A Study to Assess the Effectiveness of Kaleidoscope in Reducing Physical Stress during Venipuncture Procedure among Hospitalized Pre-School Children at Selected Hospital of Ahmadabad City, Gujarat State.

 

Himali Raj Prajapati

HOD of Child Health Nursing, C.M Patel College of Nursing, Gandhinagar Gujarat

 

ABSTRACT:

A study to assess the effectiveness of kaleidoscope in reducing physical stress during venipuncture procedure among hospitalized pre-school children at selected hospital of ahmedabad city, gujarat state.Objectives of the study: To assess physical stress among hospitalized preschool children (experimental group) with kaleidoscope during venipuncture procedure. To assess physical stress among hospitalized preschool children (control group) without kaleidoscope during venipuncture procedure. To assess the effectiveness of kaleidoscope in reducing physical stress by comparing experimental group and control group score. It included the true experimental research approach, post only design, variables under study were kaleidoscope as independent variable, reducing physical stress among hospitalized preschool children as dependent variable. Research is based On Imogene king’s goal attainment model selected Hospital of Ahmedabad city as research setting, total 40 samples, and non probability sampling techniques was used. The instrument used for this study was kaleidoscope and tool used for data collection were demographic data, Hospitalization profile and modified observational behavioral pain scale. The data obtained were analyzed and interpreted in the light of objectives and hypothesis using both descriptive and inferential statistical in terms of frequency, percentage and chi-square. The calculated chi-square value (10.141) is greater than the tabulated chi- square value (7.815). Therefore the null hypothesis H0 was rejected and research hypothesis H1 was accepted and it revealed that the modified behavioral observational pain scale was effective in terms of physical stress among the sample. Association between post test score of experimental and control group with selected variables among that the duration of venipuncture procedure, Child past experience to immunization/ injection, child’s reaction towards health personnel were found to be significant at 0.05 level of significance in experimental group and duration of venipuncture procedure, child’s reaction towards health personnel were found to be significant at 0.05 level of significance in control group. In the overall and specific content area, the calculated chi-square value is greater than the tabulated chi-square value. The findings indicate that the kaleidoscope was an effective method of distraction technique during venipuncture procedure. Based on the findings, the following recommendations were offered for future research. The study can be replicated on a large sample, thereby; findings can be generalized for a large population. A similar study can be conducted on children undergoing invasive Pediatric procedures other than the selected one (access to IV line). The study can be replicated in other settings (e.g.: private settings) which might allow comparisons. A comparative study can be conducted to see the effect of distraction techniques during different developmental stages. It was concluded that kaleidoscope reduced physical stress of hospitalized preschool children during venipuncture procedure.

 

 

INTRODUCTION:

Pain is a complex phenomenon for children and the concepts of hospitalization and pain are often linked in the minds of children. Despite best-practice guidelines and standards related to pain management, many hospitalized children continue to have unrelieved pain. This suggests that analgesics alone do not sufficiently relieve their discomfort. Complementary therapies may have an important role in holistic paediatric pain management. This review of literature evaluates available evidence related to the use and effectiveness of complementary therapies on the pain experience of children in hospital settings. A variety of complementary therapies are including relaxation, distraction, hypnosis, art therapies and imagery.

 

Sikorovaa L, Hrazdilovab P (2011) conducted study on special consultation between nurse and child regarding venipuncture had positive effects on reducing perceived pain during the intervention. Children between five to seven years old experienced pain more intensely, than children between eight to ten and children whose venipuncture was for peripheral venous catheter experienced more pain than those for undergoing blood withdrawal. A finding of this study was if the parents were not educated on how to encourage and support their child during venipuncture, they might increase the perceived pain level in their children. They found no difference between boys and girls in perceived pain.

 

Lander. M, Hodgins (2011) conducted study on Children's coping with venipuncture. Children's strategies for coping with the pain and distress of venipuncture were examined in this descriptive study. Eighty-five children (aged 5-13 years) were interviewed prior to and following blood collection. Twenty-seven different strategies were identified from the children's responses. active involvement in procedure, behaviour-regulating cognitions, cognitive reappraisal, direct efforts to maintain control, diversionary thinking, emotion-regulating cognitions, information seeking, reality-oriented working through, reliance on health-care interventions, support seeking and avoidance and catastrophizing. Results showed that the direct efforts to maintain control was the most frequently used category. Age and gender differences were observed in both number and type of strategies reported by the children.

