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

1. Children’s needle procedures: How can health professionals ensure a positive experience? Rosemary Chesson Health Services Research Group The Robert Gordon University RCN Conference, York, October 2004

3. Research Assistant: Lesley Horne Advisory Group: Dr. Cleo Hart, Angela Horsley, Sheila Lawtie, Dr. Graeme Wilson

4. 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)

5. 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.

6. Study design • Audit of needle procedures (n=230). • Interview study with children (n = 30) (+ drawings). • Staff interviews (n=30) (+ critical incidents).

7. The audit • Royal Aberdeen Children’s Hospital. • Audit forms completed over 4 week period. • All children who experienced a needle procedure. • All departments involved.

8. Audit children Gender 56.5% boys 42.6% girls Age % < 4 years 35.2 5-11 years 38.7 12-16 years 33.9

9. Staff undertaking procedure n = 230 % Doctor 84.4 Nurse 13.8 Other 1.7

10. Doctor’s grade % HO 45.4 Consultant 19.0 Registrar 17.5 Staff grade 10.8 Other 7.2 n=194

11. Main type of procedure % Cannulation 49.6 Venepuncture 33.5 Finger prick 10.9

12. Child’s response % Child cried 28.7 Child struggled 13.5 Child restrained 12.6

13. Family support n = 230 78.6% a family member was present (52.7% mother)

14. Staff present Range 1 to 5 staff 43.5% 2 or more staff

15. Information explained by n=230 % Doctor 36.5 Nurse 22.6 Dr + Nurse 13.0 Other 27.9

16. Consent n=230 46.1% cases child gave consent 73.5% cases parent gave consent

17. Needle insertion n=230 74.8% needle inserted on 1st attempt 12.6% “ “ “ 2nd attempt 7.7% “ “ “ 3rd/4th attempt 5.2% not specified

18. Main findings • Low level of nursing input. • Identified areas of practice for review.

19. 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

20. Staff interviews ‘I usually say it’s a straw .. I usually avoid using the term needle .. I explain to them .. That hopefully it won’t hurt’ ‘If it’s for pain relief, I dinna see why we have to do it, because there are other ways to give pain relief apart from an injection ... I just feel horrible for doing it but I know it has to be done so I do it!’ Staff interviews

21. 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.

22. Acknowledgements All staff who participated in the audit. Funding from BBC Children in Need