Abstract
The paper provides a thorough summary of research purposes, methods, results, and conclusions as described in the study by Canbulat, Ayban, and Inal (2015), “Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients.” The first section, Purpose, explains the rationale for the investigation of the issue and the aims. Section two, Methods, focuses on the review and analysis of the employed sampling techniques and data collection tools, while the Results section gives a recap of the main research findings. Lastly, the final section is devoted to the interpretation of results and the clarification of study limitations and significance.
Introduction
The article by Canbulat et al. (2015) is devoted to the exploration of potentially favorable effects of non-pharmacological pain relief methods during the procedural insertion of needles. It has the defining characteristics of a high-quality empirical study and contains the informative introduction, results, methods, and conclusion sections. The analysis of the methodologies and techniques implemented by the researchers at different stages of investigation can help identify the level of validity and credibility of findings and inform about factors that may help improve the design and outcomes of future research.
Purpose
Previous research evidence demonstrates that the insertion of needles during medical procedures is one of the major sources of pain in anxiety in different patient populations, including the pediatric one. At the same time, studies mainly focused on pharmacologic methods of pain management before, while the investigation of non-pharmacological approaches, such as cold and vibration, remains limited. Considering the identified research gap, Canbulat et al. (2015) aimed to explore the benefits in terms of pain management associated with the application of external cooling and vibration via Buzzy (a reusable, plastic bee with a vibrating motor and an ice pack attached to it, specifically designed for alleviation of pain) when administering peripheral intravenous (IV) cannulation in children. It was hypothesized that this technique could help reduce peripheral pain and psychological distress during the procedure.
Methods
The selected research design was a randomized clinical trial with a sample comprised of 176 pediatric patients (age 7-12) who needed IV cannulation. The exclusion criteria during the recruitment were the presence of skin breaks and abrasions at the area where Buzzy would be placed, nerve damage in the extremity, poor health, developmental delays, recent exposure to analgesics, history of syncope during medical needle insertion, and prior experience of peripheral IV cannulation. All study participants were randomized and divided into two groups (n = 88) with similar demographic and clinical characteristics. The computerized, random sample technique allowed reducing the chance for biasing the study outcomes due to different population compositions.
Nevertheless, Canbulat et al. (2015) did not provide information about whether they conducted a power analysis when determining the sample size. To choose the right sample size one should know study power (1 – β), which is determined by the possibility of a false acceptance of the null hypothesis (the minimal value of 0.80 is usually considered acceptable), alpha value (α), mean deviations, and minimal effect size (p). Although some of these measures are not explained in the article by Canbulat et al. (2015), a p-value <.05 helped the researchers identify a statistically significant difference between the studied populations and reject the null hypothesis. It means that the number of participants was enough to answer the main question of the study.
The intervention (external cold and vibration via Buzzy) was implemented only in the experimental group, while the control population was exposed merely to standard procedure. As Canbulat et al. (2015) note, parents were informed about the study purposes and, thus, it was impossible to control a placebo effect, “the pure psychological effect that a medical treatment can have on a patient” (Lesaffre & Verbeke, n.d., p. 2). It is also possible to say that the intervention was not compared with the placebo effect because Canbulat et al. (2015) carried out a phase I trial: it was small, involved volunteers, and had an aim to learn about the pain management technique (Lesaffre & Verbeke, n.d.). At the same time, placebo-controlled studies usually employ large cohorts of participants and engage multiple centers, and often have a purpose of rationalizing the registration of new treatment methods…
The two population groups were treated equally in terms of data collection. The same standardized tools (for instance, the Children’s Fear Scale, the visual analog scale [VAS], and the Wong-Baker Faces Scale [WBFS]) were utilized to gather information about the procedure perceptions from both children and their caregivers. The data collection and medical procedures were performed in the same order and by the same nurse and researchers regarding all the members of the research project. Additionally, they all were informed about the study methods and purposes and provided with a right to withdraw at any time.
Results
The collected data were analyzed by using statistical tools (SPSS version 15.00). First of all, all variables (including age, gender, BMI, caregivers’ educational level, and so forth) that could affect procedural pain and fear levels were determined and contrasted with frequency and x2 comparisons. Additionally, the t-test was employed to compare the pain and anxiety indicators between the experimental group and the control group.
The comparison of variables did not show the presence of any significant differences that could bias the procedural outcomes in the analyzed populations. At the same time, the t-test results demonstrated a significantly higher degree of perceived pain and anxiety in the control group compared to the experimental one. The level of self-reported procedural pain measured with the WBFS (p <.001) in those participants who were exposed to external cooling and vibration via Buzzy equated 2.75 compared to 5.70 in those who were exposed to the standard procedure. Similarly, the level of self-reported procedural pain examined by using the VAS (p <.001) was 1.66 in the experimental group and 4.09 in the control group. The difference was statistically significant and led to accepting both of the suggested hypotheses regarding the benefits of the intervention in reducing pain and anxiety during peripheral IV cannulation in children.
Conclusions
Research findings make it clear that Buzzy is an efficient pain control method during minor invasive medical procedures in the pediatric population. The obtained results have multiple practical implications as previous research findings show that pain reduction is correlated with greater patient satisfaction with needle procedures. Additionally, compared to widely used pharmacological pain management remedies, external cooling and vibration have no adverse side effects. Therefore, Canbulat et al. (2015) recommend nurses implement Buzzy routinely when administering peripheral IV cannulation in younger individuals.
The study is significant because it contributes to the literature and aims to close the research gap in the area of non-pharmacological pain relief techniques. Nevertheless, it has a few limitations: it is not double-blind, researchers were unable to control placebo effects because parents were aware of research hypotheses, and the nurse participant was not selected randomly. As a result, the findings could be affected by some researcher and caregiver biases.
References
Canbulat, N., Ayhan, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), 33-39.
Lesaffre, E., & Verbeke, G. (n.d.). Clinical trials and intervention studies: The intervention study. Web.