RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 NAME OF THE CANDIDATE MS. ZENCY MATHEW,

AND ADDRESS (IN BLOCK FIRST YEAR M.Sc. NURSING,
LETTERS) BGS COLLEGE OF NURSING ,
KUVEMPUNAGAR,MYSORE-23.

2 NAME OF THE BGS COLLEGE OF NURSING ,

INSTITUTION MYSORE.

3. COURSE OF STUDY AND M.Sc. NURSING

SUBJECT CHILD HEALTH NURSING.

4. DATE OF ADMISSION 08.06.2010

5. TITLE OF THE TOPIC:

“A STUDY TO EVALUATE THE EFFECTIVENESS OF FLASH OF LIGHT
ON PAIN REDUCTION DURING VENOUS CANNULATION AMONG 3-8
YEARS OLD CHILDREN IN SELECTED HOSPITALS AT MYSORE”
6.BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Children are the pride of a nation ,it is the duty of every adult citizen to keep up this

unit of pride safely for the benefit of the country.So we should be sensitive to the feelings ,needs

and tastes of children to build a better tomorrow.We should not only show love and affection and

provide protection and security to children but also ensure them a sound health Health care

experiences ,including hospital and medical procedures can be very stressful for children of all

ages.Child receive both traumatic and non traumatic experiences in hospital.Pain is one such

experience that child fears when taken to hospital.1

“Pain is such an uncomfortable feeling that even

a tiny amount of it is enough

to ruin everything”

-Will Rogers

Pain is a highly unpleasant and very personal sensation that cannot be shared with

others .It can occupy of all of a person’s thinking ,direct all activities and change a person’s

life.Yet pain is a difficult concept for a client to communicate.A nurse can neither see nor feel a

client’s pain. No two people experience in exactly the same way. In addition, the differences in

individual pain perception and reaction as well as the many causes of pain ,present with a nurse

with a complex situation ,when developing a plan and provide comfort.2

 The pain caused by common minor procedures such as venipuncture is a major

source of concern for children and their caretakers. Too little attention has been paid to relieve

such pain. Most children find having a needle stressful.Child have the right to be pain free and

relief of pain is the basic need of children.Beyond early infancy all children fear bodily injury

and manipulating procedural techniques minimizes fear of bodily injury.So recognition of pain

and its treatment of pain is as important as that of other diseases.3

Pain management is an important facet of nursing care.and it involves pain

assessment as its critical component. Behavioural observation is the primary assessment

approach for pre-verbal and non-verbal children, and is an adjunct to assessment for verbal

children.Observations focus on vocalisations (e.g., crying, whining, or groaning), verbalisations,

facial expressions, muscle tension and rigidity, ability to be consoled, guarding of body parts,

temperament, activity and general appearance. Adequate reliability and validity documentation is

lacking for behavioural observations, even though clinicians often attribute greater importance to

non-verbal expression than to self-report.4

Effective pain management requires a number of interventions to achieve

optimum results.Pain reduction methods can be grouped in to 2 categories: pharmacologic and

non pharmacologic methods.To ensure adequate pain relief or to make pain tolerable and to give

a sense of control over the situation non pharmacologic methods are widely accepted.It includes

physical and cognitive and behavioural pain management strategies.

 Distraction is a non pharmacologic technique that draws person’s attention from away

from noxious stimuli through passively redirecting the subject’s attention or by actively

involving the subject in the performance of diversion task.It is useful for younger children and is

easy to administer.The type of distracters are visual(reading

,watchingTV,imagery),auditory(humuor,music),tactile(breathing,massage),intellectual(crosswor

ds,puzzles)etc. Other distractors like kaleidoscope,blowing bubbles,flashing light counting out

aloud are being used.5

So we can understand that pain can be effectively managed by non pharmacologic methods like

distractions in children.

6.2NEED FOR THE STUDY

Children have the way of touching hearts and never seen of seasoned

professionals.So when you are performing procedures like venipuncture ,concern should be to

minimize discomfort and pain for children.Surveys of parents, staff direct observation, and

children's drawings and self-ratings have suggested that venipuncture is associated with

considerable distress in children,with between 34% and 64% of children experiencing moderate

stress from the procedure. Other studies have suggested that almost 50% of children 7-18 years

of age report needlestick experiences as unpleasant and painful, which causes subsequent high

levels of anticipatory fear and distress.

