Guideline Title
Best evidence statement (BESt). Child life support during medical procedures.
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] |
Guideline Status
This is the current release of the guideline.
UMLS Concepts ( what's this?)
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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
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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
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
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
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.
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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.
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Evidence Supporting the Recommendations
References Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).
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Benefits/Harms of Implementing the Guideline Recommendations
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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.
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Implementation of the Guideline
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
Audit Criteria/IndicatorsFor information about availability, see the Availability of Companion Documents and Patient Resources fields below.
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Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
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Identifying Information and Availability
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
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.
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 Children's Hospital Medical Center Health Policy and Clinical Effectiveness Department at HPCEInfo@chmcc.org.
In addition, suggested process or outcome measures are available in the original guideline document  .
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) 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 HPCEInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.
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