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Büyük ET, Uzsen H, Koyun M, Ateş Y, Can S, Bakan F. Atraumatic care practice from the child and parent perspective: The case of a pediatric phlebotomy unit. J Pediatr Nurs 2024:S0882-5963(24)00314-2. [PMID: 39153917 DOI: 10.1016/j.pedn.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This study aimed to determine the effect of the child's self-selected distraction methods used during the phlebotomy procedure on the feeling of fear and pain in children and parental satisfaction. METHODS The study, planned as a randomized controlled trial, was conducted with 219 children aged 5-10 years and their parents in the pediatric phlebotomy unit between March and June 2023. Different distraction methods (foam balloon, stress ball, musical book) were applied to the children in the intervention group during the phlebotomy procedure. The data were analyzed with the SPSS 22.0 package program. RESULTS There was a statistically significant difference between the scores of the children in the intervention and control groups on the Children's Fear Scale before the phlebotomy, and on the Wong-Baker Faces Pain Rating Scale after phlebotomy according to self- and parental assessment (p < 0.05). A statistically significant difference was found between the satisfaction levels of the parents after the procedure in the intervention and control groups with the health care service provided during the phlebotomy process (p < 0.05). CONCLUSION Distraction methods, one of the atraumatic nursing interventions used before the phlebotomy procedure, were determined to be effective in reducing the child's fear and the pain experienced due to the procedure. The study also showed that the satisfaction of parents was positively affected by the atraumatic care provided to their children. PRACTICE IMPLICATIONS The atraumatic care approach should be used to prevent anxiety and fear experienced by parents and children and to reduce the child's pain.
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Affiliation(s)
- Esra Tural Büyük
- Department of Pediatric Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey.
| | - Hatice Uzsen
- Department of Pediatric Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Merve Koyun
- Department of Pediatric Nursing, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Yeşim Ateş
- Health Practice and Research Hospital, Ondokuz Mayis University, Samsun, Turkey
| | - Selma Can
- Health Practice and Research Hospital, Ondokuz Mayis University, Samsun, Turkey
| | - Figen Bakan
- Health Practice and Research Hospital, Ondokuz Mayis University, Samsun, Turkey
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Koç S, Küçük Alemdar D. Effect of a musical toy used during peripheral venous access on children's pain, fear and parental satisfaction: Randomized controlled trial. J Pediatr Nurs 2024; 77:e573-e582. [PMID: 38821765 DOI: 10.1016/j.pedn.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/19/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE This research was completed to determine the effect of a musical toy (xylophone) on pain and fear in children and parental satisfaction during peripheral venous access in children. DESIGN AND METHODS This research was completed as a randomized controlled trial study. The sample for the research comprised 70 children (control: 35, experiment: 35) aged 3-6 years with peripheral venous access who were admitted to the Pediatric ward and their parents abiding with case selection criteria. RESULTS The mean Children's Emotional Manifestation Scale score for children in the experiment group was found to be statistically significantly lower than in the control group (p < 0.05). Children in the experiment group had statistically significantly different mean Children's Fear Scale scores, which were found to be low (p < 0.05). No statistically significant difference was found between the pain scores of the experimental and control groups (p > 0.05). There was a statistically significant difference present for patient cooperation with the nurse in the experiment group (p < 0.05). CONCLUSION Though the use of a musical toy during the peripheral venous access procedure had positive impacts on fear and emotional symptoms in the child, it did not appear to have any effect on the child's pain level or parental satisfaction. PRACTICE IMPLICATIONS The use of a xylophone during painful procedures performed on children is recommended in terms of reducing the negative impact of the procedure on children by ensuring the child and parent focus on each other during the procedure and the parent contributes to care.
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Affiliation(s)
- Sena Koç
- Giresun Gynaecology and Paediatrics Training and Research Hospital, Department of NICU, Giresun, Turkey
| | - Dilek Küçük Alemdar
- Ordu University Faculty of Health Sciences, Department of Nursing, Ordu, Turkey.
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Şen T, Çetinkaya B. The effect of virtual reality glasses used during intravenous catheter application on the Child's emotional responses. J Pediatr Nurs 2024; 77:e251-e256. [PMID: 38692952 DOI: 10.1016/j.pedn.2024.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE This study was conducted to determine the effect of virtual reality glasses used during intravenous catheter insertion on the child's emotional responses. DESIGN AND METHODS The sample of the research, which was carried out as a randomized controlled experimental study, consisted of 102 children, including 51 in the control group and 51 in the study group, who were aged between 7 and 12 years and were on treatment in the pediatric emergency department(PED). Research data were collected using a Descriptive Data Form for Children and the Children's Emotional Manifestation Scale. No intervention was applied to the control group. After the tourniquet was tied in the study group, the children started watching a video of their choice through virtual reality glasses. When the process was completed, the video was stopped. During this period, the child was evaluated using the Children's Emotional Manifestation Scale. RESULTS A statistically significant difference was found between the Children's Emotional Manifestation Scale scores of the children in the study and control groups (p = 0.000). The scores of the children in the study group were statistically significantly lower than the scores of the children in the control group. CONCLUSION During the intravenous catheter insertion process, children who watched cartoons on virtual reality glasses showed less negative emotional behavior than those who did not. PRACTICE IMPLICATIONS The use of virtual reality glasses is a developing technology in child health services, and it is recommended to encourage their use in these services.
