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Table 3 Description of themes and subthemes with example quotations for caregiver interviews in the ED

From: Procedural pain in children: a qualitative study of caregiver experiences and information needs

Theme and sub-themes Example of statements
A. Source of healthcare information
 Videos are a neutral medium for sharing information “I think hearing it from the nurse is fine, if the child feels comfortable with that person. But you don’t really have a way of gauging that, necessarily, every time, depending on how much pain they’re in, or why they’re here. If they’re physically really, really sick, I think a video would be cool” [mother, 5 year-old girl].
 Videos as a tool for distraction “[The video] can kind of distract them as they’re watching it. Even if they could be watching a video that explains what’s going to happen, in a really friendly, easy, kiddy kind of way, you know, and then, even if it could go on a little further… and then kept it going while [the procedure] was happening… I think that would help. Because then they’d still be distracted” [mother, 5 year-old girl].
 Posters stimulate conversation with healthcare providers “For an older child this age, probably a poster would work. That way, if you had to have the visual, then you’d think “oh, maybe I should ask about this”” [mother, 12 year-old girl].
 Pamphlets can be referred to in the future I don’t throw [the brochures] away. I keep them in case somebody else gets hurt – in the same situation to see how I can manage them, to help with them” [mother, 3 year-old boy].
I am old school. I like paper. I can refer back to it. And have it in front of me” [mother, 9 year-old boy].
B. Delivering healthcare information
 Treat the child as someone who is going to understand “Today [my daughter] was very calm, and everything was explained to her. She was treated like someone who’s going to understand, instead of just a kid and you know, you’re – you’re being out of control or anxious, and let’s just get this done, so… the patience, the compassion, everything that has been said is really important” [mother, 5 year-old girl]..
 Ensure the child knows what to expect “[My daughter is] at the age where she wants things explained to her. The more information she has, the better [the procedure goes]. So it’s better for the doctor or the nurse, just to talk directly to her, at this age” [mother, 12 year-old girl].
 Describe the procedure in a way they understand and can relate to (e.g., use “kid terms”) [The nurse] was explaining what she was looking for and described the veins to him in kid terms” [mother, 8 year-old boy].
Another mother elaborated on this concept by providing an example of how “kid terms” were used when her daughter had an IV insertion: “[When] they explained the freezing gel and how it’s supposed to make her feel, they compared it to Elsa and how it’s going to be frozen and, of course, every kid loves Elsa right now, so that helped too – relating it to things that kids know…” [mother, 5 year-old girl]
 Give the child adequate processing time to understand and prepare themselves for the procedure “[My daughter] needs to know. She needs time to process what’s happening. And then, when she – [the nurses] were more patient with her, to – then she watches them put the needle in. Which seems to help her. So today was good” [mother, 12 year-old daughter].
 Involve children in the procedure by giving choices or opportunities for decision-making or other input where possible “[The nurse] was very calm in asking [my daughter] how she wanted [the IV procedure] done. So it was more so letting her know that this isn’t being done to you – that you’re still a part of this. And just letting her know… okay, do you want the board underneath your arm? Or, “does it still hurt?” And just letting her know what’s gonna happen next. You know what I mean? So I think… just strategically telling her about [the procedure], and calmly doing it in a manner that is not going to scare her.” [mother, 5 year-old girl].
“I do like that they explained to him and involved him in what’s going on. It prepares him, right?” [mother, 9 year-old boy].
C. Communication with caregivers
 The need for reassurance “[During the procedure] have the doctor say, “No, you’re doing good, dad. Just keep talking to [your son], keep talking to him.” So maybe, if that’s explained ahead of time, that you should do what naturally comes to you, like for distraction just talking to him, have him look at you in the eyes. Ah, that – feel free to do that. And if there’s something that you shouldn’t be doing or that may obstruct the medical procedure, [the doctor] will let you know. But otherwise, continue what you’re doing until you’re told otherwise” [father, 7 year-old boy].
 Information about Maxilene “I’m not sure too much about the information about the cream. So maybe… information about that would help me out. Yeah. ‘Cause they don’t normally give it to [my son] at the bloodwork clinic” [father, 6 year-old boy].
 Information about the nature and duration of pain “Is it gonna hurt right now? What’s it gonna hurt? How long is it gonna hurt for? Ah, would be good to know beforehand” [mother, 12 year-old girl].
 More information about potential discomfort after the IV has been inserted “I think, more for the child to be told… that not only will there be an initial pinch – but it will probably be uncomfortable… for the duration that it’s in. So that they don’t think once the pinch is done, it’s all done. But rather, that if someone pulls on it or you turn the wrong way, there’s still going to be that discomfort that happens” [mother, 8 year-old boy].
D. Procedure-related anxiety and long-term effects
 Increasing comfort with procedures as child gets older “Now it’s okay. ‘Cause I know that [my son] is going to be okay. When he was younger, we’d be a bit nervous, ‘cause you never know how they’re going to react [to the procedure].” [aunt, 10 year-old boy].
 Strong preference to have their child’s procedure done in a pediatric centre People, I think [at the Stollery Children’s Hospital] people are… people are more aware of how to treat a child. Whereas outside, sometimes… they’re not as… caring…” [mother, 4 year-old boy].