Tarja Pölkki

Objective: This review evaluates the effectiveness of active distraction-based interventions, compared with passive distraction-based ones, for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling. Introduction: Venous blood sampling is a procedure that causes anxiety, fear, and pain in hospitalized children. It is essential that health care professionals relieve a child’s negative emotions and pain because untreated pain may have many long-term effects on children’s development. It is important to know which distraction-based interventions are effective for relieving these outcomes in children during blood sampling. Eligibility criteria: This review considered randomized controlled trials (RCTs) and quasi-experimental studies that included active and passive distraction-based interventions for relieving hospitalized preschool and school-age children’s anxiety, fear, and pain during venous blood sampling. Methods: CINAHL, PubMed, Scopus, and Cochrane Library databases were searched for published studies, and MedNar, Google Scholar, and PsycArticles were searched for in-progress and unpublished studies in English, Finnish, or Swedish. Two independent researchers performed critical appraisal and data extraction using the JBI methodology. The data were described in a statistical meta-analysis of RCTs. If statistical analysis was not possible, the findings were reported narratively using a Synthesis Without Meta-analysis (SWiM) approach. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess certainty in the quality of the evidence. Results: Eleven RCTs involving 1164 children were identified. Blinding of the participants, those delivering the treatment, and assessors was not achieved in all of the studies, thereby introducing a potential risk of bias. A passive distraction-based intervention was significantly effective in relieving the children’s fear during blood sampling according to observers (MD: 0.77, 95% CI: 0.16 to 1.38, P = 0.01). There was no statistically significant difference between the active and passive distraction-based interventions in relieving children’s fear during blood sampling according to the children and parents. There was also no statistically significant difference between the groups in relieving children’s anxiety and pain during blood sampling according to the children, parents, and observers. Narrative analysis reported that a passive distraction-based intervention was more effective than an active distraction-based one in regard to relieving the children’s anxiety during blood sampling according to the children (mean ± SD: 5.08 ± 3.40 vs 2.79 ± 3.38, P = 0.023), parents (mean ± SD: 5.32 ± 2.99 vs 3.62 ± 2.76, P = 0.045), and observers (mean ± SD: 5.20 ± 2.76 vs 2.00 ± 2.81, P = <0.001). Conclusions: Passive distraction-based interventions were more effective in relieving children’s fear during blood sampling according to the observers. There was no statistically significant difference between the groups in relieving children’s anxiety and pain during blood sampling. Blinding was not possible in most of the studies, the population`s age range was large, and analysis heterogeneity was high. Review registration: PROSPERO CRD42023455617 Supplemental digital content: Japanese- https://links.lww.com/SRX/A200 and Finnish-language https://links.lww.com/SRX/A201 versions of this abstract are available.

Background: Early skin-to-skin contact (SSC) is an evidence-based care practice with well-documented benefits for preterm infants and their parents. Among extremely preterm infants, implementation of early SSC remains variable across neonatal intensive care units (NICUs), despite growing evidence supporting its safety. Nurses play a central role in facilitating SSC, and their perceptions and perceived barriers may influence its implementation. Purpose: To describe NICU nurses' perceptions of early SSC for extremely preterm infants and to identify perceived barriers to its implementation in neonatal intensive care settings. Methods: A descriptive cross-sectional study using a web-based survey was conducted among NICU nurses in Finnish university hospitals. A total of 148 nurses responded, and the data were analyzed using descriptive statistics and one-way analysis of variance. Results: Most nurses held positive perceptions toward early SSC, whereas most considered it not feasible for all extremely preterm infants, and many reported safety-related and family-related concerns. Perceived barriers varied significantly between NICUs ( P < .001) and by NICU experience ( P = .018), with higher barriers among nurses with 2-5 years of experience. Early SSC was not perceived by most nurses to increase workload. Implications for Practice and Research: Consistent implementation of early SSC appears to depend on unit-level practices and nurses' experience. Clear clinical guidance, staff education, and parental support may facilitate its integration into routine neonatal care, whereas further research is needed to identify effective implementation strategies.

