Running head: CONTROLLING PEDIATRIC ANXIETY DURING PROCEDURES
Controlling Pediatric Anxiety During Procedures: Future Research Needed
Elisabeth Seldon
Northeastern University
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CONTROLLING PEDIATRIC ANXIETY DURING PROCEDURES
In pediatric nursing, pain management and a child’s controlled anxiety in the hospital
setting are always a priority. Many pediatric patients suffer from anxiety related to painful
procedures, and Landier & Tse (2010) stress the importance of alleviating that anxiety as well as
how it is the nurse’s responsibility to provide atraumatic care for a pediatric patient. It is
important for nurses to be aware of research that displays how unmanaged pain can be harmful to
a child’s neurological development in addition to how unmanaged childhood pain can affect
one’s pain threshold later in adulthood (Koller & Goldman, 2012).
Many studies have been done on different strategies that help patients cope with
procedure-related anxiety and many of these techniques are used in practice and produce positive
results. Doellman (2003) summarizes the use of distraction, guided imagery, relaxation,
modeling and music along with pharmacological techniques used to control anxiety in children
undergoing a PICC line insertion. Distraction alone is becoming a much more accessible tool
with the new technology available to consumers today. Hospitals are now able to utilize video
games and even Apple iPads for the use of distraction thanks to the knowledge of Child Life
Specialists trained in the psychological aspects of healthcare with pediatrics (McQueen, Cress &
Tothy, 2012). Parents who aid in distraction, secure the child and provide preparation for the
procedure have also been studied in order to find the best ways they are able to assist in relieving
their child’s anxiety (Schechter et al., 2007).
All of these techniques have been studied and yet there are still pediatric patients whose
anxiety is not being relieved effectively. This renders the question of whether or not the most
effective ways to manage children’s pain have been found. Many of the techniques found to be
effective are non-pharmacological ways to relieve anxiety with less focus on pharmacological
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CONTROLLING PEDIATRIC ANXIETY DURING PROCEDURES
techniques such as analgesics. There are holes in the research that has been done on this topic,
and this paper proposes further research to fill these gaps.
Many of these studies have not taken into consideration the fact that individual patient
variables exist. The child's age, developmental level, temperament and type of treatment can all
affect coping during procedures and these variables are not always addressed. Kleiber &
McCarthy (2006) recognize the need for these variables to be taken into consideration and their
research identifies ways of using a pilot study in research with complex variables to find the best
measurements and ways to control individualities. Their research looks specifically at parent
involvement in distraction, however, their method of including a pilot study to better control
participant variables is something future researchers can adapt for their specific topic.
This paper suggests that the next step of research would be to use Kleiber & McCarthy’s
strategies to control differences in the patient’s pain tolerance, temperament, age and
developmental level while investigating what types of interventions are most effective. Knowing
whether non-pharmacological or pharmacological techniques are more effective would be
essential for nurses to be able to avoid the negative impact that unmanaged pain can have on a
child. Therefore it is critical this further research is conducted to better control pediatric anxiety.
Reflective Note: This abstract is for a research proposal that answers a hypothetical general Call
for Papers for the Journal of Pediatric Nursing. The intention of the proposal is to underline the
importance of further research on ways healthcare professionals can help pediatric patients
reduce their anxiety and fear of painful procedures. This abstract proposes using improved
research methods to look into the unanswered question of what type of intervention is most
effective in relieving pediatric anxiety during procedures while taking into consideration each
child’s individual differences.
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CONTROLLING PEDIATRIC ANXIETY DURING PROCEDURES
References
Doellman, D. (2003). Pharmacological Versus Nonpharmacological Techniques in Reducing
Venipuncture Psychological Trauma in Pediatric Patients. Journal of Infusion Nursing,
26(2), 103-109.
Kleiber, C. & McCarthy, A. (2006). Evaluating Instruments for a Study on Children’s Responses
to a Painful Procedure When Parents are Distraction Coaches. Journal of Pediatric
Nursing, 21(2), 99-107.
Koller, D. & Goldman, R. (2012). Distraction Techniques for Children Undergoing Procedures:
A Critical Review of Pediatric Research. Journal of Pediatric Nursing, 27, 652-681.
Landier, W. & Tse, A. (2010). Use of Complementary and Alternative Medical Interventions for
the Management of Procedure-Related Pain, Anxiety, and Distress in Pediatric Oncology:
An Integrative Review. Journal of Pediatric Nursing, 25, 566–579.
McQueen, A., Cress, C. & Tothy, A. (2012). Using a Tablet Computer During Pediatric
Procedures A Case Series and Review of the ‘‘Apps’’. Pediatric Emergency Care, 28(7),
712-714.
Schechter, N., Zempsky, W., Cohen, L., McGrath, P., McMurtry, M. & Bright, N. (2007). Pain
Reduction During Pediatric Immunizations: Evidence-Based Review and
Recommendations. Journal of American Academy of Pediatrics, 119(5), 1184-1198.
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