The Effect Of Finger Pupiling On Pain And Physiological Parameters in İnfants
Condition: Pain
Study type: Interventional

Summary: 
      . In this determined, it was carried out to determine the effect of finger puppet play on
      pain and physiological parameters during urine culture with urinary catheter in infants.

      Research Hypotheses and Variables H0: There is no difference between the pain levels of
      babies who were manipulated with finger puppets during urine culture sampling with urinary
      catheter compared to babies in the control group.

      H1: Babies whose finger puppet is played during urine culture sampling with urinary catheter
      have low pain levels.

      H2: Physiological parameters of babies who are played with finger puppets during urine
      culture sample collection with urinary catheter are positively affected.
    

Detailed description: 
      The research was designed as a randomizer controlled experimental study to determine the
      effect of finger puppet manipulation on pain and physiological catheter parameters during
      urinary culture with urinary catheterization in 2-12 month old infants. This Research was
      conducted in pediatric emergency department of SBU Zeynep Kamil Women's and Children's
      Diseases Training and Research Hospital between Feb.2021-Feb.2022. "Infant follow-up form"
      and "FLAAC pain scale" were used to collect data. The data obtained from the research were
      analyzed with appropriate statistical tests in the SPSS 22.0 package program.

      Research Hypotheses and Variables H0: There is no difference between the pain levels of
      babies who were manipulated with finger puppets during urine culture sampling with urinary
      catheter compared to babies in the control group.

      H1: Babies whose finger puppet is played during urine culture sampling with urinary catheter
      have low pain levels.

      H2: Physiological parameters of babies who are played with finger puppets during urine
      culture sample collection with urinary catheter are positively affected.

      Dependent Variables: Infants' physiological parameters (Pulse, Blood pressure, Respiration,
      SpO2) and Infant Follow-up Form, FLACC pain scale.

      Independent Variables: Baby's age, gender. Sampling inclusion criteria

        -  The baby is between 2 and 12 months

        -  Suspicion/diagnosis of urinary tract infection being followed

        -  The baby/child does not have a vision or hearing problem (sight-hearing screening tests
           have been completed)

        -  Not taking drugs containing analgesics in the last 4 hours before the procedure

        -  Parents' willingness to participate in the research

        -  It has been determined as the appropriate cognitive level and motor development of
           infants/children.

      Exclusion criteria

        -  Mentally or neurologically handicapped

        -  Having a life-threatening illness

        -  Babies who failed the procedure, took longer than 3 minutes and needed to be repeated
           were excluded from the sample.

      Data were collected using the Baby Monitoring Form, monitor and sphygmomanometer Infant
      Follow-up Form: After the written Informed Consent Form (Appendix-1) was obtained from the
      parents of the infants who met the conditions for participation in the study, stating that
      they volunteered to participate in the study, the data were collected by the researcher,
      questioning the age, gender, current complaint, whether the procedure was performed before,
      and his reaction to the procedure. 7 questions were collected with the Infant Follow-up Form,
      which included physiological parameters (pulse, blood pressure, SpO2, respiratory rate) and
      the FLACC pain scale (Appendix-2).

      FLACC Pain Scale: It is an observational behavioral pain scale used in infants and children
      who cannot express their pain verbally. It is used for babies and children aged 2 months to 7
      years. It consists of five categories that measure the baby's facial expression, leg
      movements, activity, crying, and comfortability. Each of the categories is scored between
      0-2, and a total score of 0-10 is obtained, and an increase in the score indicates that the
      pain also increases. The total score according to the scoring system made after the
      observation; 0: comfortable, calm, comfortable, 1-3: mildly uncomfortable or mild pain, 4-6:
      moderate pain, 7-10: significant severe discomfort or significant severe pain, or both. The
      FLACC pain scale was evaluated independently by two different observers.

      Bedside Monitor Device: A COVIDIEN Nellcor brand monitor was used to measure the patient's
      pulse and SpO2.

      Blood pressure monitor: A Unitest brand digital sphygmomanometer with a cuff compatible with
      the baby was used.

      Finger Puppet: Fish-shaped finger puppet made of red fabric is used. Families of infants who
      were admitted to the emergency department and followed up with the diagnosis/suspect of
      urinary tract infection were informed about the study by face-to-face interview technique,
      and the informed consent form prepared by the researcher was read and permission was
      obtained. Out of 80 infants aged 2-12 months, 40 infants (intervention group: finger puppet
      group) and 40 infants (control group) were divided into two groups. In order to assign the
      babies to the groups randomly, between the dates of the study, the babies who would be
      treated on odd number days of the calendar formed the group to be treated with finger
      puppets, and the baby who was treated on even number days constituted the control group.

      First of all, the procedure to be done was explained to the family. Written and verbal
      consent was obtained after giving information about the study. During the procedure, the
      family was informed that only the mother, the physician performing the procedure, the
      researcher and the observer nurses would be present in the room.