This study assesses the effectiveness of a gamified mobile health intervention designed for the pediatric day surgery pathway in reducing children's anxiety, fear, and pain, as well as reducing parents' anxiety and increasing parental satisfaction. The study was conducted as a two-arm randomized controlled trial (RCT). Children aged 7–12 years (n=40) and their parents, equal to the number of children, were recruited from the day surgery unit of a university hospital in Finland between August 2020 and August 2021. The control group (n=20 children) received routine care, including a parental mobile care path solution (the BuddyCare App) to inform parents about procedures in the children's day-surgery pathway. Whereas, the intervention group (n=20 children) received the same routine care with a parental care path solution and an additional mobile game (the Triumf Game App) designed to help children cope with anxiety, fear, and pain during the day surgery process. Assessments were conducted before the treatment at home, at the hospital before and after the treatment, and at home 7 days after treatment. In total, 86 were found eligible for this RCT study, and 40 participated. Median age of participants was 9.5 [IQR: 8.0–11.0] years and 15 (39%) were girls. In the control group median mYPAS scores were 32.0 (at the hospital before the treatment), 38.0 (during induction before anaesthesia), and 28.0 (in the recovery room). The corresponding numbers for the intervention group were 33.0, 43.0, and 28.0. No statistically significant differences were observed in mYPAS scores between the intervention and control group (all p-values >0.5). Furthermore, secondary outcomes (children´s fear and pain and parent´s anxiety and satisfaction) did not differ statistically significantly between the intervention and control group. A gamified health intervention may not be superior to routine care in reducing children’s anxiety, fear, pain, or parents’ anxiety and satisfaction. Routine care, including a parental care path solution, prepares parents and children for day surgery and boosts treatment-related satisfaction. This approach may be safe and support digital transformation in healthcare settings, such as hospitals.

Background: While the need for palliative care (PC) is growing, both national and international studies have shown insufficient PC competence among healthcare professionals. Good PC both reduces healthcare costs and promotes quality of life. It is therefore necessary to examine the current state of healthcare professionals’ level of PC competence and identify the areas in particular need of improvement. Objective: To describe the self-assessed PC competence of healthcare professionals working in a university hospital, and to study which background factors are associated with it, in order to identify areas of PC requiring improvement and further education. Design and methods: This mixed methods study with a convergent design was conducted in one hospital in Finland in 2024. The participants (n=100) were asked to rate their self-assessed PC competence using a 30-item instrument developed for the study. The data were analysed using both quantitative (descriptive statistics, comparisons between groups) and qualitative (inductive content analysis) methods. Results: Healthcare professionals’ self-assessed PC competence was “Good” or above in 18/30 items. Nurses and physicians generally rated their competence higher than did those representing other professions; competence was rated the highest in Oncology and in General Medicine and Geriatrics, respectively. Work experience in healthcare overall did not correlate with the level of competence, whereas experience in PC specifically did. In the open-ended responses, participants identified factors that promote, hinder, or otherwise impact self-assessed competence. Conclusion: PC competence was considered important, and 18/30 items were rated “Good” or “Very good”. However, the study revealed areas potentially in need of improvement and more education, both indirectly as lower scores for self-assessed competence and directly as comments provided by the participants. To provide high-quality PC, more education is required especially concerning advance care planning, guardianship, and multiprofessional cooperation. Further research is needed regarding competence among representatives of different professions.

Background: The infants of diabetic mothers are at higher risk of hypoglycemia and admittance to neonatal intensive-care units leading to failure in exclusive breastfeeding. Aim: To determine the effects of antenatal expression of milk in late pregnancy by diabetic women on exclusive breastfeeding during the first days and 2 months after birth. Design: This was a prospective cohort study. Methods: A total of 106 pregnant women with diabetes who were treated at one outpatient maternity clinic and three local maternity units over a period of 2 years were recruited for the study. Patient records and structured interviews by phone were conducted to collect the data 2 months after birth. The data was analyzed statistically. Results: Most of the participants expressed breast milk during late pregnancy and did so for an average of 10 days before birth. Half of the women had challenges in breastfeeding, and only 14% exclusively breastfed their infants. The proportion of women exclusively breastfeeding was similar between those who antenatally expressed and those who did not. Women who had antenatal expressed milk were slightly more likely to use their own milk as a supplement feed. Women who found antenatal expression easy exclusively breastfed more. A higher amount of antenatal expressed milk increased exclusive breastfeeding at the hospital. Conclusion: Antenatal expression of milk had no effect on exclusive breastfeeding later at home. The infants of diabetic women are at a high risk of receiving supplemental feeding after birth.

Aim: To explore parents' experiences of psychosocial support in the neonatal intensive care unit (NICU). Design: A qualitative descriptive study. Methods: The study involved nine individual and three pair interviews; in total, 15 parents described their experiences of psychosocial support in the neonatal intensive care units. The data were analysed using inductive content analysis. Results: Parents' experiences of psychosocial support consisted of four main categories: (1) supporting parenting; (2) strengthening the sense of security; (3) social support; and (4) mental wellbeing support. Parents described how important it was to receive support in caring for an infant, to be able to participate in decision‐making or to feel safe despite a difficult situation. Conclusion: Even though parents described peer support and trauma‐informed care as important forms of support, many NICUs lacked these. The results provide essential information to healthcare professionals, enabling them to understand and support parents. This can increase parental satisfaction and improve the wellbeing of families, as well as support parents during neonatal intensive care and after discharge. Implications for the Profession and Patient Care: This study provides tailored information on parents' experiences of psychosocial support in neonatal intensive care units. The results can be used in the education of healthcare professionals and to assist them in integrating psychosocial support methods into their practice, such as consistent emotional support. Impact: The findings emphasise the importance of systematically asking parents about their experiences in order to identify their needs and the various forms of psychosocial support they require. These insights can guide healthcare professionals in providing personalised psychosocial support to parents in NICUs. Reporting Method: The reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Patient or Public Contribution: Parents contributed to the study through data collected from the national peer support association (Kevyt) in Finland.

