Ask an answerable question (PICO)：
Fear and scared behavior are often shown in toddler while experiencing when are suppressed in the treatment bed during intravenous injection. Children will member this unpleasant experience if they are treated inappropriate as well as their attitude toward provided health care. This leads to strained relationship between Nurse-Patient. The purpose of this evidenced- based study was to explore what kind of caregivers’ holding position on toddler can decrease children’s fear and pain.
The Method and Analysis of Literature Review：
Key words for search are toddler, intravenous injection, hold, sit, lie down, fear and pain through PubMed MeSH Database using 「OR」and 「AND」. Database includes Cochrane Library, PubMed, Medline, and CEPS. This is a therapeutic issue. The inclusion criteria were systemic review or randomization articles. A total of 378 articles were searched and 2 randomization articles were included at the end due to excluding repetitive literature, accepting prone and sitting position.
Critical Appraisal：
According to Oxford CEBM 2011 Levels of Evidence grading system, the two articles belonged to level 2 evidence. Both articles were appraised by CASP (Critical Appraisal Skills Program). The three broad issues should be considered: Validity, Importance, and Practice. The participants were between 9 months to 4 years old. Family holding children on the leg or children sitting on a therapeutic bed and family holding their trunk were as experimental group while children lay down were as control group. Anxiety, fear, and pain were measured. The first article of ANOVA statistical analysis was used to analyze three stages (T1: before injection, T2: during injection, T3: after injection). There was significant difference between experimental group and control (P< .001) on fear and satisfaction. The second article result of a Mann-Whitney U test analysis showed a significant difference in the pain score between the intervention and control groups (P< .001). The parental holding and upright position can be applied as a non-pharmacological pain management strategy for children who undergo intravenous injection procedures.
Results, Conclusions and Recommendations：
This study revealed the through evidence-based search, children’s fear can be reduced significantly when patients held them on the leg, in front of chest, or holding their trunk while they were sitting on a therapeutic bed as well as improving parents’ satisfaction on care. This is a safe, effective, and non-invasive method but the samples are too little. In the clinical practice, local anesthetic paste or therapeutic play are used to alleviate children’s fear. We would recommend future study on these two methods for pediatric nursing staff.
