CLINICAL NURSES FORUM
NONPHARMACOLOGIC PEDIATRIC PAIN
MANAGEMENT IN EMERGENCY DEPARTMENTS:
A SYSTEMATIC REVIEW OF THE LITERATURE
Author: Sarah J. K. Wente, PhD, RN, Richfield, MN
Section Editor: Andrew D. Harding, MS, RN, CEN, NEA-BC, FAHA, FACHE
Earn Up to 9.0 CE Hours. See page 212.
Introduction: Children account for numerous ED visits each
year, with the majority of children reporting pain or requiring
painful procedures. The fast-paced, noisy environment, varying
resources, and staff trained in taking care of pediatric patients
make the ED a unique place to care for children in pain.
Nonpharmacological interventions are an essential part of pain
management. The purpose of this review was to examine what
nonpharmacological interventions EDs are using for pain
management in children ages birth to 18 years.
Methods: A systematic literature search was conducted to
examine nonpharmacological interventions used for pain
management of children in EDs.
Results: Fourteen articles met the inclusion/exclusion criteria.
Ten studies used distraction, 2 examined the use of sucrose, 1
pproximately one-third of patients visiting the
A emergency department are children and adolescents.
Seventy-seven percent of patients presenting to the
emergency department are in pain and/or require painful
procedures. 1-3 Busy, noisy emergency departments and
limited pediatric resources and/or staff trained in caring for
these patients, combined with acuity, create a set of unique
challenges for the patient, family, and care providers. 4-6 A
prompt and thorough assessment, combined with imple-
Sarah J. K. Wente is Adjunct Faculty, College of Nursing, Globe University/
Minnesota School of Business, Richfield, MN.
For correspondence, write: Sarah J. K. Wente, PhD, RN, College of Nursing,
Globe University/Minnesota School of Business, 1401 West 76th Street,
Richfield, MN 55423; E-mail: swente@msbcollege.edu.
J Emerg Nurs 2013;39:140-50.
Available online 28 November 2012.
0099-1767/$36.00
Copyright © 2013 Emergency Nurses Association. Published by Elsevier Inc.
All rights reserved.
http://dx.doi.org/10.1016/j.jen.2012.09.011
140 JOURNAL OF EMERGENCY NURSING
explored cold application, and 1 looked at parental holding and
positioning. Benefits of using nonpharmacological methods
included decreased pain, distress, and anxiety reported by the
parent, child, and/or observer.
Discussion: Findings suggest nonpharmacological inter-
ventions such as distraction, positioning, sucrose, and cold
application may be helpful in pediatric pain management
in the ED. Nurses can implement these methods indepen-
dently when caring for children and their families. In
addition, nonpharmacological methods are relatively inex-
pensive to organizations.
Key words: Emergency department; Pediatric; Nonpharmaco-
logical pain management; Systematic literature review
mentation of nonpharmacologic and pharmacologic inter-
vention best practices, often leads to optimal pain
management for children. Although a significant amount
of pharmacologic best practice exists, evidence regarding
nonpharmacologic interventions is not well-known and not
always incorporated into the delivery of everyday patient
care. Therefore the purpose of this article is to present a
systematic literature review regarding nonpharmacologic
pain management techniques provided for children, from
birth to age 18 years, seeking ED care.
Overview of Nonpharmacologic Pain Management
Nonpharmacologic pain management is a broad term and
encompasses those interventions that do not use pharma-
cologic methods to treat pain. These types of interven-
tions are an “integral part of the care of all children
experiencing pain” 7 and include cognitive-behavioral and
physical approaches. Cognitive-behavioral approaches actively
engage children and help them to redirect their attention away
from fearful and painful procedures. 8 Examples of cognitive-
behavioral interventions include music, guided imagery,
VOLUME 39 • ISSUE 2 March 2013

