Abstract
Fear and anxiety among the children can contribute to low cooperation during medical procedures, thus interrupting the delivery of quality care. The use of distraction techniques can help the children deal with traumatic events and boost trust and confidence in the healthcare providers. Since children are likely to demonstrate high levels of anxiety during medical procedures or hospitalization, it is essential to incorporate effective destruction techniques that will ensure that their experience in the healthcare setting is less daunting. This study aims to determine the efficacy of distraction techniques in lowering pain among children during medical procedures. The children in the intervention arm reported low levels of distress compared to those in the control group. Distraction techniques are effective in lowering pain, fear, and anxiety in children during medical procedures.
Introduction
Healthcare settings can influence fear and anxiety among children, which can be attributed to previous experiences of pain. Fear and anxiety among the children can contribute to low cooperation during medical procedures, thus interrupting the delivery of quality care (Hanevold, 2019). The use of distraction techniques can help the children deal with traumatic events and boost trust and confidence in the healthcare providers. Since children are likely to demonstrate high levels of anxiety attributed to pain during medical procedures or hospitalization, it is essential to incorporate effective destruction techniques that will ensure that their experience in the healthcare setting is less daunting. The use of the distraction technique has been associated with reduced levels of pain during injection procedures, thus ensuring better cooperation and positive patient outcomes (Xiang et al., 2021). However, limited research has been directed toward determining the efficacy of various distraction techniques in pain management among children undergoing medical procedures. Henceforth, this study aims to evaluate the effectiveness of distraction techniques in promoting lower pain among children during medical procedures compared to standard care. A randomized controlled trial was used to assess the efficacy of distraction techniques in lowering pain among children during venipuncture procedures.
PICOT Question: In children under 12 years of age undergoing medical procedures (P), how do distraction techniques (I) compared to standard care (C) affect pain scores (O) within 60 minutes of the procedure (T)?
Multiple distraction techniques have been identified in eliminating fear triggers that result in stress and anxiety among children during medical procedures. Moore et al. (2020) proposed the use of parental distraction during medical procedures, such as injections, to lower pain, which can exacerbate fear. Parents are the primary caregivers of the children; thus, they understand their needs. Additionally, parents have a strong relationship with their children, which impacts trust and confidence (Moore et al., 2020). Thus, they can act as essential guides in facilitating distraction. Parents can also be involved in other distraction procedures such as play and music, where they can sing along and calm the child. Longobardi et al. (2019) propose the use of soap bubbles in facilitating pain, anxiety, and fear management among children. Play activities help the children express their emotions and connect to their surroundings. Thus, soap bubbles can be an exciting activity for the child, distracting them from their current fear and thus promoting better cooperation. Nejla et al. (2019) also propose another form of playing activity involving distraction cards to lower this problem and facilitate better outcomes.
Gaurav et al. (2022) proposed using audio and audio-visual distraction techniques to manage pain during injection. This concept was supported by Alkahtani et al. (2020), and Kabarndi et al. (2020), who believed music could be an effective distraction and pain management approach in children. Visual distractions like video games and kaleidoscopes can also be effective in lowering pain and anxiety among pediatric patients. According to Prescot (2021), virtual reality, which includes audio and video distractions, can be placed close to the child’s eyes, thus ensuring that they can have visual and sensory input, thus lowering the pain outcomes. Gold et al. () support these concepts by indicating that virtual reality procedures effectively lower pain during medical procedures like injection, burns wound care and blood sample collection. Atak & Özyazıcıoğlu (2021) proposed the use of audio distractions in lowering the patient pain, while Godino-lane et al. supported the use of play activities as a distraction technique.
Method
The search method
A comprehensive search was conducted through electronic databases like CINAHL, Cochran Library, PubMed, and Biomed Central using key terms such as distraction techniques, pain, and child. The initial search identified 1000 articles, which were narrowed down to 232 eligible studies. Out of this article, only 15 were used in the integrative review. The inclusion criteria were peer-reviewed articles published in the last five years in English and focused on comparing distraction techniques like play to standard care. The eligible articles were also RCTs, systematic reviews, and quasi-experimental studies, with the participants being children. The exclusion criteria were duplicate articles published more than five years ago with access restrictions.
Results
The initial search resulted in 1000 articles. From these articles,768 were published in the past five years; 100 had irrelevant abstracts, 90 had limited access, 20 were duplicates, and seven focused on adolescents. Fifteen studies met the inclusion criteria. The type of distraction used varied across the studies. One of the studies focused on soap bubbles, one parental distraction and one distraction card. Four articles analyzed the efficacy of visual reality techniques such as distraction cards, kaleidoscopes, and video games. Four articles proposed using music or audio distraction to lower pain scores among children undergoing various medical procedures.
Discussion
The analysis of the current intervention to distract children from the pain associated with medical procedures such as venipuncture indicated that distraction could serve as the ultimate solution to this problem. Distraction techniques, such as visual and verbal methods by parents and caregivers, can effectively lower anxiety and promote children’s cooperation (Bannink et al., 2022). However, the knowledge gap has been attributed to a lack of effective measures to cater to effective gender and socioeconomic-racial representation, which can facilitate the generalizability and applicability of the research findings.
According to Thi et al. (2022), distraction entails behavioural intervention that can help reduce procedural pain during injection in pediatric patients with cancer. Music and audio interventions can also serve as essential distractions among children undergoing medical procedures like injections (Gurav et al, 2022; Karbandi et al., 2020). In some cases, pain arises from fear and anxiety from past procedures, thus reducing cooperation. Alkahtani et al. (2020) also indicated that music possesses an intrinsic expressive power with spiritual and cultural enhancement, distracting the children from medical procedures like injections, thus lowering the pain score.
Implication for nursing practice
Distraction techniques like venipuncture should be integrated into patient care during medical procedures. The nurse administration can implement educational programs to ensure that the health professional understands the importance of these techniques in delivering quality care. According to Prado et al. (2019), proper training on the use of nonpharmacological interventions for fear, pain, and anxiety among children in the paradisiac sector can facilitate an evidence-based approach, which can be associated with better pain expression and satisfaction. For future research, this study proposes the need to analyze the efficacy and cost-effectiveness of intervention in patient care. The Iowa Model of EBP can guide the integration of these findings into patient care through problem identification, evidence, and selection of the best intervention.
Conclusively, healthcare procedures and hospitalization can result in traumatic experiences in children, which can instil fear and anxiety in future scenarios. Effective intervention can address the children’s needs and preferences, build relationships with the health care providers, and ensure adequate care delivery. Distraction techniques such as using parents to deliver visual and verbal intervention can allow the children to adjust to the new surroundings and cope with stressful events. Educating nurses on effective nonpharmacological intervention can ensure better patient care and the involvement of children in activities that build their confidence and trust in the healthcare providers. However, further research is essential in analyzing effective interventions and determining their cost-effectiveness and applicability in a broad and diverse population.
References
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