 

OBJECTIVES OF STUDY:-

1.      Assess physical stress among hospitalized preschool children (experimental group) with kaleidoscope during venipuncture procedure.

2.      To assess physical stress among hospitalized preschool children (control group) without kaleidoscope during venipuncture procedure.

3.      To assess the effectiveness of kaleidoscope in reducing physical stress by comparing experimental group and control group scores.

 

MATERIALS AND METHODS:

Research design:

True experimental design or randomized controlled trial (RCT) and used these three properties that are manipulation, control group and randomization. The research design adopted for the study was only post test design (or after–only).

 

Settings:

The study was conducted study in the paediatric medical ward.

 

Population:

the target Accessible population comprised of all preschool children

 

Samples:

In this present study the sample consisted of 40 children, 20 each in the experimental group and control group, between 3-5 years who admitted in the pediatric medical ward with complain of fever and are undergoing for venipuncture during the period of data collection.

 

Sampling Technique:

Probability simple random sampling technique.

 

Data Colleciton Procedure:

Modified behavioural observational pain scale was the appropriate for collection of data regarding physical stress of hospitalised preschool children

 

Data analysis:

The Investigator planned to analyze the data in the following manner:

 

Section I:

Demographic data and hospitalization profile to be analyzed by using frequency and percentage and will be presented in the form of the tables and graph.Section II: The data of modified behavioural observational pain scale would be analyzed in terms of frequency and percentage will be presented in the form of the table and graph.Section-III: Effectiveness of kaleidoscope by comparing experimental group and control group pain scores analyzed by chi-square value and presented in the form of tables.

 

FINDINGS:

The data shows that the children belongs to age group of 3 and 5 years in the experimental group is similar such as 7(35%). Whereas in control group highest 8(40%) children from 5years and lowest 5(25%) children from 3 years, as regards gender of samples that both group were equal number of female 11(55%) and males 9(45%). as regards presence of caregiver that the majority of caregiver were present with children during procedure in experimental group 15(75%) and control group 13(65%). data shows that the, in experimental and control group equal number of children 7(35%) were calm and quite. Minimal resistances children were 8(40%) in experimental group and rebellious and high resistance children were 7(35%) in control group made the majority in the respective groups. As regards duration of venipuncture data shows that the venipuncture procedure in experimental group 9(45%) children took about 1-3 minutes; whereas, it was 4-6 minutes in control group 9(45%) children. As regards number of venipuncture that the highest number of children had undergone only one time venipuncture in experimental group13 (65%) and control group10 (50%). In contrast, lowest number of children had more than three times in experimental group 1(5%) and control group 2 (10%) respectively. Distribution of sample according to Child’s reaction toward health personnel from that the majority of children 9(45%) from experimental group and control group had easily acceptance of nurse in the hospital.

 

 

Physical stress among hospitalized preschool children during venipuncture procedure by comparing experimental and Control group pain scores. [N=40]

Level of physical stress	Experimental Group		Control Group		Calculated Chi square value	Table value	Level of significance	df
	Frequency	Percentage%	Frequency	Percentage%
No Pain	6	30	2	10	10.141	7.815	0.05	3
Mild pain	10	50	4	20
Moderate pain	3	15	10	50
Severe pain	1	5	4	20

 

 

This shows that in experimental group 6 (30%) of children were no pain, 10(50%) were mild pain, 3(15%) were moderate pain and 1(5%) severe pain. Control group 2(10%) of children were no pain, 4(20%) were mild pain, 10(50%) were moderate pain and 4(20%) were severe pain. comparison between experimental group and control group pain score obtained during venipuncture procedure. The calculated chi-square value is 10.141 and the tabulated chi-square is 7.815 at 0.05 level of significance. Hence the null hypothesis may be rejected.

 

CONCLUSIONS:

The findings indicated that kaleidoscope was effective in reducing physical stress of hospitalised preschool children. Hospitalised preschool children had reduced pain in experimental group shows that kaleidoscope was effective. The modified behaviour observational pain scale was acceptable and useful for observing child response to pain during venipuncture procedure.

 

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Received on 30.06.2017           Modified on 16.07.2017

Accepted on 23.08.2017         © A&V Publications all right reserved