Records identified from
database search
CINAHL 221
PubMed 1133
Total 1354
Number of records screened
1358
Number of studies included in the
systematic review 14
FIGURE
Search results.
distraction, hypnosis, relaxation techniques, controlled
breathing, and biofeedback exercises. 8 Nonpharmacologic
physical approaches include hot and cold application,
massage, stroking, swaddling, sucking, splinting, acupunc-
ture, temperature regulation, and transcutaneous electrical
nerve stimulation, 1,9,10 as well as cutaneous stimulation to
reduce pain perception. 11
The goals of nonpharmacologic interventions are to
decrease fear, reduce distress and pain, and give children a
sense of control. 8 Both physical and cognitive-behavioral
approaches are essential to providing a comfortable environ-
ment for the child. 12 In addition, using nonpharmacologic
interventions during medical procedures has been found to
reduce the stress experienced by parents, and nurses can
independently implement these practices and encourage
family members to actively participate in the patients’ care.
Incorporating nonpharmacologic interventions should be an
essential part of pediatric pain management in the emergency
department, alone or in conjunction with pharmacologic
measures based on the needs of the child.
The choice of nonpharmacologic interventions varies
by the age of the child and developmental factors. Common
nonpharmacologic interventions for infants in pain include
pacifiers, swaddling, holding, rocking, singing/music, and
sucrose via pacifier, syringe, or gloved finger. 9,10,13-19
Distraction using toys and books is often used for younger
children, whereas older children may use video games or
computers. Physical strategies that are beneficial to children
and adolescents include hot or cold application, pressure,
massage, acupuncture, or immobilization. 1,9
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Additional records through article
reference lists
4
Number of records excluded
1344
Reasons for exclusion
• Study not conducted in ED
• Sample >18 years
• Pharmacological
intervention
• Expert Opinion
Systematic Literature Search
The purpose of this systematic literature review was to
address the following question: What nonpharmacologic
interventions are emergency departments using for pain
management in children? CINAHL (Cumulative Index to
Nursing and Allied Health Literature), PubMed, and the
Cochrane database were searched. To capture pain manage-
ment practices after the release of the Agency for Healthcare
Policy and Research (now known as the Agency for
Healthcare Research and Quality) guideline, 20 articles
were limited to those published between January 1, 1995,
and December 1, 2010. All research articles involving
nonpharmacologic interventions with children aged 0 to 18
years in emergency departments were included. Articles were
excluded if they were not published in English, focused
solely on pharmacologic interventions, included adults only,
and/or addressed prehospital or inpatient pain strategies. A
search of PubMed, CINAHL, and the Cochrane database
yielded a total of 1,354 articles, and 10 articles met the
inclusion/exclusion criteria. Reference lists of the 10
identified articles were also reviewed, and 4 additional
articles met the inclusion/exclusion criteria. Thus a total
of 14 articles were identified that met the inclusion/
exclusion criteria for this review. The Figure displays
the search process. Seven of these studies used an
experimental randomized controlled design, five used a
quasi-experimental design, and two were descriptive studies.
The majority of studies (n = 10) compared responses in a
group of children who received a nonpharmacologic
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TABLE
JOURNAL OF EMERGENCY NURSING

Summary of articles included in systematic literature search

Author Type of Type of Type of study Sample Outcome Instruments Results
intervention procedure variables
Carlson et al 27 Distraction Venipuncture 2-Group 384 Pain, distress, VAS-fear scale, No difference was found
(2000) using illusion or IV line randomized children, and fear PRS-R, between the control and
kaleidoscope insertion design aged 4-18 y, Oucher scale kaleidoscope groups for
13 sites observed behavioral distress
or child self-report of pain
and fear. No significant
differences were found
between the kaleidoscope
and control groups in
parent or nurse ratings
of fear.
Cavender Distraction using Venipuncture Experimental 43 children, Pain, fear, FACES, The experimental group
et al 28 choice of or IV line comparison aged 4-11 y and distress Glasses showed significantly lower
(2004) kaleidoscope, insertion group Fear Scale, fear compared with the
I Spy book, or PBCL control group as reported
Thomas the by CLS and parents
Tank lift and (P = .003, P b .001). No
flap book and significant difference was
parental found between child's
positioning self-report of pain or fear.
(side sitting or No difference in behavioral
chest to chest) distress was found between
groups as rated by the CLS.
Curtis et al 37 Sucrose, placebo, Venipuncture RCT 84 infants, Pain, crying FLACC On the basis of unadjusted
(2008) pacifier and sucrose, aged 0-6 mo time, and scale effects analysis, the pacifier
pacifier and placebo heart rate group showed decreased
change from pain compared with the
baseline group using no pacifier;
VOLUME 39 • ISSUE 2

the difference was not

significant (P = .06). On
unadjusted analysis, the
sucrose group was not
found to significantly affect
FLACC score change,
crying time, or heart rate.
March 2013

