Journal of Pediatric Nursing (2016) xx, xxx–xxx

Interactions Between Children and Pediatric

Nurses at the Emergency Department: A Swedish
Interview Study
Malin Grahn RN b , Emmy Olsson RN c , Marie Edwinson Mansson PhD, RchN a,⁎
a
Department of Health Sciences Centre, HSC, Medical Faculty, Lund University, Lund, Sweden
b
Department of Gynecology, blå stråket, Sahlgrenska Hospital, Gothenburg, Sweden
c
Department of Surgery Section 49, Blekinge Hospital, Karlskrona, Sweden

Received 18 January 2015; revised 20 November 2015; accepted 22 November 2015

Key words:
Admission to an emergency department can be considered a stressful event for both the child and the
Parents/family;
family. Due to the nature of traumas, illnesses and fatalities it is a chaotic forum in which good
Nurse's role;
communication between child and staff can be difficult to establish.
Pediatric nursing;
Purpose: The purpose of the study was to describe nurses' methods when interacting with children aged
Children;
three to six at a pediatric emergency department and to identify aspects in need of further investigation.
Encountering;
Methods: The study included seven nurses who work with children. The data were collected through
Emergency care;
semi-structured interviews and analyzed using qualitative content analysis.
Communication
Results: The analysis resulted in three main themes; fundamentals for being able to create a good
encounter, nurse's adaptations when encountering children and limitations associated with providing
child and family-centered care in the pediatric emergency department.
Conclusions: Healthcare organizations must create time to allow important communication to take place
between staff and pediatric patients so that children and families feel safe when being treated. The
implementation of effective measures to train staff in communication with pediatric patients is important.
Practice implications: The child should participate in his/her care and in procedures as much as possible. By
listening to children and their parents proposals, especially before invasive procedures, effective ways to
handle pain and discomfort may be developed.
© 2016 Elsevier Inc. All rights reserved.

Children react in very different ways to hospital visits and
admission due in part to previous life experiences and also
cognitive function and age (Edwinson Månsson & Enskär,
2011). Invasive medical procedures are some of the most
distressing aspects of illness and hospitalization both for
children and their parents. It is generally agreed that pediatric
health care professionals in particular have a crucial obligation to
manage pain and relieve suffering (Gozdzialski, Schlutow, &
Pittiglio, 2012; Kolcaba & DiMarco, 2005; Stephens, Barkey, &
Hall, 1999). Olsson and Jylli (2001) identified the fear of being
hurt as a major cause of children's anxiety. Admission to an
⁎ Corresponding author: Marie Edwinson Mansson, PhD, RchN.
E-mail address: Marie.edwinson_mansson@med.lu.se.
emergency department can be considered a stressful event for
both the child and his or her family. Due to the nature of traumas,
illnesses and fatalities with which staff of the emergency room
have to deal with, it is a chaotic forum in which good
communication can be difficult to establish (Gozdzialski et al.,
2012). Wissow et al. (1998) showed that even when nurses
communicate well, children are rarely involved in discussions
related to their own care. It has been argued that children who are
not involved in their care, might experience loss of control, less
feelings of security and are likely to experience more pain and
discomfort than children who are involved (Edwinson Månsson
& Dykes, 2004; Hemingway & Redsell, 2011; Runeson,
Mårtenson, & Enskär, 2007). If the nurse fails to create a feeling
of security for a child during a meeting or the child does not

http://dx.doi.org/10.1016/j.pedn.2015.11.016
0882-5963/© 2016 Elsevier Inc. All rights reserved.
2 M. Grahn et al.
understand what is happening he/she will experience anxiety
and fear.
According to the UN charter “Rights of the Child” every
child has the right to receive necessary and good health care,
information, education and to be involved in their own care
(UNICEF, 2009). Gozdzialski et al. (2012) described how
misuse of the emergency department (ED) for non-urgent
conditions has increased over the past decade. Lack of
resources, access to care and knowledge can all contribute to
the inappropriate use of the ED, which increases the number
of patients and adds to the waiting time for those who need
urgent treatment.
