Distraction Intervention To Reduce Venipuncture Pain in School-Aged Children

Pain is a stressful experience and is known as a global issue. Inadequate pain management is known to lead to higher stress levels and immediate as well as long term negative health outcomes. The topic of pain is a large medical issue in the health field for both adults and children, since they are subject to a number of painful and invasive medical procedures. When it comes the pediatric field, venipuncture is the most common painful and invasive procedure for children.

Venipuncture is a necessary practice in the pediatric field because it is the only way to administer IV fluids and IV medications, as well as obtain blood draws for cultures and labs like CBC differentials and Venous Blood Gases. Because venipuncture is oftentimes required for higher quality care and is such a common yet painful procedure in the pediatric field, it is a large problem for the health care team because inflicting such short-term traumatic stress can lead to long-term problems.

For example, children are less cooperative and more anxious with venipuncture when it comes to having prior negative memories of venipuncture procedures. Reducing or blocking anxiety and pain memories in children can increase cooperation and decrease anxiety related to future visits. To do so, distraction-based interventions have been a recent topic of study for many researchers. The most used interventions to decrease procedural pain, and the most effective, are distraction-based interventions. Distraction-based interventions fall under the behavioral interventions of nonpharmacological strategies, with the other category of strategies being physical intervention.

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Traditional forms of behavioral interventions involves mixtures of strategies, such as distraction, breathing techniques, emotional imagery and redirection of perception of pain. Examples of other distraction-based intervention studies include the use of bubble blowing and cartoon-patterned clothing, an external cold and vibration device, picture books, cartoons, oral instruction, kaleidoscope, and many others. Although there have been a great variety of distraction-based interventions, assessed on different platforms such as parent-report, self-report, and observation, the outcomes of these studies have shown the effectiveness of distraction again pediatric pain and distress.

Purpose

The purpose of the study, A New Distraction Intervention to Reduce Venipuncture Pain in School-Age Children: Different Colored Flashlights; An Experimental Study with Control conducted by Tufekci, Kucukoglu, Aytekin, Polat & Bakan, (2017) is to observe and examine the effect of the new distraction-intervention of different colored flashlights as a cost-effective and easy-to-use means, to decrease the perception of pain during venipuncture in school-aged children.

Relevance to Pediatric Nursing

Venipuncture, despite how common and necessary, creates anxiety and pain in children. With this unnecessary short-term torment, pediatric distress can create long-term negative effects on patients. As seen in a study by Bijttebier and Vertommen H, they show a correlation between children having a history of negative medical experiences to having higher anxiety levels prior to a venipuncture-type procedure, and these children presented to be more troubled and less cooperative throughout the venipuncture. The same childhood distresses from pediatric procedures have been linked to reported pain and fear of hospital events from adults, which in turn links those who have claimed to have early negative medical experiences to avoidance of future care as well. Another study shows recent physiological data demonstrating early pain from medical insults can alter neurological pathways that lead to heightened sensitivity to future stimulations. Therefore, any means to decrease the pain perception related to venipuncture would benefit the pediatric health field worldwide, especially when the intervention is nonpharmacological and accessible to the less cost-adequate areas of the globe.

Results

Demographically, all the children in this study were Turkish, ages 6-12, could report using the numeric scale, and had no developmental delays/disabilities that would have impeded communication. There were 144 total children evenly split into 1 control group and 3 experimental groups (a clear glass, red glass, and blue glass light group), so n=36 for each group. In the control group, there were 22 males and 14 females. The average age was 9± 2.04. In the control group, 91% had a venipuncture before, and for the rest it was their first time. The control group resulted in 50% being fearful of the procedure and showed higher cortisol levels related to the venipuncture compared to the experimental groups (however, the difference in values between the groups was insignificant. Nonetheless, in painful procedural experience using the visual analogue scale (VAS) scale, the control group ranked significantly high. Summarize the author’s conclusions and implications.