Regression analysis adjusted

for age showed that sucrose
compared with placebo
(P = .01) and pacifier
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compared with no pacifier

(P b .0001) yielded
significantly shorter
crying times.
Goymour Play therapist Venipuncture Control/ 100 children, Parent/child Author- The play therapy group was
VOLUME 39 • ISSUE 2

et al 29 using or cannulation intervention, aged 4-15 y rating of child designed significantly more prepared
(2000) distraction vs randomization preparedness, questionnaire (P b .001) and had a
standard care unknown child's distress, for parent significantly lower rating
and staff ease and child to of distress before, during,
jointly rate, and after the procedure
as well as compared with the standard
medical staff care group (P = .001,
member P b .001, and P = .002,
respectively). Medical
staff perceived the procedure
as quicker and easier when
the play therapist was present.
Malone 30 Distraction with IV line insertion, Equivalent 40 children, Behavioral Predominant Music intervention groups
(1996) music venipuncture, and matched aged 0-7 y distress Behavior showed significantly less
intervention injections, on age, Categories behavioral distress during
heel sticks procedure, List pre-needle and post-needle
and type of stages compared with
insertion the control group
(P b .05). In the music
group, children aged 0
to 1 y showed significantly
less distress during music
than older age groups
(P b .05).
Movahedi Cold therapy Venipuncture Quasi- 80 children, Physiological, CHEOPS, There were no significant
et al 11 experimental, aged 6-12 y behavioral, Oucher differences in physiological
(2006) treatment/ and scale, blood responses between groups
control subjective pressure, before or after procedure.
responses heart rate, The treatment group with

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WWW.JENONLINE.ORG

and an ice bag applied had

respiratory significantly less pain
rate behavioral responses
(P = .001) and self-reported
pain after the procedure
(P = .0097) than the
control group.
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TABLE
Continued
JOURNAL OF EMERGENCY NURSING

Author Type of Type of Type of study Sample Outcome Instruments Results

intervention procedure variables

Press et al 31 Active distraction Venipuncture Randomized 94 children, Pain and VAS combined There was no significant
(2003) via music controlled aged 6-16 y procedure with pain difference between
combined design duration face scale experimental and control
with uncertainty groups after controlling for
reduction confounding variables
of age and pain threshold.
No difference in duration
of procedure was found
between groups. Interactions
identified that in the
experimental group, female
patients reported lower pain
levels than girls in the control
group (P b .01); children
in the experimental group
reported lower pain levels
than controls only in children
with higher sensitivity
to pain (P b .05); and
children with a white blood
cell count of b 12,000 in the
experimental group reported
significantly lower pain
than those in the control group
(P b .05).
Rogers et al 38 Sucrose Bladder RCT, randomized 80 infants, Pain, crying DAN scoring Overall, no significant difference
(2006) catheterization double blinded aged b 90 d time, and system, a was found between the placebo
behavior measure of and control groups in pain
infant scores and crying time.
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behavioral Subgroup analysis showed

responses that infants aged 1 to 30 d
to pain had less pain (P = .035),
were significantly less likely
to cry during the procedure
(P = .008), and returned
to baseline behavior sooner
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(P = .04) after catheter removal

compared with the placebo
group. For infants aged N 30 d,
there was no difference
 March 2013

between groups in pain scores,

crying time, or return to
baseline behavior.
Sinha et al 32 Distraction using Laceration repair Random 240 children, Pain, distress, FPS, VAS for No difference in pain was
(2006) age-appropriate assignment aged 6-18 y and anxiety distress, and found between the control
VOLUME 39 • ISSUE 2

items including to control STAIC and intervention groups

music, video or invention for all children. Children
games, cartoon group aged b 10 y had a significant
videos, books, difference in distress as
or blowing reported by the parent
bubbles (P = .01); distress was lower
in the intervention group.
Anxiety was significantly
less in the intervention group
for children aged ≥10 y
(P b .001). There was no
difference in distress as
reported by the parent for
children aged ≥10 y.
Sobieraj et al 33 Distraction using Simple laceration Quasi- 57 children, Distress and PBCL and No difference was found in
(2009) music, parents repair experimental aged parental parental parental participation between
were encouraged 12-71 mo participation participation the control and intervention
to sing along during score (time groups. There were no
procedure distracting/ significant differences in
total procedure distress scores between the
time) intervention and control
groups based on parental
participation. The greatest
predictors of distress in the
child were age (young
children were more distressed)
and the presence of the
father (more distress) during
the procedure. A significantly

