Skip to Content
MDPIMDPI

Advanced

ChildrenChildren
PDF
  • Article
  • Open Access

23 October 2026

17 Pages

Childhood Experiences of Nursing Support During Medical Procedures and Their Association with Later Perceptions of Psychological Preparation and Information Provision

Department of Nursing, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara 723-0053, Japan
Children2026, 13(11), 1462;https://doi.org/10.3390/children13111462
This article belongs to the Section Pediatric Nursing
Version Notes
Review Reports
Order Reprints

Highlights

What are the main findings?
  • Childhood experiences of receiving information, having questions answered, and receiving supportive care during medical procedures were associated with later perceptions of the importance of psychological preparation and information provision.
What are the implications of the main findings?
  • Positive childhood experiences of nursing care may be associated with how individuals perceive the importance of psychological preparation and information provision for children.
  • Nurses should continue to provide care that supports children’s understanding, participation, and sense of security during medical procedures.

Abstract

Background/Objectives: Since the adoption of the Convention on the Rights of the Child, greater attention has been paid to ethical nursing practices that respect children’s rights. This study examined childhood experiences of nursing support during medical procedures and their associations with current perceptions of psychological preparation and information provision for children. Methods: A web-based survey was conducted among 220 individuals aged 15–49 years who reported remembering medical procedures, such as blood sampling, intravenous infusions, or surgery, experienced during childhood. Participants reported their childhood experiences of nursing support and their current perceptions of psychological preparation and information provision for children. Results: More than 40% of participants reported receiving information about medical procedures, having questions answered, receiving verbal encouragement, and receiving rewards, whereas approximately 20% experienced distraction or physical restraint. Approximately 40% considered psychological preparation “very important,” and approximately 50% considered it necessary to provide children with information about medical procedures. Conclusions: Childhood experiences of receiving information, having questions answered, receiving verbal support, and distraction were associated with later perceptions of psychological preparation and information provision for children. These findings suggest that childhood nursing experiences may contribute to shaping later attitudes toward children’s rights in healthcare, highlighting the potential long-term significance of rights-based nursing care during childhood.

1. Introduction

Psychological preparation was introduced into pediatric nursing practice in Europe and the United States in the 1970s to reduce the psychological distress associated with medical procedures in children. Since the 1980s, initiatives such as the World Health Organization (WHO) recommendations on child nursing in hospitals (1982) and the Charter of the European Association for Children in Hospital (EACH) (1988) have emphasized the provision of medical and nursing care while protecting children’s rights [1,2]. The EACH Charter states that “children and parents have the right to informed participation in all decisions involving their health care” [3]. Following Japan’s ratification of the Convention on the Rights of the Child in 1994, nursing practices aimed at protecting the dignity and rights of children and their parents through psychological preparation became increasingly established. In 1999, the Japanese Nursing Association advocated providing clear explanations to children and caregivers in its standards for pediatric nursing practice [4]. The proportion of nurses who provided explanations to children with the intention of respecting their right to know was less than 50% in 2000 but increased to 70% in 2005 and more than 90% in 2010, suggesting increased awareness of ethical nursing practices in pediatric healthcare [5]. In pediatric clinical settings, nurses have been reported to consciously engage with children sincerely, involve parents, use gentle language and smiles, and help relieve children’s tension after blood collection. However, physical restraint used to ensure the safety of medical procedures may overlap with children’s experiences of distress or discomfort [6].
In a 2007 survey of third-year junior high school students examining their perceptions of hospitals, doctors, and nurses, less than 40% reported difficulty talking with doctors and nurses. However, less than 50% stated that they wanted healthcare professionals to explain things more clearly, just under 30% indicated that informing only their parents was acceptable, and just under 30% wanted explanations using dolls [7].
More recently, the Japan Pediatric Society [8] proposed the ‘Charter for Children in Healthcare,’ which emphasizes that healthcare should be provided in accordance with children’s best interests and that children have the right to receive information about matters associated with them and to express their feelings, hopes, and opinions. The Children and Families Agency of the Government of Japan [9] similarly promotes a society in which children and youth can exercise their rights and live in a state of well-being. Its basic policy emphasizes respecting the perspectives of children, youth, and those raising children and promoting child-related policies through consultation and dialogue.
According to the National Survey on Child Poverty and Children’s Rights [10], the proportion of children aged 15–17 who had never heard of the Convention on the Rights of the Child increased slightly from 31.5% in 2019 to 32.9% in 2024, whereas the proportion who were well informed about its content increased from 8.9% to 12.2%. The proportion of children who considered their rights to be “respected” or “somewhat respected” increased from 69.7% to 74.7%; nevertheless, 25.3% reported that their rights were “not respected much” or “not respected.” Among adults, the proportion who had never heard of the Convention increased from 42.9% to 47.6%, while the proportion who had never considered their children’s rights increased from 13.3% to 19.8%, raising concerns about declining awareness. Furthermore, 40.2% of children identified access to medical and health services as an important right, demonstrating awareness of the importance of healthcare. Although 39.8% considered prioritizing the child’s best interests in all activities involving children to be important, 31.4% also identified this right as insufficiently protected [10]. Even after the adoption of the Convention on the Rights of the Child in 1989, children’s rights have often been misunderstood, undervalued, or challenged, and serious challenges have been identified in realizing a vision for children [11,12]. Although nurses’ awareness of ethical practices in pediatric healthcare has improved, further consideration is needed regarding how psychological preparation should be implemented during medical procedures and how such support can be incorporated into nursing practice.
Previous studies on psychological preparation have primarily focused on short-term outcomes, such as reducing children’s anxiety and distress before medical procedures. However, relatively little is known about how these experiences are remembered and evaluated later in life. Understanding which aspects of care remain meaningful from the perspective of individuals who experienced medical procedures during childhood may provide important insights into child-centered care and children’s rights in healthcare settings. Although children’s rights to receive information, express their views, and participate in healthcare decisions have received increasing attention, few studies have examined whether childhood experiences related to these rights may be associated with attitudes toward psychological preparation in later life.
Therefore, this study aimed to examine how individuals retrospectively evaluate nursing support received during childhood medical procedures and to explore whether these experiences are associated with their current perceptions regarding the importance of psychological preparation for children undergoing medical procedures.

