"Keeping pace according to the child" during procedures in the paediatric intensive care unit: A grounded theory study.
Masayuki Iwata, Shigeko Saiki-Craighill, Ryouhei Nishina and 1 others
PMID 29550158WHAT IT FOUND
Experienced PICU nurses matched their procedural pace to the child's comfort and understanding rather than their own schedule.
This child-centred approach required combining pharmacological soothing with behavioural cues and clear communication to gain cooperation during painful procedures.
Key findings
01Nurses chose between two pacing strategies: matching the child's pace for comfort or maintaining their own pace for speed and efficiency.
02Child-centred care required nurses to interpret subtle non-verbal cues of pain or resistance, especially in sedated children who could not speak.
03Gaining child cooperation depended on a combination of soothing, checking understanding, and clear communication, not a single intervention.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study took place in a single academic hospital in Japan, limiting cultural generalisability. The sample was small, with only six children and seven observed procedures. The children were aged three to five, so findings may not apply to infants or adolescents. Nurses' interpretations of child behaviour were subjective and could not be verified against objective pain measures.
Declared interests
The study was funded by JSPS KAKENHI. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the nurse-centred pattern as a failure of care. The study found that nurses often chose this pattern deliberately for urgent or highly invasive procedures to minimise the total duration of pain, even if it meant ignoring the child's immediate comfort.