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Original Article (Pages: 8423-8432)
Abstract
Background
Children undergo painful procedures during care and treatment. This study aimed to determine the
effect of distraction on the intensity of pain in children aged 6 to 12 years old.
Materials and Methods
This clinical trial was conducted on the school-age children, who referred to Imam Hossein Hospital,
Iran, Heris city, East Azarbaijan province (Iran) in 2017. In total 48 patients were selected through
convenience sampling technique and were randomly divided into three groups of 16 cases. In all
three groups, pain was measured using the Oucher1 self-report scale, 3 minute before and after the
venipuncture. One minute before venipuncture, in the "deep breathing with blowing paper whirligigs"
groups after spinning the paper whirligigs and exhalation, in the "deep breathing" groups after
exhalation, numbers were counted up to 10 spins or 10 breaths. In the control group, no intervention
was performed. The data analysis was performed in the SPSS software (version 13.0).
Results: The results showed that "deep breathing with blowing paper whirligigs" (Mean + standard
deviation [SD]: 2.69±0.79) and "deep breathing" (Mean + SD: 2.63±1.31) reported less pain intensity
than the control group (Mean + SD: 5.25±1.00), and the "deep breathing with blowing paper
whirligigs" method had the least pain intensity. The results of ANOVA test showed that there was a
significant difference among the groups in terms of pain intensity after intervention (P ≥0.001).
Conclusion
The findings showed that both methods of distraction in this study (deep breathing with blowing paper
whirligigs and deep breathing) can effectively decrease the venipuncture pain.
Key Words: Children, Distraction, Pain, Venipuncture.
*Please cite this article as: Abdolalizadeh H, NamdarAreshtanab H, Janani R, Arshadi Bostanabad M.
Comparing the Effect of Two Methods of Distraction on the Pain Intensity Venipuncture in School-age
Children: A Controlled Randomized Clinical Trial. Int J Pediatr 2018; 6(10): 8423-32. DOI:
10.22038/ijp.2018.32366.2850
*Corresponding Author:
Mohammad Arshadi Bostanabad, Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz
University of Medical Sciences, Tabriz, Iran.
Email: arshadi_m@yahoo.com
Received date: Mar.23, 2018; Accepted date: Apr. 22, 2018
measure its effect on pain intensity papers and kept them in a covered
venipuncture in school age children. package. After introduction and with
regard to the research ethics, the children
2- MATERIALS AND METHODS were required to select a card according to
2-1. Design which they were entered into the
respective study groups. This continued
This study is a randomized clinical trial until the completion of the groups.
without blinding. This clinical trial was Eligibility criteria for participants
conducted on the school age children, who including: aged 6-12, who were able to
referred to Emergency department of count from 1 to 10, the child and their
Imam Hossein Hospital, Tabriz, Heris parents were willing to cooperate with the
count (East Azarbaijan peovince, Iran) in study was included in to the study.
2017. The study diagram is represented in
Figure.1. 2-3. Instrument
during exhalation, after spinning whirligig descriptive statistics (mean and standard
and exhalation, numbers were counted up deviation), paired t- test (for intra-group
to 10 spins (Picture.1). In group 2 (deep comparison), and one-way ANOVA (to
breathing), inhalation was by nose and evaluate the difference between the mean
exhalation by mouth, after exhalation, scores of the participants). P-value less
numbers were counted up to 10 breaths. than 0.05 were statistical significant.
The venipuncture was performed before
the counting was completed. In the control 3- RESULTS
group, no intervention was performed. In The purpose of this study was to
each of the three groups, 3 minutes after compare pain intensity changes in three
venipuncture, the researcher asked the groups ("deep breathing with blowing
child about the intensity of pain, using paper whirligigs", "deep breathing" and
Oucher self-report scale, instrument, and control). The demographic variables were
recorded the results in the (16). shown in Table.1. According to this table,
the frequency distribution and percentage
of other baseline characteristics of children
according to the three groups and the
results showed no statistically significant
difference among the three groups of
blowing paper whirligigs and deep
breathing, deep breathing and control
group in demographic variables such as
age, gender, birth rank, history of
admission and venipuncture site (P>0.05).
Fig.1: Deep breathing with blowing paper In other words, three groups were
whirligigs. homogeneous in terms of these variables.
The results of the normal test related to the
2-5. Ethical considerations pain intensity before and after the
intervention according to the groups
In line with the ethical considerations, the (control and experiment). According to the
research objectives were explained face-to- Kolmogorov-Smirnov test (P>0.05), the
face to the mothers of the participants in distribution of data is normal (Table.2).