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Affiliation(s)
- Türkan Şen
- Pamukkale University Institue of Health Sciences, Nursing Department, Child Health and Diseases Nursing Graduate Program, Denizli, Türkiye.
| | - Bengü Çetinkaya
- Pamukkale University Faculty of Health Sciences, Department of Pediatric Nursing, Denizli, Türkiye
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Cardinal É, Bilodeau K, Lebeau J, Aubin M, Guiné J, Dutey-Harispe O, Delage J, Caron-trahan R, Véronneau J, Landry M, Ogez D. Cultivating Comfort: Examining Participant Satisfaction with Hypnotic Communication Training in Pain Management. J Multidiscip Healthc 2024; 17:2973-2987. [PMID: 38948391 PMCID: PMC11213529 DOI: 10.2147/jmdh.s463738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
Context One in four Canadians experiences chronic pain, yet insufficient services and restrictions surrounding prevailing treatments result in inadequate management and significant negative consequences for these individuals. Previous work indicates that hypnotic communication represents a promising complementary treatment; however, training protocols for healthcare professionals are underdeveloped and understudied. Aim To evaluate the level of satisfaction for a training program on hypnotic communication in pain management clinics. Design Qualitative study. Methods Six health professionals who first completed the hypnotic communication training participated in 30 minutes virtual semi-structured interviews. These testimonials allowed them to elaborate on their user experience and potential areas for improvement. Thematic analysis using qualitative data management software NVIVO was conducted on the interview data. Results Two themes emerged from the interviews. 1) Satisfaction: Participants expressed satisfaction on various structural aspects of the training, including the provided materials, atmosphere, training structure, presentation modalities, practical workshops, acquired knowledge, trainer quality, and training duration. 2) Areas for Improvement: Five main improvement suggestions were identified (providing more material; more practical workshops, more concrete and adapted; testimonials from former patients; follow-up training meeting; and continuing education). Implications for the Profession and/or Patient Care and Conclusion The results improved the training program to help minimized inherent biases related to this technique, cut associated costs, and identify reasons that would explain its underutilization among medical professionals in Quebec. Our work highlights that healthcare professionals in chronic pain management clinics (eg, respiratory therapists, nurses) can incorporate this simple hypnotic communication technique into their usual care and contribute to the well-being of patients. Impact This study aimed to address the lack of training protocols for healthcare professionals, that are underdeveloped and understudied. The main findings on participant' satisfaction and the areas of improvement for the training will help the refinement of the training to better suit healthcare professional's needs in hospitals and chronic pain facilities.
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Affiliation(s)
- Éloïse Cardinal
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Karine Bilodeau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Faculty of Nursing Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Julie Lebeau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Faculty of Nursing Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Maryse Aubin
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Joséphine Guiné
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Odile Dutey-Harispe
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Julie Delage
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Rémi Caron-trahan
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Jade Véronneau
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Mathieu Landry
- Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - David Ogez
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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Nie Y, Tian Y, Han X. Music Nursing as Complementary Therapy Improves Anxiety, Fatigue, and Quality of Life in Children with Acute Leukaemia: A Retrospective Study. Noise Health 2024; 26:25-29. [PMID: 38570307 PMCID: PMC11141699 DOI: 10.4103/nah.nah_33_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To explore the effects of music nursing as a complementary therapy on anxiety, fatigue, and quality of life in children with acute leukemia (AL). METHODS This study included 150 children with AL admitted to our hospital from August 2021 to August 2023 and divided them into two groups based on treatment: the control (n = 76, received routine nursing) and observation (n = 74, received music nursing on the basis of routine nursing) groups. Comparison of groups was performed in terms of general information, anxiety, fatigue, and quality of life at admission (T0) and 1 month after admission (T1). RESULTS No significant differences were observed in the general data between the two groups (P > 0.05). Anxiety, fatigue, and quality of life of the two groups also showed no significant differences at T0 (P > 0.05). The observation group showed significantly lower anxiety than the control group at T1 (P < 0.05). At T1, the observation group exhibited a lower fatigue degree compared with the control group (P < 0.05). At T1, the observation group attained higher scores on physiological and emotional dimensions of the quality of life compared with the control group, and the differences were statistically significant (P < 0.05). CONCLUSION Music nursing for AL children, which has a certain clinical application value, can effectively reduce their anxiety and fatigue and improve their quality of life.
