“It Could Become a Standard” – A Qualitative Study of the CARDTM System for Needle-Related Procedures in a Children's Hospital

Background: /Objectives: Needle-related procedures such as venous catheter access are common in pediatric hospitals and are a major cause of pain, stress and anxiety for those affected. Nowadays, a wide range of evidence-based support options are available, but it is often the professionals who decide which interventions are offered. In this study, we adapted the CARDTM (Comfort, Ask, Relax, Distract) system for needle-related proce-dures in hospitals. CARDTM was originally developed to encourage children to actively participate in their vaccination process at school. It allows them to choose from numerous evidence-based interventions in the four different letter categories (C-A-R-D) to reduce pain, anxiety and related vaccination symptoms. Our aim was to examine the experiences of using CARDTM during needle-related procedures in a children's hospital. Methods: A qualitative descriptive design was used. The sample included nine children aged 10 to 15 undergoing needle-related procedures and seven nurses who performed these procedures. We conducted individual interviews and asked them about their experiences with CARDTM. Data were evaluated using qualitative content analysis. Results: Four themes were identified: Awareness of options and needs; relationship building; empowerment; and acceptability. CARDTM was helpful for children in identifying available options, pre-paring themselves, recognising their own needs and developing strategies. CARDTM of-fered a concrete framework for action that promotes participation and self-efficacy and strengthens the relationship between nurses and children. In practice, CARDTM proved to be easy to implement and highly accepted. Conclusion: The present findings largely confirm previously published research results on CARDTM in the school vaccination setting.