Nurses' Management of Children in the ED
All nurses and professionals working with children know
that information, preparation and different methods of
distraction prior to examinations and treatments can reduce
pain and discomfort, which can make the situation less
uncomfortable (Coyne, 2006a, 2006b; Coyne & Harder, 2011;
Edwinson Månsson & Dykes, 2004; Perry, Hooper, &
Masiongale, 2012; Stephens et al., 1999). Norena Pena and
Cibanal Juan (2011) emphasize the need to respond to children
as individuals and see to their needs. They also point out that it
is of great importance that the nurse establishes a well-
functioning relationship with pediatric patients as children
have different needs than adults. Children's ability to adapt to
the hospital environment and understand what is happening
around them is more limited than it is for adults. Dealing with
children is thus often challenging for the nurse. The nurse's
response may be important for children's experiences of care.
Furthermore, Norena Pena and Cibanal Juan (2011) propose
that the better treatment a child receives and the more secure
they feel, the more likely it is that they will regain their health.
Wente and Richfield (2013) conducted a systematic literature
review to examine nonpharmacological interventions used for
pain management of children in EDs. Fourteen articles met the
inclusion criteria. Findings suggest nonpharmacological
interventions such as distraction, positioning, sucrose and
cold application may be helpful in pediatric pain management
in the ED. Nurses can implement these methods independently
when caring for children and their families. Alex and
Whitty-Rogers (2012) suggest that nurses adapt their language
to suit the needs and values of individual patients and that this
may affect patients' experiences of care. The National Society
for Pediatric Nurses and the Swedish Nurses' Association
(2013) and Phair and Heath (2012) have jointly developed
guidelines for the professional conduct of specialist trained
pediatric nurses. The competence description proposes that the
nurse acts as the child's advocate, talks directly to the child as a
patient, is respectful, educational and empathetic and encour-
ages the child to be involved in his/her own care.
Nursing Theoretical Perspective
Kolcaba and DiMarco (2005) discuss the nurse's role when
interacting with children and the application of the “comfort
theory”, which aims to achieve a sense of comfort and security
for a child in care. They also pointed out that when working
with children, nurses ought always to individualize care and
apply a holistic philosophy. The nurse needs to be able to
identify and eliminate factors that can possibly make the child
feel insecure. By optimizing physical, social and environmen-
tal factors, the desired results defined in the comfort theory can
be achieved and thus the child's chances to recover health can
be increased (Kolcaba & DiMarco, 2005). Stephens et al.
(1999) listed several interventions to comfort children and
families during stressful procedures. Among them are (a)
preparing the child and parent, avoiding the word “pain” in all
explanations (social comfort); (b) inviting the parent/caregiver
to be present (social and psycho-spiritual comfort); (c) utilizing
the treatment room for stressful procedures instead of the
child's hospital room (environmental comfort); (d) positioning
the child in a comforting manner (physical comfort); and (e)
maintaining a calm and positive atmosphere (environmental
comfort). Locke, Stefano, Koster, Taylor, and Greenspan
(2011) show that the lower the quality of interaction and
communication is in a children's emergency room, the more
dissatisfied are the patients. They further describe that, at
present, research on factors that optimize interactions with
children in an emergency department is limited which also
Hemingway and Redsell (2011) point out. There are few
studies conducted with the aim of exploring how children can
become more confident and involved in their own health care.
However, it is known that if nurses treat children in a way that
induces a feeling of security and being involved, the children
will experience a better understanding and control over their
illness (Gozdzialski et al., 2012; Hemingway & Redsell, 2011;
Stephens et al., 1999). Therefore, it was considered of interest
to conduct a study to describe interactions between nurses and
children in emergency care and to identify important aspects
that might arise and need to be addressed. The aim of this study
was to describe nurses' methods when interacting with
children aged three to six at a pediatric emergency department
and to identify aspects in need of further investigation.
Methods
Design
This is an interview study using content analysis as
described by Graneheim and Lundman (2004) with an
inductive approach to the analysis. Before beginning the
interview process, a pilot study was conducted in order to
assess questions in the interview guide, in accordance with
Polit and Beck (2012). The pilot study illustrated that the
interview guide was sufficient and therefore no changes were
made. Interesting and relevant information was revealed
from the pilot study and was therefore included in the
analyses.
