{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:52:42Z","timestamp":1791834762309,"version":"4.3.4"},"reference-count":52,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Needle-related procedures such as venipuncture are common in pediatric hospitals and are a major cause of pain, fear and distress for those affected. Despite the availability of a wide range of evidence-based support options, it is often the professionals who decide which interventions are offered. In this study, we adapted the CARDTM (Comfort, Ask, Relax, Distract) system for needle-related procedures in hospitals. CARDTM was originally developed to encourage children to actively participate in their vaccination process at school. It allows them to choose from numerous evidence-based interventions in the four different letter categories (C-A-R-D) to reduce pain, fear and related vaccination symptoms. Our aim was to examine perceptions of CARDTM for needle-related procedures in a children\u2019s hospital, including aspects of acceptability, feasibility, self-efficacy in managing fear and pain, and overall experiences. Methods: A qualitative descriptive design was used. The sample included nine children aged 10 to 15 undergoing needle-related procedures and seven nurses who performed these procedures. We conducted individual interviews and asked them about their experiences with CARDTM. Data were evaluated using qualitative content analysis. Results: Four themes were identified: awareness of options and needs; relationship building; empowerment; and acceptability. CARDTM helped children identify available options, prepare themselves, recognize their own needs and select strategies. CARDTM offered a concrete framework for action that promoted participation and self-efficacy and strengthened the relationship between nurses and children. In practice, CARDTM was perceived to be easy to implement and acceptable. Conclusions: The present findings suggest the applicability of CARDTM for hospital needle-related procedures.<\/jats:p>","DOI":"10.3390\/children13070951","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:18:31Z","timestamp":1784553511000},"page":"951","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cIt Could Become a Standard\u201d\u2014A Qualitative Study of the CARDTM System for Needle-Related Procedures in a Children\u2019s Hospital"],"prefix":"10.3390","volume":"13","author":[{"given":"Flurina","family":"Casaulta","sequence":"first","affiliation":[{"name":"Eastern Switzerland Children\u2019s Hospital, 9000 St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Marfurt-Russenberger","sequence":"additional","affiliation":[{"name":"Eastern Switzerland Children\u2019s Hospital, 9000 St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6888-6600","authenticated-orcid":false,"given":"Adelheid","family":"Zeller","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4432-8975","authenticated-orcid":false,"given":"Anna","family":"Taddio","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada"},{"name":"The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"Vetsch","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1002\/ebch.1864","article-title":"The Cochrane Library and Procedural Pain in Children: An Overview of Reviews","volume":"7","author":"Curtis","year":"2012","journal-title":"Evid.-Based Child Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1542\/hpeds.2014-0084","article-title":"Pain Outcomes in a US Children\u2019s Hospital: A Prospective Cross-Sectional Survey","volume":"5","author":"Friedrichsdorf","year":"2015","journal-title":"Hosp. 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