This study developed a substantive theory of child-centered involvement.

The study provides a practical framework to guide nurses in procedural care.

Three forms of involvement were identified: exploratory, socio-emotional and symbolic.

Child involvement was found to be dynamic and tailored to individual preferences.

The findings enhance conceptual clarity in Child-Centered Care practice.

Knowledge about how paediatric patients are involved in their healthcare is limited. The purpose of the study was to explore the involvement of children and adolescents in nurse-led procedures in hospital settings and how they perceive their involvement in these procedures.

With a grounded theory design, data were collected through participant observation and in situ questioning of 13 children aged 5 to 16 years, across three inpatient and three outpatient paediatric units. Field notes were recorded. Consistent with constructivist grounded theory, data were analysed through three phases of coding.

Three forms of involvement were identified: Exploratory involvement, Socio-emotional involvement, and Symbolic involvement. Four related subcategories, spanning across the forms of involvement, were identified: The nurse's assessment of the child's needs, The child's position in interaction with the nurse, Communication, and The sequence of actions. The three forms of involvement and subcategories constitute the theory: Forms of Child-Centred Involvement during Nurse-led Procedures.

This study contributes to a theoretical framework for understanding how the involvement of children can be tailored to meet the child's needs.

The three different forms of involvement guide paediatric nursing practice and can serve to inform the further development of Child-Centred Care.

Adolescent

Child

Nursing

Pediatrics

Patient-Centered care

Patient participation

© 2026 The Authors. Published by Elsevier Inc.