Ethical Considerations
Before the data collection was initiated the authors
applied to the Advisory Committee for Research Ethics in
Children’s Interactions With Pediatric Nurses
Health Education at Lund University for an advisory
statement about the study (VEN 135-13). Every participant
in the study was informed about confidentiality and informed
consent was sought. The Declaration of Helsinki (2013)
describes that it is essential that the researchers take into
consideration the integrity and confidentiality of participants.
The use of code numbers for the individuals who partook in
the study ensures that they remain anonymous to the reader.
All the interviews were recorded on a password-protected
phone for the transcribing process. During analysis the text
material was stored in a locked cabinet.
Inclusion Criteria
The manager of the department was informed of the study
before the data collection was initiated, and she gave her
written consent. A meeting was held at the ED (by two of
the authors, MB and EO) where the nurses were informed
about the aim of the study and the structure of the interviews.
They were also ensured that their responses would be
handled with discretion. Seven nurses gave their written
consent to participate.
Interviews took place at a pediatric emergency department
in southern Sweden in the fall of 2013. The criteria for
participation in the study were that the participant had to be a
licensed nurse and experienced in working with children
within emergency care. All participants were registered nurses
and six of the seven participants confirmed they had specialist
education in child and youth care and one participant had
education in emergency care. Participants had range of
5–40 years of experience in nursing at the time of the study.
Study Setting
Semi-structured interviews were used in order to obtain an
overview of the topic. Using this type of interview gives the
interviewer the opportunity to follow a structure while
simultaneously encouraging the participants, through open
questions, to develop and reflect on their answers (Polit &
Beck, 2012). The pediatric ED in this study has 13 rooms
plus one trauma room and is visited by approximately 20,000
children per year. Four daytime physicians are available each
day plus one extra physician on call and the number of
assistant nurses changes depending on workload and season.
Data Collection and Analysis
One of the authors (EO) conducted each interview, and
another author (MB) listened and took notes regarding
interactions between the interviewer and the participant. The
interviews began with general questions addressing the
informant's education and experience. The interview guide
(see Appendix) was then used for the interviews. Probes,
shorter follow-up questions, were used during the interviews,
which, according to Polit and Beck (2012) gives the
interviewee an opportunity to develop their answers with
more detail. Each interview was transcribed directly after it
was conducted by EO and MB. Interviews were conducted
until no further reflections came up.
3
A qualitative content analysis developed by Graneheim
and Lundman (2004) was used. The method which is
described as breaking down, interpreting and analyzing the
interview texts encompasses the following five steps:
meaning units, condensed meaning units, codes, subthemes
and themes. An inductive approach was used in the analysis
of the material in order to minimize pre-conceived ideas
from the authors. The analysis process began by identifying
meaning units in all the interview texts, which are sentences
or phrases that contain information pertinent to the aim of
the study. The authors (MB and EO) condensed these
meaning units, shortening them without changing the content.
Subsequently, codes were formed to summarize the meaning
units. An example of the analysis is demonstrated in a
flowchart in Figure 1 below.
Nine sub-themes were developed by amalgamation of the
codes. From the subthemes, three themes emerged. Data
analysis was conducted by all three authors in order to
enhance validity. Themes and subthemes are illustrated with
citations in the results. Individuals are referred to by the letter
“P” for participant, followed by a number.
Results
The three themes that emerged from the analysis were: the
fundamentals for being able to create a good encounter,
nurses' adaptations when encountering children and limita-
tions associated with providing child and family-centered
care in the emergency department. Themes and the nine
sub-themes are presented in Table 1.
Fundamentals for Being Able to Create a Good
Encounter
The fundamentals for being able to create a good
encounter are the nurses' professionalism, the nurse's
knowledge and experiences and the parent's role. These
factors were described as vital to the interaction.
The Nurse's Professionalism
The informants revealed that the nurse's professionalism
was indispensable in encounters involving children. They
also felt that they ought to always be in control, as they have
the expertise and experience, and therefore the responsibility.
