NU225CL Unit 4 Pediatric IV Start Skills Reflection Example

The Tourniquet, Not the Needle: A Skills Reflection From the Chair Holding the Tablet During a Composite Five-Year-Old's IV Start, on Which Distraction Suited a Preschooler, Which Word Backfired and What the Second Attempt Changed

[Student Name]

Purdue University Global

NU225CL: Pediatric Nursing Clinical

Unit 4 Skills Reflection

[Instructor Name]

[Date]

The child, family and staff are composite; the student assisted with distraction only, and the IV was placed by the assigned nurse.

Before

[Mia], composite, 5, came in dry and listless after a stomach virus and needed an IV for fluids. Numbing cream was applied to both hands [40] minutes before the attempt, as ordered. The child life specialist walked Mia through the steps with a doll: "First a tight band, then a cold wipe, then a little poke, then a tape bracelet." Her mother chose to stay. My job was to hold a tablet with her favorite cartoon and blow bubbles when the nurse was ready.

During

Mia lay on the bed with her mother beside her. When the nurse tightened the tourniquet, Mia screamed, not at the needle, which had not yet appeared, but at the band squeezing her arm. I said, "It's only going to be a little pinch," which was not what she was worried about. She cried, "You said it wouldn't hurt!" when the needle went in, and pulled her hand. The first attempt missed.

She screamed at the tourniquet, not the needle, and I answered a fear she did not have with a promise I could not keep.

After

The nurse paused. The child life specialist suggested a change: Mia sat upright on her mother's lap, facing her, with her arm held gently along her mother's side. Her mother hugged her. This time I held the tablet at her eye level and asked her what the dog in the cartoon was going to do next, so she had to answer. The nurse warned her about the band: "It's going to squeeze like a big hug on your arm." The second attempt worked. Mia picked a purple bandage with stars and showed it to the dog on the screen.

Why the Second Attempt Worked

Preschoolers fear bodily harm and may imagine procedures are worse than they are, and lying flat can make a young child feel restrained and helpless (Perry et al., 2022). Sitting upright on a parent's lap, in a comfort position, gives the child a sense of safety and some control. Distraction works better when it engages the child actively, by asking questions, than when it simply plays in front of her. Psychological interventions such as distraction can reduce children's pain and distress during needle procedures, though the quality of the evidence is limited (Birnie et al., 2018). My word choice backfired. "Only a little pinch" is a promise that can be broken, and when it was, she trusted me less. Honest, specific language, such as describing the tourniquet as a tight hug, prepares a child for what she will feel and is recommended for children's procedures (Fein et al., 2012).

What I Did Well and What I Did Not

I held the tablet steadily and stayed calm. But I chose words without thinking about what Mia was actually afraid of, and I used passive distraction when she needed something to do.

Next Time: Two Changes a Helper Can Make

1. Ask before the procedure what the child is most worried about, and prepare her for that specifically, including the tourniquet.

2. Make the distraction active: questions about the show, counting bubbles together, choosing the bandage color in advance.

I will also avoid any promise about pain. Instead I will say what she will feel and that it will end.

What Her Mother Noticed

Afterward her mother told me that Mia hates having her arm held down, ever since a blood draw at her four-year checkup. If I had asked the mother before we started what Mia found hardest, I would have heard about the arm and the band, and we could have started on her lap from the beginning. Parents of young children often know the exact trigger, and asking is part of preparation, not a courtesy after the fact.

The Child Life Specialist's Role

Watching the child life specialist taught me as much as the procedure did. She prepared Mia with a doll, used words a five-year-old could picture and changed the plan quickly when the first attempt failed. A student helper can borrow her approach even when she is not on the unit.

How This Connects to My Objectives

My first objective was to prepare a child using preparation and distraction matched to her development. This procedure showed me that preparing for the needle alone is not enough, and gave me two specific changes to practice on my next procedure.

References

Birnie, K. A., Noel, M., Chambers, C. T., Uman, L. S., & Parker, J. A. (2018). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 2018(10), Article CD005179. https://doi.org/10.1002/14651858.CD005179.pub4

Fein, J. A., Zempsky, W. T., Cravero, J. P., & the Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine. (2012). Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics, 130(5), e1391-e1405. https://doi.org/10.1542/peds.2012-2536

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.