Children’s needle procedures: How can health professionals ensure a positive experience?

Rosemary ChessonHealth Services Research Group

The Robert Gordon University

RCN Conference, York, October 2004

Research Assistant: Lesley Horne

Advisory Group: Dr. Cleo Hart, Angela Horsley,

Sheila Lawtie, Dr. Graeme Wilson

Background

Informational needs for children with cystic fibrosis.

Children with mental health problems.

Children find needles the most frightening thing in hospital (Polkki et al, 1999)

Aims of study

Main aims were to:

Determine the nature of problems that occur when taking blood from children;

Estimate the prevalence of ‘needle phobia’;

Make recommendations for reducing children’s distress.

Study design

Audit of needle procedures (n=230).

Interview study with children (n = 30) (+ drawings).

Staff interviews (n=30)

(+ critical incidents).

The audit

Royal Aberdeen Children’s Hospital.

Audit forms completed over 4 week period.

All children who experienced a needle procedure.

All departments involved.

Audit children

Gender

56.5% boys 42.6% girls

Age %< 4 years 35.2

5-11 years 38.7

12-16 years 33.9

Staff undertaking procedure

n = 230

%

Doctor 84.4

Nurse 13.8

Other 1.7

Doctor’s grade

%

HO 45.4

Consultant 19.0

Registrar 17.5

Staff grade 10.8

Other 7.2

n=194

Main type of procedure

%

Cannulation49.6

Venepuncture 33.5

Finger prick10.9

Child’s response

%

Child cried 28.7

Child struggled 13.5

Child restrained 12.6

Family support

n = 230

78.6% a family member was present (52.7% mother)

Staff present

Range 1 to 5 staff

43.5% 2 or more staff

Information explained by

n=230

%

Doctor 36.5

Nurse 22.6

Dr + Nurse 13.0

Other 27.9

Consent

n=230

46.1% cases child gave consent

73.5% cases parent gave consent

Needle insertion

n=230

74.8% needle inserted on 1st attempt

12.6% “ “ “ 2nd attempt

7.7% “ “ “ 3rd/4th attempt

5.2% not specified

Main findings

Low level of nursing input.

Identified areas of practice for review.

Audit & interview studies

‘I thought it was ace’

‘She was holding my arm like that and my

blood was dripping all over her. It was

dripping all over her glove and everything’

Child interviews

Staff interviews

‘I usually say it’s a straw .. I usually avoid usingthe term needle .. I explain to them .. Thathopefully it won’t hurt’

‘If it’s for pain relief, I dinna see why we have todo it, because there are other ways to give painrelief apart from an injection ... I just feelhorrible for doing it but I know it has to be doneso I do it!’

Staff interviews

Recommendations for practice

Children are given appropriate information.

Review staff training, including re communication.

Review setting e.g. nos of staff present, use of play specialists.

Establish good practice guidelines.

Acknowledgements

All staff who participated in the audit.

Funding from BBC Children in Need