It was, however important that while maintaining control of
the meeting, the nurse was aware of the need to not dominate
but to listen to the family's experiences of the problem. The
nurses emphasized the importance of their professional role
and maintaining an empathetic approach that creates calm
and security for those involved in the encounter. Creating
security was described as fundamental in order to achieve
the good encounter and to be able to help the children with
their problems.
“It is me who should help the child to become healthy, or at
least achieve better health in their disease.” (Participant 1)
In the emergency department, the child often has to
undergo procedures in order to determine what the health
4 M. Grahn et al.

Figure 1 The development of subthemes and a theme in the analysis process.

problem is. According to the informants, this can be needed in order to inform the child and the family about what
traumatic for children and families, and information plays is going to happen.
a significant role. The nurse must take the time and effort
“The more informed you are, the more you know what's
going to happen, the safer you will feel, both as a parent
Table 1 The analysis resulted in nine sub-themes which were
and child.” (Participant 5)
organized into three themes.
Sub-themes Themes The nurses stated that considerable patience is needed in
The nurse's The fundamentals for being the difficult situations they may be exposed to in
professionalism able to create a good meeting connection with the care of sick children and parents
The nurse's knowledge who feel frustrated when they don't know what is wrong
and experience with their child, as is often the case in an emergency
Parents' role department. Regardless, the nurses have to maintain their
Adjusting the Nurses' adaptations when professionalism in all situations.
environment encountering children
The child's The nurse's Knowledge and Experience
participation Experience, brings knowledge and thereby increased
Encountering the child
self-confidence for them in their professional role and in the
Communication Limitations associated with child
barriers and family-centered care in the ED
performance of their duties. It was revealed that experience
Time constraints and plays an important role in the nurses' encounters with
resource limitations children. Through experience, the nurses can more easily
Ethical approach read the child and the signals they give. Self-confidence
allows them to provide reassurance to the child.
Children’s Interactions With Pediatric Nurses
“Experience provides the ability to read body language,
read and interpret a child. And I think that is so exciting.
Not only is it what children say, but you can take everything
else into consideration as well.” (Participant 5)
The nurses considered knowledge as a key element of
their work. Knowledge of the child's different stages of
development and his/her illnesses and symptoms were all
equally important. In addition, the nurses expressed a
desire for training for self-reflection and how to handle
situations such as when parents become aggressive, in
order to increase the chances for a good encounter. Several
nurses described that in their daily work nurses needs to
find their own method of communicating with the child and
expressed a desire for training in effective ways to
communicate with children.
“There is never any training in, for example communica-
tion, how to meet the child, how to play with the child.
Everybody has to find their own way.” (Participant 2)
Parents' Role
The nurses explained that the child needs his/her parents'
help and support during an encounter at the emergency
department. They also said that usually it is an entire family
who needs to be taken care of. Although the child is the patient,
the parents have a significant role in the meeting. Parents can
provide nurses with relevant information pertaining to their
child's needs.
The importance of listening to the parents and informing
them in order to increase their sense of security and
comprehension was emphasized in the interviews. Further,
it was implied that by involving the parents and making them
feel safe they could contribute to a better contact and mutual
trust. The nurses noted how children are influenced by their
parents by interpreting signals the parents emit. For example,
if the parents feel insecure, this feeling will be conveyed to
the child as well, and can thereby obstructs the nurses' work
in achieving the child's cooperation.
“Then, I also think parents can influence their children
very much, in both good and bad ways. If a parent is
calm and, it seems that we're on the same team, I think it
will be easier.” (Participant 6)
The informants described that it was helpful when parents
took a passive and reassuring stance in the encounter. The
interviews revealed that some parents become overprotective
and act out their anxieties and fears. They are therefore less
susceptible to information as they have already created their
own view of the situation, which can result in the nurses'
contact with the child being compromised.
Nurses' Adaptations When Encountering Children
Nurses' adaptations when encountering children concern
adjusting the environment, stimulating the child's participa-
tion and encountering the child. Adaptations made by the
nurses were tailored to individual children's needs.
