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  • Guideline Summary
  • NGC:008990
  • 2011 Dec 22

Best evidence statement (BESt). Child life support during medical procedures.

Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Child life support during medical procedures. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Dec 22. 5 p. [5 references]

View the original guideline documentation External Web Site Policy

This is the current release of the guideline.

Major Recommendations

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a‒5b) are defined at the end of the "Major Recommendations" field.

It is recommended that children ages 0–18 years old receive developmentally appropriate preparation and support led by either parents, a Child Life Specialist or nurses for intravenous catheter placement, immunizations and laceration repair, to reduce the amount of procedure related distress and anxiety (Chambers et al., 2009 [1a]; Stevenson et al., 2005 [2a]; Cavender et al., 2004 [2b]; Gursky, Kestler & Lewis 2010 [4a]).

Definitions:

Table of Evidence Levels

Quality Level Definition
1a or 1b Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5a or 5b General review, expert opinion, case report, consensus report, or guideline
5 Local consensus

a = good quality study; b = lesser quality study

Table of Recommendation Strength

Strength Definition
It is strongly recommended that…
It is strongly recommended that… not…
There is consensus that benefits clearly outweigh risks and burdens (or vice versa for negative recommendations).
It is recommended that…
It is recommended that… not…
There is consensus that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

Clinical Algorithm(s)

None provided

Disease/Condition(s)

Pediatric conditions requiring medical procedures

Guideline Category

Management

Clinical Specialty

Family Practice

Nursing

Pediatrics

Intended Users

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Guideline Objective(s)

To evaluate among pediatric patients if receiving support and/or distraction provided by a Child Life Specialist during medical procedures compared to not receiving support and/or distraction from a Child Life Specialist during medical procedures affects the child's anxiety during the time of the medical procedure

Target Population

Children ages 0–18 years old receiving medical procedures

Interventions and Practices Considered

Support and distraction provided by a Child Life Specialist, parents or nurses during medical procedures

Major Outcomes Considered

Anxiety level

Methods Used to Collect/Select the Evidence

Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

Search Strategy

  • Filters: English
  • Limits: None
  • Date Ranges: All dates included
  • Date of last search: 04/05/2011
  • Search Terms: Pediatric patients, supporting pediatric patients during medical procedures, anticipatory anxiety, anxiety, Child Life Specialist, child medical procedures, minimally invasive procedures, support, sensory information, sensory support, psychological interventions
  • Databases: PubMed, Medline, CINAHL

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence

Weighting According to a Rating Scheme (Scheme Given)

Rating Scheme for the Strength of the Evidence

Table of Evidence Levels

Quality Level Definition
1a or 1b Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5a or 5b General review, expert opinion, case report, consensus report, or guideline
5 Local consensus

a = good quality study; b = lesser quality study

Methods Used to Analyze the Evidence

Systematic Review

Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations

Expert Consensus

Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Table of Recommendation Strength

Strength Definition
It is strongly recommended that…
It is strongly recommended that… not…
There is consensus that benefits clearly outweigh risks and burdens (or vice versa for negative recommendations).
It is recommended that…
It is recommended that… not…
There is consensus that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation

Peer Review

Description of Method of Guideline Validation

This Best Evidence Statement has been reviewed against quality criteria by 2 independent reviewers from the Cincinnati Children's Hospital Medical Center (CCHMC) Evidence Collaboration.

References Supporting the Recommendations

Cavender K, Goff MD, Hollon EC, Guzzetta CE. Parents' positioning and distracting children during venipuncture. Effects on children's pain, fear, and distress. J Holist Nurs. 2004 Mar;22(1):32-56. PubMed External Web Site Policy

Chambers CT, Taddio A, Uman LS, McMurtry CM, HELPinKIDS Team. Psychological interventions for reducing pain and distress during routine childhood immunizations: a systematic review. Clin Ther. 2009;31(Suppl 2):S77-S103. [40 references] PubMed External Web Site Policy

Gursky B, Kestler LP, Lewis M. Psychosocial intervention on procedure-related distress in children being treated for laceration repair. J Dev Behav Pediatr. 2010 Apr;31(3):217-22. PubMed External Web Site Policy

Stevenson MD, Bivins CM, O'Brien K, Gonzalez del Rey JA. Child life intervention during angiocatheter insertion in the pediatric emergency department. Pediatr Emerg Care. 2005 Nov;21(11):712-8. PubMed External Web Site Policy

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

Potential Benefits

Reduced anxiety

Potential Harms

Not stated

Qualifying Statements

This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools

Audit Criteria/Indicators

For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Patient-centeredness

Bibliographic Source(s)

Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Child life support during medical procedures. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Dec 22. 5 p. [5 references]

Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released

2011 Dec 22

Guideline Developer(s)

Cincinnati Children's Hospital Medical Center - Hospital/Medical Center

Source(s) of Funding

Cincinnati Children's Hospital Medical Center

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Team Leader/Author: Lauren P. Wolfe, BS, CLS II, Division of Child Life and Integrative Care

Support/Consultant: Mary Ellen Meier, MSN, RN, CPN, EBP Mentor, Center for Professional Excellence Research & Evidence-Based Practice

Ad Hoc/Content Reviewers: Kitty O'Brien, MA, CCLS, Clinical Manager, Division of Child Life and Integrative Care

Financial Disclosures/Conflicts of Interest

No financial conflicts of interest were found.

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center Web site External Web Site Policy.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Availability of Companion Documents

The following are available:

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

In addition, suggested process or outcome measures are available in the original guideline document External Web Site Policy.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on May 8, 2012.

Copyright Statement

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of this Cincinnati Children's Hospital Medical Center (CCHMC) External Web Site Policy Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

  • Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
  • Hyperlinks to the CCHMC website may be placed on the organization's website
  • The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents
  • Copies may be provided to patients and the clinicians who manage their care

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

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