2. Materials and Methods

2.1. Participants

From a pool of approximately 8000 general consumers registered with the web-based survey platform QiQUMO (Cross Marketing, Tokyo, Japan), we preselected individuals who had experienced medical procedures (e.g., blood draws, intravenous infusions [IV drips], vaccinations, or surgery, etc.) during childhood, up to elementary school age. A total of 220 participants aged 15–49 years were recruited for the survey.
The required sample size was estimated using G*Power 3.1.9.7 based on an effect size of 0.30 and a statistical power of 0.95, resulting in a target sample size of 220 participants. The sample size was calculated based on a χ2 test (α = 0.05, effect size w = 0.30, df = 5). An effect size of 0.30 was selected because it represents a medium effect according to Cohen’s criteria.

2.2. Methods

Using the web-based survey platform QiQUMO, we collected responses from the public regarding their experiences of and preferences for psychological preparation and ethical nursing practices during medical procedures experienced in childhood, including blood draws, IV drips, vaccinations, and surgeries. Data was collected from 5 August to 20 August 2026. Responses were obtained using multiple-choice and partially open-ended questions.
The questionnaire comprised four demographic and experiential attributes (age, experience with medical professionals, experience with pediatric healthcare professionals, and the presence of healthcare professionals in the family) and nine items from previous studies [13]. In addition, the item content was informed by a preliminary qualitative survey conducted in 2023 among high school students, in which participants provided free-text descriptions of memorable aspects of childhood medical procedures. The questionnaire was developed to reflect themes identified in both the literature and these qualitative responses. Participants were provided with the following definition before answering: “Psychological preparation refers to nursing support such as explanations, communication, and play activities that help children prepare emotionally before a medical procedure.” Information provision referred to explanations about the procedure. Communication referred to opportunities for children to ask questions and express concerns and for healthcare providers to respond to them. Children’s participation referred to opportunities for children to express their preferences or opinions regarding their care. The questionnaire was newly developed for this study based on the previous literature, findings from a preliminary qualitative survey, and discussions among the researchers. Although content relevance was considered during questionnaire development, the instrument was not a previously validated scale and did not undergo formal cognitive interviewing or pilot testing prior to administration.
Participants were not instructed to recall a specific medical procedure. Responses may therefore reflect overall recollections of childhood medical procedures rather than a single event. Participants were asked to rate the current importance they attributed to psychological preparation for children undergoing medical procedures. This item assessed their present perceptions regarding the importance of psychological preparation rather than whether they had personally received psychological preparation during childhood.
Regarding experiences of nursing support, participants were asked whether they had received six types of support: “Information provision,” “Answered my question,” “Distractive care,” “Listened to or spoke to me,” “Physical restraint,” and “Received a reward.” Responses were recorded as “Yes,” “No,” or “I don’t remember”; these were coded as 1 = yes and 2 = no. Participants were also asked to rate the necessity of information provision on a four-point scale ranging from “Necessary” (1) to “I don’t know” (4) and the importance of psychological preparation on a five-point scale ranging from “Very important” (1) to “I don’t know” (5).
Additionally, participants provided open-ended responses describing their most memorable experiences with nurses during medical procedures.

