CS Mott Children Hospital - Children`s Hospital of Illinois

CS Mott Children Hospital
Practice Guideline for Needlesticks and Procedures
Individualize
Assess: Know the patient/connect with them on a personal level
Age and Developmental level
Past Experience
Personal coping skills and style
Approach vs Avoidance
Watch vs Not Watch
Parental anxiety & coping
Develop plan/record plan/communicate plan
Mascot: Poke-a-Dot the Comfort Dog
Preparation
Major procedures requires advance preparation
Minor procedure may require information on the same day
Experience with the procedure- less information needed
High distress with prior pokes- emphasize coping skills- not
explanation of procedure
Best Words (Pocket Guide)
Preparation for the needle stick/procedure
During the procedure: Distract from the procedure
During recovery: Change topic and praise accomplishments
Positive reinforcement
Dots for bravery
Praise for bravery and holding still
Positioning
Up-right
Skin-to-Skin
Cross cradle
Restrain extremity
Distraction: Teach skills for coping (can use for life)
Timing
Prior to procedure to lessen anxiety
During procedure to lower distress
After procedure to enhance recovery
Match coping style: avoidance/approach
(reading a story vs “magic glove” at the injection site)
(Not watch vs Watch)
Age appropriate:
Coaching cards (Child Life)
Parent as helper and coach
Positioning
Distraction
Encourage coping skill
Praise for being brave/holding still
Explain that words of assurance and apology are not effective
(eg. I’m sorry; It will be OK)
Parent will model clinician’s behavior and action.
(Clinician to use distraction and best words)
Equipment/Drugs/Devices/Work Flow and Process
Sucrose/pacifier (Policy in place)
One Voice: Identify roles for each person
Number of attempts before getting help- (Policy in process)
Topical Anesthetic
Vapocoolants
Buzzy (vibration and cold)-( Piloting and guideline development)
Positioning and preparing for multiple immunizations at one time
Positioning
Positioning
Positioning
Topic
Megel, ME, Heser, R & Matthews, K
Parents’ Assistance to Children
Having Immunizations
Issues in Comprehensive Pediatric
Nursing, 2002 25:151-165
Lacey, CM, Finkelstein, M &
Thygeson, MV
The Impact of Positioning on Fear
During Immunizations: Supine Versus
Sitting Up
Journal of Pediatric Nursing 2008,
23(3) :195_=220
Citation
Sparks LA, Setlik, J Luhman, J
Parental Holding and Positioning to
Decrease IV Distress in Young
Children: A Randomized Controlled
Trial
Journal of Pediatric Nursing 2007
22(6); 440-447
Key Findings
Distress was lower in parent
held group in all 3 periods
IV attempts similar
RNs preferred lying flat
Parents had greater satisfaction in
the held group.
Comments
Parents felt comfortable
holding
Nurses needed to
change their technique
when child was supine
64 % of children did not
RCT
receive topical even
though it was a standard
4-6 yrs
Crying prior to injection more likely Less fear when sitting
108 patients
in supine position
up
General ped clinic
Staff reluctant to use
Receiving
Crying after injection was greater
sitting up—if child
immunizations
in supine position
showed signs of distress
Excluded:
(mean = 10 min vs 2 min)
they would often tell child
children who had
they had to lie down
4 or more
procedures.
chronic illness, CI
Random- 2 group
41 parents
Coded behaviors from audiotapes Negative parental
40 children
Physical contact and explanations coping behaviors were
Immunizations at during immunization
related to more
clinic
Crying was not reprimanded, half
distress. Positive
indicated positive feedback.
coping behaviors were
Descriptive
Physical contact and rewards
related to more positive
given and promised
coping
Learned from health care
provider, just knew, read about
what to do Strategies that
parents used recommended in
literature included: relaxation/deep
breathing, distraction.
Sample
9 mos-4 yrs ED
N=118
Held upright by
parent or lying flat
Practice Area: Positioning for Needlesticks/Procedures
Synthesis Table-4: Positioning