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LITERATURE REVIEW

Literature Review

Jordyn L. Elwell

Grand Canyon University: NSG-324

29, March 2020

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LITERATURE REVIEW

Literature Review

For young children, the experience of venipuncture can be a very difficult and even

traumatizing experience. While some children experience it more than others, it can still be

equally difficult every time they go through it. It is important to understand the child and help

them throughout the procedure as much as possible because negative experiences can affect them

later in life. It has been discovered that children who experienced traumatizing venipunctures at a

young age often grew up having a fear of needles or even avoided getting medical help due to

phobias that were created in the clinical setting (Shave, Ali, Scott, & Hartling, 2018). Due to this,

it is vital to make the experience as tolerable as possible for the patient. This literature review

will be addressing the question: for children between the ages of 4 to 8 receiving venipuncture,

do distraction techniques compared to no distractions at all affect the child’s reaction to the pain

they experience during the procedure? The literature reviews will look at three different articles

and include the methods that were included in choosing the articles, a comparison and contrast of

the articles and areas where further research is needed.

Methods

When looking for articles that supported this specific PICOT question, it is important to

look into several different areas to ensure that the articles met certain criteria. Articles that talked

about distraction techniques that were used to help reduce pain in venipuncture and whether or

not it was effective were used to help collect evidence for this PICOT question. The study was

focused specifically on patients ranging between four and eight years old. While there were not

many articles with that exact age range, there were articles that used very close ages. The articles

also had to be less than five years old to make sure that the evidence that was being collected
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LITERATURE REVIEW

was relevant to this time period and that the tools that were being used were accurate to the tools

that are used today.

Synthesize of Literature

In the first article, “Effectiveness of Cartoon Movies as Distracter on Pain among

Children Undergoing Venipuncture”, researchers looked at whether or not the distraction of

cartoons would be beneficial to help lower the child’s pain scale rating. In this quantitative study,

60 children between the ages of three and six were chosen from a hospital in Pune city and were

split evenly into a control group and experimental group. Researchers used the FLACC pain

scale which is an observational pain scale that helps rate pain based off of facial expressions, leg

movement, activity, cry and consolability. The result of this study showed that the children who

watched the cartoon during venipuncture experienced much less pain than the children who did

not have the cartoons. 93.3 percent of the control group experienced extreme pain while only 6.7

percent of the experimental group did. (Gandhar, Deshpande & Borude, 2016). This shows that

the distraction technique of having the children watch cartoons helped significantly with the pain

that they felt.

The second article, “Video-Distraction System to Reduce Anxiety and Pain in Children

Subjected to Venipuncture in Pediatric Emergencies” is similar to the first article as researchers

looked at whether or not videos would lower a child’s pain during venipuncture but using a

different method. Researchers used the Groninger Distress Scale which required the patient to

rate their pain on a scale of one to ten when the venipuncture had been completed. Patients

between ages three and eleven who were in the emergency room in Madrid were used in this

study. The results of this study consisted of a 5.74 mean scale rating for children who did not

watch a video during venipuncture and a 3.18 mean scale rating who did have that distraction
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(Míguez-Navarro & Guerrero-Márquez, 2016). The conclusion to this study was that there was

less pain experienced in the children who were distracted than the children who were not.

In the last article, “The Effectiveness of Distraction Techniques on Minimizing Pain and

Anxiety for Cancer Children Undergoing Venipuncture”, researchers looked at the effectiveness

of distraction techniques during venipuncture but focused it more on cancer patients between the

ages of 6-12. Several distraction techniques were used such as toys, music, games, puzzles,

bubbles, and puppets. The researchers used the FLACC scale which was also used in the first

article to assess the pain levels. Both groups were assessed before the procedure and had a very

similar means scores, both around 9/10 for anxiety (Mohammed & Fattah, 2017). The results of

this study showed that the control group had a mean pain scale score of 8.97 while the

experimental group only had a mean pain scale score of 2.7 (Mohammed & Fattah, 2017).

All three of these articles directly supported the PICOT question. Each one of them had

the main idea of whether or not pain can be decreased in children receiving venipuncture through

the use of distractions. While the age groups were slightly different than what was stated in my

PICOT, each article was still valid due to the ages not being drastically different and keeping the

same main idea.

Areas of Further Study

In all three articles, it is shown through evidence and data collection that the use of

distractions during venipuncture is effective for lowering the pain stimulus in a child. Through

the use of different methods and tools, the results looked very similar each time with the children

being distracted experiencing less pain. From looking only at these three studies, it is unknown

which distraction techniques are the most effective and whether or not age plays a big part in the
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effectiveness. These can both be topics that can be looked further into to help improve the

quality of the results.

Conclusion

All in all,
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LITERATURE REVIEW

References

Gandhar, S., Deshpande, J., Borude, S. (2016). “Effectiveness of Cartoon Movies as Distracter

on Pain among Children Undergoing Venipuncture.” International Journal of Science and

Research (IJSR), volume 5, issue 6, 2016, pp. 2242-2244

Míguez-Navarro, C., & Guerrero-Márquez, G. (2016). Video-Distraction System to Reduce

Anxiety and Pain in Children Subjected to Venipuncture in Pediatric Emergencies.”

Pediatr Emerg Care Med Open Access. 2016, 1:1.

Mohammed, A., Fattah, S. (2017). "The Effectiveness of Distraction Techniques on Minimizing

Pain and Anxiety for Cancer Children Undergoing Venipuncture.” IOSR Journal of

Nursing and Health Science (IOSR-JNHS) , vol. 6, no.6 , 2017, pp. 35-43.

Shave, K., Ali, S., Scott, S. D., & Hartling, L. (2018). Procedural pain in children: a qualitative

study of caregiver experiences and information needs. BMC Pediatrics, 18(1). doi:

10.1186/s12887-018-1300-y