TOPLINE:

A nurse practitioner (NP)-led procedural support service (NPLPSS) reduced pain and distress and enabled the safe completion of medical procedures in children with anxiety.

METHODOLOGY:

• Researchers conducted an effectiveness-implementation hybrid type 3 study using a prospective, parallel mixed-methods evaluation design, including 40 participating children (mean age, 12.6 years) with their parents and 14 clinicians at a quaternary-level pediatric hospital in Queensland, Australia.
• Overall, 73% of participants (n = 29) had generalized anxiety disorder and/or autism spectrum disorder. The majority of clinicians were women with at least 5 years of experience in pediatric care.
• Clinical efficacy was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, Visual Analog Scale for Anxiety (VAS-A), and Child-Adult Medical Procedure Interaction Scale-Short Form to assess pain, distress, and coping behavioral outcomes. Implementation was assessed using an exploratory qualitative approach through semi-structured interviews with children, parents, and healthcare providers.
• NPs observed the participants receiving the procedural care and used the University of Michigan Sedation Scale to evaluate sedation levels, with most children achieving moderate (53%) or minimal (38%) sedation.

TAKEAWAY:

• Most children did not experience distress throughout the procedure, with median FLACC scores of 0 before, 3 during, and 0 after procedures. NPs reported that most children showed low levels of distress before and after the procedure, with a peak median VAS-A score of 32 during the procedure.
• Child coping behavior demonstrated a significant positive correlation with staff coping-promoting behavior (P < .001), and child distress behavior was positively correlated with parent coping-promoting behavior (P = .03); parent distress-promoting behavior (P = .002); staff distress-promoting behavior; pain; and anxiety before, during, and after the procedure (P < .001 for all).
• A significant negative correlation was observed between behavioral interventions using phones or tablets and the highest FLACC scores during the procedure (P = .008).
• NPLPSS integrated moderate sedation and psychological care, which improved procedural success and reduced trauma. Although it cut costs and the need to use anesthesia, its impact was limited by funding gaps, a lack of clinician training, unpalatable medications, and restricted availability in hospital wards for children with anxiety.

IN PRACTICE:

“This study underscores the value of investing in advanced practice nursing roles to support children with procedural anxiety and medical complexity,” the authors of the study wrote, providing evidence for the NPLPSS “to be effective and safe, achieving positive procedural outcomes and meeting the needs of children, families, and clinicians.” They added, “Implementation outcomes highlighted the necessity for enhanced community engagement and resources to prevent escalating procedural anxiety.”

SOURCE:

The study was led by Karin Plummer, School of Nursing and Midwifery, Griffith University, Gold Coast, Australia. It was published online on December 07, 2025, in the Journal of Advanced Nursing.

LIMITATIONS:

The study was limited by its small sample size, lack of formal psychosocial screening of children, and limited resources for families of children with procedural anxiety. The opportunistic nature and time constraints in the study resulted in the absence of a baseline or pre-intervention analysis.

DISCLOSURES:

The study received support through an Australian College of Nursing research grant. One author reported receiving consultation fees to her employer from BD Medical. The rest of the authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.