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of Table 3

Synthesis Table-3: Cognitive/Behavioral Techniques

Practice Area: Cognitive/Behavioral Techniquesfor Needlesticks/Procedures

Topic / Citation / Sample / Key Findings / Comments
Ulman, LS, Chambers, Ct, McGrath, PJ and Kisely S / Cochrane Review
Psychological interventions for needle-related procedural pain and distress in children and adolescents.
Assessed as up – to –date 2006 / 28 trials 1951 participants
immunizations and injections were most commonly studied / Review of
Distraction , Memory Alteration
CBT, Nurse Coaching, Parent Coaching, Video tape modeling
Suggestion, Blowing out air
The largest effect for treatment over control exits for distraction, hypnosis, and combined CBT
Behavioral approaches-over view / Cohen LL
Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access
Pediatrics2008 122 S134-139 / Article / Preparation
Positioning
Adults should encourage coping
Engage child in distraction
Infants: swaddling skin-to –skin contact, breast feeding, and sucrose. / Research in behavioral approaches provide recommendations for minimizing anxiety and pain.
86 references
Excellent article
Distraction / Klieber C, Craft-Rosenberg, M & Harper DC
Parents As Distraction Coaches During IV Insertion: A Randomized Study
Journal Pain Symptom Management 2001: 22:851-861. / 44 children with chronic illness
4-7 yrs old
Dyads randomized to groups
RCT / 2 groups: standard vs. distraction education for parents
No difference between groups in observed behavior scores, pain scores
Educated Parents displayed more distraction
Experimental group displayed less distress over the time of the IV start / Small n-power low to evaluate child’s pain response
Some parents did well –other were not effective
**5 key points for coach
Focus attention away from procedure
Use activities to keep attention
Try to get attention back
Using distraction takes effort
Praise child at the end
Distraction / Dahlquiest, LM, Busby, SM, Slifer, KJ, Tucker, CL et al.
Distraction for Children of Different Ages Who Undergo Repeated Needle Sticks
Journal of Pediatric Oncology Nursing 2002: 19:22-34 / 6 children
longitudinal study
2-8 years / 5 of 6 children showed a decrease in distress, Parent and staff reported less anxiety and better cooperation from the child.
Young children had trouble staying distracted during traumatic procedure / Distraction is a simple, practical and relatively inexpensive pain management strategy that may have the potential to remain effective over repeated invasive procedures.
Tailor activities to developmental level of child
Distraction / Cohen, LL, Blount, RL & Panopoulos G.
Nurse Coaching and Cartoon Distraction: An Effective and Practical Interventions to Reduce Child, Parent and Nurse Distress During Immunizations
Journal of Pediatric Psychology 22(3): 355-370 / 92 children
4-6yrs
4th graders- completed 3 immunization, exposed to 3 conditions
Standard
Nurse coach
Nurse coach + parent child education
Videotaped
Nurse not blinded
RCT / Distraction had greater decreases in distress and increased coping than EMLA
Less distress reported over time
More nurse coaching with distraction intervention
Less parent distress / Distraction helps build coping skills, Less effect of EMLA on older children
Simple instruction by nurse help parents be coaches
Parent participation as a coach may decrease feelings of stress and helplessness. Decrease in nurse stress may be related to having a protocol, focusing on procedure while child is distracted and having child/parent less stressed.
Distraction / Cohen LL
Can’t find it / Rural health care cents
92 children and parents / More coping behaviors with / Parents have less stress when they are coaching. Parents model nurses behaviors.
Best words. Distress promoting behaviors increases child’s distress: reassurance, empathy, apologies, criticism and giving child control over beginning of the procedure.
Distraction / Megel, M E, Houser, CW, Gleaves, LS.
Children’s Response to Immunizations: Lullabies as a Distraction
Issues in Comprehensive Pediatric Nursing 21:3 129-145 / 99 children in pediatric clinic
3-6yrs
RCT / No difference in vital signs and pain measure, but difference in total scores of distress behaviors over the procedure / ? if younger patients do not find music as effective of a distraction as older children
Distraction & positioning / Cavender, K, Goff, MD, Hollon, ED and Guzzetta, CE
Parent’s Positioning and Distracting Children During Venipuncture: Effects on Children’s Pain, Fear, and Distress / 43 children
Chronic illness
ED
4-11years
RCT / Standard care included preparation and education- treatment group received instruction by CLS on how to position and distract
Pain scores- lower in exp group but not significant / Good reference list for studies related to behavioral response
Fear and pain scores were related
Behavioral distress dropped over time ( recovery was quicker)
Good article for ED
Distraction- touch and bubble blowing / Sparks, L
Taking the” Ouch” Out of Injections for Children: Using Distraction to Decrease Pain
MCN 26(2): 72-78 / 105 children
public health clinic
4-6 yrs
3 groups; Standard, touch or bubble blowing
DTP vaccine
Oucher scale
RCT / Both distraction methods reduced pain perception
Touch group had the lowest pain score.
Bubble blowers would stop blowing bubbles when immunization started. / Two components of injection pain: needle through skin and solution in tissue.
Touch: light stroking of the skin around the injection site prior to and during injection
Fear is a factor in pain
Distraction
Cough Trick / Wallace, DP, Allen KD, Lacroix, AE and Pitner, SL
The “Cough Trick”, A Brief Strategy to Manage Pediatric Pain From Immunization Injections
Pediatric 2010 125: e 367-373 / Immunization clinics
4-5 yr and 11=13yr
68 participated (many refused due to perceived time to complete papers)
RCT / Assessed nurse satisfaction
Pain scores were lower but not significantly different
Participants identified as black did not find trick as helpful / Cough Trick: single warm-up cough of moderate force followed by a second cough that coincides with needle puncture- first tested in adults
Some children delayed cough when they learned the injection would occur with the cough
Infants- sucrose and positioning / Reis, EC, Roth EK, Syphan, JL, Tarbell, SE, Holoubkov, R
Effective pain reductions for multiple immunizations injections in young infants
Arch pediatr Adolesc Med , 2003 157: 1115- / 116 infants
7-11 weeks
2 month injections ( 4 shots)
RCT / Sucrose and pacifier, held by parent less crying for infant
Parent preference for holding and sucrose / Cross cradle position- upper body close to mother’s chest, held in that position for 6 minutes
Injection site cleaned 2 minutes after sucrose was given
Heel stick -Infants / Gray, L, Watt, L & Blass, EM
Skin-to-skin contact is analgesic in healthy newborns
Pediatrics 20002, 105(1) / 30 newborns
Held by mother ( skin contact) or swaddled in crib
RCT / Crying and grimacing were reduced by 82% and 65% respectively. Heart rate was also reduced.