Pain and Fear During Intravenous Blood Collection in Children
Condition: Procedural Pain
MeSH terms: Pain, Procedural
Study type: Interventional

Summary: 
      Medical procedures can cause significant stress and anxiety for children and parents,
      impacting their overall hospital experience. Numerous studies have demonstrated that
      techniques aimed at diverting attention during procedures can effectively reduce pain and
      fear. Considering the rapid advancements in technology and the strong connection between
      Generation Z children and technology, this study aims to explore the use of hologram
      technology through a hologram fan and the traditional method of bubble blowing as
      interventions to assess their impact on pain and fear levels during intravenous blood
      collection in children.

      The study design will follow a randomized controlled trial approach. The sample will consist
      of patients between the ages of 3 and 12 who meet the sampling criteria and receive
      outpatient care at the pediatric stem cell outpatient treatment unit between April 2022 and
      February 2024. Data will be collected using a researcher-prepared form containing
      introductory information and child pain, fear, and emotional indicator scales for which
      appropriate permissions have been obtained. The blood collection process will be performed by
      the unit's nurse, and the observer nurse will complete the scales.

      Descriptive statistics, such as mean, standard deviation (median, minimum, maximum),
      frequency, and percentage values, will be used for data analysis. IBM SPSS Statistics 25.0
      (IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.) will be employed for
      data analysis. A significance level of 0.05 will be used for all statistical analyses.

      Regenerate response Keywords: Fear, pain, pediatrics, hologram, bubble-blowing, invasive
      procedures
    

Detailed description: 
      Pediatric clinics often subject infants and children to painful medical procedures. These
      interventions include blood collection, intramuscular and intravenous injections, which can
      induce pain and fear in children. The experience of pain during medical procedures has
      long-term effects and can shape a person's approach to healthcare in the future. While
      evidence-based practices exist to address interventional pain in the pediatric population,
      they may not always be sufficient in practice. As technology advances, there is growing
      interest in innovative methods to reduce pain, alongside commercially available products.

      Distraction techniques have been proven effective in reducing acute pain in children during
      needle interventions. Distraction aims to redirect the child's attention to another stimulus,
      based on the understanding that the brain has limited capacity to focus on pain. Nurses and
      healthcare workers play a crucial role in alleviating children's fear of medical procedures,
      as they are often the first point of contact and provide ongoing care.

      In addition to traditional methods such as watching cartoons, inflating balloons, and playing
      music, innovative techniques have emerged. One such method is the use of bubble machines,
      which produce bubbles using blowing and spraying systems. Studies have shown that bubble
      blowing can effectively reduce pain intensity during phlebotomy in children aged 3-6 years.
      Other studies have recommended using bubble blowing alongside devices like Buzzy to reduce
      pain severity during phlebotomy and intramuscular injections.

      Considering the current pandemic situation, the use of bubble machines has gained attention
      as a potentially more effective distraction method than balloon blowing, as it reduces the
      risk of infection and provides a greater number of bubbles in the environment. Moreover,
      hologram technology has gained popularity in our daily lives. Holography refers to
      three-dimensional projections that can be seen without special equipment. It has the
      potential to revolutionize medicine by providing realistic and immersive experiences.
      However, there is a lack of studies exploring the application of hologram technology in
      reducing pain during medical procedures, particularly in the nursing literature. It is
      believed that this technology can effectively distract children during painful interventions.

      Technological advancements, including hologram technology, have the potential to
      significantly impact the healthcare sector. By utilizing such applications, especially for
      diversion and comfort in pediatric pain management, healthcare professionals can improve the
      overall experience of children. The use of technology can also enhance efficiency and service
      quality in healthcare, benefiting patients of all age groups.

      In this context, the present study aims to investigate the use of hologram fans and bubble
      machines to divert attention, reduce fear and pain levels, and improve compliance during
      intravenous blood collection in children. This unique study, which incorporates hologram
      technology, aims to contribute to the existing literature. Similar to bubble machines, bubble
      blowing toys have been studied and have shown attention-grabbing effects. Therefore, this
      study is necessary to explore the effects of hologram fans and bubble machines on children's
      pain and fear levels during intravenous blood collection, a highly stressful procedure for
      both children and parents, and to introduce new methods to the literature on this topic.

