INTRODUCTION:

Immunization (or vaccination) protects people from disease by introducing a vaccine into the body that triggers an antibody response as if you had been exposed to a disease naturally. Immunization is painful and children show behavioral distress to pain while receiving immunization.¹

Younger children are particularly in need of interventions because they report more pain and display more behavioural distress during medical process.² Distraction techniques are used to divert the attention from a noxious stimulus. Reports from children, parents and nurses consistently indicate that many children do indeed fear of the shot³. Behavioural observation is the primary assessment approach for pre-verbal and non- verbal children, and is an adjunct to assessment for verbal communication. Observation focus on vocalizations (eg.,crying, whining, or groaning) verbalizations, 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 Researchers have observed various interventions to reduce the pain during vaccination. Distraction and coaching are also the fewer interventions which reduces pain.. Distraction techniques namely video, music, tactile, blowing and oral distraction will help to reduce the pain effectively during vaccination.⁵ Distraction is a non – pharmacological intervention that diverts attention from a noxious stimulus through passively redirecting the subject’s attention or by actively involving the subject in the performance of diversion task⁶.

A Quasi experimental study was conducted to assess the effectiveness of the cartoon movie on pain perception among schoolers undergoing IV cannulation in Masonic Medical Centre for children at Coimbatore. The study inferred that cartoon movie is effective among schoolers undergoing IV cannulation.⁷According to Jacobson, the use of non-pharmaceutical procedures to cope with pain behavior is less costly and most of these procedures can be administered by a nurse. They have been shown to reduce the perception of pain and make the intervention more bearable. The task of the nurse is to choose an appropriate method and ensure a comfortable environment for the intervention when used in association with medical procedure.⁸

MATERIALS AND METHODS:

A quasi experimental post- test only control group design was used. The population of the study was children in the age group of 1-3yrs at selected immunization clinics, Mangalore. Approval of the study was obtained from institution’s ethics committee. Purposive sampling technique was utilized to select 60 subjects based on their inclusion criteria. The samples were randomly assigned into experimental group (n=30)and control group (n=30). The consent was taken from the parents prior to the data collections. The data was collected by demographic proforma and FLACC Behavioural Pain Assessment Scale. The experimental groupwere exposed to cartoon movie during the procedure whereas control group received only a standard care. The pain was assessed in both the group by using FLACC Behavioural Pain Assessment Scale.

RESULTS:

Demographic Variables:

Highest percentage (56.7%) of children were in the age group of 12-18 months whereas least percentage of children (5.0%) were from 24-30 months. Highest percentage (51.7%) of samples were males whereas lowest percentage (48.3%) of samples were females. Majority (65.0%) of children were Muslims and very least were in Christians (5.0%). With regard to past experience of the children to immunization majority (81.7%) of them had showed minimal resistance and least percentage of children(5.0%) had showed calm and quiet response. With regard to previous reaction towards health personnel majority (60%) of children showed withdrawal with minimal resistance and whereas least percentage (11.7%) of children showed totally reluctant to accept them. Most (98.3%) of the children’s mothers were present at the time of immunization.

Assessment of Behavioural Response to Pain:

Table 1: Distribution of the Sample in Experimental group and Control group according to the Severity of Behavioural Responses to Pain. n₁=30, n₂=30

Experimental group			Control group
Level of behavioural response	F	%	F	%
Relaxed and comfortable(0)	2	6.6	-
Mild discomfort (1- 3)	11	36.7	2	6.6
Moderate pain (4 –6)	17	56.7	8	26.7
Severe discomfort of pain (7 -10)	-	-	20	66.7

The data in table 1shows that, highest percentage (56.7%) of children demonstrated moderate level of pain whereas least percentage of (6.7%) children were relaxed and comfortable when cartoon was used as a distraction while child was receiving immunization whereas in the control group majority (66.7%) samples had severe level of discomfort or pain and least percentage (6.7%) children showed mild discomfort.

Table 2: Mean, Median, SD, and Level of Behavioural Response to Pain among children n₁=30, n₂=30

Behavioural responses	Mean	SD	Level of behavioural responses
Experimental group	3.6	1.67	Moderate
Control group	6.9	1.70	Severe

The data in table 2 shows that mean score of behavioural responses to pain of control group (6.9±1.70) was greater than that of experimental group (3.6±1.67). Behavioural response in experimental group was moderate and was severe in control group.

Effectiveness of Cartoon Movie on Behavioural Response to Pain

To find out the significant difference in the mean behavioural response to pain between experimental and control group, unpaired ‘t’ test was used.

Table 3: Effectiveness of Cartoon Movie on Behavioural Response to Pain between Experimental and Control Group n1=30, n2=30

Group	Mean	SD	‘t’ value ‘p’ value
Experimental	3.6	1.67
Control	6.9	1.70	7.557* 0.017*

t₅₈=1.67, p<0.05

*Significant

The data in table 3depict that, the calculated ‘t’ value (t=7.557) was greater than that of table value (t₅₈=1.67) at 0.05 level of significance. Hence it is conclude that there will be a significant difference in the mean behavioural response to pain between experimental and control group

Association of Behavioural Response to Pain with their Selected Demographic variables

There was no significant association between the behavioural response to pain and selected demographic variables except age in experimental group.

DISCUSSION:

In the present study, highest percentage (56.7%) of the samples in the groups were 12-18 months of age. Highest percentage (51.7%) of the samples in the groups were males. Majority (65.0%) of the samples were Muslims. Majority (81.7%) of the children showed minimal resistance to previous immunisation. Majority (60%) of children showed withdrawal with minimal resistance towards health personnel (nurses). Most (98.3%) of the children’s mothers were present at the time of immunisation. The findings of the present study shows that in the experimental group the behavioural response to pain was moderate with mean 3.6±1.673 where as in control group behavioural response to pain was severe with the mean 6.9±1.709.The findings were supported by a study conducted at University of Pittsburgh, USA, compared the efficiencies of two pain management methods in reducing immediate immunisation injection pain and distress in school aged children (4-6 years). They compared the EMLA cream and distraction, vapocoolant spray and distraction and distraction alone (control). The mean pain score in spray was less (1.2±1.9) than the control group (3.1±2.18).⁹The study is supported by the study conducted at the Department of Paediatrics, Ohio State University, College of Medicine, Children Hospital, Columbus, to study the effect of an active distraction technique, blowing out air, on pain in preschool children receiving diphtheria, pertussis and tetanus immunisation. The mean score in the experimental group was less (5.24±0.56) compared to the control group (5.26±0.64). The behavioural responses were expressed through verbalisation of the pain. The study findings showed that cartoon movie was effective in altering the behavioural response to pain among children receiving immunisation (t₅₈=7.557, p<0.05).The study is supported by the study conducted in PGIMER, Chandigarh, and also at Mangalore, Karnataka on children during venipuncture and cannulation respectively. The cartoon movie demonstrated lower behavioural distress in both the studies (p<0.001).The study findings are also supported by the study conducted in Mangalore, Karnataka to find out the effectiveness of two distraction technique that is toy and music which showed that distraction with toy was more effective (t₃₈=2.4897, p<0.05) than music and both distraction groups show lower behavioural distress than control group.¹⁰

CONCLUSION:

The findings of the present study indicated that cartoon movie was effective in altering the behaviour responses to pain in children receiving immunization.

REFERENCES:

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Received on 31.10.2016 Modified on 03.04.2017

Int. J. Nur. Edu. and Research. 2017; 5(2): 179-181.

DOI: 10.5958/2454-2660.2017.00037.0