International Society Of Paediatric Oncology (Siop) 2013, 25th–28th September, 2013, Hong Kong, China. Pediatric Blood & Cancer, 60(S3), 42-42
Open this publication in new window or tab >>Parents' Perceptions of Their Child's Symptom Burden During and After Cancer Treatment
2013 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 60, no S3, p. 42-42Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-211138 (URN)000324735500160 ()
Conference
45th Congress Of The International Society Of Paediatric Oncology (Siop) 2013, 25th–28th September, 2013, Hong Kong, China
Available from: 2013-11-20 Created: 2013-11-20 Last updated: 2017-12-06Bibliographically approved
Hedén, L., Pöder, U., von Essen, L. & Ljungman, G. (2013). Parents' Perceptions of Their Child's Symptom Burden During and After Cancer Treatment. Journal of Pain and Symptom Management, 46(3), 366-375
Open this publication in new window or tab >>Parents' Perceptions of Their Child's Symptom Burden During and After Cancer Treatment
2013 (English)In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 46, no 3, p. 366-375Article in journal (Refereed) Published
Abstract [en]

Context

Parents’ perceptions of their child’s symptom burden during and after cancer treatment.

Objectives

The aim is to describe parents’ perceptions of their child’s symptom burden during and after cancer treatment and to investigate whether parents’ perceptions vary with child characteristics and parent gender.

Methods

160 parents (49% fathers) of 89 children answered a modified version of the Memorial Assessment Symptom Scale (MSAS) 10-18 at six assessments from one week after the child’s diagnosis (T1) to 12-18 months after the end of successful treatment (T6).

Results

Feeling drowsy, pain, and lack of energy are initially the most prevalent symptoms, and less hair than usual the most prevalent symptom during treatment. Pain, feeling sad, and nausea are initially the most distressing symptoms. Pain is both prevalent and distressing throughout treatment. The child’s symptom burden decreases over time. There is no difference with regard to reported symptom burden between parents of a daughter or a son, or parents of a child over or under 7 years of age. Mothers’ and fathers’ assessments of the symptom number, total MSAS, and the subscales are associated, but mothers’ assessments are often higher than fathers’.

Conclusion

The prevalence and distress of symptoms and symptom burden decrease over time. However, even though the cancer is cured, feeling sad is reported as being prevalent and psychological distress is an issue. A dialogue between staff and the family about distressing symptoms and when they can be expected may increase acceptance and adaptation in children and parents during the disease trajectory.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-172337 (URN)10.1016/j.jpainsymman.2012.09.012 (DOI)000324026700006 ()23498966 (PubMedID)
Available from: 2012-04-10 Created: 2012-04-04 Last updated: 2017-12-07Bibliographically approved
Hedén, L. (2012). Distressing Symptoms in Children with Cancer in General; During Needle Procedures in Particular. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Distressing Symptoms in Children with Cancer in General; During Needle Procedures in Particular
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main aims of this thesis were to investigate the effect of distraction, midazolam and morphine on fear, distress, and pain during needle procedures, and to longitudinally describe parents’ perceptions of their children’s symptom burden during and after cancer treatment.

The design in Study I-III was that of a randomized controlled trial (RCT) conducted in a medical setting; Studies II-III were placebo controlled. Study IV has a longitudinal design, and data were collected at three times during treatment and three times after the end of successful treatment. Participants in Study I were children aged 1 to 7 (n=28), in Study II children aged 1 to 19 (n=50), in Study III children aged 1 to 19 (n=50), and in Study IV parents (n=160) of children aged 1 to 19.

Blowing soap bubbles or having a heated pillow reduces children’s fear and distress in connection with needle procedures. Low-dose oral midazolam 0.3mg/kg body weight is effective in reducing fear and distress, especially in younger children. Interestingly, oral morphine at a dose of 0.25mg/kg body weight does not reduce fear, distress or pain.

These studies have evaluated interventions that may be of help for the most frightened children during needle procedures. We suggest that the first-line intervention against procedural fear, distress, and/or pain should be standard care (i.e. EMLA) in addition to distraction interventions when needed, and only when this is insufficient to add pharmacological interventions.

