The effect of pediatric invasive pictorial shield (PIPS) and distraction card use on pain, fear and anxiety during blood collection

Aim: The study was conducted to determine the effect of Pediatric Invasive Picture Shield (PIPS) and distraction cards on pain, fear, and anxiety during blood collection in children aged 6-10 years. Material and Method: The study was conducted using a single-blind randomized controlled experimental method. The study was conducted between February 17, 2025, and April 15, 2025, at the Pediatric Blood Collection Unit of Giresun Women's and Children's Diseases Training and Research Hospital with 153 children aged 6-10 who met the inclusion criteria and whose parents agreed to participate in the study (PIPS group: 52, distraction cards group: 50, control group: 51). The study data were collected using the Child Demographic Characteristics and Blood Collection Procedure Information Form, Oucher Scale, Child Anxiety Scale-State (CAS-S), Child Fear Scale (CFS), Venham Illustrated Anxiety Scale (VIAS), and Nurse-Patient Collaboration and Parent Satisfaction Form (NPC-PSF). Parametric methods were used in the analysis of data. Differences between the proportions of categorical variables in independent groups were analyzed using Chi-Square and Fisher exact tests. In the study, one-way analysis of variance (ANOVA) was used for independent samples in intergroup comparisons; multiple comparisons were performed using Bonferroni-corrected post-hoc tests for variables with significant differences. In the analysis of time-dependent variables, the ANOVA method was used for mixed measurements, and time, group, and group*time interactions were evaluated. In all statistical tests, the significance level was taken as p<0.05. Result: Descriptive characteristics of the experimental and control groups did not differ between the groups (p>0.05). Before the procedure, there were no significant differences in the mean Oucher, CFS, and CAS-S scores between the PIPS, distraction cards, and control groups based on the assessments of children, parents, and researchers (p>0.05). During the procedure, the mean scores of Oucher, CFS, CAS-S, and VIAS were found to be statistically significantly lower in the groups that received PIPS and distraction cards, according to the assessments of children, parents, and researchers (p<0.05). After the procedure, according to researcher and parent assessments, the mean Oucher and CFS scores of the groups that received PIPS and distraction cards were found to be statistically significantly lower than those of the control group (p<0.05). After the procedure, according to the child assessment, the mean Oucher and CAS-S scores, and according to the parent assessment, the mean CAS-S scores were found to be significantly higher in the control group compared to the group that underwent PIPS (p<0.05), while no significant difference was found with the distraction cards group. Conclusions: It was concluded that the PIPS application and distraction cards were effective in reducing pain, fear, and anxiety during blood collection in children aged 6-10 years compared to the control group. Keywords: Pain, Anxiety, Child, Distraction, Nursing, Phlebotomy, Fear