Routine Procedures
During a blood draw, the child life specialist explains the steps while another staff member says, “Don’t look—almost done!”
What is the biggest concern with this approach?
A. The procedure may take longer
B. The child receives too much information
C. Conflicting voices can increase anxiety and confusion
D. The caregiver may feel excluded
C. Conflicting voices can increase anxiety and confusion
During awake NG placement, staff and caregivers give simultaneous instructions ("hold still", "it's ok", etc.), add loud reassurance or distraction, and problem-solve out loud while the child gags and panics...
Which of the following DOES NOT support One Voice?
A: assigning one speaker and suing simple, repeated breathing cues
B: Coaching the caregiver to remain quiet or use one phrase
C: Multiple people talking and giving instructions
D: Pausing the attempt when distress escalates
C: Multiple people talking and giving instructions
This step in the comfort policy involved asking the child/family about past experiences with medical procedures and pain?
Assessment
When using One Voice with a nonverbal patient, which strategy is BEST in supporting effective communication?
A: Louder voices to promote auditory processing
B: Only use verbal instructions from parents and staff
C: Use visual aids and the patients' communication device
D: Use visual aids and multiple voices
C: Use visual aids and the patients' communication device
A 9-year-old with a solid tumor becomes tense and tearful before a dressing change. The room is busy, voices are raised, and the child's anxiety continues to escalate...
To best support comfort coping, what should the care team do first?
Create calm
An infant shows finger splaying, yawning, and color changes during care...
What One Voice action is MOST appropriate?
A: Pause care to reduce stimulation
B: Continue care cautiously
C: Talk softly to soothe the infant
D: Increase environmental sound for normalization
A: Pause care to reduce stimulation
A nurse, caregiver, and staff member are all giving instructions during an IV start...
The best ONE VOICE practice would be to:
A. Let everyone continue to encourage the child
B. Ask the caregiver to leave the room
C. Designate one person to give instructions to the child
D. Stop the procedure until the child calms down
C. Designate one person to give instructions to the child
During an awake drain removal, staff count down, reassure loudly, problem-solve out loud (“it’s stuck”), and multiple people talk at once while the child tenses, cries, and panics...
What response is most likely to increase pain and distress during drain removal?
A. Assigning one calm speaker and using slow, steady pacing
B. Coaching the caregiver ahead of time to remain quiet or use one phrase
C. Pausing if the child becomes overwhelmed
D. Countdowns, multiple voices, and talking through uncertainty during the pull
D. Countdowns, multiple voices, and talking through uncertainty during the pull
In additional to the child, this person should be actively involved in creating a coping plan and ideally be actively involved during the procedure?
Parent or Family Caregiver
Which individual should typically serve as the One Voice during a procedure with a child who has a developmental delay?
A: The staff member needing training with this population
B: The staffing nurse for the day
C: The staff member that has a child with a developmental delay
D: The parent or staff member with the most rapport
D: The parent or staff member with the most rapport
A 7-year-old receiving chemotherapy becomes tearful before a port access. After acknowledging their fear, the care team provides choices like deep breathing, squeezing a stress ball, or watching a video during the procedure...
What is the care team doing?
Offer coping tools
A new nurse asks why bedside conversations are limited...
What is the best One Voice explanation?
A: "It's just unit policy"
B: "Babies only need to listen to white noise"
C: "Consistent, intentional voices support neurodevelopment and regulation"
D: "It keeps the unit quieter for staff"
C: "Consistent, intentional voices support neurodevelopment and regulation"
Multiple people are talking to a 4‑year‑old during vital signs...
Who should typically be the ONE VOICE to the child?
A. The sibling
B. The caregiver
C. The staff member completing the task
D. Whoever the child looks at
C. The staff member completing the task
Tape is removed quickly while multiple people talk, count down, reassure the child not to cry, and distract loudly— turning a brief pain into a loss of trust and escalation...
Which of the following ignores ONE VOICE principles and minimizes the child’s fear?
A. Explaining each step before touching
B. Removing tape slowly with ONE VOICE
C. Offering a pause signal
D. Countdowns, fast pulling, and multiple voices talking
D. Countdowns, fast pulling, and multiple voices talking
When available, nurses can contact these disciplines to provide expert procedural preparation and support to the child?
