Çocuklarda İşlemsel Ağrı Yönetiminde Dikkati Başka Yöne Çekme Yöntemlerinin Kullanımı

Year 2015, Volume: 13 Issue: 2, 116 - 121, 01.09.2015

Sevil İnal , Nejla Canbulat

https://doi.org/10.4274/jcp.29292

Abstract

Kan alma, enjeksiyon uygulama gibi tıbbi işlemler çocukların en büyük ağrı kaynaklarından biridir. Ağrı çocukların iğneden korkmasına, aşı uygulaması, enjeksiyon ve kan alma uygulaması gibi bazı tıbbi işlemlere karşı gönülsüzlüğü hatta tedavinin ihmal edilmesine ya da gecikmesine neden olabilmektedir. Bu nedenle hemşire, çocuklarda ağrının uzun dönem olumsuz etkilerini azaltmak ve ağrılı prosedürlerin fiziksel ve emosyonel etkilerini gidermek için ağrılı işlemleri yönetmelidir. Çocuklarda tıbbi işlemler sırasında oluşabilecek ağrı ve anksiyeteyi azaltmaya yönelik ilaçlı ve ilaç dışı yöntemleri kapsayan pek çok yaklaşım vardır. Son yıllarda, hemşirelerin ağrılı işlemlerde ağrıyı gidermeye yönelik ilaç dışı yöntemlerin kullanımı ile ilgili araştırmalar artmıştır. Tıbbi işlemler sırasında oluşan ağrıyı gidermede en sık kullanılan yöntemlerden biri dikkati başka yöne çekmedir. Dikkati başka yöne çekme yöntemi, ağrıyı azaltmak için hastanın dikkatini başka bir uyarana yoğunlaştırma girişimidir ve beynin uyarana dikkatini yoğunlaştırma ile ilgili kapasitesinin sınırlı olduğu hipotezine dayanmaktadır. Bu makalede sıklıkla kullanılan dikkati başka yöne çekme yöntemleri tartışılacaktır

Keywords

Dikkati başka yöne çekme yöntemleri, ağrı yönetimi, hemşirelik, çocuk hasta

Using of Distraction Methods on Procedural Pain Management of Pediatric Patients

Abstract

Medical procedures such as phlebotomy and injections are the most important sources of pain for children. Pain causes children to be frightened of needles and this leads to unwillingness to medical procedures such as vaccine administration, injections and phlebotomy, even may result in neglect or delay in treatment and care. Thus, the nurse should be able to manage painful procedures to reduce emotional and physical effects of painful procedures and to avoid long-term results of pain in children. There are many different approaches to the treatment of procedural pain and anxiety of children during medical procedures, including pharmacological and non-pharmacological methods. In recent years research focusing on nurses’ use of non-pharmacological methods for pain relief of children’s has increased. Present widely used non-pharmacological method for pain relief of children during painful medical procedures is distraction methods. Distraction is a nursing attempt focusing patient’s attention to any other stimulants to control and reduce pain better. The rationale for the pain-reducing effects of distraction hypothesized that the brain has a limited capacity of focusing attention on stimulation. In this article frequently used ditraction method will be discussed