2.3. Statistical and Descriptive Analysis

Numerical data were aggregated using Microsoft Excel (Microsoft 365 Apps) and analyzed using IBM SPSS Statistics, version 32.
Statistical analyses were conducted at a significance level of p < 0.05 to examine differences according to age group and healthcare-related professional experience, and to explore associations between experiences of nursing support and perceptions of psychological preparation and information provision. The proportional odds assumption was assessed for each ordinal logistic regression model using the Test of Parallel Lines. Predictor variables entered simultaneously into each ordinal logistic regression model included childhood experiences of nursing support during medical procedures (information provision, nurses answering questions, distractive care, emotional support, physical restraint, and receiving rewards after medical procedures). Age group, healthcare-related professional experience, pediatric professional experience, and family healthcare-related professional status were additionally included as potential confounding variables based on theoretical relevance and previous findings suggesting that these characteristics may be associated with perceptions of healthcare experiences. Multicollinearity among predictor variables was assessed using variance inflation factors (VIFs). All VIF values were below 5, indicating no evidence of problematic multicollinearity. The outcome variables were coded such that lower scores represented greater perceived importance or necessity. Therefore, odds ratios less than 1 indicate a greater likelihood of reporting higher perceived importance or necessity relative to the reference category.
Open-ended responses were analyzed using inductive qualitative content analysis. The free-text question was optional, and participants could choose whether to provide a response. Responses were reviewed repeatedly and categorized according to similarities in content. Coding and categorization were conducted by a single researcher (the author), and each response was assigned to the category that best represented its primary meaning. Coding was not independently verified by a second researcher. Although inter-coder agreement was not assessed, coding validity was reviewed repeatedly throughout the analytical process.

2.4. Ethical Consideration

Participants aged 15 years or older were registered monitors of partner panel providers of QiQUMO and had agreed to the respective terms of use and privacy policies at the time of registration. These agreements included provisions regarding the collection and use of personal information, participation in online surveys, and the statistical use of survey responses. Participation in and completion of the survey was voluntary, and participants were informed that the survey concerned nursing support provided to children during medical procedures and they could discontinue the survey if recalling their childhood medical procedures caused them distress. The researchers had no access to personal identifiable information. The study was conducted with the approval of the Research Ethics Committee of the authors’ institution (approval code: No. 26MH003, approved on 8 May 2026).

3. Results

3.1. Participant Characteristics (Table 1)

A screening survey was conducted with 8000 general residents. Of these, 3461 (43.3%) reported having undergone medical procedures by 12 years of age and having some recollection of their experience. For the main survey, a maximum of 55 participants were recruited from each age group (teens, 20s, 30s, and 40s) to ensure a balanced distribution across age groups. Recruitment was closed when the upper limit for each age group was reached, resulting in 220 participants for the final analysis. Participants ranged in age from 15 to 49 years, with a mean age of 30.9 years. The most common occupations were general employees (64, 29.1%), students (60, 27.3%), and part-time or temporary workers (26, 11.8%). Forty-two participants (19.1%) had experience as healthcare professionals, 67 (30.5%) had healthcare professionals among their family members or cohabitants, and 24 (10.9%) had experience working as pediatric healthcare professionals.
Table 1. Attributes of the Participants.

3.2. Summary (Table 2)

Regarding medical procedures experienced during childhood (e.g., blood draws, IV drips, vaccinations, and surgeries), among the surveyed participants, 117 respondents (53.2%) reported receiving information about the procedure, and 122 (55.5%) reported that nurses appropriately answered their questions. In addition, 110 participants (50.0%) reported that nurses listened to them or spoke with them about their fears or dislikes, and 91 (41.4%) reported that nurses praised them or gave them a reward. Fifty participants (22.7%) reported receiving distraction using dolls or toys. Fifty participants (22.7%) reported feeling afraid when nurses or family members restrained them.
Regarding the necessity of informing elementary school-aged children about medical procedures, 109 participants (49.5%) considered such information “necessary,” and 75 (34.1%) considered it “almost necessary.” Regarding the importance of psychological preparation for children, 94 participants (42.7%) rated it as “very important,” and 91 (41.4%) rated it as “slightly important.”
Table 2. Responses to each item.

