Effects of Interventions on Child's Pain, Physiological, and Psychological Responses During Venous Catheterization

The Effects of VR Glasses and Video Screen Viewing Attempts on Physiological Parameters, Pain, Fear, and Emotional Responses During Peripheral Venous Catheter Placement for Child

The study aimed to determine the effects of virtual reality headsets and on-screen video viewing methods on physiological parameters (heart rate, oxygen saturation, and respiration), procedural pain, fear, and emotional reactions during peripheral venous catheter placement in children aged 7-12.

A parallel-group, repeated-measurement (pretest, interim, and post-test) randomized controlled trial was conducted between January 18 and June 19, 2025, with children aged 7-12 (Virtual Reality Headset Group-VRHG=22, On-screen Video Viewing Group-OVVG=22, Control Group-CG=22) who were followed in the paediatric emergency department of a university hospital in Konya. The data collection tools in the study were: Information Form, Physiological Parameters Assessment Form, Wong-Baker FACES Pain Rating Scale (WB-FPRS), Children's Fear Scale (CFS), and Children's Emotional Manifestation Scale (CEMS) were used. Two minutes before the peripheral venous catheter placement procedure, the "Under the Sea" video was shown to VRHG and OVVG, and it continued for two minutes after the procedure. Routine hospital practice was continued for the CG. Data were entered into SPSS-25.0, and descriptive statistics, chi-square test, Kruskal-Wallis, one-way ANOVA, one-way ANOVA for repeated measures, and two-way ANOVA were used for data analysis. Statistical significance was set at 0.05.

Pain is a subjective condition that varies from person to person. In the literature, pain is defined as a distressing experience expressed/shown by the individual. Pain is a subjective experience; physiologically, the perception of pain occurs in four stages (transduction, transmission, modulation, and perception). Pain can be grouped in different ways (according to neurophysiology, duration, etiology, and region).

Another concept included in the classification of pain today is procedural pain.

Procedural pain is pain that occurs due to invasive procedures or other interventions resulting from medical necessities (diagnosis, treatment, care processes, etc.). In the literature, decreased communication, increased dissatisfaction with care, and significant changes in physiological parameters are reported as occurring due to procedural pain. Procedural pain is important in all age groups, but it is a condition that requires particular attention in pediatric patients.

The response to procedural pain in children involves a complex interplay of individual and contextual factors, including age, developmental level, medical history, and parental involvement. Children may exhibit various responses to pain: physical (e.g., aggressive behavior, crying), physiological (e.g., increased heart rate and respiration), and psychological (e.g., anxiety, fear). Effective management of procedural pain has become increasingly important, encompassing both pharmacological and non-pharmacological interventions. Non-pharmacological methods, such as distraction techniques (e.g., video viewing, music therapy), have gained traction in pediatric care, particularly during invasive procedures. Despite the promising findings in the literature regarding pain management, there remains a gap in comprehensive studies addressing the role of distractions and the potential negative emotional experiences associated with procedural interventions, such as anxiety during peripheral venous catheter placement. Additionally, recent research explores the use of virtual reality and video viewing methods to assess procedural pain and anxiety, utilizing physiological monitoring without incurring costs.

The aim of this randomized controlled experimental study is to investigate the effects of virtual reality glasses and screen-based video viewing methods on physiological parameters (pulse, oxygen saturation, and respiration), procedural pain, fear, and emotional responses in children aged 7-12 years during peripheral venous catheter placement. This research will guide nursing approaches in managing pain, fear, and emotional responses that may occur in children during invasive procedures by examining the effect of video viewing with two different methods (screen-based and virtual reality glasses) from current approaches in procedural pain management. Managing physiological and psychological responses to procedural pain in children will affect satisfaction with nursing care in the short term, while, in the long term, it will increase the applicability of child-centered and atraumatic care today.

Inclusion criteria for the study

• The child should be monitored at the hospital for a minimum of 30 minutes and a maximum of 6 hours during the planned training.
• The child should be able to understand and speak Turkish fluently.
• Child must be aged 7-12 years old.
• Prior to the assessment process, the child's Wong-Baker Facial Expression Assessment Scale score must be 0.
• There should be no condition in the hand and arm area that would prevent the establishment of planned peripheral venous access.

Exclusion criteria from the study:

• The child or parent does not wish to participate in the study
• The child has a history of sedative or narcotic substance use within the last 24 hours
• The child has received analgesia within the last 6 hours
• The child has a visual health problem
• The child has a hearing health problem
• The child has a neurological disease that may be triggered by sight and sound
• The child has a history of syncope during invasive procedures (blood sampling, intravenous access, etc)
• The child has loss of sensation or tissue in the extremities (e.g., plaster casts) that would prevent intravenous access
• The child has a wound/trauma to the scalp or any part of the head
• The child has a health problem requiring isolation

Exclusion criteria from the study group:

• The child or parent expressing a desire to withdraw from the study at any stage of the research.
• The child experiencing health problems during the procedure (syncope, seizures, etc.).
• Initiating any medication or fluid treatment within 2 minutes of intravenous access (until the final test measurement).