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higher mean distress score

was found if the father
was present compared with
when only the mother
was present (43.68 vs 23.39,
P b .001).
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TABLE
Continued
Author Type of Type of Type of study Sample Outcome Instruments Results
intervention procedure variables

Sparks et al 41 Parent holding IV line Randomized 118 infants/ Distress and PBRS-R and Significantly lower distress
(2007) and upright insertion experimental or children, parent and selected scores were found in the
positioning control group aged nurse items from experimental group during
of child 9-47 mo satisfaction PPSC all time periods (before,
during, and after) compared
with control (P b .001 to
P = .044); parents in the
experimental group reported
significantly greater satisfaction
with the child's position
(P = .034). Nurses reported
significantly greater satisfaction
with the child's position in
the control group (P b .001).
Tanabe 3 groups: standard Musculoskeletal Interventional 76 children, Pain and FACES, The group receiving standard
et al 34 care (ice, trauma study with aged 5-17 y patient numeric care and distraction had a
(2002) elevation, and systematic satisfaction rating scale, significant reduction in pain
immobilization), assignment and 2 patient ratings at 30 and 60 minutes
standard care to 1 of satisfaction (P b .05) compared with the
and ibuprofen, 3 groups questions group receiving standard
or standard care and the group receiving
care and distraction standard care and ibuprofen.
All groups had a significant
improvement in pain distress
from 0 to 30 minutes and at
60 minutes.
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Winskill Distraction boxes Not reported Descriptive 13 staff Use and Interview All responses indicated
et al 35 with age-appropriate resource benefits containing that, when used, distraction
(2008) toys people of distraction 5 questions boxes reduced pain and
boxes anxiety experienced by
children in the emergency
department; 6 people
reported that the use of
March 2013

distraction boxes decreased

the need for administration
of medications in children
needing procedures.
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FLACC, Face, Legs, Activity, Cry, Consolability; IV, intravenous; PBCL, Procedural Behavior Checklist; PBRS-R, Procedural Behavior Rating Scale, revised version; RCT, randomized controlled trial; PRS-R, Procedure Rating Scale-Revised; CHEOPS,
intervention with a control group who received standard care.

was found. Improved customer

service was shown by increased
additional benefit of decreased
distress and anxiety in parents Sample sizes ranged from 40 to 384 children. Studies were
music was “helpful” or “very

Children’s Hospital of Eastern Ontario Pain Scale; DAN, Douleur Aigue du Nouveau-ne´; FPS, Facial Pain Scale; STAIC, State Trait Anxiety Inventory for Children; PPSC, Parent Perceptions of Specialty Care; VAS, visual analog scale.
scores for pain management
pain and/or discomfort. An

conducted in the United States (n = 8), Canada, (n = 2),

and overall quality of care.

reported that listening to

Australia (n = 2), Israel (n = 1), and Iran (n = 1). A variety of

86% of patients/families

helpful” in decreasing

instruments were used to measure the outcomes of pain,

anxiety, fear, distress, and parental participation. Common
scales used to assess pain and distress were the FLACC (Face,
Legs, Activity, Cry, Consolability), 21 FACES, 22 Oucher
scale, 23,24 visual analog scale, 25 and Procedural Behavior
Rating Scale, revised version/Procedural Behavior Checklist. 26
Although little information exists specific to children in
emergency departments, the information on these scales
supports their use for assessment of pain in children in
Investigator-

4-question

emergency departments. The results of the systematic review

designed

survey

are presented, and the Table summarizes each article.

Nonpharmacologic Interventions Used

Patient/family
and families satisfaction

Distraction was the most common intervention used during

procedures to manage pain in children during their ED
visits. Ten studies described various distraction methods to
reduce pain, anxiety, and/or distress and increase parental
participation. 27-36 Five studies focused on 1 method of
distraction, such as music, 27,30,31,33,36 and five studies had
50 patients

more than 1 method of distraction available. 28,29,32,34,35 In

the 5 studies with only 1 method of distraction, the
distractor was selected by the researcher, whereas in the
other 5 studies, the child was allowed to choose. 28,29,32,34,35
Although research with a well-defined distraction interven-
Descriptive

tion allows an in-depth exploration of that particular

method, in practice, a variety of distractors for children to
select from takes into consideration their developmental
stages and preferences. However, exploring a combination
of interventions together makes it difficult to determine the
and painful
procedures

efficacy of the individual distractor.

