"It Could Become a Standard"-A Qualitative Study of the CARD^TM System for Needle-Related Procedures in a Children's...

Background/Objectives: Needle-related procedures such as venipuncture are common in pediatric hospitals and are a major cause of pain, fear and distress for those affected. Despite the availability of a wide range of evidence-based support options, it is often the professionals who decide which interventions are offered. In this study, we adapted the CARD^TM (Comfort, Ask, Relax, Distract) system for needle-related procedures in hospitals. CARD^TM was originally developed to encourage children to actively participate in their vaccination process at school. It allows them to choose from numerous evidence-based interventions in the four different letter categories (C-A-R-D) to reduce pain, fear and related vaccination symptoms. Our aim was to examine perceptions of CARD^TM for needle-related procedures in a children's hospital, including aspects of acceptability, feasibility, self-efficacy in managing fear and pain, and overall experiences. Methods: A qualitative descriptive design was used. The sample included nine children aged 10 to 15 undergoing needle-related procedures and seven nurses who performed these procedures. We conducted individual interviews and asked them about their experiences with CARD^TM. Data were evaluated using qualitative content analysis. Results: Four themes were identified: awareness of options and needs; relationship building; empowerment; and acceptability. CARD^TM helped children identify available options, prepare themselves, recognize their own needs and select strategies. CARD^TM offered a concrete framework for action that promoted participation and self-efficacy and strengthened the relationship between nurses and children. In practice, CARD^TM was perceived to be easy to implement and acceptable. Conclusions: The present findings suggest the applicability of CARD^TM for hospital needle-related procedures.