Parent Child & Family Nursing

Predicting Children's Responses to Distraction From Pain
(National Institute of of Nursing Research - RO1 NR05269-01 A2)
Principal Investigator: Ann Marie McCarthy, PhD, RN, PNP

There is growing evidence that children who experience inadequate pain control during medical procedures may suffer long lasting effects. Research has demonstrated that cognitive behavioral interventions are effective in reducing pain and distress behavior for some, but not all, children during medical procedures.

Cost effectiveness and parental interest have resulted in research on parental coaching of children in the use of cognitive behavioral interventions during painful medical procedures. Results have been inconsistent. Thus, research is needed to determine which children benefit from cognitive behavioral interventions and under what circumstances.

This project is the first large study to examine multiple variables concurrently to determine the best predictors of the parents' successful use of the cognitive behavioral intervention distraction. This research will identify factors that predict which children benefit from and which parents can effectively provide distraction to alleviate the child's behavioral distress during a medical procedure. This will guide the development of a clinically relevant predictive distress profile. The specific aims of this study are to:

· Aim #1: Determine the effectiveness of training parents to be distraction coaches during a medical procedure (intravenous insertion) by comparing the responses of parents and children who receive the training (experimental group) with those who do not receive the training (control group).
Hypothesis 1A: Parents who receive the training will be more successful in providing distraction to their children than parents who do not receive the training.
Hypothesis 1B: Children whose parents receive the training will display less distress than children whose parents do not receive the training.

· Aim #2: Identify parent and child characteristics predictive of children who respond with low versus high indicators of distress following parent delivered distraction during a painful medical procedure (intravenous insertion).

· Aim #3: Determine the relationships and interactions among study variables (parent characteristics, child characteristics, extraneous procedural variables, and parent use of distraction) that are associated with low versus high distress in children following a parent delivered distraction during a painful medical procedure (intravenous insertion).

Approximately 540 children scheduled for an IV insertion for a medical test and their parents from 3 children's hospitals will be randomly assigned to an experimental or control group. The distraction intervention will be taught to families in the experimental group. The operational definition of distraction includes: reading to the child, pointing out specific items in books, talking to the child about non-procedure related topics, telling stories, blowing bubbles, finger play or using toys to capture the child's attention.

Child and parent characteristics will be assessed to describe and define how each impacts the child response to the intervention and the medical procedure. Child characteristics to be studied include age, gender, diagnosis, ethnicity, procedural experiences, anxiety, illness severity, temperament, coping style, ability to attend, and genotype. Child distress response will be measured through behavioral observation of distress, self perception of pain, biological response, and parental assessment of distress.

Parent characteristics to be studied include gender, ethnicity, experiences, expectations, anxiety, and parenting styles. Parent success response will be measured with self-assessment of success and observation of performance of distraction. Logistic regression will be used to develop the predictive models.