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

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

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?”

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

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

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

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.

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

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

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

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

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), 125-141. doi:10.1080/02739611003679915 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), 162-171. doi:10.1111/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), 109-114. doi:10.1111/jspn. 12018 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), 2180-2186. doi:10.1111/j.1365-2702.2008.02775.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.