Effects of Distraction Using Virtual Reality Glasses During Lumbar Punctures in Adolescents With Cancer
Purpose/Objectives: To determine the effects of virtual reality (VR) glasses on adolescents with cancer undergoing lumbar punctures (LPs).
Design: Pilot study using an experimental, control group design.
Setting: In-hospital oncology clinic.
Sample: 30 adolescents with cancer (17 in the VR and 13 in the control group) undergoing frequent LPs.
Methods: Subjects were randomly assigned to groups. Both groups received standard intervention during the LP, but the experimental group also wore VR glasses and watched a video. Following the LP, both groups rated their pain using a visual analog scale (VAS) and were interviewed to evaluate their experience. Main Research Variables: Pain, subjective evaluation of experience.
Findings: Although VAS pain scores were not statistically different between the two groups (p = 0.77), VAS scores tended to be lower in the VR group (median VAS of 7.0, range 0-48) than in the control group (median VAS of 9.0, range 0-59). 77% of subjects in the experimental group said the VR glasses helped to distract them from the LP.
Conclusions: VR glasses are a feasible, age-appropriate, nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents. Implications for Practice: The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored.
Abu-Saad, H., & Holzemer, W.L. (1981). Measuring children's self-assessment of pain. <i>Issues in Comprehensive Pediatric Nursing</i>, <i>5</i>, 337-349.
Atkins, C. (Director) (1996). <i>Escape</i> [Video]. (Available from Virtual i-O, 1553 SE Spokane Street, Portland, OR 97202).
Blount, R.L., Bachanas, P.J., Powers, S.W., Cotter, M.C., Franklin, A., Chaplin, W., Mayfield, J., Henderson, M., & Blount, S.D. (1992). Training children to cope and parents to coach them during routine immunizations: Effects on child, parent, and staff behaviors. <i>Behavior Therapy</i>, <i>23</i>, 689-705.
Broome, M., Lillis, P., McGahee, T., & Bates, T. (1992). The use of distraction and imagery with children during painful procedures. <i>Oncology Nursing Forum</i>, <i>19</i>, 499-502.
Bush, J.P. (1987). Pain in children: A review of the literature from a developmental perspective. <i>Psychology and Health</i>, <i>1</i>, 215-236.
Carlson, K.L., Broome, M., & Vessey, J.A. (2000). Using distraction to reduce reported pain, fear, and behavioral distress in children and adolescents: A multi-site study. <i>Journal Society of Pediatric Nursing</i>, <i>5</i>, 75-85.
Cohen, L.L., Blount, R.L., & Panopoulos, G. (1997). Nurse coaching and cartoon distraction: An effective and practical intervention to reduce child, parent, and nurse distress during immunizations. <i>Journal of Pediatric Psychology</i>, <i>22</i>, 355-370.
Downie, W.W., Leatham, P.A., Rhind, V.M., Wright, V., Branco, J.A., & Anderson, J.A. (1978). Studies with pain rating scales. <i>Annals of the Rheumatic Diseases</i>, <i>37</i>, 378-381.
Fernandez, E. (1986). A classification system of cognitive coping strategies for pain. <i>Pain</i>, <i>26</i>, 141-151.
Fowler-Kerry, S., & Lander, J.R. (1987). Management of injection pain in children. <i>Pain</i>, <i>30</i>, 169-175.
French, G.M., Painter, E.C., & Coury, D.L. (1994). Blowing away shot pain: A technique for pain management during immunization. <i>Pediatrics</i>, <i>93</i>, 384-388.
Gonzalez, J.C., Routh, D.K., & Armstrong, F.D. (1993). Effects of maternal distraction versus reassurance on children's reactions to injections. <i>Journal of Pediatric Psychology</i>, <i>18</i>, 593-604.
Johnson, M.H., & Petrie, S.M. (1997). The effects of distraction on exercise and cold pressor tolerance for chronic low back pain sufferers. <i>Pain</i>, <i>69</i>, 43-48.
Kahneman, D. (1973). <i>Attention and effort.</i> Englewood Cliffs, NJ: Prentice-Hall.
Kazak, A.E., Penati, B., Boyer, B.A., Himelstein, B., Brophy, P., Waibel, M.K., Blackall, G.F., Daller, R., & Johnson, K. (1996). A randomized controlled prospective outcome study of a psychological and pharmacological intervention protocol for procedural distress in pediatric leukemia. <i>Journal of Pediatric Psychology</i>, <i>21</i>, 615-631.
Lambert, S.A. (1999). Distraction, imagery, and hypnosis: Techniques for management of children's pain. <i>Journal of Child and Family Nursing</i>, <i>2</i>(1), 5-15.
Manne, S.L., Bakeman, R., Jacobsen, P.B., Gorfinkle, K., & Redd, W.H. (1994). An analysis of a behavioral intervention for children undergoing venipuncture. <i>Health Psychology</i>, <i>13</i>, 556-566.
Manne, S.L., Redd, W.H., Jacobsen, P.B., Gorfinkle, K., Schorr, O., & Rapkin, B. (1990). Behavioral intervention to reduce child and parent distress during venipuncture. <i>Journal of Consulting and Clinical Psychology</i>, <i>58</i>, 565-572.
McCaffery, M., & Pasero, C. (1999). Pain: Clinical manual (2nd ed.). In M. McCaffery & C. Pasero, <i>Practical nondrug approaches to pain</i> (pp. 399-427). St. Louis: Mosby.
McCaul, K., & Malott, J. (1984). Distraction and coping with pain. <i>Psychological Bulletin</i>, <i>95</i>, 516-533.
Price, D., McGrath, P., Rafii, A., & Buckingham, B. (1983). The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. <i>Pain</i>, <i>17</i>, 45-56.
Reading, A.E. (1980). A comparison of pain rating scales. <i>Journal of Psychosomatic Research</i>, <i>24</i>, 119-124.
Schneider, S.M., & Workman, M.L. (2000). Virtual reality as a distraction intervention for older children receiving chemotherapy. <i>Pediatric Nursing</i>, <i>26</i>, 593-597.
Smith, J., Barabasz, A., & Barabasz, M. (1996). Comparison of hypnosis and distraction in severely ill children undergoing painful medical procedures. <i>Journal of Counseling Psychology</i>, <i>43</i>, 187-195.
U.S. Department of Health and Human Services. (1992). <i>Acute pain management in infants, children, and adolescents: Operative and medical procedures.</i> [Agency for Health Care Policy and Research Publication No. 92-0020]. Rockville, MD: U.S. AHCPR, Public Health Service.
Vessey, J.A., Carlson, K.L., & McGill, J. (1994). Use of distraction with children during an acute pain experience. <i>Nursing Research</i>, <i>43</i>, 369-372.
Zeltzer, L.K., Altman, A., Cohen, D., LeBaron, S., Munuksela, E.L., & Schechter, N.L. (1990). Report of the subcommittee on the management of pain associated with procedures in children with cancer. <i>Pediatrics</i>, <i>86</i>, 826-831.