Evaluation of a Nurse Practitioner Led Procedural Support Service for Children With Procedural Anxiety: An Effectiveness-Implementation Study

Abstract

AIM: To evaluate the clinical effectiveness of a Nurse Practitioner led procedural support service for children with procedural anxiety, and identify facilitators and barriers to its sustained implementation and optimisation. DESIGN: An effectiveness-implementation hybrid type 3 study used a prospective mixed methods evaluation approach. METHODS: From December 2022 to May 2023, data were collected from children, parents and clinicians using a nurse practitioner-led service at a quaternary paediatric hospital in Brisbane, Australia. A prospective audit assessed clinical outcomes, while qualitative interviews explored implementation barriers and facilitators. FINDINGS: The clinical audit (n = 40) confirmed the service was effective and safe, ensuring procedural completion with minimal distress. Descriptive statistics indicated low pain and anxiety scores. There was a moderate negative relationship between pain scores and the use of distraction techniques. Interviews with thirty-three participants showed the service improved access to procedural care, reduced the need for physical restraint and general anaesthesia, and enhanced clinical workflow through preadmission assessments. CONCLUSION: Utilising a Nurse Practitioner support service represents a safe and effective strategy to enhance access for paediatric patients with procedural anxiety. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This study underscores the significance of specialised nursing roles in managing paediatric procedural anxiety, offering a replicable model to enhance procedural outcomes and mitigate medical trauma across healthcare settings. IMPACT: Minimising pain and distress is important in all clinical encounters with children to reduce the risk of medical-related trauma and the future avoidance of healthcare. REPORTING METHOD: The report of study outcomes was guided by the Standards for Reporting Implementation Studies (StaRI) initiative. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not included in the design, conduct or reporting of the study.