Child Life or Music Therapy
Which of the following supports One Voice and safety during procedures for children who sensory processing disorders?
A: Play background music to calm the child
B: Minimize environmental stressors
C: Rapidly explain the procedure to speed up the process
D: Ensure bright lights during the procedure for accuracy
B: Minimize environmental stressors
Before a scheduled port access, a 6-year-old with cancer becomes anxious because they are unsure what will happen...
To support comfort coping and increase predictability and trust, what should the care team do before beginning the procedure?
Educate the child before starting
You are caring for a 28-week infant who becomes tachycardic during rounds. Five staff members are speaking at once near the bedside...
What is the BEST One Voice response?
A: Ask everyone to whisper at the same time
B: Allow discussion to continue- it's important for care planning
C: Turn up monitor alarms to compensate
D: Designate one spokesperson to speak softly and step away from the bedside
D: Designate one spokesperson to speak softly and step away from the bedside
A distressed caregiver is speaking rapidly to a toddler during an ear check...
Why is ONE VOICE especially important here?
A. Toddlers respond better to silence
B. Toddlers can only process one direction at a time
C. Caregivers should not speak
D. It speeds up procedures
B. Toddlers can only process one direction at a time
While a child is yelling during a catheter placement, staff give competing commands, caregivers reassure loudly, and cartoons or music are turned up to distract—resulting in confusion, loss of control, and escalation...
What is abandoning ONE VOICE and increasing distress during a VCUG?
A. Establishing ONE VOICE before catheter placement
B. Using calm, predictable language
C. Allowing the child to pause if overwhelmed
D. Everyone trying to calm the child at the same time with words and noise
D. Everyone trying to calm the child at the same time with words and noise
Providing comfort during procedures is the responsibility of this group?
All caregivers!
For a child with a hearing impairment, how can One Voice be MOST effective?
A: Stand behind the child to avoid distraction
B: Rely solely on written instructions
C: Have multiple staff members repeat loud instructions to ensure understanding
D: Use clear facial expressions and ensure the child can see the designated speaker
D: Use clear facial expressions and ensure the child can see the designated speaker
A 6-year-old with leukemia is undergoing a port access and becomes overwhelmed as multiple providers and caregivers talk at once...
To best support comfort coping and reduce the child's distress, the team should do this during the procedure?
A painful procedure in planned and the infant is medically stable...
How can One Voice support comfort?
A: Multiple staff soothe the patient during the procedure
B: One consistent voice is paired with containment
C: Silence is used during the procedure
D: Only medical instructions are spoken aloud
B: One consistent voice is paired with containment
Several staff give urgent instructions during a quick injection...
Which approach best supports ONE VOICE under time pressure?
A. Use multiple short commands
B. Skip coping strategies
C. Use one calm, simple instruction
D. Complete the injection without warning
C. Use one calm, simple instruction
During an awake circumcision, staff explain, comment, and reassure over the infant’s crying while caregivers are coached out loud—adding stimulation instead of regulation...
What practice increases infant stress and caregiver anxiety during awake circumcision?
A. Quiet containment and swaddling
B. One calm voice or silence
C. Using non-pharmacologic pain supports
D. Layered voices, narration, and verbal reassurance over crying
D. Layered voices, narration, and verbal reassurance over crying
This technique create safe, nurturing proximity with a parent or familial caregiver?
Comfort Positioning
When working with a family and child with limited English proficiency, which of the following supports One Voice?
A: Speak slowly in English for comprehension
B: Request that family members translate important information
C: Use a certified interpreter as the designated One Voice
D: Use a staff member with some proficiency to translate during care
C: Use a certified interpreter as the designated One Voice
To best support comfort coping and help the patient maintain focus and regulation during the procedure, the care team should do this before proceeding?
Eliminate extra stimulation
An infant begins to desaturate to the low 50s during routine care. Multiple caregivers respond...
How is One Voice maintained while ensuring safety?
A: One leader gives calm, clear directions
B: Everyone announces what they are doing
C: Silence all voices and other sounds
D: Only the bedside nurse speaks to the team
A: One leader gives calm, clear directions