1. The effectiveness of distraction intervention for pain relief in child receive needle-related : A systematic review Yi-ping Kung Ching-ching Sheng Pei-fan Mu Li-fen Wu

2. Reviews objective The purpose of this systematic literature review, investigate distraction for reducing the effect of children needle-related caused pain. @@ 影片摘自 YouTube 網路資料

3. Background Hospitalization, whether it is elective, planned in advance, or the result of an emergency or trauma, is stressful for children of all ages and their families. Children facing stress sources include separation anxiety, and loss of control, injury on the body and pain. (Hsieh, Liu, & Cho, 2012 ; Wu, 2007)

4. When children in the hospital, the environment change and many invasive treatment measures, adds to their emotional distress or behavioral problems.

5. Children often experience unpredictable and severe procedure-related pain in hospitals, the venipuncture is one of the most feared procedures for children. (Murphy, 2009)

6. Children the medical fear Scale (Child Medical Fears Scale, CMFS) assessment study of 100 received injections of 4-6 years old children, found that 74.2% of children fear injections. (Lacey & Finklestein, 2008)

7. For youth with chronic illness children, the painful medical procedures such as injections, needle sticks, and intravenous placements, which they report is the worst part of having an illness. ( Keith et al, 2011)

8. In the hospital, stranger things with invasive treatment of hospitalized, the young children received intravenous fear behavior reaction more intense than other age groups. This stage children have emotion including crying, biting, sweating, clinging to their loved ones, or refuse cooperation. (Chou, 2002)

9. If inadequate pain management has the potential to affect future care and can be associated with negative emotional and psychological implications. (Lindsay, Christine, Partick, & Stephen, 2008)

10. In 73% of young children will appear negative behavior and reaction to strong emotional and physical resistance to any real or perceived pain. (Lai, 2010)

11. Before the exposure to new experiences, give sometime to prepare, maybe can help children to reduce the fear of strangers triggered, by nurses speak story 、 model doll therapeutic games to help young children can not be expressed in words through pictures of strangers, things objects of fear of emotional vent, alleviate fearful behavior caused by injection reaction. (Wu, 2008; Xiao 、 Wu & Yang, 2006)

12. Cognitive behavior theory is the foundation for one of the most widely used types of psychotherapy. The blending of two approaches to psychotherapy: behavior therapy and cognitive therapy.

13. The cognitive behavioral treatment also can help to promote resilience by changing one's perception of the situation. (O'Connor & Creswell, 2008;Steinhardt & Dolbier, 2008)

14. CBT is thought to be effective for the treatment of a variety of conditions, including mood, anxiety, fear, pain, personality, substance abuse, tic, and psychotic disorders. (Steinhardt & Dolbier, 2008)

15. It has been widely applied to adults as well as adolescents and children with emotional and behavioral problems, that help children cope with invasive procedures. (Thush et al., 2007)

16. Psychological interventions for managing pain and distress in children are primary cognitive behavioral treatment. (Steinhardt & Dolbier, 2008)

17. Behavior therapy interventions such as controlled breathing, progressive muscle relaxation, visual imagery, and distraction have been used in children to supplement management during painful procedures. (slifer, Zettler, Hendricks & Reesman, 2012)

18. Distraction and imagery focus a child’s attention away from the painful aspects of a procedure using strategies similar to those used with hypnosis. In this process, the child’s ability to engage in fantasy is used to train the child to focus not on the procedure, such as blowing bubbles, playing video games, looking books, imaginary place. (McCathy & Petersen, 1996)

19. In study, 4 to 6 year-old children undergoing immunization injections were found to have significantly lower observed behavioral distress and significantly more observed coping behaviors when a movie intervention was provided compared to standard medical care. (Cohen et al, 1997)

20. A recent study in the primary care setting demonstrated that audiovisual distraction provided as a routine psychological intervention was effective in reducing self- reported pain in school-age children, improving their cooperation, and increasing success of needle stick procedures. (Keith et al, 2009)

21. Wang & Chen (2008) in 300 children between 8 and 9 years of age requiring initial venipuncture, use audiovisual distraction to observational visual analogue scale (VAS) was used for quantitative assessment of pain during the procedure. The result no significant difference (P>0.05) in venepuncture times and pain intensity (assessed with visual analogue scale, VAS).

22. The purpose is to identify the effectiveness of distraction intervention for pain relief in child receive needle- related procedural.

23. Inclusion criteria Types of participants Include of children and adolescents between 1 and 18 years of age were examined during receiving needle-related procedures. The needle-related procedures including venipuncture 、 blood draw and port-A access etc.

24. Types of intervention This review consider studies that evaluate distraction technology. The distraction technology included use any distraction technology.

25. Types of outcomes Primary outcomes: pain reactivity, pain level. Second outcomes: fear, distress level.

26. Types of studies Systematic reviews. Randomized controlled trials. Quasi- experimental for inclusion.

27. Exclusion criteria Types of participants Newborn and infants under 1 years of age and order then 18 years of age. The participants who have received anesthetic treatment during receiving needle-related procedures.

28. Exclusion criteria Types of intervention The participants who have received anesthetic treatment and use non- distraction technology during receiving needle-related procedures.

29. Exclusion criteria Types of outcomes The outcomes measure pain level, fear and distress, beside the outcomes were excluded. Types of studies Non English or Chinese languages paper. Non Systematic reviews, randomized controlled trials, quasi- experimental study.

30. Search strategy English and Chinese languages. Published 1990-2012.

31. Databases Cochrane Central Register of Controlled Trials MEDLINE (1950 to present) EMBASE/Ovid (1980 to present) PubMed(from 1945 to present) CINAHL(1982 to present) JBI( 1996 to present) Chinese library ：華藝線上圖書館、全國碩博士 論文資訊網 Google scholar

32. keyword Types of participants: child/children, pediatric, toddler, preschool, adolescent, venipuncture, needle-related procedural, injection, needle sticks, and intravenous placements. Types of interventions: distraction, game, video, toy, music, behavior, non-pharmacological, cognitive behavioral, psychological.

33. keyword Types of outcome measures: pain relief, fear, distress. Types of studies: systematic reviews, experimental study, randomized controlled trial, quasi-experimental study.

34. Chinese keyword Types of participants: 兒童、幼兒、學齡前期、學齡 期、青少年、注射、靜脈注射、針刺相關 Types of interventions: 轉移注意力、遊戲、音樂、玩 具、影片、非藥物、行為、認知行為、心理 Types of outcome measures: 疼痛、害怕、壓力 Types of studies: 系統性文獻、隨機對照、實驗性研究、 類實驗性研究

35. Assessment of methodological quality Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

36. Assessment of methodological quality Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

37. Data collection Data will be extracted from papers include in the review using the standardized data extraction tool from JBI-MAStARI. The data extracted will include specific details about the interventions, study methods and outcomes of significance of the review question and specific objectives.

41. Thanks for your attention