Implementation Evaluation of CALM Care: Examining a Universal Procedural Care Approach for Healthcare Workers in a Tertiary Paediatric Hospital Setting

BACKGROUND: Children experience procedural trauma from medical interventions that may cause harm. Yet, healthcare workers report limited access to relevant training. CALM Care (Comfort, Analgesia, Language, Mindfulness, Memory) is a trauma-informed model and training approach for universal best-practice procedural care. AIM: (1) Examine how CALM Care is implemented in real-world settings, (2) generate knowledge about how multi-modal implementation strategies influence uptake, (3) pilot measures of clinical effectiveness. DESIGN: Mixed-methods implementation evaluation. METHODS: CALM Care was implemented across eight departments (~480 staff) within a metropolitan paediatric teaching hospital between October 2024 and June 2025, guided by the integrated Promoting Action of Research Implementation in Health Services framework. Implementation strategies (e.g., facilitation) were informed by programme theory. Structured observations (N = 63) of children (mean age 2 years, 7 months) undergoing needling was used to assess fidelity, acceptability and clinical outcomes. Organisational metadata informed adoption and feasibility. Data was analysed using a deductive-inductive hybrid thematic approach. RESULTS: Seven departments participated. Following implementation, CALM Care principles (except Comfort) were adopted (i.e., > 20% increased use in standard care). Up to 80% of targeted staff (n = 360) completed training. Documentation of procedural plans increased six-fold. First-attempt proceduralist success improved > 10%, although pain scores did not clinically change significantly. Acceptability to staff and consumer satisfaction was high. Fidelity was strongest for Language (95%), Mindfulness (95%) and Analgesia (85%). Key enablers were adaptability of CALM Care operationalisation, leadership engagement and integration of context-specific resources and workflows. CONCLUSIONS: Theoretically informed strategies support adoption of trauma-minimising practices. However, sustained leadership and policy support are essential to maintain cultural change. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Organisational adoption of CALM Care may enable delivery of least-restrictive care to reduce medical trauma in paediatric hospital settings. REPORTING METHOD: The evaluation followed the StaRI and TIDieR checklists. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution: Patients or members of the public were not involved in the design, conduct, reporting, or dissemination plans of this research, which has been acknowledged as a limitation of this study. GLOBAL CONTRIBUTION: Dynamic facilitation that builds workforce confidence in procedural care may shape a child's lifelong engagement with healthcare. CALM Care, every time, matters.