The comparative effects of ball squeezing and cartoon watching in pain management in children during intramuscular injection: A randomized control trial

Year 2022, , 134 - 145, 31.12.2022

Feyza Bülbül , Serap Özdemir

https://doi.org/10.24998/maeusabed.1123566

Abstract

This study was designed as a randomized controlled trial to investigate the comparative effect of ball squeezing and watching cartoons on pain management in children during intramuscular injection. The population of the study was comprised of 6-12 years old children who came to emergency for intramuscular injection. Power analysis was performed by G*Power program. Approximately 147 protocols completed with 6-12 years old children (each group 49 children). In the study, a questionnaire including child and socio-demographic characteristics their experiences of hospitalization data and Facial Pain Scale- Revised (FPS-R), Visual Analog Scale (VAS), and ball (for squeezing) were used. According to the results of the study, the FPS-R score during the procedure was the lowest in the stress ball group and was statistically significant (p˂0.05). The lowest VAS scores during the procedure the lowest score was in the stress ball group and the differences between the relevant groups were statistically significant (p˂0.05). It was determined that squeezing the ball and watching cartoons were effective in reducing pain during injection, however, the ball squeezing group had the lowest pain level. Among non-pharmacological methods, ball squeezing can be preferred as a practical and effective method, especially by pediatric nurses, in reducing pain during intramuscular injection in children.

Keywords

Pain management, Stres ball, Cartoon watched, Injection

Supporting Institution

Yok

Project Number

Yok

Thanks

We would like to thank children and their parents and also emergency nurses.

