Pain Management Nursing 23 (2022) 682–688

Contents lists available at ScienceDirect

Pain Management Nursing

journal homepage: www.painmanagementnursing.org

Review Article

The Effect of Parental Presence on Pain Levels of Children During

Invasive Procedures: A Systematic Review
Merve Azak, M.Sc., B.S.N. ∗, Gözde Aksucu, M.Sc., B.S.N. †,1, Seda Çağlar, Ph.D., M.Sc., B.S.N. ∗
∗
Department of Pediatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
†
Department of Nursing, Faculty of Health Sciences, Beykent University, Istanbul, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Aim: This systematic review was conducted to determine the effect of parental presence on the child’s
Received 21 February 2021 pain intensity during invasive procedures.
Received in revised form 26 March 2022
Design: A systematic review.
Accepted 26 March 2022
Method: The systematic review was conducted in July 2019 and updated in December 2020 to include
the latest research published during the publication process by scanning the articles in English. Scopus,
Pubmed, Cochrane, Science Direct, MedLine databases were used for scanning. The keywords “parental
presence”, “family presence”, “parent involvement”, “invasive procedures”, “venipuncture”, “painful proce-
dures”, “child”, “children”, “pediatric” were used in the scanning. Preferred Reporting Items for Systematic
reviews and Meta-Analyses protocol was followed to prepare the study and the report, and the systematic
review was created according to the patient, intervention, comparison, outcomes (PICOS) strategy.
Results: A total of 248 articles were reached, and the full texts of 18 articles were evaluated for eligibility.
After the articles excluded by the full-text search were eliminated, six studies, involving 730 children with
a sample aged between 0-12 years, were included in the analysis. In 4 studies, it was determined that
having a parent with the child during the invasive procedure significantly decreased the pain level, and
in 2 studies, there was no statistically significant decrease in the pain level of the children.
Conclusions: Parental presence and parental involvement during invasive procedures effectively reduced
the children’s pain levels. Since the number of studies with a high level of evidence regarding the effect
of family participation on pain level is limited, it is recommended to conduct more randomized controlled
studies.
© 2022 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

During hospitalization, children are subjected to numerous
medical procedures. Invasive procedures performed in children fol-
lowing emergencies such as injuries or diagnosed with any illness
often lead to long-term physical and psychological problems and
have the potential to turn into traumatic events (Brown et al.,
2018). Peripheral vascular access and blood collection are some
of the invasive procedures that are frequently repeated in hos-
pitals and usually performed by nurses. These attempts cause
pain, anxiety, and stress in patients (MacLean et al., 2007; Ortiz
et al., 2012; Wier et al., 2013). Patients hospitalized in the pedi-
atric clinic encounter an average of 6.3 painful procedures per day
(Stevens et al., 2011).
1
Address correspondence to Gözde Aksucu, M.Sc., B.S.N., Research Assistant,
Beykent University, Faculty of Health Sciences, Department of Nursing, Istanbul,
Turkey.
E-mail address: gzdylmz23@gmail.com (G. Aksucu).
Family-centered care is a model of care that best meets the
needs and expectations of parents and children, in which the
healthcare worker and the family cooperate (Cooper et al., 2007;
Pruitt et al., 2008). Family-centered care in pediatric nursing in-
cludes holistic care approaches in which the child and family are
supported in physical, emotional, intellectual, social, cultural, and
spiritual aspects as a whole, and the family should be involved in
the care of the child as soon as possible (Conk et al., 2018; Toruner
& Buyukgonenc, 2012). By accepting the continuity of the child in
the family’s life, the unity of the child and family is advocated
at every stage of care (Harrison, 2010). Family-centered care en-
sures the preservation and continuity of the relationship between
the hospitalized child and his family (Conk et al., 2018). Pediatric
nurses should support parents’ participation in care practices, in-
cluding asking questions in the hospital environment (Yavas Ce-
lik, 2018). Family-centered care practices allow the parents to sup-
port the children by being with them during painful procedures. In
the studies, the family-centered care approach reduced the anxiety

