Influences shaping nurses' use of distraction for children's procedural pain

Abstract

Nurses' distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain.

Procedural Preparation and Support as a Standard of Care in Pediatric Oncology

“…Despite this evidence, it remains unclear what make an effective distraction intervention, although considerations of adult involvement, child choice of distracter, requirement to interact with a distracter, and/or use of technology may be helpful . Pediatric oncology nurses identified distraction as less effective for children with extreme anxiety or fear, children who are not receptive to distraction, children who have had previous negative experiences, or where there is insufficient time . Higher parent anxiety is also associated with decreased distraction efficacy …”

“…Psychological interventions involve cognitive and/or behavioral components that focus on modifying children's thoughts and beliefs or teaching behavioral strategies to enhance coping and reduce pain and distress from medical procedures. [64][65][66][67]79,[85][86][87][88][89][90][91][92] Strategies can be implemented prior (immediately or days/weeks before), during, and/or following completion of the procedure. Reviewed interventions included distraction (21 studies), combined cognitive-behavioral (11 studies), hypnosis (six studies), memory reframing (two studies), breathing (one study), art therapy (one study), behavioral training (one study), and biofeedback/relaxation (one study).…”

“…[64] Pediatric oncology nurses identified distraction as less effective for children with extreme anxiety or fear, children who are not receptive to distraction, children who have had previous negative experiences, or where there is insufficient time. [79] Higher parent anxiety is also associated with decreased distraction efficacy. [106] Combined cognitive-behavioral interventions as described in the reviewed studies involved at least two of the following strategies, including imagery, coping self-statements, reframing, relaxation, breathing exercises, modeling, rehearsal, desensitization, positive reinforcement, cognitive or behavioral distraction, parent training, and/or parent/staff coaching.…”

Exploring distraction and the impact of a child life specialist: Perceptions from nurses in a pediatric setting

“…Distraction is one nonpharmacological strategy found to be effective in providing comfort and decreased experiences of pain for the child and their family (Hyland et al, ; Short, Pace, & Birnbaum, ). Studies identify that nurses often struggle with the delivery of distraction due to workplace constraints, such as focusing on the task, time, and assisting the physician during the procedure (Boztepe, & Yildiz, ; Olmstead, Scott, Mayan, Koop, & Reid, ). Research into distraction as nonpharmacological pain management strategy confirms pain and anxiety is lessened when distraction is used.…”

“…Distraction is one technique used by healthcare professionals and families to alleviate pain and stress for the child undergoing a painful procedure (Koller & Goldman, ). Pain management for children has been studied by many researchers, in particular, the role of the nurse has received considerable attention (Beckett, Henderson, Parry, Stoddart & Fletcher, ; Twycross, Allen Finley & Latimer, ; Olmstead et al, ). Alongside nurses, child life specialists are seen as experts in advising on the management of a child’s pain.…”