The effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis

Pain Manag Nurs. 2010 Jun;11(2):85-91. doi: 10.1016/j.pmn.2009.03.005.


Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures and one of the most frequently performed ones, and children and adolescents on hemodialysis are anxious about repeated venipunctures. Distraction is one of the most effective ways to relieve pain, and nurses are responsible for pain control. The purpose of this quasi-experimental study was to test the effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis. All of the pediatric hemodialysis centers in Tehran (three centers) were assigned to case group (one center with 21 patients) and control groups (two centers with a total of 21 patients) randomly. The Wong-Baker face pain scale was used to assess pain caused by venipuncture. Assessing of pain was done in 12 sessions in both case and control groups. Three first sessions were held without intervention (pretest) and the next nine sessions were held with distraction intervention (posttest). To cause distraction, the adolescents were asked to look at two similar pictures and tell the number of differences between them during venipuncture. Results showed that case and control groups matched in demographic variables and pain intensity. After distraction, pain intensity during venipuncture significantly decreased (p=.003); but this decrease began from the sixth session; at the five first sessions, pain intensity had not changed. This study shows the effect of distraction with a simple, inexpensive, and quick way for decreasing the pain caused by venipuncture. We recommend that the reasons of the intervention's delay in effect be assessed in future studies.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Attention
  • Attitude to Health
  • Cartoons as Topic
  • Clinical Nursing Research
  • Female
  • Hospitals, Pediatric
  • Humans
  • Male
  • Nursing Assessment
  • Pain / diagnosis
  • Pain / etiology
  • Pain / prevention & control*
  • Pain / psychology
  • Pain Measurement
  • Phlebotomy / adverse effects*
  • Psychology, Adolescent
  • Relaxation Therapy / methods*
  • Relaxation Therapy / nursing
  • Relaxation Therapy / psychology
  • Renal Dialysis*
  • Treatment Outcome