Table of Contents
Abstract
Purpose: The purpose of this paper is to synthesize current research on the influence of canine and music therapy with pediatric pain.
Methodology: Pediatric pain as the nursing subject was accessed through CINAHL Database. From CINAHL, the five most relevant articles addressing pediatric pain and canine or music therapy were selected. All five of these articles are based around nursing.
Results: After synthesizing two articles on canine therapy and three articles on music therapy, it is evident that continued research needs to be conducted on these two nonpharmacological methods. Four of the five articles concluded that canine visitation and music therapy addressed pain during and after procedures. As a whole, research suggests that allowing canines to visit patients in hospitals and playing music during painful procedures can provide some decrease in pain.
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Discussion: The need to decrease pediatric pain is both known and desired by many. Pairing canines and music with other pharmacological and nonpharmacological methods has the potential to positively impact many children. This country is experiencing an opioid crisis, thus making it important to be aware of other therapies that can help with pain. Canine visitation and music therapy may be two useful strategies.
Introduction
Pediatric pain involves many children in the United States as well as throughout the world. There are different influences on pain, but in pediatric patients it seems to be even more complex. The understanding of pain can be influenced by age, previous experiences, learned responses, ability to communicate, and the basic understanding of the cause (Lissienko, 2014).
Because children sometimes lack verbal communication skills, other signs that they may be in pain include: crying, facial changes, screaming, sleeping or eating changes, or refusing to move (Lissienko, 2014). It can be very difficult to control, as evident by the many different factors that can be influencing stress. Adding to the difficulty of pain detection, many pediatric patients are nonverbal, there are a variety of pain scales are used in many different hospitals and clinics. A few of the most popular include the FACES Scale, FLACC, and the numerical scale. The Purpose of this paper is to explore and understand the influence of Canine Therapy and Music Therapy on pediatric pain.
Method
Search Strategy
CINAHL Database was used to find peer-reviewed and applicable studies. CINAHL Database can be accessed through Baylor University Library Website and is a reliable resource to find peer-reviewed articles about pediatric pain. A member of my group went to talk to the librarians at Baylor University Louise Herrington School of Nursing and was directed to this database.
After thinking about the many different nonpharmacological avenues that influence pain, we narrowed it down to the influence of canine visitation and music therapy. To begin our search, I maneuvered through CINAHL by refining my search for “Scholarly & Peer-Reviewed” and published within the last 10 years. There is one article that we found that was from 2006. I do recognize that this is greater than 10 years old, but I believe that it discusses relevant and important information for canine therapy. I also paid attention to the discipline of “Nursing” when searching for these articles. After entering in all of this information, a plethora of articles appeared. It was after browsing through these many different articles that I was able to decide on the canine and music therapy. Lastly, I entered “canine therapy” and “music therapy” keywords to further filer through and find my five articles.
Results
Synthesis of Findings
As stated, a detailed synthesis of the five selected studies is provided in Table 1 and can further support the overall evidence that pain in the pediatric patient is difficult to quantify, therefore, research for pain management must be further addressed. Sobo, Eng, & Kassity-Krinch (2006) argued, “Although effective pain management is now considered a patient right, pain continues to be unrecognized and undertreated in infants and children” (p. 52).
All five articles point to the fact that there have been multiple nonpharmacological methods that are used to aid with pain. It is apparent that many health care providers are searching for other methods by using meditation, breathing, cognitive-behavioral interventions, and other distractions that the nurse can lead the patient through. Canine visitation and music both are considered in their usefulness to decrease pain.
After reading each article, it is clear that four of the five studies support the fact that music and canine therapy can decrease the perception of pain in pediatric patients. For example, in the randomized clinical trial for lumbar punctures, the researchers found that children had lower heart rates, respiratory rates, and pain scores before and after the produce (Nguyen, Nilsson, Hellstrom, &Bengtson, 2010). While Young, Griffin, Philips, & Stanley (2010) provided multiple examples of how “The IPod Intervention” helped many pediatric patients. These researchers believed that music was important in guiding pediatric patients away from their experience of pain.
Sobo et al. (2006) found that canine visitation triggered comforting thoughts. These comforting thoughts often times included their home or companionship. One of the most supportive statistics that canine therapy does decrease pain is the rating that physical pain before canine visitation was 3.79 but after the intervention it dropped to 1.64. As crying can be a direct sign that pain is present in pediatric patients, Sundar et al. (2016) found that live music reduces how long crying spells last. Improvement of vital signs, personal testimonies, pre-and post-intervention scores, and decreased crying, show that four studies are in support that music and canine therapy do in fact decrease pain in pediatric patients.