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Affiliation(s)
- Yujuan Nie
- Nursing Department, Jiaozhou Central Hospital of Qingdao, Qingdao 266300, Shandong, China
| | - Yuhuan Tian
- Operating Room, Qingdao Fifth People’s Hospital, Qingdao 266000, Shandong, China
| | - Xiaoyu Han
- Hematology Internal Department, Ganzhou People’s Hospital, Ganzhou 341000, Jiangxi, China
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Yamada Y, Kitamura M, Inayama E, Kishida M, Kataoka Y, Ikenoue T. Acoustic stimulation for relieving pain during venipuncture: a systematic review and network meta-analysis. BMJ Open 2023; 13:e077343. [PMID: 38135307 PMCID: PMC11148677 DOI: 10.1136/bmjopen-2023-077343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES To assess whether acoustic stimulations relieve venipuncture pain and determine which stimulation is the most effective type. DESIGN Systematic review and network meta-analysis. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov and the International Clinical Trials Registry Platform databases were systematically searched in September 2023. STUDY SELECTION Randomised controlled trials evaluating the efficacy of acoustic stimulations on patients undergoing venipuncture were eligible. Acoustic stimulations were classified into seven categories: five types of acoustic stimulations (music medicine (researcher selected), music medicine (patient selected), music therapy, sounds with linguistic meaning and sounds without linguistic meaning) and two controls (only wearing headphones and no treatment). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included self-reported pain intensity assessed during venipuncture and treatment cost, and secondary outcomes were self-reported mental distress and adverse events. RESULTS Of 6406 citations, this network meta-analysis included 27 studies including 3416 participants; the mean age was 31.5 years, and 57% were men. Among the five types of acoustic stimulations, only musical interventions, such as music medicine (patient selected) (standardised mean difference (SMD) -0.44 (95% CI: -0.84 to -0.03); low confidence), music medicine (researcher selected) (SMD -0.76 (95% CI: -1.10 to -0.42); low confidence) and music therapy (SMD -0.79 (95% CI: -1.44 to -0.14); low confidence), were associated with improved pain relief during venipuncture compared with no treatment. No significant differences existed between the types of acoustic stimulations. Free-of-charge acoustic stimulations were provided to patients, and no specific adverse events were reported. In many studies, the risk of bias was rated high because of the difficulty of blinding the intervention to the participants and the self-reported pain outcome. CONCLUSIONS Music interventions were associated with reduced venipuncture pain. Comparisons between types of acoustic stimulations revealed no significant differences. Therefore, music intervention could be a safe and inexpensive pain relief method for venipuncture. PROSPERO REGISTRATION NUMBER CRD42022303852.
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Affiliation(s)
- Yosuke Yamada
- Department of Nephrology, Shinshu University Hospital, Matsumoto, Japan
- Department of Nephrology, Aizawa Hospital, Matsumoto, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Emi Inayama
- Department of Nephrology, Mihama Narita Clinic, Chiba, Japan
| | | | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Koto, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Graduate School of Medicine /Human Health Science, Kyoto University, Kyoto, Japan
- Data Science and AI Innovation Research Promotion Center, Shiga University, Hikone, Japan
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Gupta M, Rohilla R, Gupta P, Tamilchelvan H, Joshi U, Kanwat J. Nebulized dexmedetomidine for attenuating hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing surgeries under general anaesthesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:406. [PMID: 38082217 PMCID: PMC10712167 DOI: 10.1186/s12871-023-02366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Sympathetic stimulation associated with laryngoscopy and endotracheal intubation (ETI) may lead to adverse cardio-/cerebro-vascular events in susceptible patients. Nebulization is a novel route for dexmedetomidine administration providing a large surface area for absorption while avoiding bradycardia and hypotension associated with intravenous route. We aimed to evaluate the efficacy and safety of dexmedetomidine nebulization for attenuating hemodynamic response to ETI in adult patients undergoing surgery under general anaesthesia. METHODS This systematic review was registered prospectively in the International Prospective Register of Systematic Reviews (CRD42023403624). PubMed, Embase (OvidSP), Cochrane library, Scopus (Elsevier), Web of Science (Clarivate) and Google Scholar were systematically searched from database inception until March 31, 2023. Two reviewers independently screened titles, abstracts and then full text against pre-specified eligibility criteria. Randomized controlled trials (RCTs) assessing effect of dexmedetomidine nebulization on hemodynamic response to ETI in adult patients undergoing surgeries under general anaesthesia were included. All studies reporting heart rate and systolic blood pressure at baseline and various time points after ETI were included. A pre-piloted data extraction form, Cochrane revised risk-of-bias tool (ROB 2) tool, GRADE approach and RevMan 5.4.1 (Cochrane Collaboration, Copenhagen, Denmark) were used for data extraction, risk of bias assessment, rating certainty of evidence and data synthesis respectively. Mean difference and relative risk with 95% Confidence Interval (CI) were used for continuous and dichotomous variables respectively. RESULTS Six RCTs randomized 480 patients with ASA I/II patients aged < 60 years of age and undergoing elective surgeries to receive either dexmedetomidine (n = 240) or saline nebulization (n = 240). Except for one RCT which used 2 μg/kg, all other RCTs used dexmedetomidine dose of 1 μg /kg. Heart rate, systolic, diastolic and mean blood pressure were significantly lower in the dexmedetomidine group at all the measured time points after laryngoscopy and ETI with the only exception being systolic blood pressure at 3 min [mean difference -13.86 (95% CI -30.01 to 2.99), p = 0.09]. Bradycardia and hypotension as adverse effects were absent across the included studies. However, only one-third of the included studies had a low risk of bias and strength of evidence was very low according to the GRADE assessment. CONCLUSIONS Compared to placebo, premedication with dexmedetomidine nebulization was associated with lower HR and BP following ETI without any risk of bradycardia and hypotension. However, the strength of evidence was very poor and came from just one country. Future well designed and conducted studies in different populations are warranted. TRIAL REGISTRATION PROSPERO Registration number: CRD42023403624.