      Hologram: The word hologram means "three-dimensional image recording system" in Turkish.
      Hologram is the name given to the picture obtained by the use of coherent laser beams. Along
      with the intensity of light, the hologram allows an object to be seen in three dimensions by
      recording the direction of the light waves.

      Hologram Fan: A hologram fan is one of the industrial electronic products that creates an
      illusion of 3D objects circling in the air. The fan rotates too fast to be seen with the
      naked eye, resulting in a transparent background for the projected object.

      Bubble Machine: These are the systems used in blowing sequencing by adding liquid mixtures
      specially prepared for bubbles to the machine chamber. Warm-up times are provided in 5-10
      seconds, the machines provide use on blowing and spraying systems and the production of
      bubbles and their release to the space used.

      Purpose of the Study: The aim of this study was to investigate the effect of hologram fan and
      bubble machine use on pain and fear levels during blood collection process in children who
      applied to Pediatric Stem Cell Transplantation Polyclinic at Ege University Children's
      Hospital.

      Hypotheses H1: The use of a hologram fan reduces interventional pain during the blood
      collection process.

      H2: The use of a bubble machine reduces interventional pain during the blood collection
      process.

      H3: The use of a hologram fan reduces the fear of interference during the blood collection
      process.

      H4: The use of a bubble machine reduces the fear of interference during the blood collection
      process.

      H5: The use of a hologram fan affects the emotional behavior scale score during the blood
      collection process.

      H6: The use of a bubble machine affects the emotional behavior scale score during the blood
      collection process.

      Wong- Baker Faces Pain Scale The scale consists of six black and white faces, ranging from a
      smiling face to a painful face. The child is told about the pain level of the faces on the
      scale and told to choose the face that best expresses his or her pain.

      Child Fear Scale It was adapted from the Faces Anxiety Scale by McMurty and colleagues to
      measure fear in children undergoing painful medical procedures. The Child Fear Scale is a
      scale rated 0-4 that shows five hundred ranging from a neutral expression (0 = no worry) to a
      feared face (4 = serious anxiety).

      Emotional Indicators Scale in Children: It is an easy-to-evaluate and easy-to-apply scale
      used to objectively define the emotional indicators that children show against medical
      procedures.

      Collection of Data Two research-independent volunteer nurses with at least 10 years of
      experience will assist in the data collection process. The observer nurse will be informed by
      the researcher about the scale forms to be used in the study process. The polyclinic nurse
      will perform the routine nursing intervention. Nurses do not have conflicts of interest with
      research.

      First of all, the participants who are waiting to have blood drawn at the entrance of the
      polyclinic by the researcher and who meet the sample selection criteria will be informed
      about the research and informed consent will be obtained from the child and parent. The data
      will then be recorded by asking questions about the characteristics of the participant and
      his/her parents included in the data collection form and the processing. Children who meet
      the criteria will be assigned to the application groups according to the randomization list
      created by the researcher.

      Data evaluation/statistical methods of the study Descriptive statistics of the data; mean,
      standard deviation (median, minimum, maximum) will be given as frequency and percentage
      values. The assumption of normality of the quantitative data will be checked by the
      Shapiro-Wilk test. Unidirectional ANOVA (Bonferroni or Tukey test for binary comparisons)
      will be used for variables with normal distributions, while Kruskal-Wallis test (Dunn test
      for binary comparisons) will be used for variables that do not provide normality assumption.
      The correlation of quantitative data with each other will be evaluated by Pearson or
      Spearman's Rho correlation coefficients. The relationships between categorical variables will
      be examined by the Pearson Chi-square test or Fisher's Full probability test.

      The data were analyzed using SPSS (22.0) software. The significance level was determined as
      0.05 in all analyzes.
    

Intervention name(s): Hologram Distraction Technique; Bubble Machine Distraction Technique
Intervention type(s): Other; Other
Intervention description(s): Hologram fan application during blood collection process; Bubble machine application during blood collection
Other intervention name(s): Hologram Fan; Bubble machine
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: The randomization method:
Children who meet the sample selection criteria will be randomly assigned to three groups: bubble machine group (n=55), hologram fan group (n=55) and control group (n=55). The assignment of individuals to the study groups will be carried out by block randomization method and the blocks will be formed according to age groups (3-7 years / 8-12 years: 2 blocks). The confidentiality of assigning to groups will be ensured by a table of numbers created on the computer by a person independent of the research.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: fear; pain; pediatrics; hologram; bubble-blowing; invasive procedures