Given the fact that four of the five support music and canine therapy to decrease pain, only one other article stands in opposition. This other article suggests that canine therapy could be helpful in decreasing pain but does not definitively state the fact that pain is reduced by the use of canine therapy. Vagnoli et al. (2015) states, “There were no significant differences in pain ratings and in the level of parental anxiety. It appears that the presence of dogs during blood draw procedures reduces distress in children” (p. 89). It appears that canine therapy may reduce distress, but not always the level of pain. This study was conducted by introducing the canine to the child in three different phases.
Phase one began when the participant entered the room to clean the puncture, the second included blood sampling until the needle was taken out, and the third was from the cotton swab to stop the bleeding to when the child left the procedure room (Vagnoli et al., 2015). The results of this study indicated that although there was a decrease in pain ratings in stage one and two, there was not a significant decrease in phase 3. Because the third phase was not affected, Vagnoli et al. (2015) cannot conclude that canine therapy decreases pain in all scenarios.
Overall, this body of literature points to the need for more randomized control trials that study the impact of canine and music therapy on reducing pediatric pain. The need is further instated due to differences in experiencing pain throughout different cultures and nations. These different experiences of pain can particularly be different because of their different scales/measurements. Randomized controlled trails with larger sample sizes with the same standardized scale would allow for more reliable information. As represented above, it would be needed to measure pain using the same scales. As newly graduated nurses, we play an important role in holistic care for all patients. In particular for those who may not have a voice, such as many pediatric patients. It is vital for us to address the pain in pediatric patients using pharmacological and nonpharmacological methods such as canine and music therapy.
Best Supporting Evidence
I find that the article by Vagnoli et al. (2015) provides the best evidence that canine therapy does not always decrease pain in pediatric patients. Although four out of the five articles found that canine therapy was effective, I believe that it is also important to recognize and take into account the studies that stand contradictory. I came to this conclusion by using “Key Principles of Conducting Intellectual Critical appraisals…of Qualitative Studies” from Understanding Nursing Research: Building an Evidence-Based Practice (2018).
The article “Can Presence of a Dog Reduce Pain and Distress in Children during Venipuncture” states the problem and purpose very clearly while also giving a well-informed introduction. (Grove, Gray, & Burns, 2018). The abstract begins the article by stating the reason of the article. The goal of the article is to understand the effectiveness of canine therapy on pediatric pain before, during, and after a procedure to collect blood (Vagnoli et al., 2015). The framework in a study provides the building blocks of a study and is absolutely essential. The framework is clear which makes it very easy for the reader to understand the relationship between canine therapy and pediatric pain.
Grove et al. (2018) recommends that we ask the question of how the purpose and framework relate with the hypothesis. This study does have a small sample size and lacks data for each group because of the short amount of time to evaluate the response. However, adding to the credibility of the study is the age range of the population. Its sample is between ages 4 to 11 and that is best age range of any of my studies (Vagnoli et al., 2015).
Although some of my other studies have a larger population, I chose this article as my best supporting evidence because it measures the most extensive age group. I believe that a more diverse age population allows for a more comprehensive view on pediatric pain. Although this study stands in opposition that canine therapy decreases pain in pediatric patients, it shows the need for greater research for the nursing field. By conducting more research, we are able to find the best methods to address pain.
Discussion
Research is very important to the nursing practice. I believe that pediatric pain in particular is important to address. There are many unanswered questions about the human experience and pain. Pain is a very complex and multifaceted phenomenon that can be hard to quantify and describe. It is one thing for pain to be expressed by adults who have the cognitive ability to speak about their pain, but it is even more complicated to address it in a child. For example, how do we know what kind of pain a child is experiencing when they do not have the verbal skills to communicate it? Other questions include, pain can be different across cultures, how do we quantify it? Lastly, if we are all using different types of pain scales, how will we be able to provide congruent results when the statistics vary?
I propose that continued research of pediatric pain continues. I believe that studies should be more comprehensive and contain larger sample sizes. As noted, each pediatric patient has distinct and different signs and symptoms of pain. In order to provide reliable data, there should be the use of the same tools, such as the Wong-Baker FACES scale, across different cultures, and with a greater number of children. I do understand that finding pediatric participants can be difficult because of many different demographic and extraneous variables, but in order to deem that canine and music therapy are effective there must be more studies conducted. In order to do so, there will need to be further quantitative research. Quantitative research will review cause and effect interactions, such as canine and music therapy on pediatric pain.
Conclusion
Pediatric pain continues to show that there needs to be greater research. Children prove to be some of the most vulnerable in our society and it is a duty of ours, as nurses, to care for those who are vulnerable. Although there are some mixed results in proving the effectives of canine and music therapy, I recommend that we continue to utilize these nonpharmacological interventions. Often times, by using nonpharmacological and pharmacological methods we are better able to treat our patients’ pain.
