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Nurs Res. 2014 Nov-Dec;63(6):397-407. doi: 10.1097/NNR.0000000000000056.

Matching doses of distraction with child risk for distress during a medical procedure: a randomized clinical trial.

Author information

Ann Marie McCarthy, PhD, RN, FNASN, FAAN, is Professor; and Charmaine Kleiber, PhD, RN, FAAN, is Associate Professor, College of Nursing, University of Iowa. Kirsten Hanrahan, DNP, RN, ARNP, is Project Director, University of Iowa Health Care, University of Iowa. M. Bridget Zimmerman, PhD, is Clinical Professor, Director, Department of Biostatistics, University of Iowa. Anne Ersig, PhD, RN, is Assistant Professor, College of Nursing, University of Iowa. Nina Westhus, PhD, RN, is Associate Professor, School of Nursing, Saint Louis University, Missouri. Susan Allen, MSN, RN, PNP, is Nursing Manager of Emergency Department, PICU, Internal Resource Team, Blank Children's Hospital, Des Moines, Iowa.



Parents often want to provide support to their children during medical procedures, but not all parents are effective in providing distraction after brief training.


The aim of this study was to investigate the effects of three doses of distraction intervention for children at high and medium risk for procedure-related distress.


Children undergoing scheduled intravenous insertions for diagnostic or treatment purposes and their parents participated. A computerized application, Children, Parents and Distraction, was used to predict distress risk. Doses of intervention were basic (parents trained on providing distraction), enhanced (basic training plus tailored instructions, environmental modifications, and support and guidance from the research assistant), and professional (a trained research assistant provided distraction). Outcome measures were Observational Scale of Behavioral Distress-Revised for behavioral distress, Oucher for self-reported pain, parent report of child distress, and salivary cortisol for physiological distress.


A total of 574 children, ages 4-10, and their parents participated. The Children, Parents and Distraction predicted that the risk for distress was high for 156 children, medium for 372, and low for 46. Children predicted to have higher risk for distress displayed more behavioral distress (p < .01). Children in the medium-risk group who had the professional intervention displayed significantly less behavioral distress (p < .001). Children in the high-risk group tended to have less behavioral distress when receiving the professional intervention (p = .07). There were no significant group differences for self-report of pain, parent report of distress, or cortisol levels.


Some parents may need additional training in providing distraction to their children during procedures, and some children at medium and high risk for distress may need professional support. Parents should be asked about their preferences in acting as the distraction coach and, if willing, be provided as much training and support as possible in the clinical situation.

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