https://doi.org/10.1016/j.pmn.2022.03.011
1524-9042/© 2022 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on January 14,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
 M. Azak, G. Aksucu and S. Çağlar / Pain Management Nursing 23 (2022) 682–688
and pain levels of the children, supported the child and the par-
ents’ adaptation to the hospitalization process, increased the fam-
ily’s sense of self-efficacy and care satisfaction, and accelerated the
recovery process (Basal et al., 2012; Boztepe & Çavuşoğlu, 2009;
O’Brien et al., 2015; Ozturk & Ayar, 2014; Pruitt et al., 2008).
The parental presence or parental involvement refers to par-
ents’ presence or involvement with their children during care and
treatment (Darbyshire, 1995). Offering parents the option to re-
main with their child during invasive procedures is controversial
(Erhaze et al., 2016). The integrity of the family unit is supported
by the involvement of parents throughout the child’s hospital stay
(Ball et al., 2017). Although parents want to be with their children
during invasive procedures, and some international organizations
like the American Academy of Pediatrics support parental presence
(AAP, 2013), hospitals such as burn centers have negative policies
in this regard (Egberts et al., 2018). In the study conducted by
Giannini (2011) in Italy, it was reported that only 12% of pediatric
intensive care units had an unlimited visit policy. In order for the
interventions applied to children in the hospital environment to be
carried out effectively, arrangements should be made in the health
system and hospital policies in clinics for parents to stay with their
children. Pediatric nurses, who have primary responsibility for the
care of children in clinics, play an essential role in forming these
policies. In the studies, nurses reported that they mostly left the
emotional support and care such as feeding and activities of daily
living (ADL) to parents in pediatric patients due to the workload
(Boztepe & Çavuşoğlu, 2009; Kuzlu et al., 2011). However, the aim
is not to leave all care burdens of children to parents, but to main-
tain the parent-child relationship in the hospital and ensure the
child’s physical and social-emotional comfort (Yavas Celik, 2018).
A study (Dur et al., 2016) reported that nurses saw parents as a
whole with the children, but parents thought that being with the
child in some cases might pose a problem.
The encouragement of parental presence can increase loci of
control for all family members. Parental presence allows for more
patient teaching, increasing their skills and knowledge (Ball et al.,
2017). The skills and knowledge of parents who see the procedures
increase. Children also get support from their parents’ presence
(Conk et al., 2018). During painful procedures, parental presence
and communication with their children and giving tactile stimuli
can reduce children’s pain (Ball et al., 2017; Cimete et al., 2018).
The American Heart Association (AHA, 20 0 0) Guidelines state
that parental presence should be encouraged during invasive
procedures and resuscitation. However, widespread practice is
still lacking, especially in the presence of parents during inva-
sive procedures. No literature reviews were discovered on the
topic of parental presence and pain intensity in children since
Dingeman et al. (2007). Between 2007 and 2010, no study met
the criteria for inclusion in the systematic review. Therefore, this
systematic review includes no articles before 2010. This system-
atic review was conducted to determine the effect of the parental
presence on the child’s pain level during invasive procedures. The
results of this review are thought to contribute to the development
of family-centered care practices.
Methods
This study is a systematic review. We followed Preferred Re-
porting Items for Systematic Reviews and Meta-Analyses (PRISMA)
protocol to prepare the study and the report (Moher et al., 2009).
In a session where three authors were together to carry out the
process in appropriate format and quality, we carried out a pre-
liminary search to include scanning through the PubMed electronic
database with a keyword included in the study, selecting an arti-
cle, extracting data with six research articles, and evaluating the
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on January 14,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
683
Table 1
PICOS Elements for Systematic Review Protocol
Participants Children aged 0-12 years
Interventions Parental presence
Comparators Parental involvement, absence of parents, presence of
a stranger, distraction techniques
Outcomes Decrease in pain level
Study design Randomized controlled trial
quality of the article. The authors discussed and resolved the dif-
ferences in opinion and information that emerged after the pre-
liminary search. In this systematic review, to reduce the risk of
possible bias, two authors independently carried out the literature
review process, article selection, data extraction, and evaluation of
article quality. We checked each stage in a session attended by the
third author and established a consensus.
Search Strategy
We conducted searches for this systematic review in July 2019
and an update in December 2020. The latest research was pub-
lished during the publication process by matching the keywords
“parental presence”, “family presence”, “parent involvement”, “in-
vasive procedures”, “venipuncture”, “painful procedures”, “child”,
“children”, “pediatric” through the boolean operators in the English
language. The search engines utilized were the Pubmed (n = 82),
Cochrane (n = 48), Science Direct (n = 77), and MedLine (n = 39)
databases. We included 247 articles published between 2010 and
2020 in the evaluation during the literature review. In order to ob-
tain additional studies, we reviewed the list of references of the
included studies and added one more article.
Selection Criteria and Selection of Studies
We created the concept of this systematic review according
to the patient, intervention, comparison, outcomes (PICOS) strat-
egy. Participants: children aged 0-12 years; Interventions: parental
presence; Comparators: parental involvement, absence of parents,
presence of a stranger, distraction techniques; Outcomes: de-
crease in pain level; Study designs: randomized controlled trials
(Table 1). We included studies suitable for this systematic review
based on inclusion criteria. The results related to the parental pres-
ence on the child’s pain level during invasive procedures, using
pain scale for children, being a randomized controlled study, En-
glish language, and the full text of the article was available. We
excluded the studies with only parent, physician, and nurse sub-
jective data (Table 1).
Two authors independently achieved the identification and se-
lection of the studies in accordance with the inclusion criteria. Af-
ter removing the repetitive studies from the search results, we se-
lected the title, abstract and full text, respectively. We give the se-
lection process followed in the systematic review in Figure 1.
Data Extraction
We used a data extraction tool developed by us to obtain data
in the study. This data extraction tool recorded the authors’ names
and publication year, research design type, participants, initiative,
data collection tool, and main results.
Evaluation of Methodological Quality
Two authors (first and second author) independently evaluated
the methodological quality of the articles included in this system-
atic review, and the third author checked. We evaluated the qual-
684 M. Azak, G. Aksucu and S. Çağlar / Pain Management Nursing 23 (2022) 682–688