 A survey conducted among 1385 high school adolescents,reported that a high level

of fear during dental and medical injections, which directly led to avoidance of subsequent

treatment in 5%-7% by these young people.an evidence-based review of approaches to pain

reduction for immunizations reported that longer needles were associated with less pain; that

parental reassurance, criticism, or apology increased distress; and that humor and distraction

reduced distress.6

Health care professionals regard injections and venipunctures as routine procedure.

For children, however, needles arouse fear and may be perceived as stressful and

unpleasant.Venipunctures are usually performed by nurses and sometimes anticipated with great

anxiety by patients in this case, children, if initial attempts are unsuccessful, patients especially

children will not allow further venipunctures due to frustration and pain. The majority of health

care professionals recognize that there is a lack of interventions to decrease the unpleasantness of

procedural pain.Unnecessary pain can also erode the nurse-patient relationship. The knowledge

of alternative techniques in pain management can improve patient care and satisfaction.7

In a workbook developed by Royal College of Nursing,London to assist

practitioners in developing competence in peripheral venous cannulation in children and young

people, suggests that children perceive pain as a physical experience and need parents and health

care professionals to help them to cope by providing distraction and topical analgesia.and also

says that when procedures are planned, and pain can be predicted, the opportunity should be

taken to prepare children through play and education, to plan pain relief for use during the
procedure. The use of psychological therapies, including distraction, coping skills and cognitive-

behavioural approaches, provides some benefit.8

A randomized controlled study was conducted at the University Hospital of

Maastrich ,Netherlands to assess the influence of distraction on pain and anxiety during

venipuncture in children aged between 8 -11 years of age. The study was conducted in a research

population of 20 ambulatory patients aged between 8 and 11 years old, who were referred to the

specialised department for child venipuncture The distraction intervention was completing a

find-the-hidden-items puzzle. Control patients did not receive any distraction and the study

showed that children with high anxiety reported more pain than children with low anxiety.

Distraction lowers anxiety in children who do not watch the venipuncture, but not in children

who prefer to watch the venipuncture and concluded that distraction can be an effective

intervention to decrease pain and anxiety.9

When pain is poorly managed, it may have significant negative sequelae. A child

who is not in control of his emotions and has experienced multiple unpleasant experience will be

fearful, less cooperative, have more anxiety for the next procedure and may have a series of

nightmares that are all based on the procedure itself.10

The health care facility or hospital is an unfamiliar environment for children and

parents and may upset or intimidate them.the procedures performed may be threatening to the

child. To minimize this stress,the field of child health has developed the concept of ‘Atraumatic
care’ which is defined as the therapeutic care that minimizes the psychological and physical

distress experienced by children and their families .The concept is based on the underlying

premises of “do no harm”.One of the most important basic principles of Atraumatic care is to

control pain via frequent assessments and use of pharmacologic and non pharmacologic

interventions.To promote this concept also this study will be useful.11

As advocates for children, nurses are obligated to minimize the emotional and physical

effects of painful procedures and provide comfort to children.Optimal management of pain is

critical to achieve this goal. Children are less likely to fear health personnel if their contact with

them are not associated with pain12.

The researcher’s personal experience with children during venipuncture have also given

an insight to this topic.The responses shown by the children and the anxiety of the parents to

painful procedures provoked to have an attempt of this study. Also distraction appeared to be

the better way to reduce the level of perception of pain in children.

“it is perfectly normal for children to dislike needles(many adults don’t like them either)”

-Action for sick children (1994)

Considering all the above mentioned facts,the researcher found it very essential to conduct the

study and contribute one more type of distractor that can be used to reduce pain among children.
6.3REVIEW OF LITERATURE

Literature review is an essential step in the whole process of research. The term review

of literature refers to the activities involving in identifying and searching for information on a

topic and developing an understanding of the state of knowledge on that topic. It is also used to

designate a written summary of the state of the art on a research problem.In this study it was

organized and presented under the following headings:

a)Pain related to Medical procedures and its long term effects.

b)Non pharmacologic interventions to reduce pain experienced by children.

A prospective, randomized, placebo-controlled study was done at Sanjay Gandhi Post

Graduate Institute of Medical Sciences, Lucknow, India, to assess the role of a flash of light

for attenuation of venous cannulation pain Randomly selected ninety children between 15–18

years, of either sex, undergoing elective laparoscopic cholecystectomy were included . Patients

were divided into three groups of 30 each. Group I (control); Group II (distraction):

photographed without a flash of light; and Group III (flash): photographed with

a flash of light just before venous cannulation of a vein on the dorsum of the nondominant hand.

