Effectiveness of distraction intervention to overcome pain and associated distress during painful procedures in children

 

Sushma Oommen1, Asha P Shetty2

1Assistant Professor, College of Nursing, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.

2Professor-cum-Principal, College of Nursing AIIMS Bhubaneswar, Sijua,

Dumduma Post, Khurdha District, Odisha 751019.

*Corresponding Author Email: sushmaoommen@gmail.com

 

ABSTRACT:

If procedures like injections and vaccinations are made free from pain, overall opinion about hospitalization will change. Nonpharmacological techniques like distraction allows focus of client to be diverted away from pain. This part of preliminary study aimed to evaluate the effectiveness of distraction in preventing or minimizing pain and behavioural distress among children while undergoing invasive intravenous procedures. Purpose: To assess and evaluate the intensity of pain and behavioural distress among children during invasive intravenous procedures with and without distraction technique and to determine the association between the intensity of pain, behavioural distress in children undergoing invasive intravenous procedures and selected variables. Method: An experimental approach with post test only control group design was used for the study. The sample for the study comprised of 24 children with age group of 3 - 12 years; 12 children for each experimental group and control group selected by purposive sampling with random assignment. Pain and behavioural distress were assessed using Revised Faces Pain Scale and Behavioural Distress Scale respectively. Findings: The results of this preliminary study showed that using distraction technique during invasive intravenous procedures reduces pain and pain associated behavioural distress among children caused due to invasive intravenous procedures.

 

KEYWORDS: Pain, Behavioural distress, Children, Distraction, Invasive procedures, Intravenous.

 

 

BACKGROUND AND PURPOSE:

Most of the people avoid hospitalization only because hospitalization is linked with procedures that are painful like injections, surgery etc.1 Even children associate hospital and health care workers with injections and pain and want to avoid it.2,3 If such procedures are made free from pain, overall opinion about hospitalization will change. Nonpharmacological techniques like distraction allows focus of client to be diverted away from pain.4 This part of preliminary study was aimed to assess the effectiveness of distraction in reducing pain during painful procedures.

 

OBJECTIVES:

The objective of the study were to

1.     Assess and evaluate the intensity of pain and behavioural distress among children during invasive intravenous procedures with and without administering distraction technique.

2.     Find the association between the intensity of pain, behavioural distress in children undergoing invasive intravenous procedures and selected variables.

 

METHODOLOGY:

An experimental approach with post-test only control group design was selected to evaluate the effectiveness of distraction in reducing pain and behavioural distress during painful procedures. The study population included children who are admitted in pediatric wards of selected hospitals undergoing intravenous procedures. Convenient sampling with random assignment of subjects to various groups was used to select the samples.

 

The study comprised of 24 children between 3-12 years of age attending paediatric units and undergoing intravenous procedures were equally divided into experimental and control group. Children with critical illness, inability to verbalize and children with immediate postoperative status were excluded from the study

 

PROCEDURE:

The data was collected from children and their primary caregivers during intravenous procedures admitted in selected hospital. The investigator obtained formal permission from the selected hospital. The purpose of the study was explained to the children and their parents and informed written consent was obtained from their parents. For the treatment group intervention in the form of distraction was given using kaleidoscope during intravenous procedure. Behavioural distress was assessed using behavioural distress checklist. Pain was assessed using Faces Pain Rating Scale. Thecontrol group received standard care.

 

FINDINGS:

The majority of the children were between the age group of 3 to 6 (50%) followed by 25 % each in early and late school age. Among the participants, 75 % were male. The majority of them 181(87.5%) were school going children. The findings showed that half of the children belonged to nuclear family. Most of the children 41.7% (12 were only child in the family and 8(33.3%) were youngest were eldest among siblings. Most of the Parents (79.2%) reported that their children had some type of illness in the past and 79.2% among those reported that their children required hospitalization sometimes during those illnesses. All parents reported that their children had undergone painful medical procedures like injection in the past.

 

Figure 1: Pain score of Children in experimental and Control Group

 

Mean score, Standard deviation, Standard error of mean difference and “t” value of pain score and behavioural distress score of experimental group and control group.”                                                                N = 24

Group

Mean Score

Mean Difference

Std. Deviation

Std. Error Difference

‘t’ value

Pain Score

Control      (n =12)

7.50

3

2.97

1.26

2.38*

 

Experimental   (n=12)

4.50

 

3.21

 

 

Behavioural Distress Scores

Control       (n =12)

15.92

6.17

5.98

2.52

2.35*

 

Experimental

9.75

 

6.67

 

 

t (22)=2.38 p<0.05                                                                                                                      t ( 22)=2.35 p<0.05

 

Mean difference of pain score of children as evident from 'FACES pain scale’ given distraction during the procedure was found to be significantly lower than control group. (t (22)=2.38 p<0.05).The Mean behavioural distress score of children given distraction during the procedure was found to be significantly lower than control group (t ( 22)=2.35 p<0.05)

 

DISCUSSION:

Children have comparatively restricted communication abilities and are less able to verbalize their fears and anxiety.5 They easily get distracted and their behavior is essentially a reflection of their inability to cope with their anxiety.6 The findings of the study supported the hypothesis that distraction is an effective strategy to reduce the perceived pain associated with invasive paediatric procedure. These results were consistent with the findings of studies that found various distraction techniques using kaleidoscope, music, a virtual reality, distraction cards etc. to be effective in reducing the pain and behavioural distress during such procedures.7-17

 

This study also found that the procedure associated behavioural distress was significantly less among children who received distraction, and the finding is supported by studies that found that bubbles, challenging book, virtual reality glasses or portable games led to significantly less fear and distress, as evaluated by the nurse, and less fearas evaluated by parents.18,19,20 All intervention group parents also stated that puncture was better tolerated due to distraction.21,22,23

 

CONCLUSIONS:

Injections and vaccinations are inseparable part of preventive, promotive or curative aspects of healthcare. Making it a positive experience or at least not negative experience is the goal of a robust healthcare system. 24,25 Pain and behavioural distress can be effectively managed by integration of distraction during such procedures.

 

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20.   Aranha P. Shetty AP et al. Assessment and Management of Pain in Children: Knowledge and Attitude of Staff Nurses. Int. J. Nur. Edu. and Research. 2015;  3(2): 137-139.

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Received on 25.03.2023           Modified on 17.04.2023

Accepted on 15.05.2023        ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2023; 13(3):194-196.

DOI: 10.52711/2349-2996.2023.00041