3.3. Statistical Analysis

Spearman’s rank correlation analysis was conducted to examine the relationship between the perceived necessity of information provision and the perceived importance of psychological preparation. A strong positive correlation was observed between the two variables (ρ = 0.691, p < 0.001) (Table 3).
Table 3. Spearman Rank Correlation Analysis.
Significant associations were observed between age group and “experiences of information provision” and “experiences of receiving rewards.” Significant trends were also identified in the tests for a linear trend. The proportion of participants who reported receiving information decreased from 72.7% among those in their teens to 41.8% among those in their 40s, whereas the proportion who reported receiving a reward decreased from 61.8% to 23.6%, respectively. Conversely, the proportions who responded that they “do not remember” increased from 20.0% to 38.2% for information provision and from 18.2% to 34.5% for rewards, respectively (Table 4).
Table 4. Correlation with Support Experience and Each Age Group.
Recognition of the importance of psychological preparation was strongly associated with experiences of information provision (r = 0.37), being listened to or spoken with by nurses (r = 0.33), receiving a reward (r = 0.32), and receiving distraction (r = 0.38). The associations with experience as a healthcare professional (r = 0.11), experience as a pediatric healthcare professional (r = 0.12), and having a healthcare professional in the family (r = 0.14) were relatively small. Recognition of the necessity for information provision was associated with experiences of information provision (r = 0.33), being listened to or spoken with by nurses (r = 0.30), receiving distraction (r = 0.31), and receiving a reward (r = 0.21). Additionally, small but statistically significant correlations were observed with experience as a healthcare professional (r = 0.06), experience as a pediatric healthcare professional (r = 0.12), and having a healthcare professional in the family (r = 0.11). Additionally, significant correlations were observed with experience as a healthcare professional (r = 0.06), experience as a pediatric healthcare professional (r = 0.12), and having a healthcare professional in the family (r = 0.11). On the other hand, neither perception exhibited any association with experience of physical restraint or age group (Table 5).
Table 5. Correlation of the importance of psychological preparation/the necessity of information provision with each item.
Ordinal logistic regression analyses were conducted with the perceived importance of psychological preparation and the perceived necessity of information provision as dependent variables, and supportive care experience, professional experience, family professional experience, and age group as explanatory variables. Responses of “don’t know” and “I don’t remember” were excluded from the respective analyses. The proportional odds assumption was met for the model examining the importance of psychological preparation (p = 0.405). For the model predicting necessity for information provision, the Test of Parallel Lines was significant (p < 0.001), suggesting that the proportional odds assumption may not have been fully satisfied. Therefore, the results of this model should be interpreted with caution (Table 6).
Table 6. Ordinal Logistic Regression Analyses of Factors Associated with Perceptions of Psychological Preparation and Information Provision.
For the perceived importance of psychological preparation, experience of distractive care was significantly associated with the outcome (OR = 0.154, 95% CI = 0.043–0.547, p = 0.004). For the perceived necessity of information provision, experience of distractive care was also significantly associated with the outcome (OR = 0.247, 95% CI = 0.066–0.918, p = 0.037). Because higher outcome scores represented less favorable perceptions, odds ratios below 1 indicate a greater likelihood of endorsing the importance of psychological preparation and the necessity of information provision. Thus, participants who reported experiences of distractive care were more likely to report stronger endorsement of these perceptions than those who did not report such experiences (Table 6).

3.4. Descriptive Responses (Table 7)

A total of 94 responses describing memorable experiences of nurses’ involvement during medical procedures were classified into eight positive categories (73 responses) and five negative categories (21 responses).
Among the positive responses, the most common category was “I received a reward” (28 responses) followed by “Nurse communicated kindly” (19 responses), “Nurse provided emotional support” (9 responses), and “Nurse distracted me during medical procedure” (6 responses). Among the negative responses, the most common categories were “There is a difference in skill level among nurses” (8 responses), “Being forced to undergo a medical procedure” (6 responses), and “Nurses disregarded my feelings and proceeded with the procedure” (4 cases). Representative anonymized quotations are presented in Table 7.
Table 7. Descriptive responses to the most memorable experiences related to nurses during medical procedures.

4. Discussion

4.1. Memories of Positive and Negative Experiences

In this study, more than 40~50% of participants reported experiences of receiving information, having their questions answered, being spoken to by nurses, and receiving rewards during medical procedures in childhood, whereas approximately 20% reported experiences of distraction or physical restraint. Additionally, many of the open-ended responses described positive experiences, suggesting that supportive interactions, including information provision and communication, may be particularly memorable to participants. This finding aligns with an interview study examining children’s memories of lumbar puncture (LP), in which approximately 60% of participants recalled negative aspects of the procedure (e.g., needle length), whereas approximately 70% recalled positive experiences (e.g., parental support) [14].
Although physical restraint was the only negative experience explicitly assessed in the present questionnaire, the open-ended responses identified additional negative experiences, including differences in nurses’ skill levels, being forced to endure or undergo procedures, and situations in which nurses’ did not acknowledge participants’ feelings and instead proceeded with the procedure. Previous research has shown that the more negative memories of medical procedures are associated with greater distress when the same or similar procedures are subsequently experienced. Childhood medical experiences may also be associated with anxiety and pain perceptions in later healthcare settings [15]. Although this study’s cross-sectional data cannot establish that childhood experiences directly caused later perceptions or responses, the findings suggest that both supportive and negative experiences may remain memorable over time and may be relevant to how individuals perceive subsequent medical care.
Given that children’s support experiences are remembered over a long period, it is important to guarantee their rights to access information and participate in decision-making in medical settings. However, the fact that children are rarely involved in decision-making processes and are marginalized in medical settings has long been a concern. Therefore, providing accurate and reliable information tailored to children’s level of understanding, along with psychological preparation, has been reported to reduce anxiety and distress, promote cooperative behavior in treatment, and enhance the feeling of being in “control” [16,17]. The negative experiences identified in this study therefore warrant further investigation, particularly regarding how experiences of being forced to undergo procedures or having one’s feelings disregarded may relate to perceptions of psychological preparation and subsequent views of healthcare.