5
Adjusting the Environment
The nurses expressed that when coming into the
hospital in an emergency situation, children often feel
afraid. A child-adapted environment and the use of
tools such as toys or hospital material can be used to
help reduce children's fears and to enable a positive
encounter. The nurses described how they initiated the
encounter by means of a diversion, for example, by
initiating a game or distracting the child by talking about
funny things.
Another factor of importance that emerged was the use of
color in the surroundings, for example wearing colored
scrubs instead of white ones.
The child's participation
In the interviews, it was revealed that all participants
agreed that the child should be involved in his/her care
and that the child's participation has a significant role and
can facilitate a more positive encounter. The informants
reported that it is essential that the child feels important and
not ignored.
It was noted in the interviews that it is up to the nurses to
involve the child by inviting them into a conversation.
“An involved child is also a child that usually
cooperates.” (Participant 3)
The nurses described the challenge it implies to speak
to the child instead of his/her parents in an emergency
situation. The nurses often tried to involve the child in the
conversation as much as possible. Allowing the child to
test, feel, and play with the medical instruments was
common. However, the nurses thought there should be
some restrictions to the child's participation for the child's
own good. If an interaction results in the child believing
she/he has infinite power, the child may exhibit a
non-acceptance of certain procedures or treatments. This
may result in the child not receiving the help they came
there for.
Meeting the Child
The nurses pointed out that by interpreting the child's
signals it becomes easier to evaluate their needs and
reactions. Also, they often succeeded in making the child
feel comfortable with the situation, which consequentially
facilitated implementation of the treatment or procedure. By
meeting the child as an individual the nurses could identify
their individual characteristics, and thereby implement care
in an appropriate manner.
“All the time it's the individual encounters, to read and
see, how can we do this?” (Participant 5)
Several of the participants pointed out that children are
very observant and that communication is more than just a
dialogue. Accordingly, they described the nurse's charisma,
body language and the construction of a safe atmosphere as
being essential.
6 M. Grahn et al.
“Everything is communication, my body language, our
eye contact, our interaction, our verbal communication. I
use communication to get the child to feel secure and
confident.” (Participant 7)
It was pointed out that children can often be afraid of
medical care, but if they are given the time and help to
prepare themselves as well as information about what will
happen, it may relieve their fears and provide reassurance.
All the nurses emphasized the importance of honesty and
clarity in relation to information given to both children and
parents. The nurses also described the challenge of always
having to adjust to the child. They talked about strategies in
order to handle the situation when a meeting was not going
well, or when the positive communication was not achieved.
One example of a strategy to help in a difficult situation was
for another nurse to come in and try instead. It is always the
nurse's responsibility to find ways that could make a
situation more positive.
Limitations Associated With Child and
Family-Centered Care in the ED
Limitations were associated with barriers to communica-
tion, time constraints, resource limitations and maintaining
an ethical approach. As stated in the interviews, children
need to be met and respected as individuals, and nurses need
to implement their professionalism and competence in caring
for this unique population. In the interviews, it was revealed,
however, that some obstacles exist in emergency care which
could inhibit creating a successful encounter.
Communication Barriers
Many children who come to the emergency department have
never had any contact with health services before and for them
the environment is entirely unfamiliar. Also, the treatment that
needs to be implemented can be frightening for a child. It is
therefore, according to the nurses, not uncommon for children to
be in a state of fear at the thought of visiting a hospital for
treatment. This fear can complicate the nurse's work with the
child and might result in a less positive meeting.
“Maybe they are afraid from the start and then you can't
reach them” (Participant 6)
For example, if a child has had a negative experience with
healthcare before and is already afraid when he/she comes in
to the hospital, the nurse can find it difficult to reverse the
child's feeling of fear at a new meeting. Nurses also noted
that linguistic problems can affect an encounter with a child.
For example, when a patient is admitted who speaks another
language, it can result in the problem that none of the parties
understand each other which can lead to misunderstandings.
Time Constraints and Resource Limitations
According to the nurses time is scarce in emergency care,
which affects their encounters with children and their
families. The participants expressed that sufficient time to
do a thorough job is requested by all staff, as it is necessary in
order to build trust with a child.