Variety of
illnesses

Two studies examined the use of sucrose in infants in

the emergency department to reduce pain and distress. 37,38
Curtis et al 37 focused on sucrose during venipuncture,
whereas Rogers et al 38 looked at the effects of sucrose on
infants during bladder catheterization. In previous research,
sucrose has been primarily studied in the newborn nursery
with music

and neonatal intensive care unit. 39,40 Prior studies showed

Distraction

that infants given oral sucrose cried less and had a decreased
behavioral pain response compared with infants who
received a placebo during procedures. 39,40
Movahedi et al 11 were the only researchers to examine
the effect of local refrigeration, cold application, before
venipuncture on pain-related responses for school-aged
(2010)
et al 36
Young

children in the emergency department. Application of cold

is one method of cutaneous stimulation that has been used
to relieve pain and promote healing. In addition, applying

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cold to an area is thought to slow the ability of pain fibers to
transmit pain impulses. 21
One study compared parental holding and upright
positioning of the child versus traditional supine positioning
during intravenous insertion. 41 Alternative positioning for
children during painful procedures has been recommended
as a method to comfort children. 42
Systematic Review Results
Study results of the use of distraction in emergency
departments were mixed when using distraction as an
intervention to reduce pain in children. Two descriptive
studies described distraction as helpful for decreasing pain or
discomfort as reported by parents, children, or resource
staff. 35,36 Approximately half of the resource staff interviewed
reported that the use of distraction boxes—boxes in the
emergency department that contained selected age-appropri-
ate toys with instructions—reduced the need for pain
medication in children undergoing procedures and thought
the use of the distraction boxes minimized anxiety and pain in
children in the emergency department. 35 Improved customer
service shown by increased scores for pain management and
overall quality of care was also found. 36
Significantly less behavioral distress, decreased pain,
and more prepared children were reported in 4 studies using
distraction. 29-31,34 Parents’ and child life specialist's (CLS)
report of fear was significantly lower in the experimental
group in one study (P b .001, P = .003), although no
difference was found for children's report of fear in this
study. 28 Distress as perceived by the parent/guardian was
significantly less in the intervention group for children
younger than 10 years of age during laceration repair (P =
.01), whereas no difference in distress was found when the
children's report of distress was analyzed. 32 In children 10
aged years or older, situational anxiety was significantly less
in the intervention group compared with the noninterven-
tion group (P b .001). 32 Several studies reported additional
unique findings. Press et al 31 found an interaction effect for
gender and condition, with girls receiving distraction during
venipuncture. Girls in the experimental group reported
significantly less pain than girls in the control group
(P b .01). Sobieraj et al 33 found that significantly higher
distress scores were reported if the father was present than if
only the mother was present during laceration repair (P b .001).
Two researchers examined sucrose use in infants in the
emergency department, one during venipuncture and
another during bladder catheterization, and initially found
no significant differences in pain between the intervention
and control groups. 37,38 In the subgroup analysis of Rogers
et al 38 of infants aged 1 to 30 days, infants receiving sucrose
148 JOURNAL OF EMERGENCY NURSING
were significantly less likely to cry during the procedure
(P = .008) and had a smaller change in pain scores (P = .035),
indicating less pain, and their behavior returned to baseline
sooner after catheter removal (P = .04) compared with the
placebo group. Infants aged older than 30 days showed no
difference between groups in pain scores, crying time, or
return to baseline behavior. 33
Curtis et al 37 examined sucrose, placebo, and pacifier
use. They found that sucrose compared with placebo
(P = .01) and pacifier compared with no pacifier (P b .0001)
resulted in significantly less crying time when adjusting for
age. The pacifier group showed a clinically significant change
in average FLACC (Face, Legs, Activity, Cry, Consolability)
score, and crying time was significantly reduced with pacifier
use versus no pacifier use in both younger groups (0-1
month, P b .017; 1-3 months, P b .003).
The study by Movahedi et al 11 was the only one to
examine the effect of “local refrigeration,” cold application,
on venipuncture pain in children. Results showed that
applying an ice bag 3 minutes before the procedure yielded
a significant difference in observed behavioral responses
(P = .0011) and self-reported pain (P = .0097) compared
with the control group.
Sparks et al 41 looked at positioning and parent holding
and their impact on distress and satisfaction with the
procedure. At each of the 3 time periods (before, during, and
after the procedure), the intervention group had a significant
reduction in child distress compared with the control group
(P b .001 to P = .044). No difference was found in overall
parent satisfaction, although significantly greater nurse
satisfaction was reported in the control group (P b .001),
which included the child lying down for the procedure.
Implications for Research and Practice
Nonpharmacologic interventions are crucial in caring for
infants and children. Although results from the studies
varied, positive outcomes of using methods such as dis-
traction, positioning and parent holding, sucrose, pacifier,
and cold application included reduced distress, pain,
anxiety, and behavioral response reported by the child,
parent, and/or observer. No negative outcomes were
reported, and nonpharmacologic interventions can be
implemented independently with little cost. Additional
research on nonpharmacologic pain management in
children in the emergency department is needed to further
explore the benefits children may receive from the use of
nonpharmacologic approaches.
Using sucrose and/or a pacifier can be implemented
independently to reduce pain in infants and is fairly
VOLUME 39 • ISSUE 2 March 2013

