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"Keeping pace according to the child" during procedures in the paediatric intensive care unit: A grounded theory
Masayuki Iwata1, Shigeko Saiki-Craighill2, Ryouhei Nishina2
1Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan; University of Washington, Box 357266, Seattle, WA 98195-7266, USA.
Insights
Nurses can improve children's experience during painful procedures in the paediatric intensive care unit by adopting a child-centered approach. This involves soothing, explaining steps, and acknowledging emotions to foster cooperation and reduce anxiety.
Area of Science:
- Pediatric Nursing
- Child Psychology
- Intensive Care Medicine
Background:
- Painful procedures are common in pediatric intensive care units (PICUs).
- Effective nurse-child interaction is crucial for managing procedural pain and distress.
- Understanding these interactions can inform best practices in pediatric critical care.
Purpose of the Study:
- To explore nurse-child interactions during painful procedures in a PICU.
- To identify strategies nurses use to manage children's responses to pain.
- To understand the impact of these interactions on children's acceptance of procedures.
Main Methods:
- Qualitative research using a grounded theory approach.
- Data collection through participant observation and interviews with nurses.
- Observations focused on nurse-child interactions during painful procedures in a Japanese academic teaching hospital PICU.
Main Results:
- Children's acceptance of procedures was enhanced by nurses "keeping pace according to the child."
- Child-centered pacing included soothing, step-by-step explanations, and emotional acknowledgment.
- These strategies promoted cooperation even during painful interventions.
Conclusions:
- A collaborative practice approach utilizing calming tactics can improve children's perception of painful procedures.
- Nurses' child-centered communication and pacing are key to enhancing cooperation.
- Findings suggest potential for improved patient outcomes through tailored interaction strategies.
Objective:
The goal was to explore how nurses interact with children in the paediatric intensive care unit during potentially painful procedures.
Research Methodology/Design:
This was a qualitative research study that used grounded theory approach. Data were collected through participant observation and interviews. Nurse-child interactions were observed and recorded during potentially painful procedures performed by nurses. Following observation of a procedure, nurses were interviewed about their intentions, feelings and emotions during the procedure.
Setting:
The study took place in a seven-bed paediatric intensive care unit in an academic teaching hospital in Japan.
Findings:
Children's acceptance of a procedure was induced by nurses' pacing, particularly in a pattern of "keeping pace according to the child." Such pacing involved soothing the child, explaining what was being done to the child at each step and acknowledging the child's emotions. All of these child-centred procedures provoked cooperation from the children even during painful procedures.
Conclusions:
Our study suggests that a collaborative practice approach, in which nurses use a series of calming tactics, might improve children's perceptions of painful procedures.