How to ensure children feel calm during clinical procedures
Lucy Bray, who is appearing at Nursing Live, RCNi’s unique event, advises nurses to focus on considering the consequences of distress on a child’s well-being
This article was updated on 11 October 2023
Thousands of children undergo clinical procedures, such as medicine administration, blood tests, examinations and X-rays every day. In many cases these procedures go well and are completed quickly, and the child leaves happily with a sticker or certificate.
However, there are occasions when a child becomes upset, distressed and resists all the attempts of healthcare professionals to complete a procedure.
Evidence shows that when a procedure is not going well and a child is distressed, professionals and parents do not always feel able to pause and discuss whether a different approach could be used.
‘It can be challenging during a stressful procedure for professionals to always judge when a tight cuddle turns into a firm, forceful cuddle and then becomes a restraining hold’
What can happen is that a child ends up being held in order for the procedure to be completed quickly. This can leave everyone involved feeling stressed and wondering what could have been done differently.
Restraining a child for a non-urgent procedure happens more often than it should
Too often during a challenging procedure the focus can be on completing the task and not on considering the consequences of distress on the short and long-term well-being of a child.
While no one starts a non-urgent procedure with the intention of restraining a child, it does happen more often than it should.
It can be challenging during a stressful procedure for professionals to always judge when a tight cuddle turns into a firm, forceful cuddle and then becomes a restraining hold.
There can be a reluctance by healthcare professionals to acknowledge and document when restraint has been used.
These challenges and tensions have been faced by healthcare professionals for years, yet there is still uncertainty over how best to support and advocate for children during non-urgent procedures.
Nursing Live – advice on children having tests, treatments and examinations
Brought to you by RCNi, Nursing Live is the first event of its kind in the UK, featuring more than 100 presentations, demonstrations and masterclasses.
Among the packed programme, including many nursing children and young people events, is a presentation by Lucy Bray, Children having tests, treatments and examinations: what does good practice look like? This takes place on the first day (Friday 10 November) at 12.00 in learning lab 2 and is part of the children's nursing strand that day.
Free event: Sign up here for Nursing Live
Rights-based standards developed through meetings, discussion and consultation
Because of this ongoing uncertainty, iSupport – a group of nurses, doctors, health play specialists, young people, parents, child rights specialists, psychologists and youth workers – decided to develop a set of international rights-based standards for children undergoing clinical procedures.
The work was prompted by Katie Dixon, a young person who met me in my role as project lead in 2020 to ask what progress has been made about supporting children to have positive procedural experiences.
The rights-based standards were developed through many meetings, ongoing discussion and through consulting with established youth and parent forums in the UK and Ireland, and Katie has been an important part of the project team.
An online survey in 2021 also gained feedback on the standards from health professionals and families.
Supportive holding helps a child feel calm, secure and settled
The standards aim to ensure that the short and long-term physical, emotional and psychological well-being of children and young people are of central importance in any decision-making for procedures or procedural practice. Regardless of their age, any disability or ability they may have, the standards apply to all children.
The standards propose an approach to minimise the procedural anxiety, distress and harm which can be experienced by children. They promote ‘supportive holding’ as an approach to prioritise children’s rights and well-being and challenge the use of restraining holds for non-urgent clinical procedures.
Supportive holding is defined as involving supporting a child to feel calm, secure and settled during a procedure. In a supportive hold a child agrees to the procedure and positioning and/or does not express signs of refusal.
What is in the rights-based standards?
The Rights-based Standards for Children Undergoing Clinical Procedures are based on internationally agreed children’s rights set out in the United Nations Convention on the Rights of the Child.
They cover the key aspects of a child’s rights during their procedure, including that a child has a right to be:
- Cared for by professionals who have the appropriate knowledge and skills to support their physical, emotional and psychological well-being and rights before, during and after their procedure
- Communicated with in a way which supports them to express (verbally or behaviourally) their views and for these views to be listened to, taken seriously and acted on
- Provided with meaningful, individualised and easy to understand information to support them to prepare and develop skills to help them cope with their procedure
- Supported to make procedural choices and decisions and for these choices to be acted on to help them gain some control over their procedure
- Positioned for a procedure in a supportive hold (if needed) and should not be held against their will
In addition the Rights-based Standards for Children Undergoing Clinical Procedures state:
- A child’s short and long-term best interests and well-being should be a priority in all procedural decisions
- A child’s health records should include clear documentation of a procedure and any use of restraining holds
What can nurses do next?
The standards are free to download and are being translated into Portuguese, Spanish and Swedish. A consultation on the standards is open until 1 June 2022, and it is important that nurses have their say and share their views and opinions about their content.
We are also keen to hear from young people and their parents.
Acknowledgement
The author would like to acknowledge and thank the iSupport team who have helped develop this article
Find out more
- Bray et al (2018) A qualitative study of health professionals’ views on the holding of children for clinical procedures: constructing a balanced approach. doi.org/10.1177/1367493518785777. Journal of Child Care
- Bray et al (2015) Holding children for clinical procedures: perseverance in spite of or persevering to be child-centered. doi.org/10.1002/nur.21700. Research in Nursing and Health
- Edge Hill University (2021) Rights Based Standards for Children Undergoing Clinical Procedures
- iSupport
- United Nations Convention on the Rights of the Child (1990)