inexpensive. Infant age and procedure type should be taken
into consideration when implementing this intervention.
More research on infants aged younger than 60 days using
sucrose to reduce pain/distress associated with painful pro-
cedures in the emergency department is needed. The con-
centration of sucrose is an area to expand on to determine
the most appropriate concentration for the infant based on
size and age.
Several of the studies used CLSs to provide the inter-
vention and standard of care. Although CLSs are an integral
part of pain management in children, they are not available in
all emergency departments and may not be present on all shifts.
CLSs have specialized training, and the results may differ if
other health care providers deliver the intervention. Additional
research is needed examining the impact when other
health care providers, such as nurses, deliver the intervention.
When appropriate, parents should be encouraged to
hold children in an upright position during procedures and
nurses may consider applying ice before intravenous
insertion to reduce pain and distress in children. Factors
such as patient condition, age, parent comfort level, and
relationship with the child are some aspects to take into
account when one is using these methods. Additional
research on positioning and cold application is needed,
including larger samples sizes and expanded ages.
An important aspect of the use of nonpharmacologic
interventions is the appropriate assessment of pain and the
use of this assessment to evaluate the effectiveness of the
intervention on reducing pain as well as distress in children.
Additional research is needed to examine the effectives of
instruments for children in the emergency department. Some
of the studies combined more than 1 intervention; additional
studies are needed to determine the impact of each specific
nonpharmacologic approach on procedural pain, distress,
and anxiety in children in the emergency department.
The review discovered mixed results when distraction
was used as an intervention to reduce pain and distress in
children in the emergency department. One reason for
finding no significant difference between groups may be the
way in which intervention and control groups were carried
out. Careful implementation and examination of both
intervention and control groups are needed to limit
treatment contamination. Several studies with no difference
noted that the control group may have included parents that
used distraction naturally, without prompting, or the
quality of the distraction may not have been sufficient to
show a difference. 27,32,33 Further research is needed using
larger sample sizes and examination of the fidelity of the
intervention provided.
Distraction is an intervention that can be provided
with little training, it has minimal risk, and it is cost
March 2013 VOLUME 39 • ISSUE 2
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effective, and there is no evidence indicating that this
technique is related to negative outcomes. Emergency
departments should have a variety of distractors available
for children of all ages. Having readily available resources
and information for nurses to use will help encourage the
use of these methods.
Conclusion
Nonpharmacologic interventions are a vital part of caring
for children in emergency departments and should be
incorporated into clinical practice in conjunction with
pharmacologic measures or alone based on the assessment
of the child. The busy environment, varying levels of
pediatric experience and resources, and heightened time of
crisis for children in emergency departments create
additional challenges for providing pain management.
Continued efforts are needed to ensure that children cared
for in emergency departments are provided adequate pain
management using nonpharmacologic and pharmacologic
interventions. Additional research is needed to identify
environmental and organizational barriers that impede the
implementation of nonpharmacologic interventions be-
cause these data will enable nurses to integrate these
techniques into their care routines.
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Submissions to this column are encouraged and may be sent to
Andrew D. Harding, MS, RN, CEN, NEA-BC, FAHA, FACHE
ADHardingRN@Gmail.com
VOLUME 39 • ISSUE 2 March 2013