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Affiliation(s)
- Mayank Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India.
| | - Rachna Rohilla
- Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, India
| | - Priyanka Gupta
- Department of Anaesthesiology, Graphic Era Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | | | - Udita Joshi
- Banglore Hospice Trust, Bengaluru, Karnataka, India
| | - Jyoti Kanwat
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India
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Jyskä I, Turunen M, Chaychi Maleki A, Karppa E, Palmu S, Viik J, Mäkelä J, Puura K. Effects of Using Guided Deep Breathing Exercises in a Virtual Natural Environment to Reduce Stress during Pediatric Treatment. Healthcare (Basel) 2023; 11:3140. [PMID: 38132030 PMCID: PMC10743274 DOI: 10.3390/healthcare11243140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
There exists a need for new methods to address treatment anxiety in pediatrics-at the same time, deep breathing exercises and virtual natural environments have both been known to have stress-reducing qualities. This article reports the combined effect of these two methods in a pediatric setting. A feasibility study was conducted in a local hospital. The study had a within-subjects design, and it included 21 child patients aged 8 to 12 years old, who used a virtual reality (VR) relaxation application developed for this purpose during an intravenous cannulation procedure related to their treatment. The key findings highlight a statistically very significant stress reduction associated with the utilized VR intervention, demonstrated by heart rate variability measurements (SDNN, p < 0.001; RMSSD, p = 0.002; Stress Index, p < 0.001; LF/HF ratio, p = 0.010). This effect was consistent regardless of the level of general anxiety or the level of needle phobia of the patient, and no adverse effects were observed. The results show the strong potential of using deep breathing exercises in virtual natural environments for addressing treatment anxiety related to invasive pediatric procedures.
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Affiliation(s)
- Ilmari Jyskä
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Markku Turunen
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Arash Chaychi Maleki
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Elina Karppa
- TamCAM Research Center, Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere, Finland; (E.K.); (S.P.); (K.P.)
- Department of Pediatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Sauli Palmu
- TamCAM Research Center, Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere, Finland; (E.K.); (S.P.); (K.P.)
- Department of Pediatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Jari Viik
- Finnish Cardiovascular Research Center, Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere, Finland;
| | - John Mäkelä
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Kaija Puura
- TamCAM Research Center, Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere, Finland; (E.K.); (S.P.); (K.P.)
- Department of Child Psychiatry, Tampere University Hospital, Central Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
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Jyskä I, Turunen M, Chaychi Maleki A, Karppa E, Palmu S, Mäkelä J, Puura K. Design and User Experience of VirNE Application: Deep Breathing Exercise in a Virtual Natural Environment to Reduce Treatment Anxiety in Pediatrics. Healthcare (Basel) 2023; 11:3129. [PMID: 38132019 PMCID: PMC10743239 DOI: 10.3390/healthcare11243129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Treatment anxiety is a serious problem among child patients. A few studies have addressed this issue with virtual reality solutions, with promising results; however, the applications used have generally been designed for entertainment instead of this purpose. This article studies the potential of using deep breathing exercises in a virtual natural environment to address this issue, with a focus on design approach and user experience. It presents the VirNE-Virtual Natural Environments relaxation application, which is based on known stress-reduction methods, and a feasibility study conducted with it in a local hospital. The study had a within-subjects design, and it included 21 eight to twelve-year-old child patients, who used the application during an intravenous cannulation procedure related to their treatment. The study found good user acceptance and user experience both among the child patients and pediatricians, with the perceived usefulness of the method being higher among the patients with increased levels of anxiety or needle phobia. In addition, a clear stress-reducing effect was found. This offers proof-of-concept for the multidisciplinary design approach based on existing scientific knowledge regarding the desired effect for pediatric virtual reality applications for this use context.