Aim: To assess how social robots impact anxiety, pain, fear and stress in children and adolescents during perioperative nursing. Design: A systematic review and meta‐analysis of randomised controlled trials and quasi‐experimental studies. Methods: Following Joanna Briggs Institute guidelines, eligible studies included participants under 21 undergoing surgery or perioperative care, used social robot interventions with comparators, assessed anxiety, pain, fear and stress, and employed randomised or quasi‐experimental designs. Two independent reviewers screened and extracted data. Data Sources: A systematic search was conducted in April 2024 and updated twice (December 2024, October 2025) across CINAHL, Web of Science, Scopus, PubMed, Cochrane CENTRAL, Medic, PsycArticles, Institute of Electrical and Electronics Engineers and grey literature sources (Google Scholar, Mednar). Results: Seven studies (663 participants) showed heterogeneity in social robotic interventions. A meta‐analysis of two studies (302 participants) found a significant reduction in children's and adolescents' post‐operative anxiety, whereas a narrative synthesis identified three studies reporting reduced perioperative anxiety. However, the interventions had little or no effect on perioperative pain, fear or stress. Conclusion: This review suggests that social robotic interventions may reduce perioperative anxiety in children and adolescents, potentially serving as non‐pharmacological distraction tools in paediatric care. Evidence for their effects on pain, fear and stress is limited, highlighting the need for further research to identify effective interventions and clarify their role in perioperative nursing. Impact: This review highlights social robotic interventions as promising non‐pharmacological tools for reducing perioperative anxiety in children and adolescents. Reporting Method: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and Synthesis Without Meta‐Analysis reporting guidelines. Patient or Public Contribution: No patient or public contribution. Trial Registration: This review was registered in PROSPERO, the International Prospective Register of Systematic Reviews ( https://www.crd.york.ac.uk/PROSPERO/view/CRD42024549796 )

Recently developed unobtrusive methods for at-home infant sleep monitoring can complement parental observations and support infant wellbeing by providing detailed information on overnight sleep patterns. However, further work is needed to understand how such methods capture variations in sleep depth and overall sleep structure in real-world environments. We compared automated assessments of whole-night sleep structure from two novel noninvasive systems designed for at-home use: an under-mattress sensor (Nucu) and a research-grade wearable device (NAPPA). Both provide a time course of sleep structure akin to a hypnogram, conceptualized as a calmness curve in Nucu and a sleep depth trend (SDT) in NAPPA. Simultaneous recordings were collected across 11 nights from four infants aged 3–10 months. Correspondence between outputs was evaluated using Spearman rank correlation (rho) and visual comparison of the time courses. Comparison of the calmness and SDT out-puts showed a very strong overall correlation rho = 0.85 (p < 0.001) in unselected whole-night data, and a nearly as high correlation during sleep-only time periods (rho = 0.81, p < 0.001). Although some night‑to‑night variability was present, correlations remained consistently high for both whole-night recordings (rho = 0.72–0.93, across nights) and the sleep-only periods (rho = 0.69–0.89, across nights). Likewise, the visual appearance of the whole-night sleep structure was comparable between systems. The strong agreement between the two methods suggests that both capture consistent information about sleep depth. Together with earlier validation of NAPPA device, the findings of the present work strengthen the evidence base for the development of feasible, non-invasive, and contactless monitoring of infant sleep depth in home environments.

Recurrent exposure to pain, combined with periods of separation from the mother, represents a significant source of stress that may adversely influence the infant’s later development. Skin-to-skin contact (SSC), where the infant is placed against a parent’s bare chest, is considered the effective parent-involved method for alleviating procedural pain. However, parental involvement is not always possible due to maternal health issues after birth, long distances between home and hospital, or competing family responsibilities. In such situations, alternative approaches are needed to support infants’ comfort without relying on the parent’s physical presence. Research has shown that using intrauterine-like sounds can help reduce pain in neonates. Involving 36 infants, we applied cross over study to compare SSC and intrauterine-like sounds with control situations during pain stimulation. An accelerometer was placed on the chest to get seismocardiogram signals for analysis. Unfortunately, most of the data suffered from artefacts and noise, leaving about 27% with acceptable signal quality, although some attempts have been done to reduce the motion artefacts. Based on the analysis using fractional amplitude of physiological fluctuations (fAPF), we found that SSC helped infants recover from pain stimulation. The physiological interpretation behind the fAPF scores related to pain was still unknown and subject to further study.