Severity of venous cannulation pain as assessed by the Visual Analog Scale scores .The results

showed that the incidence of venous cannulation pain in the flash group was lower, i.e., 50%

(14 of 28) when compared to 100% (28 of 28) observed in the other two study groups. The

severity of venous cannulation pain was also reduced in the flash group compared with the

distraction group (P < 0.01) and concluded that a flash of light before venous cannulation is a

safe, effective, and easy-to-use method for minimizing venous cannulation pain.13
 A prospective, randomized study was done at Sree Chitra Tirunal Institute for Medical

Sciences &Technology, Trivandrum, India to assess the efficacy of the valsalva maneuver on

venous cannulation pain Seventy-five samples of either sex, undergoing elective surgery

included in this study were randomized into 3 groups of 25 each. Group I (C): control; Group II

(V): blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20

s; Group III (B): pressed a rubber ball. Twenty seconds later, peripheral venous cannulation was

performed. Venous cannulation pain was graded using a 4-point scale: 0–3, where 0 = no pain, 1

= mild pain, 2 = moderate pain, and 3 = severe pain, and Visual Analog Scale of 0–10, where 0 =

no pain and 10 = worst imaginable pain. Incidence of pain was less in the Valsalva group: 18 of

25 (72%) patients, whereas 25 of 25 (100%) experienced pain in the other two groups (P <

0.001) and concluded that the Valsalva maneuver performed at the time of venous cannulation

greatly decreases this pain.14

A prospective, randomized, controlled study was done in Lucknow,India to evaluate

the efficacy of balloon inflation on venous cannulation pain in children .Purposively selected

seventy-five pediatric patients aged 6-12 yr, ASA physical status I-II, of either sex, undergoing

elective surgery were included and randomly divided into 3 equal groups of 25 each ; Group I

(control), Group II (distraction) pressed a rubber ball, and Group III (balloon) inflated a

balloon.. Pain was self-reported by a pain face scale with a 10-cm visual analog scale (VAS)

placed at its back, where 0 = "no pain" and 10 = "worst imaginable pain." The result showed

that median (interquartile range) VAS score in the balloon group was 1 (3), which was reduced

as compared with 2 (2) and 4 (2) observed in the distraction and control groups, respectively
.The study concluded that there was significant reduction in the incidence and severity of

venipuncture pain in the balloon group when compared with the other 2 groups (P < 0.05) .15

A prospective randomized control study was conducted at Seth GS Medical College

and KEM Hospital, Mumbai, India to determine comparative efficacy of local anesthetic cream,

Indian classical instrumental music and placebo,in reducing pain due to venipuncture in

children.Purposively selected children aged 5-12years requiring venipuncture at a tertiary care

center were enrolled in the study. They were randomly assigned to 3 groups: local anesthetic

(LA), music or placebo (control) group. Eutactic mixture of local anesthetic agents (EMLA) and

Indian classical instrumental music (raaga-Todi) were used in the first 2 groups, respectively.

Pain was assessed independently by parent, patient, investigator and an independent observer at

the time of insertion of the cannula (0 min) and at 1- and 5 min after the insertion using a Visual

Analog Scale (VAS). Kruskal- Wallis and Mann-Whitney U tests were used to assess the

difference amongst the VAS scores. The results indicated that higher VAS scores were noted in

control (placebo) group by all the categories of observers (parent, patient, investigator,

independent observer) at all time points. The VAS scores obtained in EMLA group were lowest

at all time points. However, the difference between VAS scores in EMLA group were

significantly lower than those in music group only at some time-points and with some categories

of observers (parent: 1min; investigator: 0-, 1-, 5 min and independent observer: 5 min).The

study concluded that pain experienced during venipuncture can be significantly reduced by using

EMLA or Indian classical instrumental music.16

 An experimental study was conducted at the paediatric OPD of Father Muller College of

Nursing, Mangalore, to evaluate the effectiveness of kaleidoscope as a distraction technique

among hospitalised children during their acute pain experience.Using convenient sampling, 60

subjects were selected – 30 in the control and 30 in the experimental group. The findings

revealed that children in Group I (37%) reported less intensity of pain, and most of the children

in Group II (43%) perceived high intensity of pain. The mean behavioural response pain showed

significant difference in the behavioural response and intensity of pain between Group I and

