Holding Children for Clinical Procedures: Perseverance in Spite of or Persevering to be Child-Centered.

Children in acute care often need procedures and interventions, and they are frequently held, often against their wishes, to enable these procedures to be completed. This report is from a qualitative investigation in which we sought to explore what happens when children undergo clinical procedures within an acute hospital, with a focus on the use of holding for procedures. Qualitative data were generated through non-participant observation of clinical procedures (n = 31) and semi-structured interviews with health professionals (n = 22), parents (n = 21), and children (n = 4) to explore the event from the participants' perspective. Data were analyzed using constant comparison. Through the central theoretical concept of perseverance, we examined the actions, inactions and interactions of health professionals, parents and children during a clinical procedure. Two broad trajectories were noted: "perseverance in spite of," when the procedure was completed despite a child's upset and lack of co-operation; and "perseverance to be child-centered," which was characterized by a purposeful plan of action focused on a child who had been prepared and informed, and which was facilitated by a "window of opportunity" at the start of the procedure when the child was calm and engaged. Our findings highlight that professionals need to be clear about their boundaries when starting or continuing with a procedure when a child is distressed, and support preparation and engagement activities with children and parents before, during, and after clinical procedures.