References

• Abdolalizadeh, H., NamdarArshatnab, H., Janani, R., Arshadi Bostanabad, M., 2018. Comparing the effect of two methods of distraction on the pain intensity venipuncture in school-age children: A randomized clinical trial. International Journal of Pediatrics 6(10), 8423-8432.
• Akgül, E.A., Karahan, Y., Başoğlu, F., Oğul, A., Öztornaci, B.Ö., Yetim, P., Sari, H.Y., 2021. Effects of watching cartoons on pain scores in children undergoing venepuncture. Nursing Children and Young People 33(3), doi: 10.7748/ncyp.2018.e913
• Alemdar, D.K., Aktaş, Y.Y., 2019. The use of the buzzy, jet lidokaine, bubbleblowing and aromatherapy for reducing pediatric pain, stress and fear associated with phlebotomy. Journal of Pediatric Nursing 45, 64-72.
• Aydin, D., Şahiner, N.C., Çiftçi, E.K.., 2016. Comparison of the effectiveness of three different methods in decreasing pain during venipuncture in children: Ball squeezing, balloon inflating and distraction cards. Journal of Clinical Nursing 25(15-16), 2328-2335.
• Bakır, E., 2017. Pediatric pain assessment and tools: the influence of culture and age on pain assessment. Turkey Clinical J Nurs Sci. 9(4), 299-314.
• Bergomi, P., Scudeller, L., Pintaldi, S., Dal Molin, A., 2018. Efficacy of nonpharmacological methods of pain management in children undergoing venipuncture in a pediatric outpatient clinic: a randomized controlled trial of audiovisual distraction and external cold and vibration. Journal of Pediatric Nursing 42, 66-72.
• Bukola, I.M., Paula, D., 2017. The effectiveness of distraction as procedural pain management technique in pediatric oncology patients: A meta-analysis and systematic review. Journal of Pain and Symptom Management 54(4), 589-600.
• Conlon, P.M., 2009. Assessment of pain in the paediatric patient. Paediatrics and Child Health 19(Suppl. 1), S85–S87.
• Çakır, O., Yıldırım, B., 2020. New method for pain, anxiety and stress management in children; virtual reality glasses. In: Goncagul, G., Gunaydın, E. (Eds.), Current Studies in Health Sciences, Duvar Publisher, İzmir, pp. 135-149.
• Çelik, N., Khorshid, L., 2015. The use of shotblocker for reducing the pain and anxiety associated with intramuscular injection. Holistic Nursing Practice 29(5), 261-271.
• Drendel, A.L., Kelly, B.T., Ali, S., 2011. Pain assessment for children overcoming challenges and optimizing care. Pediatric Emergency Care 27(8), 773–781.
• Erkul, M., Efe, E., 2017. Efficacy of breastfeeding on babies' pain during vaccinations. Breastfeeding Medicine 12(2), 110-115.
• Girgin, B.A., Göl, İ., 2020. Reducing pain and fear in children during venipuncture: A randomized controlled study. Pain Management Nursing 21(3), 276-282.
• Gülnar, E., Çalışkan, N., 2014. Determination of knowledge level of nurses regarding intramuscular injection administration to ventrogluteal site. E-Journal of Dokuz Eylul University Nursing Faculty 7(2), 70-77.
• Hassan Ali, H., Yousef Salah, N., Wahid Amer, H., Ragab Mohamed, H., Hussein Abdelhalim, E., 2021. The effect of aromatherapy parent education in alleviating injection pain among children submitting to vaccination. Egyptian Journal of Health Care 12(1), 686-706.
• Heidari Gorji, A., Taebei, M., Ranjbar, M., BabaeiHatkehlouei, M., Goudarzian, A.H., 2017. Effect of distraction technique and hypnosis in pain of bone marrow aspiration in children: a narrative review. International Journal of Pediatrics 5(3), 4521-4531.
• Hogan, M.E., Probst, J., Wong, K., Riddell, R.P., Katz, J., Taddio, A., 2014. A randomized-controlled trial of parent-led tactile stimulation to reduce pain during infant immunization injections. The Clinical Journal of Pain 30(3), 259-265.
• Hussein, H.A., 2015. Effect of active and passive distraction on decreasing pain associated with painful medical procedures among school aged children. World Journal of Nursing Sciences 1(2), 13-23.
• Inan, G., Inal, S., 2019. The impact of 3 different distraction techniques on the pain and anxiety levels of children during venipuncture. The Clinical Journal of Pain 35(2), 140-147.
• İnangil, D., Şendir, M., Büyükyılmaz, F., 2020. Efficacy of cartoon viewing devices during phlebotomy in children: a randomized controlled trial. Journal of Peri Anesthesia Nursing 35(4), 407-412.
• International Association for the Study of Pain (IASP), 2010. Pain terminology. http://www.iasp-pain. org/. (Accessed on: 04.10.2020).
• Kaheni, S., SadeghRezai, M., Bagheri-Nesami, M., Goudarzian, A.H., 2016. The effect of distraction technique on the pain of dressing change among 3-6 year-old children. International Journal of Pediatrics 4(4), 1603-1610.
• Kassab, M., Almomani, B., Nuseir, K., 2020. Efficacy of sucrose in reducing pain during immunization among 10-to 18-month-old infants and young children: A randomized controlled trial. Journal of Pediatric Nursing 50, 55-61.
• Kaya, N., Salmaslıoğlu, A., Terzi, B., Turan, N., Acunaş, B., 2015. There liability of site determination methods in ventroglutealarea injection: a cross-sectional study. International Journal of Nursing Studies 52(1), 355-360.
• Kuo, H.C., Pan, H.H., Creedy, D.K., Tsao, Y., 2018. Distraction-based interventions for children undergoing venipuncture procedures: a randomized controlled study. Clinical Nursing Research 27(4), 467-482.
• Laures, E., LaFond, C., Hanrahan, K., Pierce, N., Min, H., McCarthy, A.M., 2019. Pain assessment practices in the pediatric intensive care unit. Journal of Pediatric Nursing 48, 55-62.
• Miller, K., Tan, X., Hobson, A.D., Khan, A., Ziviani, J., O'Brien, E., Baura, K., McBride, C., Kimble, R.M., 2016. A prospective randomized controlled trial of nonpharmacological pain management during intravenous cannulation in a pediatric emergency department. Pediatric Emergency Care 32(7), 444-451.
• Mutlu, B., Balcı, S., 2015. Effects of balloon inflation and cough trick methods on easing pain in children during the drawing of venous blood samples: A randomized controlled trial. Journal for Specialists in Pediatric Nursing 20(3), 178-186.
• Okyay, R.D., Ayoğlu, H., 2018. Postoperative pain management in children. Pediatric Practice and Research 6(2), 16-25.
• Rezai, M.S., Goudarzian, A.H., Jafari-Koulaee, A., Bagheri-Nesami, M., 2017. The effect of distraction techniques on the pain of venipuncture in children: a systematicreview. J Pediatr Rev. 5(1), 9459.
• Robabi, H., Askari, H., Saeedinegad, F., 2016. Comparing the effectiveness of two distraction techniques of inflating balloon and watching cartoon in reducing the vaccination pain among school age children. Medical-Surgical Nursing Journal 5(3), 18-22.
• Şahiner, N.C., Bal, M.D., 2016. The effects of three different distraction methods on pain and anxiety in children. Journal of Child Health Care 20(3), 277-285.
• Şahiner, N.C., Türkmen, A.S., 2019. The effect of distraction cards on reducing pain and anxiety during intramuscular injection in children. Worldviews on Evidence‐Based Nursing 16(3), 230-235.
• Schulz, KF., Altman, DG., Moher, D. CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials. PLoS Med. 2010; 7(3): e1000251. doi:10.1371/journal.pmed.1000251 Published March 24, 2010.
• Semerci, R., Kocaaslan, E.N., Kostak, M.A., Akın, N., 2020. Reduction of pain during intravenous cannulation in children: Buzzy application. Pain 32(4), 177–185.
• Sirtin Tumakaka, G.Y., Nurhaeni, N., Wanda, D., 2020. Squeezing a squishy object effectively controls pain in children during intravenous catheter insertion. Pediatric Reports 12(S1), 8-10.
• Tuğrul, E., Denat, Y., 2014. Nurses' knowledge, opinions and practices regarding injection into the ventrogluteal area. E-Journal of Dokuz Eylul University Nursing Faculty 7(4), 275-284.
• Viggiano, M.P., Giganti, F., Rossi, A., DiFeo, D., Vagnoli, L., Calcagno, G., Defilippi, C., 2015. Impact of psychological interventions on reducing anxiety, fear and then eedforsedation in children undergoing magnetic resonance imaging. Pediatric Reports, 7(1). Doi: 10.4081/pr.2015.5682
• Yıldız, D., Kızıler, E., Eren Fidancı, B., Suluhan, D., 2017. What are the trues in applicating of intramuscular injection to children?: Review. Turkey Clinical J Nurs Sci. 9(2), 144-152.
• Yilmaz, G., Alemdar, D.K., 2019. Using Buzzy, Shotblocker, and bubble blowing in a pediatric emergency department to reduce the pain and fear caused by intramuscular injection: A randomized controlled trial. Journal of Emergency Nursing 45(5), 502-511.