“It Could Become a Standard”—A Qualitative Study of the CARDTM System for Needle-Related Procedures in a Children’s Hospital

Background/Objectives: Needle-related procedures such as venipuncture are common in pediatric hospitals and are a major cause of pain, fear and distress for those affected. Despite the availability of a wide range of evidence-based support options, it is often the professionals who decide which interventions are offered. In this study, we adapted the CARDTM (Comfort, Ask, Relax, Distract) system for needle-related procedures in hospitals. CARDTM was originally developed to encourage children to actively participate in their vaccination process at school. It allows them to choose from numerous evidence-based interventions in the four different letter categories (C-A-R-D) to reduce pain, fear and related vaccination symptoms. Our aim was to examine perceptions of CARDTM for needle-related procedures in a children’s hospital, including aspects of acceptability, feasibility, self-efficacy in managing fear and pain, and overall experiences. Methods: A qualitative descriptive design was used. The sample included nine children aged 10 to 15 undergoing needle-related procedures and seven nurses who performed these procedures. We conducted individual interviews and asked them about their experiences with CARDTM. Data were evaluated using qualitative content analysis. Results: Four themes were identified: awareness of options and needs; relationship building; empowerment; and acceptability. CARDTM helped children identify available options, prepare themselves, recognize their own needs and select strategies. CARDTM offered a concrete framework for action that promoted participation and self-efficacy and strengthened the relationship between nurses and children. In practice, CARDTM was perceived to be easy to implement and acceptable. Conclusions: The present findings suggest the applicability of CARDTM for hospital needle-related procedures.