1. Kirsten Novak Scientific Writing April 8, 2015
Distraction Techniques in Pediatrics During Painful Invasive Procedures
10 slides
Kirsten Novak
Scientific Writing
April 8, 2015

2. Introduction to Distraction, Pain & Distress in Pediatrics
Unmanaged procedural pain in pediatrics is common in hospitals
Procedures causing PAIN and DISTRESS:
IV Insertion
Venipunture
Immunizations
Procedural Pain in kids
differs from adults:
Anticipation of pain and distress
Less understanding
Cost: $630,672
Nurses and the
“just get it done” approach
Anxiety & Distress may increase failed attempts
McCarthy et al., 2010; Olmstead et al., 2014

3. PICOT Question
“In school-aged hospitalized patients, does the use of parental-guided distraction during painful invasive procedures (versus no use of distraction techniques) result in reduction of pain and behavioral distress during the duration of the procedure?”

4. Key Findings
Distraction is an effective non-pharmacologic method to decrease pain and distress in various:
Subjects
Cultures & Ethnicities
Diagnoses (Cancer patients)
Ages (1-15 years)
Procedures
IV insertion
Venipuncture
Immunizations
Central Venous Port Access
Approaches
Parent coaches only
Distractor item only
Combination of both
Settings
PICU
Pre-operative wards
Outpatient clinics

5. Grading Outcomes Studies used to develop the change in practice
Grade II
McCarthy et al. (2010)
Sadeghi et al. (2013)
Windich-Biermeier et al. (2007)
Grade III
Tüfekci et al. (2013)
Grade V Study
Tomlinson et al. (2010)
(Fineout-Overholt, 2010)
Based on the Fineout-Overholt system Grade II & III Studies, significantly contributed strength to the intervention effectiveness
Randomized control trial
Case control study
Descriptive study

6. Change in Practices
Medical department with school-aged hospitalized patients for IV insertions
Combination distraction: parental coach & distractor item of child’s choice
Three month baseline data collection without intervention
Training for nurses to prepare parents will occur during this time
Then three month data collection with intervention
Compare scores to determine effectiveness

7. Measurement Scales The Wong-Baker FACES Pain Rating Scale
Simple and effective for kids able to report pain (Tomlinson et al., 2010).
Scores closer to “0” indicate “no hurt”
The Observational Scale of Behavioral Distress
Scores closer to “8” indicate “least amount of stress” (Windich-Biermeier et al., 2007).
OSBD: measures behavioral distress by 8 categories weighted on a 5 point scale: information seeking, crying, scream, restraint, verbal resistance, request emotional support, verbal pain, and flailing.

8. Potential Barriers Funding for toys, books, and other distractor items
Patients who do not want their parent in the room during procedure
Parents or nurses disinterested in the intervention
Nurses who are unable to fulfill training
Nurses’ perceived lack of time to participate

9. Ethical Considerations
All patients have the right to controlled and properly managed pain regardless of the cause
With the aim to reduce pain and distress
Beneficence
Acting in the best interest of the patient
Non-maleficence
Aims to prevent harm of patient
Beauchamp & Childress, 2009

10. Expected Outcomes
A decrease of PAIN and DISTRESS during IV insertion in school-aged hospitalized patients
Improve procedural pain/distress in children for all needle procedures
Parent(s) to have an active role in their child’s procedure and health care

11. PICOT Question Outcome
Conclusion
PICOT Question Outcome
“In school-aged hospitalized patients the use of parental-guided distraction during painful invasive procedures results in reduced PAIN & DISTRESS during the duration of the procedure versus no distraction techniques”
Recommendations: further implement in departments with needle procedures for school-aged children
“An effective, inexpensive, safe, and versatile approach with potential to reduce pain and distress in needle procedures in children”
McCarthy et al., 2010

12. References
Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., Williamson, K.M. (2010). Critical appraisal of the evidence: Part I. AJN, 110(7). 47 – 52.
McCarthy, A., Kleiber, C., Hanrahan, K., Zimmerman, M., Westhus, N., & Allen, S. (2010). Impact of parent-provided distraction on child responses to an IV insertion. Children's Health Care, 39(2), doi: /
Olmstead, D. L., Scott, S. D., Mayan, M., Koop, P. M., & Reid, K. (2014). Influences shaping nurses' use of distraction for children's procedural pain. Journal for Specialists in Pediatric Nursing, 19(2), doi: /jspn.12067
Sadeghi, T., Mohammadi, N., Shamshiri, M., Bagherzadeh, R., & Hossinkhani, N. (2013). Effect of distraction on children's pain during intravenous catheter insertion. Journal For Specialists In Pediatric Nursing, 18(2), doi: /jspn
Tomlinson, D., von Baeyer, C., Stinson, J., & Lillian, S. (2010). A Systematic Review of Faces Scales for the Self-report of Pain Intensity in Children. Pediatrics, 126(5), 999.
Tüfekci, F., Çelebioglu, A., & Küçükoglu, S. (2009). Turkish children loved distraction: using kaleidoscope to reduce perceived pain during venipuncture. Journal Of Clinical Nursing, 18(15), doi: /j x
Windich-Biermeier, A., Sjoberg, I., Dale, J., Eshelman, D., & Guzzetta, C. (2007). Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer. Journal Of Pediatric Oncology Nursing, 24(1), 8-19.