Comfort Positioning in Pediatric Ambulatory Care

Introduction: What is comfort positioning (CP)? Why should healthcare providers in pediatrics use CP during procedures? CP continues our journey of teaching nonpharmacologic pain management (NPMT) as presented at the 2017 conference. This promotes a sense of control, reduces anxiety, and offers the child security from their caregiver (PAMI, 2017). Why have a “strange healthcare worker” restrain children when the caregiver can feel empowered playing an active role in their medical care? Common themes in the literature claim that “pediatric pain is often misunderstood” and “children do not feel pain the same way adults do” (Stanley & Pollard, 2013). Provider misconceptions include “there is not enough time” and “it doesn’t work anyway.” Invasive, painful procedures are being performed without offering NPMT or CP. Evidence-based practice has shown that topical analgesics, NPMT, and comfort holds decrease pain and increase comfort.

Methods: Data collection was from a free-standing pediatric ambulatory specialty care clinic with 23 divisions that averages 800 patients/day. A needs-based pre-survey on staff perception of CP definition and what divisions were currently utilizing CP or lack thereof was completed. Additional data was obtained from child life specialists and hospitals that have implemented CP. Patient complaints surfaced in 2018 as parents reported “my child was held down too tight and by too many people” and “this was traumatizing for my child.” A hot topic locally in the media was misuse of papoose boards at pediatric dental offices. Opportunity presented for our organization to evaluate current practice, remove papoose boards, and initiate CP. Hands-on educational sessions were presented to all divisions which included a brief review of NPMT, CP introduction, demonstration of CP for different ages, and communication techniques with pediatric patients.

Results: Common themes revealed that utilization of NPMT increased; however, CP was obsolete prior to CP educational sessions. During educational sessions staff members partnered and demonstrated CP utilizing return demonstration techniques while also role playing through case scenarios. Evidence supports when caregivers are provided information on what to expect during procedures and given an active role utilizing CP, their stress is lessened, which in turn can lessen the stress of their child. CP posters were displayed in each clinic as quick reminders for staff and families of options available to use. Weekly audits and patient satisfaction surveys are ongoing to ensure CP is being utilized appropriately.

Discussion: Physician support and education is needed in addition to training staff on NPMT and CP. Staff reported education was a success and they are now utilizing CP within their clinic. Staff comments included: “fewer people are needed to complete a procedure, procedures are completed in a timelier manner, and children are less frightened.” There have been zero parent complaints about improper restraining of children during procedures post education on CP. NPMT including distraction techniques and CP have proven to make painful procedures in ambulatory care less frightening and more comfortable for children.