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Swab testing for SARS-CoV-2 screening and child-centred care. Is it possible in every setting?

  • Raffaella Dobrina
    Correspondence
    Corresponding author at: Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - Direzione delle Professioni sanitarie - via dell'Istria 65/1, Trieste, Italy.
    Affiliations
    Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - Healthcare Professions Department - via dell'Istria 65/1, Trieste, Italy
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  • Andrea Cassone
    Affiliations
    Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - Healthcare Professions Department - via dell'Istria 65/1, Trieste, Italy
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  • Livia Bicego
    Affiliations
    Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - Healthcare Professions Department - via dell'Istria 65/1, Trieste, Italy
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Published:April 19, 2022DOI:https://doi.org/10.1016/j.pedn.2022.04.006

      Keywords

      Dear Editor,
      widespread screening for SARS-CoV-2 through swab tests is still a daily burden for the healthcare force and citizens. Different kinds of swabs are available to minimise discomfort, although, to our knowledge, nasopharyngeal tests are still the gold standard (
      • Lee R.A.
      • Herigon J.C.
      • Benedetti A.
      • Pollock N.R.
      • Denkinger C.M.
      Performance of saliva, oropharyngeal swabs, and nasal swabs for SARS-CoV-2 molecular detection: A systematic review and meta-analysis.
      ). Nasopharyngeal swabs for diagnostic testing are invasive procedures and cause discomfort, especially in children (
      • Uddin M.
      • Shirin T.
      • Hossain M.E.
      • Alam A.N.
      • Ami J.Q.
      • Hasan R.
      • Banu S.
      Diagnostic performance of self-collected saliva versus nasopharyngeal swab for the molecular detection of SARS-CoV-2 in the clinical setting.
      ).
      Although tolerable for many, children approaching SARS-CoV-2 screening point-of-care are already scared. Most children had experienced nasopharyngeal tests several times since the beginning of this pandemic emergency. Some hate it; some are getting used to it; some older children tolerate it because they know it is unpleasant but quick. Sometimes, keeping the child steady is necessary for a less traumatic procedure. However, recurring to child holding intensifies distress for the children and parents involved and increases the risk of behavioural or emotional disturbances post-procedure (
      • Karlsson K.
      • Galvin K.
      • Darcy L.
      Medical procedures in children using a conceptual framework that keeps a focus on human dimensions of care - a discussion paper.
      ). As nurses and parents, we are wondering about the consequences of these, now considered “normal”, practices that we are forcing kids to get used to, without having appropriate time to embrace their fears or rejections when they say:“ I don't want to! I've had enough!”.
      Moreover, tight swab testing appointments leave very little time to nurses for adequate children welcome and involvement in the procedure in a child-centred care manner. The smile of a nurse is not enough. Excuse us: eyes smiling above masks are not enough! And, are appointments planned to adequately address the needs and timings of children, e.g. with an autism spectrum disorder?
      It is striking how little scientific literature is available in this field while websites are full of articles with “Tips for parents” to ease their child experience when taking swab tests. Therefore, there is an urgent need to use some of the different distractions techniques available to maximise children's comfort during invasive procedures (
      • Sajeev M.F.
      • Kelada L.
      • Yahya Nur A.B.
      • Wakefield C.E.
      • Wewege M.A.
      • Karpelowsky J.
      • Signorelli C.
      Interactive video games to reduce paediatric procedural pain and anxiety: A systematic review and meta-analysis.
      ), also for SARS-CoV-2 nasopharyngeal swabbing in point-of-care settings. Moreover, quick strategies, available in exemplary videos in literature, could be adopted to desensitise vulnerable children to procedures and equipment (
      • Krauss B.S.
      • Krauss B.A.
      • Green S.M.
      Videos in clinical medicine. Managing procedural anxiety in children.
      ).
      Furthermore, SARS-CoV-2 screening performed by community pharmacists yields different benefits, including improved access to timely testing. However, literature findings highlight age-appropriate approaches in best practices for SARS-CoV-2 diagnostic testing for pharmacists are lacking (
      • Goode J.R.
      • Page A.
      • Burns A.
      • Bernard S.
      • Wheawill S.
      • Gatewood S.
      The pharmacist’s role in SARS-CoV-2 diagnostic testing.
      ). We are wondering if nurses could share their expertise across specialities to enhance sensitivity and promote the most appropriate approach with children in a pandemic era, even outside hospitals' settings.
      There is also a need to consider that such high demand for SARS-CoV-2 screening swabbing, staffing shortages and tight appointments impose nurses' workforce to fast and super efficient performances. Sometimes it seems that a nurse's competence is estimated on the basis of the number of swabs performed in a given period of time. We argue that this kind of work organisation resembles the adoption of Taylorist principles, such as specialisation (swabbers?), fragmentation of work, time-controlled performances, and reduced personnel costs (
      • Wise S.
      • Duffield C.
      • Fry M.
      • Roche M.
      Workforce flexibility - in defence of professional healthcare work.
      ). These working features may lead to a general deterioration of professionals' working conditions and possible burnout, which is extremely important to avoid in order to preserve child-centred care. To prevent such issues, literature findings support nurses' job rotation, which was found to help to alleviate the low morale resulting from the highly repetitive tasks required in some health services (
      • Chen S.Y.
      • Wu W.C.
      • Chang C.S.
      • Lin C.T.
      Job rotation and internal marketing for increased job satisfaction and organisational commitment in hospital nursing staff.
      ). However, does high nurse rotation guarantee the same high number of efficient performances in time constraints?
      And, we are wondering, how long can we keep this fast pace and not lose credibility with the young public?
      It is true that the pandemic we are experiencing is an exceptional circumstance and that the nursing workforce has already faced several challenges in providing comfort and other essential care. However, maybe some aspects of care need further investigation and effort to improve them in the light of the intensification of work together with the need to ensure the best approach to children in new settings.

      Authors contribution

      All authors gave final approval for the manuscript to be submitted and agreed to be accountable for all aspects of the work.

      Funding

      This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

      CRediT authorship contribution statement

      Raffaella Dobrina: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. Andrea Cassone: Conceptualization, Investigation, Writing – review & editing. Livia Bicego: Conceptualization, Writing – review & editing.

      Declaration of Competing Interest

      No conflict of interests have been declared by the authors with respect to the research, authorship, and/or publication of this article.

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