Developing a website to demonstrate clinical holding techniques

Abstract

Healthcare staff routinely use clinical holding to help infants, children or young people stay still when treatment is being administered, to prevent children or young people from interfering with the treatment, or when invasive examinations are being carried out. However, healthcare staff rarely have any formal discussion with children and young people, or their parents, on the techniques used for clinical holding. Visual tools are important when talking to children or young people about their healthcare, and a website with images of clinical holds would allow staff to discuss relevant holds with their patients. In this article, we describe a collaboration between Birmingham City University and Birmingham Children's Hospital to develop a website that presents 3D images of clinical holds, outlining how we introduced it to staff in the clinical areas that would benefit from it and how we have been evaluating its effectiveness. We hope this website will formalise the professional discussion of clinical hold techniques. This will allow information on the appropriate holds for different situations to be documented, which will enhance best practice. In addition, the website should provide information needed to allow children, young people and their parents to give true, informed consent for any procedures they need.

‘The mean mummy way’ – experiences of parents instilling eye drops to their young children as described in online forums and blogs

“…Having highlighted the difficulties experienced by some parents we need to consider possible solutions. The use of eye drop instillation aids may improve parental dexterity when administering eye drops to their children [ 28 ] and replacing liquid drops with ointment may also help. There is a recognised need for clinicians to describe and demonstrate eye drop administration techniques at the time of prescribing and pharmacists to reinforce these messages when dispensing the drops or ointment.…”

“…Our findings highlight a need for this advice to be extended to include tips on managing a young child’s reluctance to stay still and for parents to manage their own anxieties and distress. There are resources already available for training health care staff in restraint, for example “Evidence-based holding of children for clinical procedures” [ 28 ] and there are guidelines and information to help healthcare professionals to educate caregivers to instil eye drops to babies and young children [ 29 , 30 ]. In a brief informal review of currently available patient information leaflets and relevant websites we observed that they are generally strong on administration of medications into the eye, but less informative about dealing with an uncooperative recipient.…”

Restraint in paediatrics: A delicate balance

“…Notably, for many painful procedures, including venepuncture, vascular cannula insertion, lumbar puncture and chest drain insertion, the need for restraint can be reduced by judicious use of local anaesthetic (either topically applied or injected), sucrose solution for breastfeeding infants, nitrous oxide, ketamine or even general anaesthetic. The aim should also be to give more agency to children to assent to simple interventions when possible by providing age‐appropriate explanations, distraction techniques and ‘hugs’ not ‘holds’ …”

Clinical Holding in Pediatric Venipuncture: Caring by Empowering the Caregiver

“…quickly and effectively with the consent of the child. There are various synonyms for Clinical Holding including “Therapeutic Holding”, “Supportive Holding” and “Holding Still” [ 6 , 18 , 19 , 20 , 21 ]. The difference between Clinical Holding and Restrictive Physical Intervention (restraint) rests on the degree of force required, the patient’s consent and the underlying intent [ 5 , 6 , 18 , 19 , 22 ].…”