Figure 1. PRISMA flow diagram (Moher et al., 2009).

ity assessment of the included studies using the quality assess-
ment tool prepared by the Joanna Briggs Institute (JBI) according
to the research pattern (Tufanuru et al., 2020). According to the
design of the studies included in the systematic review (random-
ized controlled trials), we used an evaluation tool consisting of 13
questions. The questions in this tool are answered with the options
“Yes, No, Indeterminate, Not Applicable”. Table 1 gives the quality
assessment results for each study under the heading “Critical Ap-
praisal Tool”.
Data Syntheses
The authors used the method of narrative synthesis to analyze
the data. Narrative synthesis is a method that can be used to syn-
thesize both quantitative and qualitative studies and can be used
when the findings of the studies included in the systematic review
are not similar enough for meta-analysis (Snilstveit et al., 2012).
The data collection methods, tools, and pattern of the studies ex-
amined in this systematic review differed. Therefore, we presented
the findings with the narrative synthesis method.
Ethical Aspect of Research
The articles included in the sample did not require ethics
committee approval because they were obtained from electronic
databases and search engines. All work stages were carried out
according to the principles contained in the Helsinki Declaration
Principles. The articles examined were shown in the bibliography.
Results
Study Selection
In the initial search, we reached 248 records, removed the re-
peated articles (n = 213), and reached 18 articles due to the inves-
tigation made according to the title, abstract, and full text, respec-
tively. We performed data extraction with six studies (Al-Abbas
et al., 2016; Inan & Inal, 2019; Matziou et al., 2013; Ozcetin et al.,
2011; Sonmez Saglik & Caglar, 2018; Tantikul & Theeranate, 2014)
after the examination according to the inclusion criteria. We show
the explanations about selecting the articles in Figure 1 according
to the PRISMA-P flow chart .
We used the data extraction form prepared by us to reveal the
article features. This data extraction tool obtained the data for each
study under the titles of author, year, study design, country, age,
participants and intervention, procedure, scales, main results, and
critical appraisal tool. Table 2 shows the sample characteristics,
data collection tools, and main results of the studies.
Study Characteristics
The six studies that met the inclusion criteria included a total of
730 children aged 0-12 years. All studies were randomized clinical
trials and conducted in different countries such as Turkey (Inan &
Inal, 2019; Ozcetin et al., 2011; Sonmez Saglik & Caglar, 2018), Jor-
dan (Al-Abbas et al., 2016), Thailand (Tantikul & Theeranate, 2014),
and Greece (Matziou et al., 2013) (Table 2).

Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on January 14,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
 M. Azak, G. Aksucu and S. Çağlar / Pain Management Nursing 23 (2022) 682–688 685

Table 2
Summary of the Studies Included in This Systematic Review

Author, Year Study Country Age Participants & Procedure Scales Main results Critical
design intervention appraisal tool