Group II (t58 = 6.383 and 6.66 respectively; p < 0.001) and concluded that kaleidoscope as an

effective distractor for pain 17

A randomized control study was conducted in Oxford University,London on

psychological interventions for needle related procedural pain and distress in children and

adolescents. The study was conducted among randomly assigned 1951 participants aged between

2-19 years undergoing needle related procedures.The data was collected using Oxford Quality

Scale.The result was that largest effect sizes for treatment improvement excist for distraction

techniques, hypnosis and combined cognitive behavioural interventions and concluded that

cognitive behavioural interventions can be used with children and adolescents to successfully

manage or reduce pain and distress associated with needle related procedures18.
 A quasi-experimental study was conducted at West Virginia University,

Morgantown, USA to examine the efficacy of training children to cope with immunisation pain

without the assistance of trained coaches and determine whether untrained parents or nurses are

more effective at decreasing children distress.Randomly selected thirty one 3-7 year old children

trained in coping skills and thirty who did not receive training participated in the study.

Procedural coping and child’s distress was compared. The Child-Adult Medical Procedure

Interaction Scale assessed children’s, parents’, and nurses’ behavior distress. Children completed

self-report measures assessing their perception of procedural distress. Parents and nurses also

completed visual analog scale(VAS) ratings to describe their perception of child procedural

distress and pain, and how fearful they were of future injections The result showed that children

demonstrated understanding of the training but they did not use the coping skills during the

procedure. In general, the nurse behaviour was associated with child coping and parents with

child distress.The conclusion was that more extensive child training or the involvement of

coaches for procedural distress might be necessary. Nurses’ behavior appears to center on

encouraging child coping, and parents tend to comfort children.19

A prospective cohort study was conducted to assess the effect of neonatal circumcision

on pain response during subsequent routine vaccination at Department of Paediatrics, Hospital

for Sick Children, Toronto, Ontario, Canada.The objectives of this study were to find out

whether neonatal circumcision altered pain response at 4-month or 6-month vaccination

compared with the response in uncircumcised infants, and whether pre treatment of circumcision

pain with EMLA affects the subsequent vaccination response.Eighty seven randomly selected

infants were grouped in to three groups--uncircumcised infants, and infants who had been
randomly assigned EMLA or placebo in a previous clinical trial to assess the efficacy of EMLA

cream as pretreatment for pain in neonatal circumcision. Infants were videotaped during

vaccination done at the primary care physician's clinic. Videotapes were scored using visual

analogue scale pain scores.The result showed that a significant group effect (p < 0.001) in

difference values for percentage facial action, percentage cry time, and visual analogue scale

pain scores and were significant for all outcome measures (p < 0.05) There was a increasing

pain scores from uncircumcised infants, to those circumcised with EMLA, to those circumcised

with placebo.The study concluded that circumcised infants showed a stronger pain response to

subsequent routine vaccination than uncircumcised infants. Among the circumcised group,

preoperative treatment with EMLA attenuated the pain response to vaccination.20

A meta analytic study was done at Florida hospital,Orlando,USA to assess the usefulness

of distraction to decrease children's distress behavior and pain during medical procedures The

objectives was to investigate effects of distraction on young children's distress behavior and

self-reported pain during medical procedures.A total of 491 samples randomly selected was

analyzed from 16 studies on child’s distress and behavior and 10 studies from on chlidren’s pain

using Hunter and Schmidt's (1990) procedures .The results indicated that for distress behavior,

the mean effect size was 0.33 (+/-0.17), with 74% of the variance accounted for by sampling and

measurement error. For pain, the mean effect size was 0.62 (+/-0.42) with 35% of the variance

accounted for. The study concluded that distraction had a positive effect on children's distress

behavior. The effect of distraction on children's self-reported pain is influenced by moderator

variables.21
 An experimental study was conducted in University of Siena on analgesic effect of

watching TV during venipuncture to assess the analgesic effect of passive or active distraction

during venipuncture in children.A purposively selected sample of 69 children aged 7–12 years

undergoing venipuncture were randomly divided into three groups: a control group (C) without

any distraction procedure, a group (M) in which mothers performed active distraction, and a TV

group (TV) in which passive distraction (a TV cartoon) was given.The pain was scored with

visual analogue scale for mother and children. Scores assigned by mothers and children

indicated that procedures performed during TV watching were less painful (p<0.05) than control

or procedures performed during active distraction and concluded that TV watching was more

effective than active distraction. This was due either to the emotional participation of the mothers

in the active procedure or to the distracting power of television.22

A descriptive study was done at Pediatric medical unit, University Hospital of Wales,

