ISSUES AND PURPOSE: Distraction during painful procedures has been shown to be effective in previous studies, yet this simple intervention is not used routinely. This study examined the effectiveness and feasibility of distraction in reducing behavioral distress, pain, and fear during venipuncture or intravenous insertion. DESIGN AND METHODS: A two-group randomized design with 384 children in 13 children's hospitals. RESULTS: Age was a significant factor in observed behavioral distress, reports of fear, and self-reported pain. The use of a kaleidoscope, however, did not significantly reduce pain or distress during venipuncture or i.v. insertion. PRACTICE IMPLICATIONS: Failure of the distraction intervention to reach statistical significance in this study is puzzling, given anecdotal reports of clinical efficacy. Methodological issues may have obscured actual differences between experimental and control groups.

Adolescent↗

PubMedDate not supplied

The relationship between maternal characteristics, maternal vulnerability beliefs, and immunization compliance.

The purpose of this descriptive study was to determine the relationship of demographic variables and mothers' perceived vulnerability to eight communicable diseases with immunization compliance. A random sample consisting of 40 mothers with preschool-age children 4-24 months of age was interviewed by means of the Communicable Disease Perceived Vulnerability Scale and the investigator-developed Demographic Data Collection Instrument. Data were analyzed with descriptive statistics and chi-square (p < or = .05). The average mother in the sample was White, had a 10th- to 12th-grade education, was 24-31 years old, and had a yearly income of $10,000-$45,000. Statistically there were no significant relationships between maternal characteristics or between maternal vulnerability beliefs and immunization compliance. However, it is clinically significant that the overall compliance rate of 70% in this rural area is much higher than the national average of 50%. Findings suggest that using health education materials at the time of newborn discharge, mailing reminder cards, and accessing a statewide computer recall system may increase immunization compliance. In addition, mothers who perceived a vulnerability to the diseases had a 60.6% compliance rate, suggesting that perception of vulnerability may be a useful predictor of immunization compliance.

Adult↗

PubMedDate not supplied

Nonpharmacological interventions to use with children in pain.

Children's pain is often poorly managed, and interventions other than medications are rarely used. Yet many nonpharmacological interventions are helpful in managing children's pain. These techniques are reviewed, and the physiological mechanisms underlying them are briefly addressed. A discussion of the three major classifications (sensory, cognitive, and cognitive-behavioral) of interventions follows. Factors that influence the use of nonpharmacological techniques, including type of pain and developmental level, are discussed.

Adolescent↗

PubMedDate not supplied

Use of distraction with children during an acute pain experience.

The purpose of this study was to investigate the effectiveness of a distraction technique in reducing a child's perceived pain and behavioral distress during an acute pain experience. A convenience sample of 100 children, ages 3 years 6 months through 12 years 11 months, scheduled for routine blood draws, was recruited and randomly assigned to an experimental or control group. During venipuncture, the control subjects received standard preparation, which consisted of being comforted by physical touch and soft voices, while 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 behavioral distress than the control group.

Attention↗

PubMedDate not supplied

Providing health care for children in foster care: a role for advanced practice nurses.

Children placed in foster care remain one of the country's most medically underserved groups. At the same time, health care problems are increasingly common in this population. The child welfare system is in a crisis as it struggles to place greater numbers of children with increasingly complex health care needs into limited foster care settings. Six solutions have been proposed in the literature, and are as follows: (a) designation of a particular agency or individual to serve as health care coordinator; (b) timely assessment and care provision; (c) use of a medical passport; (d) increased training for foster care providers and case workers; (e) advocating for improved legislation and standards; and (f) development of community-based clinics. Advanced practice pediatric nurses have the capability to play a key role in providing and coordinating care for children in foster care.

Case Management↗