According to parents, feeling drowsy, pain, and lack of energy are initially the most prevalent symptoms in their children, whereas less hair than usual is the most prevalent symptom during treatment. Pain, feeling sad, and nausea are initially the most distressing symptoms. Pain is both prevalent and distressing throughout treatment. The child’s symptom burden, as reported by parents, decreases over time. Information about distressing symptoms and when they can be expected may increase acceptance and adaptation in children and parents during and after cancer treatment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 772
Keywords
Childhood cancer, pain, RCT, symptoms
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-172905 (URN)978-91-554-8358-6 (ISBN)
Public defence
2012-06-02, Rosénsalen, Ingång 95-96 NBV, Akademiska barnsjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2012-05-10 Created: 2012-04-17 Last updated: 2012-08-01Bibliographically approved
Hedén, L. E., von Essen, L. & Ljungman, G. (2011). Effect of morphine in needle procedures in children with cancer. European Journal of Pain, 15(10), 1056-1060
Open this publication in new window or tab >>Effect of morphine in needle procedures in children with cancer
2011 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 15, no 10, p. 1056-1060Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to investigate whether children experience less fear, distress, and/or pain when they receive oral morphine vs. placebo before a needle is inserted in a subcutaneously implanted intravenous port when combined with topical anesthesia.

Method: Fifty children 1-18 years of age who were treated in a pediatric oncology and hematology setting were included consecutively when undergoing routine needle insertion into an intravenous port. All children were subjected to one needle insertion following topical anesthetic (EMLA) application in this randomized, triple-blind, placebo-controlled study comparing orally administered morphine (n = 26) 0.25 mg/kg body weight with placebo (n = 24). The patients' fear, distress, and pain were reported by parents, nurses and the children themselves (if >= 7 years of age) on 0-100 mm Visual Analogue Scales. In addition, observational methods were used to measure distress and procedure pain.

Results: No differences between the morphine and the placebo group were found with respect to age, weight, height, physical status, sex, weeks from diagnosis, or weeks from latest needle insertion. According to, parents, nurses, and children, oral morphine at a dose of 0.25 mg/kg body weight did not reduce fear, distress or pain compared with placebo.

Conclusion: We could not reject the null hypothesis that there is no difference between the oral morphine and placebo groups assuming an effect size of 15 mm on VAS. Therefore it seems that oral morphine at 0.25 mg/kg does not give any additional reduction of fear, distress or pain compared with placebo when combined with topical anesthesia in pediatric patients undergoing subcutaneous port needle insertion, and would not be expected to be of any advantage for similar procedures such as venipuncture and venous cannulation when topical anesthesia is used.

Keywords
Child, Cancer, RCT, Oral morphine
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-162464 (URN)10.1016/j.ejpain.2011.05.010 (DOI)000296723300011 ()
Available from: 2011-12-01 Created: 2011-11-30 Last updated: 2017-12-08Bibliographically approved
Ljungman, G., Hedén, L. & von Essen, L. (2010). Effect of morphine on fear, distress and pain in needle procedures in children with cancer. Pediatric Blood & Cancer, 55(5), 954-955
Open this publication in new window or tab >>Effect of morphine on fear, distress and pain in needle procedures in children with cancer
2010 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 55, no 5, p. 954-955Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Purpose: Children with cancer often mention needle procedures as the most frightening, distressing and sometimes painful aspect of the disease and treatment.The aim was to investigate whether children experience less fear, distress, and/or pain according to parents, nurses, and children>7 years of age when they receive oral morphine vs. placebo before a needle is inserted in a subcutaneously implanted intravenous port and if there is a difference in procedure time.

Method: Fifty children 1–18 years of age who were being treated in a pediatric oncology and hematology setting were included consecutively when undergoing routine needle insertion into an intravenous port. All children were subjected to one needle insertion and recieved EMLA in this randomized, triple-blind, placebo controlled study in which orally administered morphine (n¼26) 0.25 mg/kg body weight was compared with placebo (n¼24). Parents, nurses and children>7 years reported the patients’ fear, distress, and pain on 0–100 mm Visual Analogue Scales. In addition behavioral observation with CHEOPS for pain and PBCL for procedure related distress was performed.

Results: No differences between the morphine and the placebo group were found with respect to age, weight, height, physical status, sex, weeks from diagnosis, or weeks from latest needle insertion. According to parents, nurses, and children oral morphinein a dose of 0.25 mg/kg body weight did not reduce the primary outcome measure fear; neither did it reduce distress nor pain in the morphine group compared to placebo. No differences in behavioral observations with CHEOPS and PBCL or procedure time for morphine vs. placebo were found.