Cardiff, England to assess nurses' attitudes to pain management during routine venipuncture in

young children .A survey method was used to explore nurses' views on the experience of pain by

infants and toddlers and the pain management techniques they use.A convenient sample of 55

children nurses on the general medical and surgical wards at one hospital site were invited to

participate; 45 responses were received (81 per cent). The result showed that children nurses

believe that infants and toddlers feel more pain and display more distress than older children and

reported that pharmacological preparations were not generally used on infants prior to venous

cannulation. Distraction and parental presence during these procedures were highlighted and that
nurses should ensure infants and toddlers receive appropriate pain management prior to and

during venipuncture and venous cannulation.23

A quasi experimental study was conducted in Nursing Department, Tarbiat Modares

University, Tehran,Iran to assess the effect of programmed distraction on the pain caused by

venipuncture among adolescents on hemodialysis.Three pediatric hemodialysis centers were

assigned to case group (one center with 21 patients) and control groups (two centers with a total

of 21 patients) randomly. The Wong-Baker face pain scale was used to assess pain caused by

venipuncture. Assessing of pain was done in 12 sessions in both case and control groups. Three

first sessions were held without intervention (pretest) and the next nine sessions were held with

distraction intervention (post test). To cause distraction, the adolescents were asked to look at

two similar pictures and tell the number of differences between them during venipuncture.

Results showed that case and control groups matched in demographic variables and pain

intensity. After distraction, pain intensity during venipuncture significantly decreased (p = .003);

but this decrease began from the sixth session; at the five first sessions, pain intensity had not

changed. This study concluded that the effect of a simple, inexpensive distraction ,is a quick way

for decreasing the pain caused by venipuncture24.

An experimental study was conducted at University of Maryland, Baltimore County,

Baltimore, USA to evaluate a distraction intervention designed to reduce the distress of

preschool children undergoing repeated chemotherapy injections. Twentynine children aged 2-5
years were randomly assigned. Distraction by developmentally appropriate electronic toy was

adpoted. Children who received the distraction intervention demonstrated lower overt

behavioural distress and were rated by parents and nurses as less anxious than children in the

control condition. The results suggested that a developmentally appropriate multi-sensory

variable distracting activity that requires active cognitive processing and active major responses

may be a variable cost effective alternative to move time intensive parent training programmes

for preschool age children.25

A comparative study was conducted at the University of Arkansas for Medical

Sciences, College of Nursing, Little Rock to investigate the effectiveness of a distracting

technique in reducing a child’s perceived pain and behavioural distress during an acute pain

experience. One hundred children aged 3 years 6 months through 12 years 11 months, scheduled

for routine blood draws were recruited randomly assigned to an experimental or control group.

During venipuncture, the control subjects received standard preparation which consisted of being

comforted by 23 physical touch and soft voices while the experimental subjects were encouraged

to use a kaleidoscope as a distraction technique. Results of the MANCOVA with age as a

covariate indicated a significant difference between the groups. Univariate post hoc tests

confirmed that the experimental group perceived less pain and demonstrated less behavioural

distress than the control group26

.
6.4 PROBLEM STATEMENT

“A study to evaluate the effectiveness of flash of light on pain reduction during venous

cannulation among 3-8 year old children in selected hospitals at Mysore”

6.5 OBJECTIVES

1.To assess the level of pain among 3-8 year old children during venous cannulation in

experimental group.

2. To assess the level of pain among 3-8 year old children during venous cannulation in control

group.

3.To find the effectiveness of ‘flash of light’ on pain reduction among 3-8 year old children

during venous cannulation.

4.To find association between level of pain among 3-8 year old children with selected

demographic variables.

6.6 OPERATIONAL DEFINITIONS

Effectiveness:

Effectiveness is defined as having a definite or desired effect. (Oxford English dictionary)

In this study it refers to distraction in pain experienced by 3-8 year old children during venous

cannulation measured by Modified CHEOPS(Childern’s Hospital of Eastern Ontario Pain Scale)

scale.

