A Study on Effectiveness of Virtual Reality as a Distraction in reducing the Level of pain among Children undergoing iv Canulation in Selected Hospitals of  Moodbidri and Karkala

 

Sudheendra. R. Mutalikdesai

Associate Professor, Alva’s College of Nursing. Mooodbidri, Mangalore, Karnataka, India.

 

ABSTRACT:

Introduction: Cannulation causes moderate or severe pain in a substantial number of children. Some institutions have procedures for minimizing the predictable pain of cannulation, especially in children. Hence the investigator decided to conduct a study on effectiveness of virtual reality as distraction among children undergoing I V cannulation  in selected hospitals Moodbidri.

Aims: The present study aimed to evaluate the effectiveness of virtual reality as distraction among children undergoing I V cannulation  in selected hospitals.

Settings and Design: An evaluative approach with True-experimental design, post-test only with control group was adopted in order to evaluate effectiveness of virtual reality as distraction among children undergoing I V cannulation  in selected hospitals Moodbidri. Probability simple random sampling was used to select the 40 sample for the study. Methods and Material: Demographic profile and Wong Baker’s pain scale was developed as the tool to collect data. Statistical analysis used: Descriptive and inferential statistics were planned to analyze the collected data.

Results: In the experimental group the data shows that 10 (50%) of the samples had mild pain and 10(50%) of the samples had moderate pain. In the control group the data shows that 16 (80%) of the samples had severe pain and 4(20%) of the samples had moderate pain. There was significant difference between mean post test pain score between experimental and control group..

Conclusions: The findings of the study shows that the virtual reality as distraction was effective in reducing the level of pain among children undergoing I V cannulation.

 

 

 

INTRODUCTION:

Pain relief is a human right, yet pain in children is an under-recognized problem around the world. The Special Interest Group on Pain in Childhood of the International Association for the Study of Pain is dedicated to pain prevention and treatment for children everywhere.

 

Children not only have pain from injuries, surgery, burns, infections, and the effects of war, terrorism, and violence; Children also undergo pain from the many procedures and investigations used by doctors and nurses to investigate and treat disease. Even newborn and premature babies feel pain.¹

 

Cannulation causes moderate or severe pain in a substantial number of children and adults. Some institutions have procedures for minimizing the predictable pain of cannulation, especially in children. However, a survey from the United States reported that emergency departments rarely use drugs to reduce pain during insertion of intravenous catheters in children. In less predictable situations, such as emergency departments, non-pharmacological alternative, like distraction, may be more appropriate³.

 

Pain and discomfort are perceptible during many medical procedures. In the past, drugs have been the conventional means to alleviate pain, but in many instances, medications by themselves do not provide optimal results. Current advances are being made to control pain by integrating both the science of pain medications and the science of the human mind. Various psychological techniques, including distractions by virtual reality environments and the playing of video games, are being employed to treat pain².

 

According to Whaley and Wong’s, schooler children easily distracted even though they have different temperaments. In order to decrease the painful experience during procedures diversional activities in the form of play, game, radio, video-cassette recorder and television can be used. Cartoon movies are successful diversion for a child who is hospitalized⁴.

 

Pain is a subjective experience among children respond to pain with behavioural reactions that depends upon their age and cognitive process. Pain may occur as a result of procedure. The degree of pain perception varies from child to child, the preschool children still have limited ability to understand anything beyond the immediate event. They may see themselves as the cause of pain and fear mutilation, body invasion and loss of recently gained control. They may try to delay procedures until they feel some control over the situation. Participation in the procedure or making simple choices will assist the child to maintain some control.²

 

The investigator’s personal experience When observing the children having increased pain and behavioural responses during medical procedure in paediatric wards motivated the researcher to conduct a study on using diversional technique to decrease the pain and modify the behavioural responses of children. As children are much exposed to modernization ,computer aided video cartooning as virtual reality is selected by the researcher.

 

SUBJECTS AND METHODS:

In order to achieve the objectives of the study an evaluative approach was found to be appropriate and selected for the study. The research design adopted for the present study was true-experimental design (post-test only) with control  group to evaluate the effectiveness of virtual reality as distraction among 40 children (20 in experimental and 20 in control) on I v cannulation by using Wong Baker facial pain scale. Probability simple random sampling technique was used. . The reliability value of the tool is 0.89. Hence the tool was found to be highly reliable. The reliability of the tool was estimated by the Karl – Pearson's Correlation formula. Pilot study was conducted among 8 children; the tool was found feasible, practicable and no changes were made after the pilot study.