Inan & Inal, 2019 Rct Turkey 6-10 Distracted by parents - Children’s It was found that the pain 10
Intervention group: 45 Venipuncture Fear Scale, levels of the children in the
Watched cartoon Wong- group playing the video game
movies - intervention Baker during the blood draw were
group: 45 Played video FACES Pain significantly lower than the
games - Intervention Scale other groups, but all three
group: 45 Control methods were effective in
group: 45 Total: 180 reducing the child’s pain.
Sonmez Saglik & Rct Turkey 9-12 Parental involvement - Visual The pain levels of the children 9
Caglar, 2018 intervention group: 40 Venipuncture analog in the group whose parents
Parental presence - scale were included in the
intervention group: 40 procedure during blood
Parental absence - collection, vascular access, and
control group: 31 intravenous injection
Total: 111 applications decreased
significantly during the
procedure compared with the
pre-procedure; the pain level
of the children in the group
with their parents but not
involved in the procedure
decreased. However, the
control group’s pain levels
were found to increase
significantly compared with
before the procedure.
(Al-Abbas et al., Rct Jordan 4-9 Parental presence - Wong- It was found that the parental 7
2016) intervention group: 53 Venipuncture Baker presence during venipuncture
Parental absence - FACES Pain significantly reduced the pain
control group: 49 Scale level of children.
Total: 102
Tantikul & Rct 0-4 Parental presence - Faces Pain No significant difference was 6
Theeranate, 2014 Thailand intervention group: 22 Venipuncture Scale found between the groups and
Parents were not or the experimental groups in
allowed to be present intravenous terms of the child’s pain level
- intervention group: cannula- during venipuncture and
22 Parental absence - tion blood collection.
control group: 28
Total: 72
(Matziou et al., Rct Greece 7-10 Parental presence - Verbal Both intervention methods 10
2013) intervention group: 43 Venipuncture rating scale were significant in reducing
Toy - intervention the pain level of children
group: 44 Control during the blood draw.
group: 43 Total: 130 However, it was found that
the presence of a parent with
the child was significantly
more effective than using a
kaleidoscope in reducing the
child’s pain level.
(Ozcetin et al., Rct Turkey 3-6 Parental presence - Wong- There was no significant 9
2011) intervention group: 68 Venipuncture Baker difference in terms of the
A hospital staff FACES Pain child’s pain level between the
member presence - Scale presence or absence of parents
control group: 67 at the time of blood collection.
Total: 135 It was found that parental
presence had a minimal
positive effect on the child’s
pain tolerance.

Pain Assessment Instrument
It was seen in studies that visual analogue scale (VAS) (n = 1),
Faces Pain Scale (n = 1), verbal rating scale (VRS) (n = 1), Wong-
Baker Faces Pain Scale (n = 3), Children’s Fear Scale (n = 1) were
used to assess pain in children.
ies such as parental passive distractors (n = 1), parental involve-
ment in the procedures (n = 2), parental absence (n = 1), a hos-
pital staff member presence (n = 1), watching cartoons (n = 1),
playing video games (n = 1), using toys (kaleidoscope) (n = 1), and
non-intervention groups (n = 6) were also included in the studies
(Table 1).

Pain Management Influence of Interventions

All studies used the parental presence intervention. In addition Parental presence during invasive procedures significantly re-
to the parental presence, there are other interventions in the stud- duced children’s pain scores in 4 studies (Al-Abbas et al., 2016;

Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on January 14,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
686 M. Azak, G. Aksucu and S. Çağlar / Pain Management Nursing 23 (2022) 682–688
Inan & Inal, 2019; Matziou et al., 2013; Sonmez Saglik &
Caglar, 2018). Although it was not statistically significant in one
study, it reduced children’s pain scores (Ozcetin et al., 2011). One
study found that it did not affect children’s pain scores (Tantikul &
Theeranate, 2014).
A study reported that the group with parental support dur-
ing blood collection effectively reduced the child’s pain compared
with the group that was not intervened (Inan & Inal, 2019). In the
study by Sonmez Saglik & Caglar (2018), the children’s pain lev-
els in the group whose parents were included during invasive pro-
cedures (blood collection, vascular access, intravenous injection)
were significantly reduced compared with before the procedure.
Al-Abbass et al. (2016) reported that the presence of parents dur-
ing vascular access significantly reduced the pain level of children.
A study found a significant reduction in the child’s pain due to in-
vasive intervention in the parental presence group (Matziou et al.,
2013).
Tantikul & Theerenate (2014) found that parental presence
significantly reduced the child’s pain level compared with toys.
Ozcetin et al. (2011) found no significant difference in the child’s
pain level between the groups during vascular access, but it was
reported that the parental presence had a minimal positive effect
on the child’s pain tolerance.
Discussion
Six studies that met the inclusion and exclusion criteria were
included in this systematic review that was conducted to review
the effect of parental presence on the child’s pain intensity during
invasive procedures. To the best of our knowledge, this is possibly
the first systematic review recently attempted to gather informa-
tion on this subject.
The systematic review included six studies published in the
past 20 years and involved 730 children with a sample aged be-
tween 0-12 years. All children underwent the invasive procedure
and were compared with parental presence, parental involvement,
and other methods. Published studies indicate that pain is a fre-
quent complaint in invasive procedures. It has been reported that
the parental presence during invasive procedures effectively re-
duced pain in the majority of studies (Al-Abbas et al., 2016; Inan
& Inal, 2019; Matziou et al., 2013; Sonmez Saglik & Caglar, 2018)
included in the systematic review. One study reported that the
parental presence intervention decreased the children’s pain level,
but there was no statistically significant decrease (Ozcetin et al.,
2011), while another study stated that this intervention was not
effective (Tantikul & Theeranate, 2014).
No studies evaluating the impact of parental presence have
reported negative effects of parental presence on their children
(Afshar et al., 2011; Cox et al., 2011; Mayo et al., 2021; Piira et al.,
2005; Shindova & Belcheva, 2013; Sun et al., 2017; Vasiliki et al.,
2016; Wolfram et al., 1997). Parental presence during painful med-
ical procedures enables the child to cope with pain more easily
(Pancekauskaitė & Jankauskaitė, 2018). All studies included in this
systematic review (Al-Abbas et al., 2016; Inan & Inal, 2019; Matziou
et al., 2013; Ozcetin et al., 2011; Sonmez Saglik & Caglar, 2018; Tan-
tikul & Theeranate, 2014) also focused on the importance and ef-
fects of parental presence intervention.
Although negative results of the parental presence interven-
tion were not detected for children, some studies did not reach
significant results. In two studies included in this systematic re-
view (Ozcetin et al., 2011; Tantikul & Theeranate, 2014), which
did not yield significant results, the age of the children may have
been influential. These studies were conducted with children in
the younger age group (0-6 years). Accordingly, health profes-
sionals need to carry out studies with larger samples in differ-
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on January 14,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
ent age groups to prove the effectiveness of parental presence
in the younger age group. Guducu and Erci (2007) reported that
the parental presence during painful procedures was ineffective
in reducing pain. Studies (Afshar et al., 2011; Cox et al., 2011;
Shindova & Belcheva, 2013) evaluating the parental presence dur-
ing dental examinations have also reported that the parental pres-
ence alone does not reduce the children’s anxiety levels. In these
studies (Afshar et al., 2011; Guducu & Erci, 2007; Shindova &
Belcheva, 2013), the parent was with the child but did not inter-
vene in the procedures. In these two studies (Ozcetin et al., 2011;
Tantikul & Theeranate, 2014), parents were only present with the
child and did not intervene in any way, so the pain and anxiety
levels of children did not decrease. This situation may be more ef-
fective in reducing pain in invasive interventions when parents are
educated and participate in the procedure rather than passively
staying with their children (Inan & Inal, 2019; Sonmez Saglik &
Caglar, 2018). In a study, during vaccination, the parents the chil-
dren in the group of parents who received information about the
techniques to help their babies in vaccination were more comfort-
able than parents in the other group, and the salivary cortisol lev-
els taken 1 hour after the procedure were lower (Felt et al., 20 0 0).
In the study by Sun et al. (2017), parents were allowed to intervene
to comfort their children, and the pre- and post-operative anxiety
of the children was found to be statistically lower than the control
group.
The positive relationship between parents and the health care
team is a crucial component of family-centered care (Ball et al.,
2017). Parental satisfaction increases when parents’ concerns about
their child’s condition and necessary care practices are answered
and when health professionals are courteous and concerned (Fisher
& Broome, 2011). A study found that nurses generally have pos-
itive thoughts about the effect of parental involvement on the