4.2. Awareness of and Factors Related to Psychological Preparation and Communication About Medical Procedures

Children seek opportunities for consultation and information to understand their illnesses, participate in care, and prepare for medical procedures; however, in reality, children’s opinions as well as perspectives are not fully considered, and there have been reports of varied experiences regarding the approach to care and treatment consultations among children [18]. Furthermore, whether efforts to promote children’s participation in hospital settings are promoted or supported depends largely on the involvement of healthcare professionals and parents [19]. The stories of the children who visited clinics highlighted the desire to engage proactively, the importance of play, the need for psychosocial support, and the significance of the clinical environment. Vaccinations, body measurements, and acts of restraining the body by adults have been described as memorable events that are associated with children’s care experiences [20].
To understand children’s information needs (amount, format, providers, etc.), it has been proposed that evaluation strategies centered on children and families be developed; methods to understand the optimal amount and type of information to be communicated to children should be understood by parents and healthcare professionals; and consensus on who should best communicate information to children has been proposed [21]. In this study, approximately 40% of participants considered psychological preparation to be “very important,” while approximately 50% of participants considered providing children with information about medical procedures to be “necessary.” A strong positive correlation was observed between these two perceptions. Psychological support, respect for children’s rights to participate, and self-determination are distinct but closely related concepts. Experience of distractive care was associated with greater perceived importance of psychological preparation and greater perceived necessity of information provision. One possible explanation is that experiences of distractive care may be particularly memorable representations of supportive nursing care during childhood medical procedures. However, because this study relied on retrospective self-reports, the underlying reasons for this association remain unclear and warrant further investigation.
Although several childhood experiences examined in this study, including information provision, conversations with healthcare professionals, and distraction, can be considered components of psychological preparation, the outcome variable did not assess receipt of psychological preparation itself. Rather, it assessed participants’ current perceptions of the importance of psychological preparation for children undergoing medical procedures. Therefore, the observed associations should be interpreted as relationships between childhood experiences and later attitudes toward psychological preparation.
Moreover, the presence of healthcare professionals or healthcare professionals in the family was not strongly correlated. In contrast, several childhood experiences of nursing support showed stronger associations with these perceptions. This finding may indicate that recollected experiences of nursing support during childhood medical procedures are associated with how individuals perceive communication and psychological preparation in pediatric healthcare.

4.3. Importance of Protecting Children’s Rights Across Generations

The age group analysis showed that younger participants more frequently recalled receiving nursing support, with reported memories of such support declining with increasing age. However, no significant age-group differences were observed in perceptions of the importance of psychological preparation or the necessity of providing information about medical procedures. The rate of nurses providing explanations to children was below 50% around 2000 but increased to 90% by 2010, while the proportion of nurses who perceived psychological preparation as “always necessary” increased from 59% in 2010 to 65% in 2023 [5,13]. These findings may reflect temporal changes in pediatric nursing practices, including increased emphasis on communication with children and psychological preparation. However, certain factors need to be confirmed—such as the types of medical procedures assumed when answering, age-related differences in memory, the absence of a longitudinal cohort study, and the extent to which the results of the survey on nurses’ perceptions are reflected in the subjects themselves. The temporal sequence “childhood support” and “adult attitudes” is psychologically plausible but cannot be established from retrospective cross-sectional data.
In particular, experiences of receiving information and rewards were reported more frequently among younger age groups. This pattern may reflect changes in pediatric nursing practice over time, including emphasis on children’s understanding and positive engagement during medical procedures. In the future, when teenagers become future parents, it is expected that memories of childhood support and their experiences will be retained, respecting children’s right to information and fostering a positive perception of the need for psychological preparation and explanation across generations.