 

RESULTS:

In order to find out the effectiveness, data were tabulated, analysed and interpreted using descriptive and inferential statistical methods.

 

Table no 1 shows that the mean percentage of pain score of the control group than experimental group(31%) and fig no 1 shows that, in an experimental group the data shows that, 10 (50%) of the subjects had mild pain and 10(50%) of the subjects had moderate pain. In the control group the data shows that, 16 (80%) of the subjects had severe pain and 4(20%) of the subjects had moderate pain. There was significant difference between mean post test pain score between experimental and control group; t (39) = 13.80, table value t (39) = 2.02 (p < 0.05, highly significant).

 

 

 

TABLE 1: Comparison of Mean, median, mean percentage and standard deviation of subjects according to their severity of pain                                                                                                                                                                                                                                                 n=40(20+20)

Pain scores	Possible  Pain scores	Min score obtained	Max score obtained	Mean	Median	Mean %	SD
Control group	0-5	3	4	3.8	4	76%	0.4103
Experimental Group	0-5	1	3	1.55	1.5	31%	0.6048

 

TABLE 2:Mean, standard deviation (SD), mean deviation (MD) and ‘t’ test of post-test pain scores of children                N=40(20+20)

Pain scores	Mean	Standard deviation	Mean deviation	t-value	Remark
Control group	3.8	0.4103	2.25	13.80	Highly significant
Experimental Group	1.55	0.6048

Table value t₍₃₉₎ = 2.02, P < 0.05, *  Significant

 

 

 

 

FIG-1.Comparison between control and experimental group of subjects regarding severity of pain

 

The data presented in Table 2 shows that ‘t’ value computed between mean post test pain score (t₍₃₉₎=13.80, table value t₍₃₉₎=2.02,( p < 0.05) is statistically significant. Hence the null hypothesis is rejected and research hypothesis is accepted. It shows that there is a significant difference between post test pain scores of experimental and control group among children.

 

DISCUSSION:

The findings of the study demonstrated that majority of subjects in experimental group were in the age group of 3-5 years (95%) while in control group they are 70%, in control majority were females(65%), in control 70% were studying in LKG, among most of the children 22 gauze needle was used for the cannulation (85%) for control group and for the experimental group(70%) and    and most of the children have been hospitalized previously(80% in control and 85% in experimental).

 

The paired ‘t’ test computed to find the difference between post-test pain scores of children (t ₍₃₉₎  = 13.80, table value t ₍₃₉₎ = 2.02, (p < 0.05) was statistically significant. Hence the researcher rejected null hypothesis and research hypothesis was accepted, indicating that the virtual reality was effective in pain reduaction.

 

SUGGESTIONS:

1    Suggestions were mainly focused on healthy practices and also focused on those factors which are limiting these healthy practices

2    Community Health Nurse, Public Health Nurse and Pediatric nurses should focus on health education related to pain reducing procedures.

 

RECOMMENDATIONS:

Based upon the study findings, the following recommendations were made for the future study.

1.    A similar study may be replicated on a larger sample.

2.    Descriptive studies can be conducted among children.

3.    A similar study can be replicated by using other pain distracting procedures.

4.    A similar study can be conducted by using virtual reality on other painful procedures like on I m injection.

 

CONCLUSION:

Pain and discomfort are perceptible during many medical procedures. In the past, drugs have been the conventional means to alleviate pain, but in many instances, medications by themselves do not provide optimal results. Current advances are being made to control pain by integrating both the science of pain medications and the science of the human mind. Various psychological techniques, including distractions by virtual reality environments and the playing of video games, are being employed to treat pain².

 

ACKNOWLEDGEMENT:

I thank Dr. B.A. Yathikumara Swamy Gowda , Principal  Alva’s College Of Nursing for his guidance, genuine concern  and my  collogues for their constant support and valuable contributions and suggestions throughout this study. I am indebted to all participants of the study.

 

REFERENCES:

1.     Brenner and Sitharth. Text Book of Medical and Surgical Nursing 2007 12th edition; P-p251-256

2.     Dorathy R Marlow. Text  book of pediatric nursing 2006. 6^th edition. Elsevier health science publication;P-p286-295

3.     Mark DW and Brenda KW. Virtual reality and interactive stimulation for pain distraction. American Academy of Pain Medicine. 2009; 8(3) : 182–188. Available from: htt://www3.inter science.wiley.com.

4.     Mosby Harcourt Health Science Company;1999. Lindsey L Cohen Distraction techniques and procedural pain in children 2008

 

 

 

 

Received on 25.02.2016           Modified on 21.03.2016

Accepted on 06.04.2016           © A&V Publication all right reserved