Flash of Light:

In this study,it refers to the distraction technique that is used on the children during

venous cannulation using a camera or other light sources.

Pain Reduction:

In this study it refers to reduction in pain experienced by 3-8 years old children as

measured by Modified CHEOPS(Childern’s Hospital of Eastern Ontario Pain Scale) .

Venous cannulation:

It refers to procedure of insertion of venous cannula in to the vein.

6.7 ASSUMPTIONS

The researcher assumes that

 All children between 3-8 years old will get distracted using flash of light.

 Cannulation in pediatric ward is a painful pediatric procedure.

 Cannulation in pediatric wards are done by experienced health care personnel.

6.8 DELIMITATIONS:

The study is delimited to Children

 Between years 3-8 of age.

 Ready to participate in the study

 Available at the time of the study.

6.9 PROJECTED OUTCOMES (HYPOTHESIS):

At 0.05 level of significance.

H1: There will be significant difference between pain score of experimental and control group.

H2 :There will significant association between ain scores of 3-8 years old children with selected

demographic variables.
7.MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

The data will be collected from Children aged between 3-8 years old children undergoing

venipuncture in a selected hospital at, Mysore.

7.1.1 Research Design:

The study design selected for this study is post-test only control group design.

Group Intervention Post-test

E X 01

C - O2
7.1.2 Variables

A variable is an attribute of a person or an object that varies ,ie takes on different values(eg:-

age,sex,education etc).

There are three types of variables :independent,dependent and extraneous variables.

Independent variable:In ths study ,independent variable is ‘flash of light’ which is used as a

distraction technique.

Dependent variable:In this study ,dependent variable is the pain experienced by 3-8 years old

children during venipuncture.

Extraneous variables:In this study , the extraneous variable are

-Age of child

-Sex

-Previous experience

-Presence of caregiver

7.1.3 Settings:

The study will be conducted in selected hospitals at Mysore.

7.1.4 Population

Children aged between 3-8 years undergoing venipuncture in selected hospitals at Mysore.

7.2 METHOD OF DATA COLLECTION:

7.2.1 Sampling Procedure:

This research study will adopt purposive sampling for selecting samples and through simple

random sampling method the samples will be assigned to experimental and control group. Out of

the total population defined those who will meet the inclusion criteria will be selected for the

study.

7.2.2 Sampling Size:

Sixty children will be selected for the sample by simple purposive sampling technique. Thirty

each for experimental and control group.

7.2.3 Inclusion Criteria for Sampling:

The study will include the children

 Aged between 3-8 years undergoing venous cannulation

 Children and their willing to participate in the study

 Those who are present at the time of study

7.2.4 Exclusion Criteria for Sampling:

The study will exclude the children

 Those who are chronically ill

 Those who mentally handicapped

 Those who are admitted for emergency procedures.

 Those who are above 8 years of age.

7.2.5 Instrument Used:

The data collection tool adopted in the study is to observe the variables in this study using

standardized Modified CHEOPS (Childern’s Hospital of Eastern Ontario Pain Scale)

 7.2.6 Data Collection Method:

The data collection technique adopted in the study is observational method to assess pain scores

using Modified CHEOPS (Childern’s Hospital of Eastern Ontario Pain Scale)

7.2.7 Data Analysis Plan:

The data obtained would be analyzed using both descriptive and inferential statistics. The

analysis will be done on the basis of objectives and hypothesis stated.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION ON INTERVENTION TO

BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO

PLEASE DESCRIBE BRIEFLY:

Yes, the study requires providing a Flash of light as a distraction technique for 3-8 years old

children during venous cannulation.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN

CASE OF 7.3:

Yes, Ethical clearance has been obtained from our institution.The permission will be

obtained from concerned athorities and informed consent will be obtained from samples.
8. LIST OF REFERENCES

1.Children’s hospital of Philadelphia. “Kids and Hospitals-Children’s Miracle Network” 2010

Mar ; 21(1): p. 1-2

2.Barbara Kozier,Glenora Erb. “Fundamentals of nursing-concepts ,process,and practice”. 7th ed.