their presence. Furthermore, they were
informed about the possibility to withdraw The results of paired t-test for within-
from the study at any time without any group comparisons in deep breathing with
effect on the venipuncture process. In blowing paper whirligigs group (p≥0.001),
addition, the researcher was available and control (p≥0.001) was a significant
throughout the study and answered all the difference between the two groups before
questions. The written informed consents and after the intervention, but this
were obtained from the mothers prior to difference was not significant for the "deep
the study. The research was confirmed by breathing" group (p≥ 0.14). The results of
the Regional Medical Sciences Research ANOVA test showed that there was no
Ethics Committee of Tabriz University of significant difference between the three
Medical Sciences (ID- code: groups in terms of pain intensity changes
IR.TBZMED.REC.1396.171). before the intervention (P = 0.29), but
there was a significant difference between
2-6. Statistical analysis the three groups after the intervention
The data analysis was performed in the (P<0.001) (Table.3). In addition, the post-
SPSS software version 13.0, using the hoc Tukey test demonstrated that the
control group had a significant difference "deep breathing with blowing paper
with the distraction techniques of "deep whirligigs" (Mean + SD: 2.69±0.79), and
breathing with blowing paper whirligigs" "deep breathing" (Mean + SD: 2.63±1.31)
(P=0.001), and "deep breathing" reported less pain intensity than the control
(P=0.001). However, no significant group (Mean + SD: 5.25±1.00); and the
difference was observed between the two "deep breathing with blowing paper
intervention groups in this regard whirligigs" method had the least pain
(P=0.98). The results showed that the intensity (P<0.05).
Table-2: The results of the normal test related to the pain intensity before and after the intervention
according to the groups (control and experiment)
Pre-test Post-test
Variables Groups Number K-S statistics P-value K-S statistics P-value
Intensity Deep breathing with blowing 16 0.214 0.051 0.307 0.269
of pain paper whirligigs
Deep breathing) 16 0.195 0.107 0.168 0.200
Control 16 0.205 0.070 0.214 0.050
Table-3: The comparison of changes of pain intensity before and after intervention
Pretes Post-test
Variables Groups Number K-S statistics P-value K-S statistics P-value
Intensity deep breathing with blowing 16 0.214 0.051 0.307 0.269
of pain paper whirligigs
Deep breathing) 16 0.195 0.107 0.168 0.200
Control 16 0.205 0.070 0.214 0.050
had the least pain intensity. In this study, than deep breathing on the pain intensity
52% of the participants were boys and venipuncture in school-age children.
47% were girls. The participants in the Esmaeili et al., and Valizadeh et al. in two
"deep breathing with blowing paper separate studies, the effect of two methods
whirligigs" group were 50% girl and 50% of deep breathing and music on the pain
boy, so the gender variable in this study severity of intravenous cannulation during
was not effective in reporting the severity blood transfusion in school-age children
of pain. The mean age of participants was was compared. The results of their study
8.31, 9.25, and 8.38 in the "deep breathing showed that music and deep breathing
with blowing paper whirligigs", "deep significantly reduced the pain of children
breathing", and control groups, and music is more effective than deep
respectively. Considering that the "deep breathing (16, 17). Based on the results of
breathing with blowing paper whirligigs" these two studies (Esmaeili et al.,
group the mean age of children was lower Valizadeh et al), we combined deep
than the other two groups (Mean: 8.31+ breathing with a blowing paper whirligigs
1.99), it can be concluded that in young to measure its effect on the severity of
children, the treatment game gives more venipuncture pain, which showed that deep
distraction than pain. Distractions are an breathing with blowing paper whirligigs
effective technique for reducing pain. was more effective than deep breathing.
Making bubbles was more effective than
The basis for distraction is that, if the
control group in two studies, but there was
reticular structure in the brain stem
no significant difference between cream
receives sufficient and different sensory
(Eutechtic mixture of local anesthetics
stimulation, it can selectively prevent and
[EMLA]), and regular breathing (5, 6).
overlook the sensory transmission, such as
pain (5). Using regular breathing makes Razaghi et al. studied two methods of
the child effortlessly distracting his mind bubble and touch in reducing the severity
and it creates feelings of control over pain of venipuncture pain in children aged 5-10
and anxiety and reduces pain and anxiety years old, results showed that both
behaviors (14). Deep breathing will keep methods were effective in reducing pain
the child focused on doing it and reporting (22). The results of the Robabi et al.’s
less pain. The results of this study showed study showed that two distraction methods
that deep breathing has been effective in of inflating balloon and watching cartoons
reducing the pain of venipuncture in could effectively decrease the pain induced
children. Deep breathing will cause more by Diphtheria, tetanus, and pertussis
endorphin secretion which plays the role of (DPT) vaccine school-age children (23).
natural relieve pain in the body (21). The results of the Aydin et al.’s study
Playing in the hospital provides a way to showed that three different methods of
distract the child from the painful pressing the ball, blowing the balloon and
procedure (3), and the cheerfulness of the the card are effective in reducing the pain
patient will be possible with very little in school-age children (24). Blowing paper
facilities (17). If deep breathing is carried whirligigs, making bubbles and blowing
out with a blowing paper whirligigs, when the balloon is a kind of distraction from the
the children see them blowing will cause game that requires deep breathing, which
the whirligigs to spin it was attractive to have been effective in reducing children's
them and tend to repeat it. As the results of pain in the studies. Paper whirligigs that
this study showed that the distraction with can be used to make it from paper, tongue
"deep breathing with blowing paper depressor and pins which can be used to
whirligigs" technique are more effective make it, compared to the previous two
support, as well as the personnel of Imam Journal of Burn Care & Research.
Hossein Heris Hospital and families who 2007;28(5):694-702.
participated in this project. 10. Babaie M, Shirinabadi FA, Nourian
M, Pourhoseingholi A, Masoumpoor A. Pain
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