Overall, what did this study show and what are the anticipated effects on the pediatric population or nursing in general? As interpreted by Tufekci et al., children’s pain severity connected to venipuncture in the control group was significantly higher than the three experimental groups. Children’s cortisol levels connected to venipuncture in the control group was higher than the three experimental groups. The difference between groups was determined to be insignificant. Only a low positive correlation was found between the cortisol levels and pain severity In addition, describe how you would apply the results of this research, personally and specifically, to the practice of pediatric nursing and how you would educate others regarding these findings. Be creative and convincing. If you had unlimited funding, what would you create to draw people in and be interested in these findings or implement the findings? Please avoid the standard of posting fliers and holding a class.

Critique

This experimental study included a control group, and took place at a child blood collection unit in Turkey. The sample size was 144 children who fit the criteria of being between the ages 6-12 and could identify and report numbers (for the numeric pain scale). Aside from 144 seeming too small to represent the child population as a whole, children who could not use the numeric scale, possibly those with lesser education, have been excluded from the represented population. Tufekci et al. also mentioned that to qualify for the study, the children could have no developmental disorder or delay that would make communication difficult, so given this information, it seems that a portion of the disabled population has been excluded from representation in this study as well.

Despite the inadequacy of the sample size, there is a demand for pain management/prevention interventions for venipuncture procedures. This study was a response to another study using kaleidoscopes as distraction intervention that did not get significant results yet was the first of its kind. Additionally, the study looked into the use and efficacy of a new and different type of distraction-based intervention due to children still being inadequately treated against pain despite other recent studies under this topic. In terms of the methodology, the process was clear enough for people to recreate the study. However, some variables may need to be adjusted given the following:

I believe the Turkish culture and race may have affected the results. By this I mean the result may have been different if performed in the United States. I also believe if the sample size would have been bigger and represented a more diverse population, the results would have turned out differently. Given that the experiment took place at one blood collection clinic over two years, the sample group only could have been surrounding the one clinic and excluded the children who had no access to that clinic. In each group of 4, they did not have an even number of girls and boys. The one control group had a few more males and the 3 experimental groups has a few more females, which I think may have swayed the results despite the effort to be a randomized trial.

References

1. Bergomi, P., Scudeller, L., Pintaldi, S., & Dal Molin, A. (2018). Efficacy of Non-pharmacological Methods of Pain Management in Children Undergoing Venipuncture in a Pediatric Outpatient Clinic: A Randomized Controlled Trial of Audiovisual Distraction and External Cold and Vibration. Journal of Pediatric Nursing, 42, e66–e72. https://doi-org.libproxy.sdsu.edu/10.1016/j.pedn.2018.04.011
2. Bijttebier P., Vertommen H. (1998) Coping with peer arguments in school-age children with bully/victim problems, (Pt 3): 387-94. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9788212
3. Carlson KL, Broome M, & Vessey JA. (2000). Using distraction to reduce reported pain, fear, and behavioral distress in children and adolescents: a multisite study. Journal of the Society of Pediatric Nurses, 5(2), 75–85. Retrieved from http://libproxy.sdsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107119727&login.asp&site=ehost-live&scope=site
4. Cavender K, Goff MD, Hollon EC, & Guzzetta CE. (2004). Parents’ positioning and distracting children during venipuncture: effects on children’s pain, fear, and distress. Journal of Holistic Nursing, 22(1), 32–56. Retrieved from http://libproxy.sdsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=106758181&login.asp&site=ehost-live&scope=site
5. Kuo, H.-C., Pan, H.-H., Creedy, D. K., & Tsao, Y. (2018). Distraction-Based Interventions for Children Undergoing Venipuncture Procedures: A Randomized Controlled Study. Clinical Nursing Research, 27(4), 467–482. https://doi-org.libproxy.sdsu.edu/10.1177/1054773816686262
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10. Tufekci, F. G., Kucukoglu, S., Aytekin, A., Polat, H., & Bakan, E. (2017). A New Distraction
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15. (Tufekci, Kucukoglu, Aytekin, Polat & Bakan, 2017)
16. (Tukekci et al, 2017)
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18. (von Baeyer, Marche, Rocha, Salmon, 2004)