Philadelphia: Pearson’s education; 2003. p. 1133-8,60-62

3. Catherine Van Hulle V, Mary J Denyes. “Relieving Children’s Pain: Nurse’s Abilities and

Analgesic Administration Practices”. J Pediatr Nurs 2004;19 (1): p. 40-9

4.Craig KD. “Textbook of pain”. 2nd ed. Oxford: University of Printing House;

1989.

5.Donna L Wong,Marilyn J Hockenberry. “Wongs nursing care oof infants and children”. 7th ed.

China: Mosby’s publication; 2003.

6. Desiree Lie. “Minimizing Needle Pain in Kids-A New Device May Help”. Medscape Famliy

Med 2010 ; 2(21): p. 2-3

7. Vinetta M. Hussey,et.al. “Effectiveness of Lidocaine hydrochloride on venipuncture sites”.

AORN J 1997 ;7(66): p. 1-5.

8.Karen Bravery,et.al “Peripheral venous cannulation in children and young people-A workbook

to assist practioners in developing competence” .Royal college of nursing,London 2005; (1): p.

6-7.

9. Karoline LH, Vangronsveld. “The influence of distraction on pain and anxiety during

venipuncture in children aged between 8-11 years”. Netherlands J of Psy 2006; 63(20):

p. 21-8.

10. Abu-Saad. “Assessing Children’s responses to pain”. J Pain 1984; 19: p. 163-171.

11.Theresa Kyle, Terry Kyle. “Essentials of pediatric nursing”. 1st ed. Philadelphia : Lippincott

Williams &wilkins; 2007. p. 56.

12.Nagen Gast S. “The use of EMLA cream to reduce and / or eliminate procedural pain in

children” . J Pediatr Nurs 1993; 8: p. 406-407.

13.Anil Agarwal, Ghanashyam Yadav. “The role of flash of light for attenuation of venous

cannulation pain” .Anaesth Analog 2008 Mar ; 106(3): p. 814-6.

14. Manish Tendon,Sanjay Dhirani. “Evaluating the Efficacy of the Valsalva Maneuver on

Venous Cannulation Pain”. Anaesth Analog 2005 Mar ; 101(4): p. 1230-2.

15. Gupta, D,et.al “An evaluation of efficacy of balloon inflation on venous cannulation pain in

children : a prospective, randomized, controlled study” .Anesth Analg. 2006 May ; (102): p.

1372-5.

16. Rajiv Balan,et.al. “Can Indian Classical Instrumental Music Reduce Pain Felt During

Venepuncture?”. Indian J Pediatr 2009; 76 (5): p. 469-473.

17. Preetha S. “Effectiveness of kaleidoscope as a distraction technique among hospitalised

children during their acute pain experience”. Unpublished dissertation, RGUHS, Bangalore.

2004.

18.Uman LS, et.al. “Psychological interventions for needle related procedural pain and distress

in children and adolescents”.Pain and palliative support care group 2006 Oct; 4: p. 1-4.

19.Cohen LL, et.al. “A child-focussed intervention for coping with procedural pain:”. J Pediatr

Psychol 2002 Dec; 27(8): p. 749-57.

20. Anna Taddio. “Clinical Evidence for Long Term effects of pain in Neonates”. Pediatr Pain

letter 1998; 2(1): p. 7-8.

21.Kleiber, et.al.. “Effects of distraction on children’s pain and distress during medical

procedures”.J Nur Res. 1999; 1(48): p. 44-9.

22.Belleni CV, Cordelli DM. “Analgesic effect of watching television during venipuncture” .

BMJ 2006; 91(12): p. 1015-7.

23. Melhuish, S. and Payne, H . “Nurses' attitudes to pain management during routine

venepuncture in young children”. Paediatr Nurs 2006 ; 18: p. 20-23

24 .Fatemah Alhani,Hamedeh Shad Monireh Anoosheh. “ The Effect of Programmed

Distraction on the Pain Caused by Venipuncture among Adolescents on Hemodialysis” .Nur J

2009 Mar ; 3 : p. 12-4

25.Dahlquist LM,et.al.. “Distraction for children of different ages who undergo repeated needle

sticks”. J Pediatr Oncol Nurs 2002 Jan-Feb; 19(1): p. 22-34.

26. Vessey JA, et.al. “Use of distraction with children during anacute pain experience”. Nurs Res

1999 Nov-Dec; 43(6): p. 369-72.

Websites references:

 www.google .com

 www.askMEDLINE.com

 http://www.ncbi.nlm.nih.gov/pubmed/
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