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Child life intervention during angiocatheter insertion in the pediatric emergency department
Michelle D Stevenson1, Christine M Bivins, Kitty O'Brien
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. mstevenson@chmca.org
Insights
Certified child life specialist (CCLS) intervention may reduce distress in children aged 4-7 during angiocatheter insertion. CCLS services support patients and families during routine pediatric procedures.
Area of Science:
- Pediatric Emergency Medicine
- Child Psychology
- Healthcare Interventions
Background:
- Limited literature exists on the effectiveness of certified child life specialist (CCLS) services in pediatric emergency departments.
- Understanding the scope of CCLS interventions is crucial for optimizing pediatric care.
Purpose of the Study:
- To evaluate the impact of CCLS intervention on child distress during peripheral venous angiocatheter insertion.
- To analyze the effectiveness of CCLS in a routine pediatric emergency procedure.
Main Methods:
- A randomized controlled trial involving children aged 2-16 years, comparing CCLS intervention to standard care.
- Distress was measured using the Observation Scale of Behavior Distress-revised (OSBD-r).
- Secondary outcomes included child/parent anxiety and parent satisfaction, analyzed via intention-to-treat and explanatory analyses.
Main Results:
- A statistically significant reduction in distress was observed in the 4-7 year age group during the anticipation phase (mean difference 0.61 OSBD units).
- In analyses excluding children with multiple attempts, significant reductions in OSBD-r scores were found across multiple phases.
- No significant differences in child/parent anxiety or satisfaction were detected between groups.
Conclusions:
- CCLS intervention shows potential in mitigating behavioral stress associated with angiocatheter insertion, particularly in younger children (4-7 years).
- Findings support the role of CCLS in advocating for patients and families during medical procedures.
- Further research may elucidate the full scope of CCLS effectiveness in pediatric emergency settings.
Objective:
Current literature is deficient regarding the scope of procedures for which certified child life specialist (CCLS) services are effective in the pediatric emergency department. The purpose of this study is to analyze the effect of CCLS intervention during routine peripheral venous angiocatheter insertion on child procedure-related distress.
Methods:
Eligible children were aged 2 to 16 years. Subjects were randomly assigned to CCLS intervention or standard care. The Observation Scale of Behavior Distress-revised (OSBD-r) [J Pediatr Psychol 12 (1987) 543] was recorded during the procedure. Secondary outcomes included child and parent State Trait Anxiety Inventories [Manual for the State-Trait Anxiety Inventory (1973) and Manual for the State-Trait Anxiety Inventory for Children (1973)] and an adapted parent customer satisfaction survey [Eval Program Plann 5 (1982) 233; Eval Program Plann 6 (1983) 299; and J Paediatr Child Health 31 (1995) 435]. Explanatory and intention-to-treat analyses were performed.
Results:
One hundred forty-nine children completed the study. Although there was no statistical difference in mean total OSBD-r in the intention-to-treat analysis, the mean difference of 0.61 OSBD units (95% confidence interval, 0.04-1.19) in the anticipation phase in the 4- to 7-year age group was statistically significant. When the patients with only 1 insertion attempt were analyzed (n = 121), the total OSBD-r, anticipation, and preparation phase differences were statistically significant in the intention-to-treat analysis. In the explanatory analysis (n = 138), a mean significant difference in total OSBD-r score of 1.80 (95% confidence interval, 0.19-3.42) was found. There were no significant differences in child or parent anxiety or customer satisfaction between groups.
Conclusions:
CCLS intervention may reduce the behavioral stress associated with angiocatheter insertion, especially in children aged 4 to 7 years. These data further support the role of the CCLS as a patient and family advocate during routine procedures.
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