ARTICLE INFO

Article Type

Original Research

Authors

Irani   H. (1)
Eshghizadeh   M. (1)
Zivari   M. (*)






(*) Nursing Department, Nursing & Midwifery School, Gonabad University of Medical Sciences, Gonabad, Iran
(1) Nursing Department, Nursing & Midwifery School, Gonabad University of Medical Sciences, Gonabad, Iran

Correspondence

Address: Nursing & Midwifery School, Gonabad University of Medical Sciences, Imam Khomeyni Street, Gonabad, Iran
Phone: +985157727310
Fax: +985157727315
mostafazivari@yahoo.com

Article History

Received:  October  26, 2015
Accepted:  June 8, 2016
ePublished:  June 30, 2016

BRIEF TEXT


Pain Intensity due to medical procedures and injections is one of the most common stressful and frightening experiences among children. Injections in any way are annoying [1].

... [2-11]. Puppet therapy is a pleasure method for medical treating in the field of psychotherapy. Puppet is an accepted mediator by both adults and children to communicate and exchange feelings, emotions and thoughts between these two generations. The child in doll playing can balance his /her motivation and can drain his/her extra energies [12]. Considering the fact that most of the injections are doing by nurses, these groups in addition to performing this accurate procedure should have detailed program to reduce the unpleasant experience of pain in children [13].

The aim of this study was to investigate the effects of injection display on a doll on the pain intensity due to the intramuscular injection in the preschool children.

This study is a randomized controlled clinical trial.

This study has done over 62 kids aged between 4 and 6 years with pharyngitis in the clinic of the health network of Khalil- abad Township in 2015. The intramuscular injection of penicillin 6.3.3 was administrated for the kids.

The sample size based on pilot study were determined 31 patients in each group comparing the ratio formula in two independent groups and including the most sample size over pain variable intensity considering 95% reliability,80% test power and a significance level less than 0.001including 10% drop. In this way, the total sample size was n = 62. Assignment of samples in two groups of experimental and control was based on day visit to the clinic (odd days for control group and even days for experimental group). Inclusion criteria included : along with one of the parents , lack of intramuscular injection in the past week, the lack of acute and chronic pain due to other factors in the body, lack of physical disability, lack of chronic disease ,lack of taking medications that reduce pain and power and the ability of communication. Kids who did not cooperate with the therapist, were excluded.

Data was collected using a demographic characteristic collecting form and Oucher Standard Pain Assessment Scale. Basic information such as age, gender, birth order, parental age, parents 'education, parents' occupation and place of residence were collected through interviews with one parent. Oucher standard tools is one of the most valid, oldest and widely used self-report measures of pain for kids, which has been developed by Beer to assess the pain intensity among 12-13 year old kids. It contains 6 Portrait of a child with different intensities of pain that have been scored vertically based on least to the most severe pain from the bottom to the top from one to six, number 1 shows painless and number 6 shows the most severe pain. Reliability and validity of this scale has been confirmed in numerous studies [14-16]. Also, the reliability of the scale has been evaluated in the Mehdipour et al study and Pearson product-moment correlation coefficient has obtained as 0.92[17]. In experimental group, at first a nurse performed an intramuscular injection display by a 5 ml syringe without penicillin solution on the Gluteal muscles part of a doll (named Princess Sofia product Jakks Pacific; Product Code 93118) while the kid was watching. Then, the kid underwent an intramuscular injection of penicillin 6.3.3 using 5 cc syringe and a number 22 needle. The control group received routine intramuscular injection method. Measuring pain intensity in both groups was completed in one stage. This tools in the control group and the experimental group was completed while doing penicillin intramuscular injection by observing the kid's face. Data was analyzed by SPSS 19 software and descriptive and inferential statistics, in addition, Mann-Whitney test was used to comparing the pain intensity after injection in both groups. Also, independent t-test, and Chi-square tests were used to evaluate the distribution of variables in both experimental and control groups.

Among 62 case studies, 32 persons (51.6%) were male and 30 persons (48.4%) were female .The mothers` mean age was 29.00 ±5.70 years old and the fathers` mean age was 32.00 ± 6.25 years old.49 of mothers (79.0%) were housewives and 13 of them (21.0%) were employed. About fathers, 24 (38.7%) were employed and 38 (61.3%) were self-employment.15 (24.2%) of mothers and 18 (29.0%) of fathers had academic degree and 28 persons (45.2%) of mothers and 24 (38.7%) of fathers were under diploma. In case of birth rank, the most frequency was related to the first rank (first child) with the frequently of 20 cases (32.3%) and the least frequency was related to the forth rank (fourth child) with the frequency of 12 cases (19.4%). Two groups did not have any significant difference in terms of age and gender, parental age, education level and parents birth and the two groups were homogeneous (p˃0.05). Mean pain intensity after injection in experimental group (3.22±0.90) was significantly lower than control group (4.19±0.83; p<0.001).

A lot of studies has been made on the effect of different methods of distraction in reducing pain in kids; for instance, the results of study conducted by Dahlquist et al. showed that different methods of distraction successfully reduce pain in kids [8]. Also, in the Hassanpoor et la study, it was found that both methods of distraction and cold therapy are effective in reducing the pain.[9]. …[18-21]

It is recommended to compare the effects of the doll injection and other form of distraction on pain intensity in the kids.

Of the limitations of the study, individual, social, cultural, psychological and family differences despite of the efforts to take samples from the same area and the environment can be mentioned. Also, there were variables Interference such as samples’ previous experience about intramuscular injection, which was not strictly controlled.

The injection display on a doll before the intramuscular injection might lead to pain reduction in the preschool kids.

The authors of this article appreciate Vice Chancellor of Research, Members of the Council of Graduate, Respected professors of Gonabad Medical Science University, Nursing and Midwifery collage, officials and personnel of the Khalil-abad Township health center and all parents and children who were participated in the study that made it possible to perform this study.

No conflict of interest has been expressed by the authors.

Ethical approval for this study was obtained from the ethics committee of the Gonabad University of Medical Sciences as the code of IR.GMU.REC.1394.19 and Iran clinical trial site with the IRCT2015070623103N1 code.

This article is the student’s thesis in M.A degree of nursing major at Gonabad Medical Science University.


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