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Affiliation(s)
- Ilmari Jyskä
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Markku Turunen
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Arash Chaychi Maleki
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Elina Karppa
- TamCAM Research Center, Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere, Finland; (E.K.); (S.P.); (K.P.)
- Department of Pediatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Sauli Palmu
- TamCAM Research Center, Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere, Finland; (E.K.); (S.P.); (K.P.)
- Department of Pediatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - John Mäkelä
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, FI-33014 Tampere, Finland; (M.T.); (A.C.M.); (J.M.)
| | - Kaija Puura
- TamCAM Research Center, Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere, Finland; (E.K.); (S.P.); (K.P.)
- Department of Child Psychiatry, Tampere University Hospital, Central Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
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Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children's pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs 2023; 73:e27-e35. [PMID: 37455147 DOI: 10.1016/j.pedn.2023.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study was conducted to determine the effects of visual and/or auditory distraction techniques applied to children aged 7-12 during invasive procedures on pain, anxiety, and medical fear. METHODS This single-blinded, randomized controlled trial was carried out in the pediatric emergency department of a public hospital between November 2021 and March 2022. In the study, 144 children were assigned to three different intervention groups, in which a kaleidoscope, music, and virtual reality were applied during invasive procedures, and the control group in which the standard invasive procedure was applied, by using the stratified block randomization method. The data were collected using a Personal Information Form, Wong-Baker Faces Pain Rating Scale, Children's Anxiety Meter-State, and Child Medical Fear Scale. RESULTS In the study, the levels of pain, anxiety, and medical fear after the invasive procedure were lower in the intervention groups than in the control group. In addition, there was no difference between the three different distraction techniques in terms of reducing pain and medical fear, but the virtual reality application was more effective in reducing the level of anxiety. CONCLUSION Visual and/or auditory distraction techniques are effective methods that can be used by nurses in pediatric healthcare to reduce invasive procedure-related pain, anxiety, and medical fear. IMPLICATIONS FOR PRACTICE This study provides evidence that can guide the use of non-pharmacological methods such as distraction to prevent the traumatic effects of invasive procedures in children.
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Affiliation(s)
- Nursen Goktas
- Mehmet Akif Ersoy State Hospital, Child Monitoring Center, Canakkale, Turkey
| | - Dilek Avci
- Bandirma Onyedi Eylul University, Faculty of Health Sciences, Balikesir, Turkey.
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Kavlakci M, Ogce F, Yavan T. The effects of playing digital games on children's pain, fear, and anxiety levels during suturing: A randomized controlled study. Turk J Emerg Med 2023; 23:162-168. [PMID: 37529788 PMCID: PMC10389094 DOI: 10.4103/tjem.tjem_8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE The aim was to determine the effects of digital game play on children's pain, fear, and anxiety levels during suturing. METHODS Data were obtained from 84 children between the ages of 8 and 17 years at the pediatric emergency department between January 16 and March 19, 2020, using the Socio-Demographic and Clinical Characteristics Form, the Wong-Baker Faces Pain Rating Scale (WBFPS), the Visual Analogue Scale (VAS), the Fear of Medical Procedures Scale (FMPS), and the State-Trait Anxiety Inventory for Children (STAI-CH). A four-block randomization system was used. The study group (n = 42) played digital games during the suturing procedure, unlike the control group (n = 42). Ethical permissions were obtained from the ethical committee, hospital, and families. RESULTS Before the suturing procedure, there was no statistically significant difference between the groups' mean scores. The intervention group was found to have statistically significantly lower WBFPS and VAS pain scores than the control group during the suturing procedure, and after the procedure, statistically significantly lower WBFPS, VAS, FMPS, and STAI-CH mean scores than the control group. CONCLUSIONS The digital game-playing approach applied before and during the suture procedure was found to be effective in reducing children's pain, fear, and anxiety levels.