4.4. Nursing Education and Advocacy for Children’s Rights

Expressions in children’s medical procedures are diverse; negative reactions to pain are often interpreted as immaturity, difficulty in handling, exaggeration, or disobedience, whereas only obedient attitudes are often considered preferred. In painful and stressful procedures, physical restraint is applied according to the child’s responses and characteristics, and content of the procedure. In this study, in addition to physical restraint, experiences such as “being forced to endure” and “not having one’s feelings accepted” were described in the free-form description. These findings suggest that involvement does not sufficiently respect a child’s responses and intentions may persist in memory for a long period. Therefore, rather than viewing physical restraint as “a standard practice,” it is recommended that its application be reconsidered as an approach that prioritizes the multifaceted evaluation of children’s responses as well as the protection and respect of children as individuals with needs, rights, and desires [22]. It is important to shift the perspective of children to “knowers,” positioning pediatric nurses as advocates who guarantee children’s rights in pediatric healthcare and as central agents of “epistemic repair” [23].
It is important to note that the survey item assessed whether participants felt scared when nurses or family members restrained or held them during medical procedures, rather than whether physical restraint itself occurred. Physical restraint may encompass a range of practices, including supportive positioning, safety-related holding, procedural immobilization, and coercive restraint. Because the questionnaire did not distinguish between these forms, the findings should be interpreted as reflecting fear associated with restraint-related experiences rather than the prevalence or impact of any specific type of physical restraint. Recent evidence suggests that pediatric medical traumatic stress (PMTS) may arise from a complex interaction of child-related, family-related, and healthcare-related factors. Distressing medical experiences, including fear, anxiety, repeated invasive procedures, and perceived threat, have been identified as potential contributors to PMTS. In contrast, trauma-informed and family-centered approaches that provide emotional support and developmentally appropriate communication may help reduce children’s distress and facilitate coping. Therefore, the present findings further highlight the potential importance of nursing interventions that provide information, respond to children’s questions and emotions, and promote psychological preparation before medical procedures. Although this study did not directly assess PMTS symptoms, the findings suggest that childhood memories of supportive nursing care may be associated with later perceptions of the importance of psychological preparation. This is consistent with trauma-informed perspectives emphasizing the role of communication, emotional safety, and supportive relationships in reducing the psychological burden of medical procedures [24].
Additionally, pediatric ward nurses often experience moral distress when interacting with children and their families, and it has been reported that implementing organizational mechanisms such as specialized educational programs and workshops by healthcare administrators and policymakers is an essential step to maintain ethical practices and improve the quality of care [25]. Therefore, based on the importance of supportive engagement revealed in this study, it is important to provide opportunities for continuous learning in basic nursing and postgraduate education practices, such as receiving information, speaking to children, responses to questions, and distractive care. Furthermore, it is necessary to enhance educational content that cultivates practical skills for nurses to properly understand children’s expressions and intentions and respect them as agents participating in medical care.

4.5. Limitations

This study has several limitations. Participants were recruited from a commercial online survey panel and therefore represent individuals who voluntarily registered to participate in web-based surveys. Furthermore, recruitment was conducted using age-based quotas, with approximately equal numbers obtained from each age group rather than reflecting the age distribution of the general population. No population weighting was applied. Therefore, the reported percentages should be interpreted as frequencies within this selected survey sample and should not be considered estimates of prevalence in the general Japanese population.
In addition, participants were limited to individuals who recalled childhood medical procedures. Therefore, individuals who experienced medical procedures but did not retain memories of these experiences were not included. Because eligibility required recollection of childhood medical procedures, the study inherently excluded individuals who no longer remembered such experiences. Consequently, participants may have differed systematically from those without retaining memories. Individuals with particularly salient positive or negative experiences may have been more likely to recall childhood procedures and nursing interactions, introducing memory-related selection bias. Furthermore, participants’ current attitudes toward psychological preparation and children’s involvement in healthcare may have associated the way they recalled and interpreted their childhood experiences. Participants may have recalled different medical procedures, including vaccinations, blood draws, intravenous therapy, and surgery. Because a specific procedure was not designated, responses likely reflected overall memories or the most salient experiences, which may have varied among participants.
The questionnaire was developed specifically for this study and was not a previously validated instrument. Furthermore, formal cognitive testing and pilot testing were not conducted before data collection. Therefore, the validity and reliability of some questionnaire items may be limited, and the findings should be interpreted with caution. The questionnaire did not differentiate among various forms of physical holding or restraint during medical procedures. Consequently, it was not possible to determine whether participants’ reported fear was associated with supportive positioning, safety-related holding, procedural immobilization, or coercive restraint. Because the proportional odds assumption was not satisfied for the model predicting necessity for information provision, the corresponding findings should be interpreted cautiously. In addition, qualitative coding was conducted by a single researcher without independent verification, which may have introduced subjective interpretation.
Future studies should examine children’s experiences prospectively and use developmentally appropriate methods to assess their perceptions before, during, and after medical procedures. Further research should also investigate how specific forms of communication, psychological preparation, distraction, and physical restraint may be associated with children’s experiences and subsequent perceptions of healthcare. Such research could contribute to the development of nursing practices that protect children’s rights while supporting their psychological well-being and participation in medical care.

