childrens needle procedures: how can health professionals ensure a positive experience? rosemary...
TRANSCRIPT
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