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Affiliation(s)
- Muhammet Kavlakci
- Department Pediatric Emergency, T. R. Ministry Health, İzmir Provincial Health Directorate, Izmir University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Filiz Ogce
- Department of Nursing, Faculty of Health Sciences, Izmir University of Economics, Izmir, Turkey
| | - Tulay Yavan
- Department of Nursing, Faculty of Health Sciences, Izmir University of Economics, Izmir, Turkey
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Kleebayoon A, Sookaromdee P, Wiwanitkit V. Perceived distress due to nasopharyngeal swab collection: Correspondence. PAEDIATRIC & NEONATAL PAIN 2023; 5:49. [PMID: 37283954 PMCID: PMC10240400 DOI: 10.1002/pne2.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 06/08/2023]
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Halemani K, Issac A, Mishra P, Dhiraaj S, Mandelia A, Mathias E. Effectiveness of Preoperative Therapeutic Play on Anxiety Among Children Undergoing Invasive Procedure: a Systematic Review and Meta-analysis. Indian J Surg Oncol 2022; 13:858-867. [PMID: 36687245 PMCID: PMC9845488 DOI: 10.1007/s13193-022-01571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/25/2022] [Indexed: 01/25/2023] Open
Abstract
Play is an indispensable part of growing up and by using play to distract children while undergoing invasive procedures can have a positive impact. Play can help children to cope with painful procedures and long-term treatment. The aim of the review was to evaluate the evidence concerning the effect of play on anxiety among children undergoing invasive procedures. This is a systematic review and meta-analysis. Data sources: PubMed, The MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinical Key, Cochrane Library, and Google Scholar were searched between 2012 and 2020. Review methods: randomized controlled trials (RCTs) that evaluated the effectiveness of play on anxiety among children undergoing invasive procedures were included. Meta-analysis was done using Revman v5.3 software. A total of 451 participants from 5 trials were involved in the systemic review and meta-analysis. Self-reported anxiety, parents reported anxiety, and self-reported pain were found significant in intervention [χ2 = 7.57, df = 2 at P < 0.02]. When compared with control group, the review result revealed that experimental group reduced the anxiety and pain (P < 0.05).
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Affiliation(s)
- Kurvatteppa Halemani
- College of Nursing, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh India
| | - Alwin Issac
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha India
| | - Prabhaker Mishra
- Dept. of Biostatistics & Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh India
| | - Sanjay Dhiraaj
- Dept. of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh India
| | - Ankur Mandelia
- Dept.of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh India
| | - Edline Mathias
- Manipal College of Nursing, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka India
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Monsereenusorn C, Malaithong W, Lertvivatpong N, Photia A, Rujkijyanont P, Traivaree C. The efficacy and safety of midazolam with fentanyl versus midazolam with ketamine for bedside invasive procedural sedation in pediatric oncology patients: A randomized, double-blinded, crossover trial. Pediatr Hematol Oncol 2022; 39:681-696. [PMID: 36239702 DOI: 10.1080/08880018.2022.2055685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Children with cancer often require sedation before undergoing invasive procedures. Fentanyl, ketamine, and midazolam are effective drugs widely used for procedural sedation. This study aimed to investigate the efficacy and safety of midazolam-fentanyl (M-F) compared with midazolam-ketamine (M-K) for bedside procedural sedation among pediatric oncology patients. A randomized, double-blinded, crossover trial was conducted among children with cancer requiring procedural sedation for invasive procedures. Patients were randomly assigned either intravenous M-F or M-K and subsequently received the alternate regimens following the crossover design of the study. The efficacy and safety of the sedations including sedation time intervals, nausea score, vomiting episodes, pain score, adverse effects, and parent's satisfaction were evaluated. In all, 58 patients with 116 procedural sedations were enrolled. M-K provided a shorter induction time (0:58 vs. 1:23 min) (p = 0.005), but longer sedation (9:02 vs. 5:50 min) (p = 0.019) and emergence time (4:26 vs. 0:56 min) (p = 0.011) compared with M-F. Sedation routes affected the sedation time intervals. Patients had higher rates of vomiting (0, range 0-8 vs. 0, range 0-2) (p = 0.033) but experienced less pain (0 vs. 2) (p = 0.008) in the M-K group. Overall satisfaction and other adverse effects were comparable among both sedation regimens. Combined sedative drugs are recommended to improve the effectiveness of bedside procedural sedation. M-K provided shorter induction, but longer sedation and emergence time compared with M-F. These findings correlated with sedative routes. Patients receiving M-K experienced a higher rate of vomiting, but less painfulness compared with M-F. Overall satisfaction and tolerable side effects were comparable among both sedative regimens.