child during medical procedures in the hospital, and it was stated
that they could support parents’ participation in care (Ozkan &
Tas Aslan, 2017). Boztepe (2012) reported that health profession-
als do not prefer the presence of the parents during painful inter-
ventions. In the study, nurses reported that they did not to want
parents to be with the child during painful interventions because
parents ask too many questions that interfere with the procedure
(Boztepe, 2012). When the parents are not sufficiently informed
about procedures, they may be worried for their children and show
these behaviors. Family-centered care requires continuous and im-
partial information sharing about the child with parents. Sharing
information about their children with parents is one of the most
fundamental elements in their participation in care and decisions
made about their children (Conk et al., 2018). A systematic re-
view shows that parental presence during resuscitation and inva-
sive procedures is beneficial for parents, increases satisfaction with
care, and helps parents cope with the current situation (McAlvin &
Carew-Lyons, 2014). This evidence supports positive results for par-
ents, children, and health professionals in cases where parents are
informed impartially and included in procedures.
Limitations
This systematic review has some limitations. First, there is a
small number of studies comparing the effects of parental pres-
ence to reduce pain. Second, the findings of the studies included in
the systematic review are not similar enough for meta-analysis. For
this reason, the meta-analysis results were not presented. Third,
the differences in interventions compared with parental presence
in studies may affect pain intensity. Fourth, the use of different
pain scales in the studies is a limitation in comparing the assess-
ment of pain intensity.
 M. Azak, G. Aksucu and S. Çağlar / Pain Management Nursing 23 (2022) 682–688
Conclusion
As a result, it was determined that parents’ being with their
children during invasive procedures and participating in the pro-
cedures effectively decreased the pain scores of children. Although
only parental presence with their children decreases the pain score
of the children, it is recommended that parents be educated about
and included in the procedures in order to increase the effective-
ness of the method. However, large-scale, randomized-controlled
studies focused on different age groups and robust quantitative re-
search are urgently needed to understand the value and effect of
parental presence during invasive procedures in children and thor-
oughly map the complexity of perspectives on this topic.
Implications for Nursing
Parents’ presence with their children during invasive interven-
tions increases confidence, decreases children’s pain scores, and
supports individualized care. In line with these results, it is recom-
mended that parents be present with their children and included
in the procedures during care and treatment practices by pediatric
nurses. Pediatric nurses should be aware of the benefits of parents’
participation in processes. They should allow the presence of par-
ents during painful procedures and seek support from parents to
reduce the child’s pain and facilitate the procedure for themselves,
parents, and children. In this way, pediatric nurses can inform par-
ents about the benefits of parental presence and increase their par-
ticipation by increasing their awareness. In fact, it should ensure
that parents are involved in the process, not just present with their
children.
Declaration of Competing Interest
There is no conflict of interest.
References
Afshar, H., Nakhjavani, Y. B., Mahmoudi-Gharaei, J., Paryab, M., & Zad-
hoosh, S. (2011). The effect of parental presence on the 5 year-old children’s
anxiety and cooperative behavior in the first and second dental visit. Iranian
Journal of Pediatrics, 21(2), 193–200.
Al-Abbas, T. M., Abdelkader, R. H., Shoqirat, N., & Obeidat, H (2016). The effect of
parental presence in decreasing pain level for children during venipuncture.
Pyrex Journal of Nursing and Midwifery, 2(3), 12–19.
American Heart Association (AHA). (20 0 0). Guidelines 20 0 0 for cardiopulmonary re-
suscitation and emergency cardiovascular care. Part 10: Pediatric advanced life
support. The American Heart Association in collaboration with the International
Liaison Committee on Resuscitation. Circulation, 102(8), I291–I342.
American Academy of Pediatrics (AAP). (2013). Committee on Pediatric Emer-
gency Medicine, American College of Emergency Physicians, Pediatric Commit-
tee Emergency Nurses Association, Pediatric Committee. Joint policy statemen-
t–guidelines for care of children in the emergency department. Journal of Emer-
gency Nursing, 39(2), 116–131.
Ball, J. W., Bindler, R. C., Cowen, K. J., & Shaw, Michele (2017). Principles of Pediatric
Nursing Caring for Children (7th Edition). Hoboken, NJ: Pearson Education Inc.
Basal, A. A., Om Ebrahim, A., Sai, A., & Elazazy, H. M (2012). Perception of health
care providers, patient’s families and patients towards family presence during
invasive procedures in emergency care units. Journal of American Science, 8(11),
152–161.
Boztepe, Handan (2012). Pediatri hemşirelerinin ağrılı işlemler sırasında ebeveyn-
lerin bulunması hakkında görüşleri [Pediatric nurse views regarding parental
presence during a child’s painful procedures]. Ağrı, 24(4), 171–179.
Boztepe, Handan, & Çavuşoğlu, Hicran (2009). Bir üniversite hastanesindeki uygu-
lamaların aile merkezli bakım yönünden incelenmesi [Examination of a Fam-
ily Centered Care Practice at the Children’s Units of a University Hospital].
Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 16(1), 11–24.
Brown, E. A., De Young, A., Kimble, R., & Kenardy, J. (2018). Review of a parent’s
influence on pediatric procedural distress and recovery. Clinical Child and Family
Psychology Review, 21(2), 224–245.
Cimete, G., Kuğuoğlu, S., & Dede Çınar, N. (2018). Çocuk, hastalık ve hastane ortamı
[Child, disease and hospital environment]. In Z Conk, Z Başbakkal, H Bal Yılmaz,
& B Bolışık (Eds.), Pediatri Hemşireliği [Pediatric Nursing] (pp. 101–141). Ankara:
Akademisyen Yayınevi.
