Short summary

The major focus is to stop restraint and create a safe and confident blood sampling for children. Three initiatives will help children to prepare, teach coping strategies and to manage distress and pain during the blood test:

1. Preparation of children and parents. The preparation must ensure that both the child and its parents know what is going to happen, and teaching coping strategies.

2. A staff who meets the individual child and focus on better communication and distraction.

3. Environment that invites the child to explore and play, in order to help the child to cope with the blood test.

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Rationale

Making a blood test is one of the most common procedures in health care (WHO 2010). At the same time, procedures with needles can be very distressing, and are among the most feared of children (Uman, et al. 2013).

Every year around 15.000 blood tests are made on children at Kolding Hospital, a hospital in southern Denmark. The needle procedure often provokes severe distress and anxiety, and noncompliance is common among the children. As a result the clinicians find it necessary to restraint the child. This is of course a bad experience for the child, the parents and the clinicians.

Restraining the child can be more traumatic for the child than the sampling procedure itself (Walther-Larsen, S., et al. 2017) . Furthermore insufficient pain control during needle related procedures can produce long term negative effect such as increased pain and distress at the following procedures, needle phobia and avoiding medical interventions in the future (Birnie, KA., et al. 2014).

A prospective mixed-method cross-sectional study in Denmark showed high pain prevalence in children, most commonly mentioned by the children as being painful was needle procedures (Walther-Larsen, S., et al. 2017).

Knowledge to reduce pain during venipuncture in children, that is pharmacological and nonpharmacological interventions, has increased during the last decades (Walther-Larsen, S., et al. 2017).

This is the background for the project to develop and implement a more children centered care when making a blood test.

The purpose is to

• create a safe experience for children when making a blood test, especially without restraining
• Involve the children and improve collaboration between the children and phlebotomist
• Involve the parents and improve collaboration between the parents and phlebotomist
• Increase the competences for the phlebotomists - especially concerning communication and distraction
• altering environment that invites the child to explore and play, in order to help the child to cope with the blood test
• prepare the children and parents. The preparation must ensure that both the child and its parents know what is going to happen, and teaching coping strategies.

Overall the efforts are expected to make sampling for children more patient-centered and provide children, parents and staff with a more positive and safe experience. Children's experience of anxiety and pain in sampling is expected to decline, just as parents' and phlebotomists satisfaction is expected to increase.

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