The nurses try to do the best in the situation by giving,
where possible, the time the child needs for a positive
encounter. A consequence of lack of time could be that the
quality of the encounter with the next child awaiting
treatment is reduced. It then becomes difficult to maintain
a calm atmosphere and the nurse may not be able to prepare
the child or obtain a positive relationship with the child. The
nurses were of the opinion that if sufficient time was allowed
for each encounter, every child would receive the necessary
time to help them feel secure. That, in turn, would save time
later in the care process due to the fact that positive contact is
already established.
“You should give them the time that they need. Then it
might not always be so that I have that time. Then I have
to make some time” (Participant 4)
All the nurses expressed that a major obstacle to
creating good encounters with children in emergency care
is limited resources. The amount of patients, staff shortages
and misguided prioritizing by managers impair nurses'
ability to provide good care. The nurses described how,
when the child emergency room is overloaded, the
resources need to be increased to meet the demand so
that patients won't be negatively affected. It is essential to
have sufficient staff as this helps to eliminate problems
such as stress and waiting time. The nurses also reported
that management prioritizes effective work by the nurses
rather than quality in patient meetings.
“The staff is, we are not so many. There are many
patients. Management talks little about quality. They talk
a lot about the high flows. High flows will be a bit more
production based, ‘fast in, and fast out.’” (Participant 2)
Ethical Approach
The nurses described that the work with children involves
ethical judgment. For example, children do not always want
to participate in health care. The participants discussed
whether in such a scenario treatment and nursing procedures
should be forced on the child. The nurses agreed that forcing
treatments and procedures on the child rarely resulted in a
positive interaction with the children and they would rather
avoid having to use force.
“There are children who won't, for example, hold up their
finger voluntarily despite all the strategies. I think forcing a
child, is the hardest part to accept. And I don't know if we
really are entitled to use force.” (Participant 7)
The nurses further described that they actually have a legal
obligation toward the children. For example, the nurse must
not violate the child's rights. At the same time they have an
obligation to protect them, such as by reporting child abuse if
it occurs.
Children’s Interactions With Pediatric Nurses
Discussion
The aim of this study was to describe the nurses'
methods when encountering children aged three to six in a
pediatric emergency department and to determine any
limitations to nurses' work in this area. The results of the
study describe parents as a link between the nurse and the
child, which is in line with the results of Espezel and Canam
(2003) study, where they emphasize the importance of
collaboration and the establishment of a stable relationship
between parents and the nurse, in order to give the child
adequate care. The participants in the current study were
however, of the opinion that if the parents take an
overprotective and overactive stance, it might compromise
the nurse's ability to interact therapeutically with the child.
The child is the nurse's patient and should therefore be
given the most attention.
The respondents in this study suggest that if the child is
not given an opportunity to participate in his/her care it can
result in the child experiencing stress, loss of control and
diminished trust. This can, in turn, lead to possible negative
consequences for the child's future care and these results are
in line with findings by other researchers (Gozdzialski et al.,
2012; Kolcaba & DiMarco, 2005; Stephens et al., 1999).
Clayton (2000) points out that adults in the vicinity of
the child are responsible for determining how much and in
what way the child participates in his/hers care, which also
was expressed by respondents in the current study. Nurses
should be aware of the consequences of not allowing
children to participate in their own care and of not providing
sufficient comfort to the child (Clayton, 2000; Stephens
et al., 1999). The results in the current study demonstrate
that there is often insufficient time available in healthcare
systems, but that time to provide care for children and build
trust should be given high priority. According to Bricher
(1999) establishing trust is the key to cooperation with a
child, which is not a process that can be rushed. Bricher
(1999) also notes that if the nurse is rushed, it is difficult for
them to create time and patience for their meeting with
children. The nurses in the current study emphasize that
time and patience are always necessary in child care
regardless of the nurse's current workload. As the results
show that the pediatric emergency department, where this
study was conducted, has minimal time and resources. This
study therefore can help nurses to advocate more for the
time and resources necessary to give good care to children.
