The Effect of Virtual Reality On Pain and Anxiety During Blood Draw in Children: A Randomized Controlled Study

Purpose: The study was carried out to determine the effect of virtual reality applied during blood collection upon pain and anxiety in children aged 5-12.

MATERIAL AND METHOD Study Design, Participants This study in randomized controlled design was carried out with children aged between 5-12 in Pediatric Polyclinic blood draw unit of the University Hospital in a province in Turkey between 15 May and 31 July 2021. The study population included children who applied to the Pediatrics Polyclinic blood draw unit of the prespecified hospital between 15 May-31 July 2021. It was calculated by taking into account the pre-test anxiety score averages of the intervention and control groups in the study of Gerker et al. (2019) (for the t-test to compare the two groups). As a result of the evaluations, it was calculated as d=0.99 (high effect size), power=0.95, α=0.05 in the G*Power 3.1.9.2 statistical program. Accordingly, it was determined that the minimum number of children to be included in the study was 28 for the intervention group and 28 for the control group, a total of 56 children. Between these dates, 45 patients were included in the experimental group and 43 patients in the control group, who met the research criteria and volunteered to participate in the research, and the study was completed with a total of 88 patients. The study was carried out with children aged 5-12 years, who did not have communication barriers, did not use glasses, did not have pain before the procedure and did not have a chronic disease that would cause pain, blood was taken from the antecubital region and volunteered to participate in the study.

Randomization The children were included in groups randomly. "Stratification and block randomization methods" were used in the study for assigning the participants to the control and study groups. It was reported in the literature that the variables of age, gender, and interventional procedure experience were among the factors affecting the pain and anxiety experienced by children during interventional procedures. In this sense, the children were stratified as "female and male" for the gender variable and "5-8 years and 9-12 years" for the age variable, and block randomization was performed. In order to prevent the groups from being influenced by each other, data of the study group were collected in one day and the control group in the other. Data collection days of the study and control groups were determined with the method of drawing lots. This cycle was continued until sufficient sample size was obtained.

Data Collection Tools Question Form In this section, there were 6 questions related to the descriptive characteristics of the children (age, gender, education level of the mother, education level of the father, time of the last blood draw, the parent's presence with the child during the blood draw process).

Wong Baker Faces Pain Scale-WBFPS This scale measuring the severity of pain was used in children aged between 3-18 years. In this scale, pain was scored for facial expressions according to numerical values, and the numerical rating of the scale varied between 0 and 10. Facial expressions ranging from smiling (0=very happy/no pain) to crying (10=most painful) indicated emotions. The severity of pain increased as the score obtained from the scale increased, and the severity decreased as the score decreased. The child was possible to tell the nurse about the pain experienced more accurately with the drawing illustrating what each of the different numbers on the pain scale indicated. This scale was a reliable measurement tool for the Turkish population (Tsao and Zeltzer, 2008).