      Urine culture with the urinary catheterization method is a procedure performed by the
      physician under sterile conditions for approximately 1-3 minutes. A finger puppet was played
      by the researcher nurse in the intervention group by singing the red fish song in order to
      manage the pain during the invasive procedure and to distract the baby's attention.

      Initiative Group (Finger Puppet Played Group)

        -  The baby to be treated was taken to the intervention room by the research nurse.

        -  Before the procedure, the baby's pulse, blood pressure, SpO2, respiratory rate will be
           checked by an observing nurse and recorded on the Baby Monitoring Form.

        -  Before the procedure, the infant was recorded in the Infant Follow-up Form by evaluating
           the FLAAC pain scale independently by both observer nurses.

        -  5 minutes before the start of the procedure, a red fish-shaped finger puppet was started
           to be played by the research nurse by singing the red fish song from a distance of
           approximately 20-30 cm.

        -  An observer nurse will assist the physician at the beginning of the procedure, and then
           gently hold the infant by the upper legs to maintain the stability of the infant and
           ensure that the physician can see the urethral opening. The other observer nurse
           evaluated the respiratory rate of the baby during the procedure and recorded it in the
           Infant Follow-up Form after the procedure was completed.

        -  During the procedure, the baby was independently evaluated according to the FLAAC pain
           scale by both observer nurses.

        -  The research nurse will continue to play finger puppets for 5 more minutes after the end
           of the procedure, and the puppet play was terminated after 5 minutes.

        -  Immediately after the procedure and five minutes later, the baby's pulse, blood
           pressure, SpO2, respiratory rate will be checked and the baby's pain was evaluated by
           both observer nurses according to the FLAAC pain scale, recorded in the Baby Monitoring
           Form, and then the baby was delivered to the family.

        -  During the procedure, no pharmacological or non-pharmacological interventions were made
           for the baby's pain, and no attempts were made to distract the baby's attention except
           finger puppets

      Control group:

        -  The baby to be treated was taken to the intervention room by the research nurse.

        -  Before the procedure, the baby's pulse, blood pressure, SpO2, respiratory rate were
           checked by an observing nurse and recorded on the Baby Monitoring Form.

        -  An observer nurse will assist the doctor at the beginning of the procedure, and then the
           baby's upper legs are kept stable in order to maintain the stability of the baby and
           ensure that the doctor can see the urethral opening. The other observer nurse evaluated
           the respiratory rate of the baby during the procedure and recorded it in the Infant
           Follow-up Form after the procedure was completed.

        -  During the procedure, the baby was evaluated by both observer nurses according to the
           FLAAC pain scale.

        -  No pharmacological or non-pharmacological interventions were made for the baby's pain
           during the procedure.

        -  Immediately after the procedure and 5 minutes later, the baby's pulse, blood pressure,
           SpO2, respiratory rate were checked and recorded, and both observer nurses independently
           evaluated the baby's pain according to the FLAAC Pain Scale and recorded it in the Baby
           Monitoring Form, and then the baby was delivered to the family.

      The quantitative data obtained in the research will be analyzed in the computer environment
      after data entry is made in the SPSS 21.0 package program. Number, percentage, mean and
      standard deviation were used as descriptive statistical methods in the evaluation of the
      data. Before the data analysis, the normality test was performed to test the suitability for
      the parametric test methods. In order to test the normal distribution condition,
      Kolmogorov-Smirnov Z test was applied. Chi-square and fisherexact tests were applied to
      determine the homogeneity of the groups. Whether there is a statistical difference between
      the groups, repeated measurements; Pairwise comparison was evaluated with Independent group
      t-test. The findings were evaluated at 95% confidence interval and 5% significance level. It
      was stated that there was a significant difference between the groups when p<0.05, and there
      was no significant difference in case of p>0.05.

      Before starting the research, ethics committee approval from the Research Zeynep Kamil
      Gynecology and Pediatrics Training and Research Hospital Ethics Committee , Master's Thesis
      Work Permit from Istanbul Provincial Health Directorate , translation of FLACC Pain Scale
      into Turkish was required. necessary permissions were obtained.

      After the parents of the infants included in the study were informed about the study, their
      written consent was obtained with the "Informed Voluntary Consent Form" .
    

Intervention name(s): THE EFFECT OF FINGER PUPPET MANIPULATION ON PAİN AND PHYSİOLOGıCAL PARAMETERS DURING URINARY CULTURE WITH URINARY CATHETERIZATION IN INFANTS
Intervention type(s): Behavioral
Intervention description(s): the effect of finger puppet manipulation on pain and physiological parameters during urinary culture with urinary catheterization
Other intervention name(s): the effect of finger puppet manipulation on pain and physiological parameters during urinary culture with urinary catheterization
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized Controlled two groups (control group and intervention group)
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: pain, infants