The results illustrate that children's fear is a recurring
factor that the nurses must cope with. Children often have a
fear of hospitals due to previous experiences which can be an
obstacle in establishing trust and communication with a child
in a hospital setting. According to Kolcaba and DiMarco
(2005) nurses must identify those factors that cause fear and
eliminate these.
Limitations
An advantage of qualitative interviews is that they are
relatively open and the respondents are free to answer as they
7
wish. The authors of this study sought to build a secure
atmosphere for the participants before the interviews began,
for example, by asking simple introductory questions and
showing interest in the participant. The goal was to ensure
that the participants felt comfortable so that they would
answer honestly with the result that the answers would be as
trustworthy as possible in accordance with Kvale and
Brinkmann (2009). If more respondents had participated in
the study the results might have been strengthened further
and the credibility increased. However, there are, according
to Kvale and Brinkmann (2009), no standard rules in
qualitative interview research for how many interview
subjects should be included. The only inclusion criteria for
the study were that the participants were registered nurses
and had experience of working with children at an
emergency care unit. These inclusion criteria were chosen
to ensure a wide range of child nursing experience among the
participants. The authors of this study believe that different
perspectives provide a more holistic picture of the encounter
between the nurse and the child.
The first and second authors (MB and EO) each have
several years' experience of working in general nursing and
the third author (MEM) has extensive experience in
pediatric nursing. In order to minimize author bias during
the process of analysis, the authors' prior knowledge of the
area of research was made explicit and discussed openly. A
content analysis, according to Graneheim and Lundman
(2004), was chosen due to its being an efficient model with a
limited number of steps, making the analysis procedure
more efficient to follow. This may reduce the risk of losing
information and increases the credibility according to
Graneheim and Lundman (2004).
Our results may be transferable to other child emergency
departments in Sweden if they are working within an
equivalent structure, in this case, similar care units (Hällgren
Graneheim & Lundman, 2008). However, it would have
been desirable that the study had been conducted with more
participants as well as more child emergency departments in
order to strengthen the evidence of transferability. Further-
more, the results may not be applicable in other countries
whereas practices and organizations differ; however, studies
conducted in other international settings might provide
additional insights as to commonalities and differences.
Conclusion
All participants agreed that the child should be involved
in his/her care and that the child's participation has a
significant role in facilitating the encounter between the child
and healthcare. The continued development of effective
means of decreasing discomfort during invasive procedures
is an important goal for health care professionals. By
listening to children and their parents proposals, especially
before invasive procedures, effective ways to handle pain
and discomfort may be developed. It appears from the results
presented here, that the nurses who took part in this Swedish
study are working in line with the intentions of the
8 M. Grahn et al.
Children's Convention. Future studies should focus on how
healthcare organizations can create time to allow important
communication to take place between staff and pediatric
patients. The implementation of effective measures to train
staff in communication with pediatric patients is important.
Acknowledgements
We would like to express our gratitude to the nurses who
agreed to share their experiences with us. Grateful thanks to
Dr. Marie Hübel for constructive criticism.
Appendix
Interview guide
1. Tell us about a good meeting you have had with a child
at this emergency department?
- What factors do you think contribute to making a
meeting good?
- Do you think a good meeting will affect the patients'
outcome and if so, in what way?
- Tell me about a meeting you didn't think went well?
- According to you, what is the reason a meeting is not
successful?
- How do you try to resolve the situation if you feel like
the meeting isn't going well?
2. What aspects do you think are important when
encountering children?
- What do you think can facilitate meeting and treating
children?
- What can complicate meeting and treating children?
3. A factor in work associated with children is the ability
to create security.
- What are your thoughts about that?
4. What role does communication play when working
with children?
- What do you think is the best way to communicate
with children?
- What role do you think the parents should have
during the meeting and in the communication?
5. What are your thoughts about the child's participation in
his/her own care?
- What tools do you use to make the child more involved?
6. Everything you have described about the way a
meeting with a child should be, does it work or are there
any obstacles?
- Do you think your personality plays a big role in the
meeting?
7. Do you think there is something regarding the funda-
mentals for being able to create a good meeting that can be
improved and if so, can you give any examples?
- How do you try to optimize the meeting with the
child, as a nurse?
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