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The first step in symptom management is to assess the child's pain and fear, and the next step is to use coping strategies to provide symptom relief for children who experience or feel pain and fear during procedures. The Children's Action\u2013Reaction Assessment Tool (CARAT) is built on action\u2013reaction strategies. This study aimed to determine the inter\u2010rater reliability of the CARAT when used during needle procedures with 3\u2010 to 7\u2010year\u2010old children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design\u00a0and\u00a0Methods<\/jats:title><jats:p>We used a quantitative approach in which 21 children were observed by two independent observers during needle procedures to evaluate the inter\u2010rater reliability of the CARAT. Data were analysed with descriptive statistics, and the observation scores were calculated with an intraclass correlation coefficient (ICC) test on SPSS for Windows, version 25.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The completed CARAT indicated the use of action\u2013reaction strategies. Neither action nor reaction strategies were frequently used. The parents were seldom involved in the procedure. The inter\u2010rater reliability showed a sufficient correlation between the observers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Practice\u00a0Implications<\/jats:title><jats:p>This study showed promising results for the inter\u2010rater reliability of the CARAT, which can be used to facilitate care for children. The observational tool can be used to assess the use of action\u2013reaction strategies in conjunction with needle procedures in children aged 3\u20137 years.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jspn.12334","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T07:27:52Z","timestamp":1617694072000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Children's Action\u2010Reaction Assessment Tool (CARAT) as an observational technique for assessing symptom management: An initial validation study with children aged 3\u20137 years undergoing needle procedures"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4080-6677","authenticated-orcid":false,"given":"Katarina","family":"Karlsson","sequence":"first","affiliation":[{"name":"Faculty of Caring Sciences,\u00a0Work Life and Social Welfare University of Bor\u00e5s  Bor\u00e5s Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6203-1433","authenticated-orcid":false,"given":"Ensa","family":"Johnson","sequence":"additional","affiliation":[{"name":"Centre for Augmentative and Alternative Communication University of Pretoria  Hatfield Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8847-9559","authenticated-orcid":false,"given":"Stefan","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Institute of Health and Care Sciences and the University of Gothenburg Centre for Person\u2010Centred Care, Sahlgrenska Academy, University of Gothenburg  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,6]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060513509473"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2017.1327987"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/inr.12465"},{"key":"e_1_2_13_5_1","first-page":"104","volume-title":"Teoretiska grunder f\u00f6r v\u00e5rdande. 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