Conclusion: Surprisingly, oral morphine in this dose does not add any value in reducing fear, distress or pain combined with topical anaesthesia in pediatric oncology patients undergoing subcutaneous port needle insertion, and it probably would not add any value for other similar procedures, e.g. venous cannulation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-140027 (URN)10.1002/pbc.22779 (DOI)000282910200637 ()
Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically approved
Hedén, L., von Essen, L., Frykholm, P. & Ljungman, G. (2009). Low-dose oral midazolam reduces fear and distress during needle procedures in children with cancer. Pediatric Blood & Cancer, 53(7), 1200-1204
Open this publication in new window or tab >>Low-dose oral midazolam reduces fear and distress during needle procedures in children with cancer
2009 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 53, no 7, p. 1200-1204Article in journal (Refereed) Published
Abstract [en]

BACKGROUND

Children with cancer often mention needle procedures as the most frightening, distressing, and sometimes painful aspect of the disease and treatment. The aim was to investigate whether children experience less fear, distress, and/or pain according to parents, nurses, and children >or=7 years of age when they receive oral midazolam versus placebo before a needle is inserted in a subcutaneously implanted intravenous port.

PROCEDURE

Fifty children 1-18 years of age who were being treated in a pediatric oncology and hematology setting were included consecutively when undergoing routine needle insertion into an intravenous port. All children were subjected to one needle insertion in this randomized, triple-blind, placebo-controlled study in which orally administered midazolam (n = 24) 0.3 mg/kg body weight (maximum 10 mg) was compared with placebo (n = 26). Parents, nurses, and children >or=7 years reported the patients' fear, distress, and pain on 0-100 mm Visual Analogue Scales.

RESULTS

Fear was lower in the midazolam group according to parents (P = 0.001), nurses (P = 0.001), and children (P = 0.015). Parents and nurses also reported lower distress (P = 0.020 and 0.007, respectively). Post hoc analyses indicated that the effects were more pronounced in younger children (<7 years of age).

CONCLUSION

Low-dose oral midazolam was effective in reducing fear and distress in pediatric oncology patients, especially in younger children, undergoing subcutaneous port needle insertion.

Keywords
Cancer, child, oral midazolam, RCT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-112942 (URN)10.1002/pbc.22233 (DOI)000271363800006 ()19688837 (PubMedID)
Available from: 2010-01-22 Created: 2010-01-22 Last updated: 2017-12-12Bibliographically approved
Hedén, L., von Essen, L. & Ljungman, G. (2009). Randomized interventions for needle procedures in children with cancer. European Journal of Cancer Care, 18(4), 358-363
Open this publication in new window or tab >>Randomized interventions for needle procedures in children with cancer
2009 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 18, no 4, p. 358-363Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine whether children experience less fear, distress and pain connected to a routine needle insertion in an intravenous port when subjected to an intervention: blowing soap bubbles or having a heated pillow vs. standard care. Twenty-eight children, 2-7 years, cared for at a paediatric oncology unit, undergoing a routine needle insertion in an intravenous port were included consecutively. All children were subjected to two needle insertions; at the first they received standard care, and at the second standard care + a randomized intervention. Parents and nurses assessed children's fear, distress and pain on 0-100 mm visual analogue scales. According to parents' report, children experienced less fear when subjected to intervention vs. standard care reported by parents (P < 0.001). Children also experienced less fear (P < 0.05) and distress (P < 0.05) when subjected to standard care + blowing soap bubbles vs. standard care (n = 14), and less fear when subjected to standard care + heated pillow vs. standard care (P < 0.05). Nurses' reports did not show any differences for standard care + intervention vs. standard care. Blowing soap bubbles or having a heated pillow is more effective than standard care in reducing children's fear and distress in needle procedures, according to parents' report.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-100810 (URN)10.1111/j.1365-2354.2008.00939.x (DOI)000267538700006 ()19040458 (PubMedID)
Note
Published Online: 27 Nov 2008Available from: 2009-04-07 Created: 2009-04-07 Last updated: 2017-12-13Bibliographically approved
Organisations

Search in DiVA

Show all publications