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Affiliation(s)
- Chalinee Monsereenusorn
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Wanwipha Malaithong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Nawachai Lertvivatpong
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Apichat Photia
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Piya Rujkijyanont
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chanchai Traivaree
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
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Alonzi S, Caruso TJ, Sindher SB, Cao S, Varadharajulu S, Collins WJ, Chinthrajah RS. Virtual Reality Reduces Pediatric Anxiety During Food Allergy Clinical Trials: A Pilot Randomized, Pragmatic Study. FRONTIERS IN ALLERGY 2022; 2:779804. [PMID: 35387040 PMCID: PMC8974765 DOI: 10.3389/falgy.2021.779804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Phlebotomy procedures required in food allergy (FA) diagnosis and clinical trials often induce fear and anxiety for pediatric patients. The primary aim of this study was to determine whether virtual reality (VR) applications were effective in reducing anxiety for pediatric FA patients undergoing phlebotomy during FA clinical trials. Secondary aims assessed fear, pain, procedural compliance, and adverse events. Participants undergoing phlebotomy were enrolled and randomized to a VR group or standard of care (SOC) group for this prospective pilot randomized, pragmatic study. Participants in the VR group played interactive applications on a customized Samsung Gear VR headset and those in the SOC group received the standard of care. Participants' anxiety, fear, and pain were assessed with the Children's Anxiety Meter, Children's Fear Scale, and FACES pain scale pre, during, and post phlebotomy procedure. Compliance was assessed using the modified Induction Compliance Checklist during the procedure and compared between two groups. Forty-nine participants were randomized to VR (n = 26) and SOC (n = 23) groups. Although both the VR and SOC groups experienced a decrease in anxiety and fear from pre- to post-procedure, those in the VR group experienced less anxiety and fear during the procedure than SOC participants. Similarly, both groups experienced an increase in pain from pre- to post-procedure; however, the VR group reported less pain during the procedure than SOC. Fewer symptoms of procedural non-compliance were reported in the VR group. Interactive VR applications may be an effective tool for reducing fear, anxiety, and pain during phlebotomy for FA clinical trials.
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Affiliation(s)
- Sarah Alonzi
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Thomas J. Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Sara Varadharajulu
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - William J. Collins
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
- Department of Medicine, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - R. Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, United States
- *Correspondence: R. Sharon Chinthrajah
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Lin J, Wu C, Zhao D, Du X, Zhang W, Fang J. The Sedative Effects of Inhaled Nebulized Dexmedetomidine on Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:865107. [PMID: 35669400 PMCID: PMC9163573 DOI: 10.3389/fped.2022.865107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Children that need surgery and medical examinations are often uncooperative, and preoperative sedation is necessary. We aimed to assess the safety and efficacy of inhaled nebulized dexmedetomidine in children for sedation that underwent medical examinations or surgery. METHODS We systematically searched PubMed, Web of science, Embase, and Cochrane library, for randomized controlled trials of Intranasal dexmedetomidine using a spray or a mucosal atomization device in children undergoing examination or elective surgery. We included all studies that analyzed the sedation efficiency of intranasal dexmedetomidine in children. RESULTS Ten studies with 1,233pediatric patients were included. Compared to other sedation treatments, inhaled nebulized dexmedetomidine showed similar sedation satisfaction [risk ratio RR: 1.02; 95% confidence interval (CI): 0.87-1.18; P = 0.83; I2 = 72%]. there was also no statistical difference in the success rate of separation from parents (RR: 0.96; 95% CI: 0.82-1.12; P = 0.58; I2 = 67%), and mask acceptability (RR: 1; 95% CI: 0.83-1.20; P = 0.99; I2 = 35%). But it is worth mentioning that nebulized dexmedetomidine combined with ketamine provided better sedation satisfaction (RR: 0.69; 95% CI: 0.49-0.96; I2 = 49%) and more satisfactory separation from parents (RR: 0.85; 95% CI: 0.74-0.97; I2 = 0%). Moreover, nebulized dexmedetomidine reduced the occurrences of nausea and vomiting (RR: 0.28; 95% CI: 0.15-0.51; P < 0.01; I2 = 10%) and emergence agitation (RR: 0.30; 95% CI: 0.18-0.49; P < 0.01; I2 = 0%). There are no hypotension or arrhythmia reported that required intervention in all articles. CONCLUSION Compared to other premedication treatments, inhaled nebulized dexmedetomidine provided equivalent sedation satisfaction for the examination or preoperative sedation of children, but it reduced the occurrences of emergence agitation and postoperative nausea and vomiting.
