Distraction Techniques during pediatric medical procedures Kitty Burke Ferris State University

Introduction This presentation is based on the PICO question: In pediatric patients, do distraction techniques during medical procedures using toys/movies/games result in lower pain scores when compared to no intervention? Primary research method: Ferris State University’s FLITE smart search tool PubMed Keywords: Distraction techniques, pediatrics, emergency room, pain Numerous peer reviewed articles were utilized

Research Articles 1) Computer Tablet Distraction in Children Receiving an Injection 2) Parents’ Positioning and Distracting Children During Venipuncture Pain scales: Self-reported pain (FACES), Observed pain (FLACC), Emotional behaviors (CEMS) “Distraction is a commonly used behavioral intervention by child life specialists and nurses that entails teaching and assisting children to focus their attention from the source of fear, pain, or anxiety (e.g., an injection) to something more neutral” (Burns-Nader, Atencio & Chavez, 2016). “Each year, approximately 30 million children experience visits to an emergency department in the United States” (Cavender, K., Goff, M., Hollon, E., & Guzzetta, C., 2004).

Rationale The two following articles were selected due to the purpose of each study being close in relation to the PICO question regarding pain distraction in children. Article 1) Computer Tablet Distraction in Children Receiving an Injection The objective of this article was “To evaluate the effectiveness of a computer tablet as a distraction tool for minimizing pain and distress in children undergoing an injection” (Burns-Nader, S., Atencio, S., & Chavez, M., 2016). Article 2) Parents’ Positioning and Distracting Children During Venipuncture Effects on Children’s Pain, Fear, and Distress “The purpose of this study was to determine the effectiveness of parental positioning and distraction on the pain, fear, and distress of pediatric patients undergoing venipuncture” (Cavender, K., Goff, M., Hollon, E., & Guzzetta, C., 2004).

Study Findings Article 1: The design was experimental, randomly assigned subjects The setting was at a Pediatric Clinic Subjects: Children ages 4-11 years old Methods: During an injection, children either participated in distraction using a computer tablet or the did not use distraction with the tablet during their injection. Their emotional and pain responses were monitored using a behavioral observation scale. Results: No significant differences were found

Study Findings Article 2: Design: experimental-comparison group, randomly assigned patients undergoing an IV insertion or venipuncture. Settings: Pediatric patients receiving IV therapy or venipuncture in Emergency Room Subjects: 43 English speaking children from 4-11 years of age that had an medical order for IV or bloodwork. Methods: Consent obtained & Parent education about positioning and distracting Results: No significant differences were found

Study Findings These were quantitative studies: Controlled settings: Healthcare settings Sampling: population-based Methodology: test for group differences Data types: Scales, numbers Reporting: Statistics, presented with tables and graphs

Ethical Considerations The articles discussed the participants and how they were distributed. Article 1: 42% Caucasian, 46% African American, 7% Hispanic & 2% Biracial, lower socioeconomic status Article 2: English speaking

Strength, Quality & Credibility Article 1 Strength - Clearly identified research presented in a well written, concise, and grammatically correct fashion. Quality - High quality, consistent, generalizable results with a sufficient sample size and definitive conclusions Credibility - Peer reviewed journal articles, appropriate for the PICO question (Burns-Nader, S., Atencio, S., & Chavez, M., 2016)

Strength, Quality & Credibility Article 2 Strength - Clearly identified research presented in a well written, concise, and grammatically correct fashion. Referenced many related literature. Multiple tables and graphs utilized. Quality - High quality, consistent, generalizable results with a sufficient sample size and definitive conclusions Credibility - Peer reviewed journal articles, appropriate for the PICO question

Criteria Article 1 Location: The clinic was in a small city in the Southeast region of the United States. Contribution to EBP: The study was documented Article 2 Location: The study was conducted in the ED of a private, 322-bed, pediatric medical center in the Southwest and was approved by the hospital’s Institutional Review Board Contribution: “Parental participation using positioning and distraction represents a holistic intervention package that integrates current best evidence to sustain the integrity of the whole child during a painful procedure” (Cavender, K., Goff, M., Hollon, E., & Guzzetta, C., 2004).

Relevance to Practice Findings should be communicated to individuals who are involved in the patients care. Results could influence staffing and coordination with other departments (i.e. Child Life Specialists) This information would be communicated multiple ways. Group huddles, in-services, emails area all ways this information could be distributed. Achieving better outcomes for children and their families.

Relevance to Practice continued… Implications of these studies can improve outcomes and quality of treatment related Pediatric procedures. These changes would be implemented at Physician & Nurse level. Case to case basis. Changes could improve patient satisfaction in addition to patient safety. Results could use further research.

Barriers Barriers could be related to staffing. The Emergency Room is a 24/7 department but the need for Child Life Specialists at all times is not financially appropriate. Additional PICO Question: In pediatric patients, do distraction techniques during procedures result in lower pain scores compared to pain medication?

Conclusion Parent involvement decreases the patients anxiety level, distraction techniques were not found to make a significant difference in the pediatric patients level of fear, anxiety and pain. When studies like these are documented other researchers can relate to them and build off of them.

References Burns-Nader, S., Atencio, S., & Chavez, M. (2016). Computer Tablet Distraction in Children Receiving an Injection. American Academy of Pain Medicine. 17, 590-595. doi: 10.111/pme.12877 Cavender, K., Goff, M., Hollon, E., & Guzzetta, C. (2004). Parents’ Positioning and Distracting Children During Venipuncture Effects on Children’s Pain, Fear, and Distress. Journal of Holistic Nursing. 22, 32-56. doi: 10.1177/0898010104263306 Forister, J. & Blessing, J. (2016). Research and Medical Literature for Health Professionals. (4th ed.).