Ask any nurse and they will no doubt already know that when children and young people present to healthcare environments, they are faced with a range of emotions, from fear to anxiety, all which are potentially exacerbated by unfamiliar surroundings, people and equipment.
Compared with adults, children have fewer coping mechanisms, and when experiencing pain or illness, distress levels often escalate causing a flow on effect to not only parents and caregivers, but healthcare providers alike (Stock, Hill, and Babl, 2012). This is perhaps no more evident than when attempting painful or uncomfortable procedures, such as taking blood, or even in some circumstances, obtaining vital signs, can cause negative emotional or behavioural consequences (Duff et al. 2011).
The chances of a nurse being involved in the care of a child that hasn’t resulted in tears at some stage are slim. However by applying the use of age-appropriate language, as well as various distraction techniques, nurses and healthcare providers can successfully assist their paediatric patients through such procedures, resulting in the best patient outcomes.
Explain the procedure. This reduces anxiety and any misconceptions by allowing the child to understand the purpose for the procedure, rather than perceive it as a form of punishment. It should be honest, developmentally appropriate, succinct and free of unnecessary details that can heighten anxiety (Stock, Hill and Babl 2012). As children get older, involving them in the process and explaining intentions increases the child’s confidence and allows them to ask questions and feel their independence is maintained throughout their care (Curtis & Ramsden 2012).
Avoid negative words. Words like ‘hurt’ and ‘sting’ when used during procedure preparation do not have any effect on reducing painful sensations and can induce greater distress before the procedure even takes place. It is recommended that these are instead replaced with affirmative language such as ‘this medicine will make you more comfortable’ or ‘the needle will help your body get better’ (Stock, Hill and Babl 2012).
Give choices and empower. Children may feel like they have a loss of control in unfamiliar environments that can further heighten anxiety, so by offering choices such as ‘which arm would you like the blood pressure cuff on?’ can empower the child in a situation where many choices are already removed (Stock, Hill and Babl 2012). In similar ways, allowing children to play and become familiar with certain pieces of equipment – such as an oxygen mask – returns some feelings of control and reduces apprehension (Stock, Hill, and Babl 2012).
Evidence strongly supports the use of distraction to reduce pain and distress during medical procedures in children. Duff et al. (2011) identified two main principles: the shift of attention away from potentially distressing procedures via the use of age appropriate activities, and that the more interactive and varied the distraction technique chosen is, the greater the cognitive need and therefore likelihood that distress levels are reduced.
The Royal Children’s Hospital, Melbourne (2016) recommends a variety of distraction approaches depending on the age and development stage of the child, such as: breastfeeding for infants, playing with textured toys for toddlers, blowing bubbles for pre-school aged children, using an iPad to play games or music for school-aged children, and conversation about school or hobbies in adolescents. These have all proven to be effective.
|Breast feeding||Dummy, blanket, favourite toy||Blanket, favourite toy||Non-procedural talk about favourite topics||Non-procedural talk about favourite topics|
|Watching bubbles||Textured toys (e.g. squishy balls), imaginary play, popping bubbles||Textured toys (e.g. squishy balls), imaginary play, popping bubbles||Humour||Humour|
|Relaxed breathing of caregiver||“Blowing the hurt away”, blowing bubbles||“Blowing the hurt away”, blowing bubbles||Breathing and relaxation||Breathing and relaxation|
|Singing and music, music therapist||Singing and music, music therapist||Singing and music, music therapist||iPod, music therapist||iPod, music therapist|
|Sucrose and non-nutritive sucking||Computer game/DVD/iPad||Computer game/DVD/iPad||Computer game/DVD/iPad||Computer game/DVD/iPad|
|Rattle/shaker||Sound/pop-up books||‘I Spy’/sound books||‘I Spy’/’Where’s Wally’||Prompt cards and conversation starters|
(The Royal Children’s Hospital Melbourne, 2016)
It is important to plan two to three options so a new distractor can be introduced should the child become distressed, as well as ensuring the child does not remove focus from the distractor and attempt to look at the procedure (Royal Children’s Hospital 2016). Positioning of the child and the procedure are important; a blanket or book may assist in shielding anxiety-provoking views in certain circumstances.
Ultimately the building of trust between nurse and child and avoiding a negative hospital or healthcare experience is one of the main goals when nursing paediatric patients. Through effective communication techniques and applying some of the strategies discussed, this is not only achievable, but in turn will enable optimum assessment, management and interventions. Of course there are many other aspects other than language and distraction that can be utilised, and with experience and exposure each nurse can find their own individual way of communicating with children.