During hospital visits, children often undergo examinations and treatments that may involve an experience of pain and distress that is also connected to the staff's treatment. The United Nation's Convention on the Rights of Persons with Disability advocates the use of Universal Design. One way of implementing this idea within paediatric nursing is to increase the use of pictorial supports, and the few studies that have been published show promising results. The aim of this study was to do a comparison between two groups of children in regard to the pre- and postconditions of implementing an intervention including staff instruction and the use of pictorial support. The support consisted of a visual schedule with pictures and text, used both preparatory to and during the hospital visit. One hundred children aged 5–15 (50 children during the preinterventional data collection and 50 children postinterventionally) reported pain intensity and distress during needle-related procedures in nitrous oxide sedation. The results showed that the intervention had a positive effect in significantly lowering the level of preprocedural distress. The results showed that the pain intensity was also lowered however not reaching statistical significance. This confirms other positive research results on the use of visual supports within paediatric care, a topic that has to be further studied.

The aim of the study was to describe the experiences of communication in the caring process for children aged 7-13 years when they receive nitrous oxide during needle-related examinations and treatments. The study was of a qualitative nature and has been viewed through the lens of qualitative content analysis. Seventeen children aged 7-13 years participated, and visual and textual information was used to prepare each child. The categories described the following important activities for communication: The child has the possibility to learn about the procedure; trust in communication is based on one's own experiences; the child is disturbed in the communication during the procedure; the healthcare professional is responsive to the situation of the child; and children's emotions affect the communication. The results show that the children appreciated procedure-specific information and they felt that they have knowledge of what is going to happen. Accordingly, the children feel that they can reduce their distress when they are in control.