Department: CLINICAL QUERIES
Vicki Martin is a nursing instructor and pediatric course coordinator at Francis Marion University in Florence, S.C.
The author has disclosed that she has no financial relationships related to this article.
In the ED where I work, some of my patients are children. What's the best way to guide their attention away from painful stimuli and reduce pain and anxiety?—V.L., TEX.
Vicki Martin, MSN, RN, replies: Gaining the cooperation of the child and family is essential for a successful interaction that encompasses the child and family, and considers the child's age, developmental level, cognitive and communication skills, and culture. Because getting children to cooperate can be a challenge, you may need to use age-appropriate distraction techniques. Using distraction can reduce the time and staff members needed for a procedure and, compared with using some analgesics, can save costs.1 Remember that the parent or legal guardian is the expert about the child and needs to be involved and available to act as a positive assistant during an assessment or procedure.
Children aren't just “little people.” Keep the child's developmental level in mind when selecting various forms of distraction. Child life specialists, well-versed in the growth and development of children, can assemble age-appropriate items to use for distraction techniques in comfort or coping kits. (See Providing age-appropriate distraction techniques.) Recognize the expertise of these specialists and include them in a multidisciplinary team approach to keep a child's hospital experience positive.
Now let's see how these kits are applied in practice. “Sarah,” age 3, comes into the ED and starts crying because she's afraid she'll “get a shot.” After asking the mother to hold Sarah in her lap to console and support her, her nurse offers the child an age-appropriate comfort kit.2 This kit includes puppets and dolls for acting out what's about to happen, stories about being sick, puzzles with large pieces, and kaleidoscopes. Sarah chooses a story about a visit to the doctor, and her mother reads it to her. Sarah's cooperation was easily obtained with this distraction technique.
Distraction techniques produce a win-win situation for children, families, and healthcare professionals when they're appropriately used to gain cooperation for a successful outcome.3
3. American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Caring for Our Children, National Health and Safety Performance Standards: Guidelines for Early Care and Early Education Programs. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association; 2011.
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