Holding Children for Clinical Procedures: Perseverance in Spite of or Persevering to be Child‐Centered

Abstract

Children in acute care often need procedures and interventions, and they are frequently held, often against their wishes, to enable these procedures to be completed. This report is from a qualitative investigation in which we sought to explore what happens when children undergo clinical procedures within an acute hospital, with a focus on the use of holding for procedures. Qualitative data were generated through non-participant observation of clinical procedures (n = 31) and semi-structured interviews with health professionals (n = 22), parents (n = 21), and children (n = 4) to explore the event from the participants' perspective. Data were analyzed using constant comparison. Through the central theoretical concept of perseverance, we examined the actions, inactions and interactions of health professionals, parents and children during a clinical procedure. Two broad trajectories were noted: "perseverance in spite of," when the procedure was completed despite a child's upset and lack of co-operation; and "perseverance to be child-centered," which was characterized by a purposeful plan of action focused on a child who had been prepared and informed, and which was facilitated by a "window of opportunity" at the start of the procedure when the child was calm and engaged. Our findings highlight that professionals need to be clear about their boundaries when starting or continuing with a procedure when a child is distressed, and support preparation and engagement activities with children and parents before, during, and after clinical procedures.

Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians

“…A naming-discussion about using restraint on children is found in research literature, guidelines, and opinion papers (Bray et al, 2016; Brenner et al, 2014; Royal College of Nursing, 2003, 2010). Naming or symbols in use are not irrelevant.…”

“…Bray, Snodin, and Carter (2015) suggested that over time the emotional upset of children during medical procedures can become an accepted and expected part of practice and be regarded as something that is not necessary to mitigate or prevent. It means that procedures can be completed despite a child’s upset and lack of cooperation (Bray et al, 2016). …”

“…Pearch (2005) and others has called for discussions on restraint during medical procedures (Bray et al, 2016, 2015). When there is a lack of professional consensus, personal meanings and reasoning are ascribed to the situation and may result in differing priorities and actions (Blumer, 1969).…”

“…Potential challenges are related to healthcare providers’ double roles as appliers of restraint and providers of safe treatment, comfort, and care (Babl et al, 2012). Restraint can be challenging but has been sparingly investigated in paediatric practice (Bray, Carter, & Snodin, 2016). Furthermore, few studies have explored both physicians’ and nurses’ perspectives in these situations.…”

Strategies parents use to give children oral medicine: a qualitative study of online discussion forums

“…We categorized the techniques used by parents into strategies according to the parent–child interaction, as interactions between children and caregivers are known to shape how medical procedures are experienced [22]. Previous descriptions of techniques used by parents in other articles [6–16] were readily categorized into the three main strategies as long as the articles gave enough details about the parent–child interaction.…”