Keywords

Distraction methods, pain management, nursing, pediatric patient

References

• 1. Arts SE, Abu-Saad HH, Champion GD, Crawford MR, Fisher RJ, Juniper KH, et al. Age-related response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous cannulation. Pediatrics 1994;93:797-801.
• 2. Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, et al. Psychological interventions for needlerelated procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2013;10:CD005179.
• 3. J Pinzon, J Harvey. Canadian Paediatric Society. Care of adolescents with chronic conditions. Adolescent Health Committee. Paediatr Child Health 2006;11:43-8
• 4. SB (Sağlık Bakanlığı). Sağlık Bakanlığı Aşı Takvimi. http:// thsk.saglik.gov.tr/Dosya/halk_sagligina_yonelik_bilgiler/asi_ takvimi_07022014.pdf Erişim:29.11.2013.
• 5. Task Force on Taxonomy. Classification of Chronic Pain. Second Edition. Seattle: IASP Press, 2004.
• 6. Spielberg F, Branson BM, Goldbaum GM, Lockhart D, Kurth A, Celum CL, et al. Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men. J Acquir Immune Defic Syndr 2003;32:318-27.
• 7. Wong ML, Chia KS, Yam WM, Teodoro GR, Lau KW. Willingness to donate blood samples for genetic research: a survey from a community in Singapore. Clin Genet 2004;65:45- 51.
• 8. Luhmann J, Hurt S, Shootman M, Kennedy R. A comparison of buffered lidocaine versus ELA-Max before peripheral intravenous catheter insertions in children. Pediatrics 2004;113:217-20.
• 9. Eichenfield LF, Funk A, Fallon-Friedlander S, Cunningham BB. A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics 2002;109:1093-9.
• 10. Buckley MM, Benfield P. Eutectic lidocaine/prilocaine cream. A review of the topical anaesthetic/analgesic efficacy of a eutectic mixture of local anaesthetics (EMLA). Drugs 1993;46:126-51.
• 11. Törüner E, Büyükgönenç L. Çocuk sağlığı temel hemşirelik yaklaşımları, Ankara: Gökçe ofset; 2012.
• 12. DeMore M, Cohen LL. Distraction for pediatric immunization pain. J Clin Psychol Med Settings 2005;12:281-92.
• 13. Cassidy KL, Reid GJ, McGrath PJ, Finley GA, Smith DJ, Morley C, et al. Watch needle, watch TV: audovisual distraction in preschool immunization. Pain Mad 2002;3:108-18.
• 14. Cohen LL, Blount RL, Panopoulos G. Nurse coaching and cartoon distraction: an effective and practical intervention to reduce child, parent, and nurse distress during immunizations. J Pediatr Psychol 1997;22:355-70.
• 15. Manimala R, Blount RL, Cohen LL. The effects of parental reassurance versus distraction on child distress and coping during immunizations. Child Health Care 2000;29:161-77.
• 16. French GM, Painter EC, Coury DL. Blowing away shot pain: a technique for pain management during immunization. Pediatrics 1994;93:384-8.
• 17. Sparks L. Taking the “ouch” out of injections for children. Using distraction to decrease pain. MCN Am J Matern Child Nurs 2001;26:72-8.
• 18. Gonzalez JC, Routh DK, Armstrong FD. Effect of maternal distraction versus reassurance on children’s reactions to injections. J Pediatr Psychol 1993;18:593-60.
• 19. Mason S, Johnson MH, Wooley C. A comparison of distractors for controlling distress in young children during medical procedures. J Clin Psychol Med 1999;6:239-48.
• 20. Sander Wint S, Eshelman D, Steele J, Guzzetta CE. Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Oncol Nurs Forum 2002;29:8-15.
• 21. Tüfekci FG, Celebioğlu A, Küçükoğlu S. Turkish children loved distraction: using kaleidoscope to reduce perceived pain during venipuncture. J Clin Nurs 2009;18:2180-6.
• 22. Inal S, Kelleci M. Distracting children during blood draw: looking through distraction cards is effective in pain relief of children during blood draw. Int J Nurs Pract 2012;18:210-9.
• 23. Weisenberg M, Raz T, Hener T. The influence of film-induced mood on pain perception. Pain 1998:76;365-75.
• 24. De Wied M, Verbaten MN. Affective pictures processing, attention and pain tolerance. Pain 2001;90:163-72.
• 25. Landolt MA, Marti D, Widmer J, Meuli M. Does cartoon movie distraction decrease burned children’s pain behavior? J Burn Care Rehabil 2002;23:61-5.
• 26. Dovney LV, Zun LS. The impact of watching cartoons for distraction during painful procedures in the emergency department Pediatr Emerg Care 2012;28:1033-5.
• 27. Bellieni CV, Cordellli DM, Raffaelli M, Ricci B, Morgese G, Buonocore G. Analgesic effect of watching TV during venipuncture. Arch Dis Child 2006;91:1015-7.
• 28. Wang ZX, Sun LH, Chen AP. The efficacy of nonpharmacological methods of pain management in school age children receiving venepuncture in a paediatric department: a randomized controlled trial of audiovisual distraction and routine psychological intervention. Swiss Med Wkly 2008;138:579-84.
• 29. Manne SL, Redd WH, Jacobsen PB, Gorfinkle K, Schorr O, Rapkin B. Behavioral intervention to reduce child and parent distress during venipuncture. J Consult Clin Psychol 1990;58:565-72.
• 30. Blount RL, Bachanas PJ, Powers SW, Cotter MC, Franklin A, Chaplin W, et al. Training children to cope and parents to coach themduring routine immunizations: Effects on child, parent, and staff behaviors. Behavior Therapy 1992;23:689-705.
• 31. Gupta D, Agarwal A, Dhiraaj S, Tandon M, Kumar M, Singh RS, et al. An evaluation of efficacy of balloon inflation on venous cannulation pain in children: a prospective, randomized, controlled study. Anesth Analg 2006;102:1372-5.
• 32. Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. Ambul Pediatr 2008;8:117-28.
• 33. Press J, Gidron Y, Maimon M, Gonen A, Goldman V, Buskia D. Effects of active distraction on pain of children undergoing venipuncture: who benefits from it? The Pain Clinic 2003;15:261-9.
• 34. Fowler-Kerry S, Lander JR. Management of injection pain in children. Pain 1987;30:169-75.
• 35. Balan R, Bavdekar SB, Jadhav S. Can Indian classical instrumental music reduce pain felt during venepuncture? Indian J Pediatr 2009;76:469-73.
• 36. Caprilli S, Anastasi F, Grotto RP, Scollo M, Messeri A. Interactive music as a treatment for pain and stress in children during venipuncture: a randomized prospective study. J Dev Behav Pediatr 2007;28:399-403.
• 37. Kristjansdottir O, Kristjansdottir G. Randomized clinical trial of musical distraction with and without headphones for adolescents’ immunization pain. Scand J Caring Sci 2011;25:19-26.
• 38. Nguyen TN, Nilsson S, Hellstrom AL, Bengtson A. Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. J Pediatr Oncol Nurs 2010;27:146-55.
• 39. Lange B, Williams M, Fulton I. Virtual reality distraction during pediatric medical procedures. Pediatric Pain Letter 2006;8:6-10.
• 40. Sander Wint S, Eshelman D, Steele J, Guzzetta CE. Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Oncol Nurs Forum 2002;29:8-15.
• 41. Vessey JA, Carlson KL, McGill J. Use of distraction with children during an acute pain experience. Nurs Res 1994;43:369-72.
• 42. Carlson KL, Broome M, Vessey JA. Using distraction to reduce reported pain, fear and behavioral distress in children and adolescents: a multisite study. J Soc of Pediatr Nurs 2000;5:75-85.
• 43. Hasanpour M, Tootoonchi M, Aein F, Yadegarfar G. The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children. Acute Pain 2006;8:7-12.
• 44. Canbulat N, İnal S, Sönmezer H, Efficacy of distraction methods on procedural pain and anxiety by applying distraction cards and kaleidoscop in children. Asian Nurs Res (Korean Soc Nırs Sci) 2014;8:23-28.