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on January 14,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
687
Conk, Z, Başbakkal, Z, & Yardımcı, F (2018). Çocuk sağlığına genel bakış [Child health
overview]. In Z Conk, Z Başbakkal, H Bal Yılmaz, & B Bolışık (Eds.), Pediatri
Hemşireliği [Pediatric Nursing] (pp. 1–45). Ankara: Akademisyen Yayınevi.
Cooper, L. G., Gooding, J. S., Gallagher, J., Sternesky, L., Ledsky, R., &
Berns, S. D. (2007). Impact of a family-centered care initiative on NICU care,
staff and families. Journal of Perinatology, 27(2), S32–S37.
Cox, I. C. J., Krikken, J. B., & Veerkamp, J. S. J. (2011). Influence of parental presence
on the child’s perception of, and behaviour, during dental treatment. European
Archives of Paediatric Dentistry, 12(4), 200–204.
Darbyshire, P. (1995). Family-centred care within contemporary British paediatric
nursing. British Journal of Nursing, 4(1), 31–33.
Dingeman, R. S., Mitchell, E. A., Meyer, E. C., & Curley, M. A. Q. (2007). Parent pres-
ence during complex invasive procedures and cardiopulmonary resuscitation: A
systematic review of the literature. Pediatrics, 120(4), 842–854.
Dur, Ş., Gözen, D., & Bilgin, M. (2016). Devlet ve özel hastanedeki hemşirelerin aile
merkezli bakıma ilişkin tutum ve davranışları [Attitudes and behavior of nurses
in state and private hospitals with respect to family-centered care]. Güncel Pe-
diatri, 14(1), 1–9.
Egberts, M. R., de Jong, A. E. E., Hofland, H. W. C, Geenen, R., & Van
Loey, N. E. E (2018). Parental presence or absence during paediatric burn wound
care procedures. Burns, 44(4), 850–860.
Erhaze, Eunice K, Dowling, Maura, & Devane, Declan (2016). Parental presence at
anaesthesia induction: a systematic review. International Journal of Nursing Prac-
tice, 22(4), 397–407.
Felt, B. T., Mollen, E., Diaz, S., Renaud, E., Zeglis, M., Wheatcroft, G., & Mende-
low, D. (20 0 0). Behavioral interventions reduce infant distress at immunization.
Archives of Pediatrics & Adolescent Medicine, 154(7), 719–724.
Fisher, M. J., & Broome, M. E. (2011). Parent–provider communication during hospi-
talization. Journal of Pediatric Nursing, 26(1), 58–69.
Giannini, A., & Miccinesi, G. (2011). Parental presence and visiting policies in Italian
pediatric intensive care units: A national survey. Pediatric Critical Care Medicine,
12(2), e46–e50.
Guducu Tufekci, E., & Erci, B (2007). Ağrılı işlemler sırasında ebeveynlerin bulun-
masının ve bazı faktörlerin çocukların ağrı toleransına etkisi [The effect of par-
ents’ presence and some factors on children’s pain tolerance during painful pro-
cedures]. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 10(2), 30–40.
Harrison, T. M. (2010). Family-centered pediatric nursing care: State of the science.
Journal of Pediatric Nursing, 25(5), 335–343.
Inan, G., & Inal, S. (2019). The impact of 3 different distraction techniques on the
pain and anxiety levels of children during venipuncture. Clinical Journal of Pain,
35(2), 140–147.
Kuzlu, T. A., Kalıncı, N., & Topan, A. K. (2011). Üniversite hastanesinde çocuklara
verilen bakımın aile merkezli bakım yönünden incelenmesi [Examination of the
care given to children in the university hospital in terms of family-centered
care]. Fırat Sağlık Hizmetleri Dergisi, 6(16), 1–17.
MacLean, S., Obispo, J., & Young, K. D. (2007). The gap between pediatric emergency
department procedural pain management treatments available and actual prac-
tice. Pediatric Emergency Care, 23(2), 87–93.
Matziou, V., Chrysostomou, A., Vlahioti, E., & Perdikaris, P. (2013). Parental presence
and distraction during painful childhood procedures. British Journal of Nursing,
22(8), 470–475.
Mayo, D. G., Carretero, P. S., Martin, L. G., Calderón, J. A., Oliveros, F. H., &
Rojo, M. G. (2021). Parental presence during induction of anesthesia im-
proves compliance of the child and reduces emergence delirium. European Jour-
nal of Pediatric Surgery Online ahead of print. Jul 9. https://doi.org/10.1055/
s- 0041- 1732321.
McAlvin, S. S., & Carew-Lyons, A. (2014). Family presence during resuscitation and
invasive procedures in pediatric critical care: A systematic review. American
Journal of Critical Care, 23(6), 477–484 quiz 485.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G.Prisma Group. (2009). Preferred
reporting items for systematic reviews and meta-analyses: The PRISMA state-
ment. PloS Medicine, 6(7), Article e10 0 0 097.
O’Brien, K., Bracht, M., Robson, K., Xiang, Ye X. Y., Mirea, L., Cruz, M., Ng, E., Mon-
terrosa, L., Soraisham, A., Alvaro, R., Narvey, M., Da Silva, O., Lui, K., Tarnow–
Mordi, W., & Lee, S. K (2015). Evaluation of the family ıntegrated care model
of neonatal intensive care: A cluster randomized controlled trial in Canada and
Australia. BMC Pediatrics, 15(1), 1–9.
Ortiz, M. I., López-Zarco, M., & Arreola-Bautista, E. J. (2012). Procedural pain and
anxiety in paediatric patients in a Mexican emergency department. Journal of
Advanced Nursing, 68(12), 2700–2709.
Ozcetin, M., Suren, M., Karaaslan, E., Colak, E., Kaya, S., & Guner, O. (2011). Effects
of parent’s presence on pain tolerance in children during venipuncture: A ran-
domised controlled trial. Hong Kong Journal of Paediatrics, 16, 247–252.
Ozkan, S., & Tas Arslan, F. (2017). Nurses’ views about parent participation in the
care of hospitalized children. Journal of Contemporary Medicine, 7(4), 355–364.
Ozturk, C., & Ayar, D. (2014). The practice of art in pediatric nursing. E-Journal of
Dokuz Eylul University Nursing Faculty, 7(4), 315–320.
Pancekauskaitė, G., & Jankauskaitė, L. (2018). Paediatric pain medicine: Pain differ-
ences, recognition and coping acute procedural pain in paediatric emergency
room. Medicina, 54(6), 94.
Piira, T., Sugiura, T., Champion, G. D., Donnelly, N., & Cole, A. S. J. (2005). The role of
parental presence in the context of children’s medical procedures: A systematic
review. Child: Care, Health and Development, 31(2), 233–243.
Pruitt, L. M., Johnson, A., Elliott, J. C., & Polley, K. (2008). Parental presence during
pediatric invasive procedures. Journal of Pediatric Health Care, 22(2), 120–127.
688 M. Azak, G. Aksucu and S. Çağlar / Pain Management Nursing 23 (2022) 682–688