5. Conclusions

This study surveyed 220 individuals aged 15–49 years who recalled undergoing medical procedures, such as blood draws, IV drips, vaccinations, or surgery, during childhood to examine perceptions of psychological preparation and information provision in pediatric healthcare.
More than 40% of participants reported experience receiving information about medical procedures, having their questions answered, being spoken to by nurses, and receiving rewards, whereas approximately 20% reported experiences of distraction or physical restraint. Approximately 40% considered psychological preparation to be “very important,” and approximately 50% considered it “necessary” to provide children with information about medical procedures.
A strong positive association was observed between the perceived importance of psychological preparation and the perceived necessity of providing information to children. Participants who reported experiences of distractive care were more likely to report greater perceived importance of psychological preparation and greater perceived necessity of information provision. However, because this study relied on retrospective self-reports, the underlying reasons for this association remain unclear and warrant further investigation.
Younger participants reported having more memories of receiving nursing support, and the reported frequency of such memories decreased with age. However, age-group differences were not observed in perceptions of the importance of psychological preparation or the necessity of information provision.
These findings suggest that recollected childhood experiences of nursing support during medical procedures were associated with participants’ current perceptions of psychological preparation and information provision in pediatric healthcare. Although causal relationships cannot be inferred from this retrospective cross-sectional study, the findings support the potential importance of providing developmentally appropriate information, responding to children’s questions and concerns, facilitating communication, and using appropriate distraction strategies to support children’s participation and psychological well-being during medical procedures.

Funding

This research was supported by the Grants-in-Aid for Scientific Research from Japan [Grant Number 23K10136].

Institutional Review Board Statement

The study was conducted in accordance with the Decla-ration of Helsinki, and approved by the research ethics committee of Prefectural University of Hiroshima (approval code: No. 26MH003, approved on 8 May 2026).

Data Availability Statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgments

I would like to thank Cross Marketing, the company that operates the web survey tools, and all the respondents who cooperated with this research.

Conflicts of Interest

The author declares no conflicts of interest.