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Affiliation(s)
- Jun Lin
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chujun Wu
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dizhou Zhao
- Department of Anesthesiology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xuhang Du
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wangzhi Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieyu Fang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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KOÇ ÖZKAN T, ASLAN S, İNCİ R. Effect of Cartoon during the treatment on Anxiety and Fear in Children. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.812234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lambert V, Boylan P, Boran L, Hicks P, Kirubakaran R, Devane D, Matthews A. Virtual reality distraction for acute pain in children. Cochrane Database Syst Rev 2020; 10:CD010686. [PMID: 33089901 PMCID: PMC8094164 DOI: 10.1002/14651858.cd010686.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The effectiveness of VR distraction on acute pain intensity in children is uncertain. OBJECTIVES To assess the effectiveness and adverse effects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, handsearched relevant journals and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs), including cross-over and cluster-RCTs, comparing VR distraction to no distraction, non-VR distraction or other VR distraction. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post-procedure). Secondary outcomes were adverse effects, child satisfaction with VR, pain-related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables. MAIN RESULTS We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their different perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results. We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision. 1: VR distraction versus no distraction Acute pain intensity: during procedure Self-report: one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Observer-report: no data. Behavioural measurements (observer-report): two studies, 62 participants; low-certainty evidence. One study (n = 42) found no beneficial effect of non-immersive VR. One study (n = 20) found a beneficial effect favouring immersive VR. Acute pain intensity: post-procedure Self-report: 10 studies, 461 participants; very low-certainty evidence. Four studies (n = 95) found no beneficial effect of immersive and semi-immersive or non-immersive VR. Five studies (n = 357) found a beneficial effect favouring immersive VR. Another study (n = 9) reported less pain in the VR group. Observer-report: two studies (216 participants; low-certainty evidence) found a beneficial effect of immersive VR, as reported by primary caregiver/parents or nurses. One study (n = 80) found a beneficial effect of immersive VR, as reported by researchers. Behavioural measurements (observer-report): one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Adverse effects: five studies, 154 participants; very low-certainty evidence. Three studies (n = 53) reported no adverse effects. Two studies (n = 101) reported mild adverse effects (e.g. nausea) in the VR group. 2: VR distraction versus other non-VR distraction Acute pain intensity: during procedure Self-report, observer-report and behavioural measurements (observer-report): two studies, 106 participants: Self-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (very low-certainty evidence). Observer-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (low-certainty evidence). Behavioural measurements (observer-report): one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) reported a difference in mean pain change scores with fewer pain behaviours in VR group (low-certainty evidence). Acute pain intensity: post-procedure Self-report: eight studies, 575 participants; very low-certainty evidence. Two studies (n = 146) found a beneficial effect favouring immersive VR. Two studies (n = 252) reported a between-group difference favouring immersive VR. One study (n = 59) found no beneficial effect of immersive VR versus television and Child Life non-VR distraction. One study (n = 18) found no beneficial effect of semi-immersive VR. Two studies (n = 100) reported no between-group difference. Observer-report: three studies, 187 participants; low-certainty evidence. One study (n = 81) found a beneficial effect favouring immersive VR for parent, nurse and researcher reports. One study (n = 65) found a beneficial effect favouring immersive VR for caregiver reports. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Behavioural measurements (observer-report): two studies, 106 participants; low-certainty evidence. One study (n = 65) found a beneficial effect favouring immersive VR. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Adverse effects: six studies, 429 participants; very low-certainty evidence. Three studies (n = 229) found no evidence of a difference between groups. Two studies (n = 141) reported no adverse effects in VR group. One study (n = 59) reported no beneficial effect in reducing estimated cyber-sickness before and after VR immersion. 3: VR distraction versus other VR distraction We did not identify any studies for this comparison. AUTHORS' CONCLUSIONS We found low-certainty and very low-certainty evidence of the effectiveness of VR distraction compared to no distraction or other non-VR distraction in reducing acute pain intensity in children in any healthcare setting. This level of uncertainty makes it difficult to interpret the benefits or lack of benefits of VR distraction for acute pain in children. Most of the review primary outcomes were assessed by only two or three small studies. We found limited data for adverse effects and other secondary outcomes. Future well-designed, large, high-quality trials may have an important impact on our confidence in the results.
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Affiliation(s)
- Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Patrick Boylan
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Lorraine Boran
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Paula Hicks
- Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Arıkan A, Esenay FI. Active and Passive Distraction Interventions in a Pediatric Emergency Department to Reduce the Pain and Anxiety During Venous Blood Sampling: A Randomized Clinical Trial. J Emerg Nurs 2020; 46:779-790. [PMID: 32711948 DOI: 10.1016/j.jen.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Distraction is a method that is easy to use in emergency departments and effective in relieving procedural pain and anxiety. This study aimed to determine the effect of 2 new distraction methods-1 active distraction (rotatable wooden toy) and 1 passive distraction (toy wristband)-on procedural pain, fear, and anxiety in children during venous blood sampling. METHODS This study was a randomized controlled experimental study. The sample consisted of 216 children aged 6 years to 12 years. They were divided into 3 groups using the block randomization procedure: active distraction group (n = 72); passive distraction group (n = 72); and control group (n = 72). The levels of pain and anxiety in the children were measured before and during the blood sampling by the children themselves, their parents, and the researcher using the Visual Analog Scale, the Wong-Baker FACES Pain Rating Scale, and the Children's Fear Scale. RESULTS The children and their parents included in the control and experimental groups had similar sociodemographic characteristics. The active distraction group had lower levels of procedural pain, fear, and anxiety than the other groups (children's visual analog scale score, F = 134.22; P < 0.05; Wong-Baker FACES Pain Rating Scale score, F = 137.54; P < 0.001; and Children's Fear Scale score, F = 92.44; P < 0.001). DISCUSSION Both the toy wristband and rotatable wooden toy interventions can be used to reduce procedural pain, fear, and anxiety in children during blood sampling in emergency departments.
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