Shindova, M., & Belcheva, A. (2013). The effect of parental presence on the dental
anxiety during clinical examination in children aged 6-12 years. Journal of IMAB,
19(4), 435–438.
Snilstveit, B., Oliver, S., & Vojtkova, M. (2012). Narrative approaches to systematic re-
view and synthesis of evidence for international development policy and prac-
tice. Journal of Development Effectiveness, 4(3), 409–429.
Sonmez Saglik, D., & Caglar, S. (2018). The effect of parental presence on pain and
anxiety levels during ınvasive procedures in the pediatric emergency depart-
ment. Journal of Emergency Nursing, 45(3), 278–285.
Stevens, B. J., Abbott, L. K., Yamada, J., Harrison, D., Stinson, J., Taddio, A., &
Finley, G. A. (2011). Epidemiology and management of painful procedures in
children in Canadian hospitals. Canadian Medical Association Journal, 183(7),
E403–E410.
Sun, Y., Qi, S., Qi, R., Dong, X., An, J., & Yuan, H. (2017). The effect of parental pres-
ence to perioperative anxiety of Chinese children and their parents. Biomedical
Research, 28(17), 7519–7522.
Tantikul, C., & Theeranate, C. (2014). Effect of parental presence while children un-
dergo common invasive procedures. Journal of the Medical Association of Thai-
land, 97(2), 153–158.
Toruner, E., & Buyukgonenc, L. (2012). Çocuk sağlığı: Temel hemşirelik yaklaşımları.
Çocuk sağlığı: Temel hemşirelik yaklaşımları [Child health: Basic nursing ap-
proaches]. Ankara, Turkey: Ankara Nobel Medicine Bookstores.
Tufanaru, C., Munn, Z., Aromataris, E., Campbell, J., & Hopp, L (2020). Systematic
reviews of effectiveness. In E. Aromataris, & Z. Munn (Eds.), Joanna Briggs Insti-
tute reviewers’ manual for evidence synthesis. Adelaide, Australia: Joanna Briggs
Institute Available from https://synthesismanual.jbi.global .
Vasiliki, B., Konstantinos, A., Vassilis, K., Nikolaos, K., van Loveren, C., &
Jaap, V. (2016). The effect of parental presence on the child’s perception and
co-operation during dental treatment. European Archives of Paediatric Dentistry,
17(5), 381–386.
Wier, L. M., Yu, H., Owens, P. L., & Washington, R. (2013). Overview of children in the
emergency department, 2010: Statistical Brief #157. Healthcare Cost and Utiliza-
tion Project (HCUP) Statistical Briefs [Internet]. Rockville, MD: Agency for Health-
care Research and Quality (US) Available from https://europepmc.org/article/
nbk/nbk154386 .
Wolfram, R. W., Turner, E. D., & Phılput, C. (1997). Effects of parental pres-
ence during young children’s venipuncture. Pediatric Emergency Care, 13(5),
325–328.
Yavas Celik, Melike (2018). Çocuk hastalarda aile merkezli bakım ve hemşirelik
[Family centered care in child diseases and nursing]. Sağlık ve Toplum, 28(1),
26–31.

Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on January 14,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.