References

  1. Fujimura, M. Consideration for parents with high-risk baby. Jpn. J. Child Nurs. 1987, 10, 506–512. (In Japanese) [Google Scholar]
  2. Oikawa, I. Preparation; ways and devices, why is preparation required? Jpn. J. Child Nurs. 2002, 25, 189–192. (In Japanese) [Google Scholar]
  3. European Association for Children in Hospital. The EACH Charter with Annotations. Updated Edition 2022. EACH (Original Charter Adopted 1988). 2022. Available online: https://www.klicek.org/bratislava/charta-each-update-2015-eng.pdf (accessed on 17 September 2026).
  4. Japanese Nursing Association. Standards of pediatric nursing practice. In Standards of Nursing Practice; Japanese Nursing Association Publishing Company: Tokyo, Japan, 2003; pp. 28–38. (In Japanese) [Google Scholar]
  5. Matsumori, N. Effects of an intervention program for promoting ethical practices among pediatric nurses. Compr. Child Adolesc. Nurs. 2018, 42, 203–221. [Google Scholar] [CrossRef] [Scilit]
  6. Obinata, R.; Nonaka, J.; Yoneyama, M. Characteristics of care for children provided by nurses at pediatric clinics: Care sessions for young children during blood collection. J. Jpn. Soc. Child Health Nurs. 2022, 31, 109–117. [Google Scholar] [CrossRef]
  7. Katsuma, Y.; Matsumori, N. The survey of image and demand on doctors, nurses, medical institutes among 3rd year students of junior high school. Jpn. J. Child Nurs. 2010, 33, 260–264. (In Japanese) [Google Scholar]
  8. Japan Pediatric Society. Children’s Charter in Medicine; Japan Pediatric Society Children’s Living Environment Improvement Committee: Tokyo, Japan, 2022; Available online: https://www.jpeds.or.jp/uploads/files/20220817_kensho_p.pdf (accessed on 4 August 2024).
  9. Children and Families Agency; Government of Japan. General Principles for Child-Related Measures. 2023. Available online: https://www.cfa.go.jp/assets/contents/node/basic_page/field_ref_resources/f3e5eca9-5081-4bc9-8d64-e7a61d8903d0/276f4f2c/20231222_policies_kodomo-taikou_21.pdf (accessed on 26 February 2026).
  10. Save the Children Japan. National Survey on Child Poverty and Children’s Rights. Awareness of Child Poverty and Children’s Rights as Seen from a 30,000-Person Survey 2024. 2024. Available online: https://www.savechildren.or.jp/news/publications/download/ishiki_hinkonkenri202411.pdf (accessed on 26 February 2026). (In Japanese)
  11. United Nations. Convention on the Rights of the Child; United Nations: New York, NY, USA, 1989. [Google Scholar] [CrossRef] [Scilit]
  12. Tobin, J. The next 35 years—Realising the vision under the convention on the rights of the child: A call for more reflection and strategic thinking. Griffith Law Rev. 2026, 1–20. [Google Scholar] [CrossRef] [Scilit]
  13. Matsumori, N. Awareness survey on the psychological preparation and ethical nursing practice of children and their family for medical procedures in Japan. J. Pediatr. Nurs. 2024, 79, e154–e162. [Google Scholar] [CrossRef] [Scilit]
  14. Chen, E.; Zeltzer, L.K.; Craske, M.G.; Katz, E.R. Children’s memories for painful cancer treatment procedures: Implications for distress. Child Dev. 2000, 71, 933–947. [Google Scholar] [CrossRef] [Scilit]
  15. Noel, M.; Chambers, C.T.; McGrath, P.J.; Klein, R.M.; Stewart, S.H. The influence of children’s pain memories on subsequent pain experience. Pain 2012, 153, 1563–1572. [Google Scholar] [CrossRef] [Scilit]
  16. von Baeyer, C.L.; Marche, T.A.; Rocha, E.M.; Salmon, K. Children’s memory for pain: Overview and implications for practice. J. Pain 2004, 5, 241–249. [Google Scholar] [CrossRef] [Scilit]
  17. Li, H.C.W.; Lopez, V. Effectiveness and appropriateness of therapeutic play intervention in preparing children for surgery: A randomized controlled trial study. J. Spec. Pediatr. Nurs. 2008, 13, 63–73. [Google Scholar] [CrossRef] [Scilit]
  18. Coyne, I. Consultation with children in hospital: Children, parents’ and nurses’ perspectives. J. Clin. Nurs. 2006, 15, 61–71. [Google Scholar] [CrossRef] [Scilit]
  19. Coyne, I. Children’s participation in consultations and decision-making at health service level: A review of the literature. Int. J. Nurs. Stud. 2008, 45, 1682–1689. [Google Scholar] [CrossRef] [Scilit]
  20. Ortju, L.; Haaranen, A.; Kankkunen, P.; Karlsson, L. Child participation and care experience in child health clinic nursing encounters: Children’s views by multi-methodology. Int. J. Qual. Stud. Health Well-Being 2026, 21, 2697603. [Google Scholar] [CrossRef] [Scilit]
  21. Lambert, V.; Glacken, M.; McCarron, M. Meeting the information needs of children in hospital. J. Child Health Care 2013, 17, 338–353. [Google Scholar] [CrossRef] [Scilit]
  22. de Souza, D.M.; Bray, L.; Rocha, V.A.; Maia, E.B.S.; Anacleto, A.S.C.B.; Rossato, L.M. How often are hospitalised children physically restrained during painful and stressful procedures? J. Clin. Nurs. 2026, 35, 822–838. [Google Scholar] [CrossRef] [Scilit]
  23. Georgousopoulou, V.; Manomenidis, G. When the child is not heard: Children’s rights and epistemic injustice in paediatric nursing practice. Nurs. Philos. 2026, 27, e70106. [Google Scholar] [CrossRef] [Scilit]
  24. Özbay, S.Ç.; Şahin, R.S.; Kudubeş, A.A.; Sarıkahya, S.D.; Boztepe, H. Which factor impacts medical traumatic stress for pediatric patients: Scoping review. J. Pediatr. Nurs. 2026, 85, 412–423. [Google Scholar] [CrossRef] [Scilit]
  25. Rahmani, N.; Nabavian, M.; Roshan, F.S.N.; Alipour, H. Iranian nurses’ experiences of moral distress in paediatric wards: A qualitative study. Nurs. Open 2026, 13, e70716. [Google Scholar] [CrossRef] [Scilit]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Article Metrics

Citations

Article Access Statistics

Journal Statistics
Multiple requests from the same IP address are counted as one view.
Logopaedic and Educational Observations During the COVID-19 Pandemic on the Development of Preschool Children with Language Disorders in a Speech and Language Therapy Preschool (Kindergarten): A Retrospective Real-World Study
Previous
Lateral-Flow Device (LFD) Aspergillus Antigen Detection in Broncho-Alveolar Lavage (BAL) Fluid in Paediatrics: A Literature Review and Pilot Study
Next