In young children aged between 2-4 years old, do distraction techniques during vaccination administration using toys help overcome pain compared to usual interventions such as soothing?

In young children aged between 2-4 years old, do distraction techniques during vaccination administration using toys help overcome pain compared to usual interventions such as soothing?

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Clinicians caring for children are using distraction techniques to minimise distress during vaccination (McLenon & Rogers, 2019). Children’s negative experiences during medical procedures, such as vaccinations, arise from needle pain and fear (Ahmadpour et al., 2020; Birnie et al., 2018; Boerner et al., 2015; Lescop et al., 2021; McLenon & Rogers, 2019). This project aims to answer the question, “In young children aged between 2-4 years old, do distraction techniques during vaccination administration using toys help overcome pain compared to usual interventions such as soothing?” Clinicians implement toys in medical settings to enable children unable to complete their immunisation schedules to overcome their avoidance behaviours (Lescop et al., 2021).
Research Design and Rationale
The tool that will be used in this qualitative study is the Standards for Reporting Qualitative Research (SRQR). According to O’Brien et al. (2014), qualitative studies enable researchers to understand issues based on participants’ perspectives. Researchers achieve their end goal by focusing on a relatively larger sample to gather in-depth insights. Qualitative research is considered subjective as data is collected in a written format (O’Brien et al., 2014). Qualitative data lacks commonalities; hence a researcher cannot use statistical techniques to analyse it (O’Brien et al., 2014). A researcher implements a coding process to analyse findings in qualitative research. According to O’Brien et al. (2014), qualitative research design accounts for what is said and done by participants. The mannerisms exhibited by research participants, their body language and tone are key considerations during thematic analyses.
Qualitative studies are factual as researchers collect objective information from participants. Yesodharan, Renjith & Jose (2018, p.301) indicates that “Improving the quality of the research reporting through structured approach is the key in solving the problems related to reporting.” Reporting qualitative research in nursing has revolutionised the profession as clinicians access valuable information needed to solve problems. However, incomplete and unusable reports have not been valuable to healthcare stakeholders due to researchers’ reluctance to follow criteria used in reporting qualitative research. Yesodharan, Renjith & Jose (2018) upholds that poor reporting of qualitative research happens during the production stages employed by researchers while conducting their studies. This makes poor reporting a significant problem that cannot be quickly addressed.
Literature used in different disciplines is contributed by qualitative research, which describes, interprets and generates theories to address issues. O’Brien et al. (2014) affirm that the SRQR tool enhances transparency in qualitative studies by providing standards that researchers use for reporting. Authors of medical journals or articles follow the standards provided in the SRQR tool to prepare their manuscripts, edit, review and evaluate information before publishing (O’Brien et al., 2014). Readers critically appraise study findings and apply them if they contain credible information. Bergin (2018) maintains that researchers conduct qualitative studies to gain detailed information about a particular problem at hand. Qualitative research is valued in medical education literature, although researchers find it challenging to report key elements (O’Brien et al., 2014). Theories are generated in qualitative research as it focuses on individual experiences occurring in natural situations (O’Brien et al., 2014). Example of individual experiences covered in qualitative research includes patient experiences, and professional dilemmas (O’Brien et al., 2014).
Researchers conduct qualitative research to understand individual’s perspectives and environments. According to Smith et al. (2018, p.889), “In nursing science, qualitative research sets out to explore very complex phenomena and produce nuanced understandings that can directly influence health care delivery and policy.” In medical education literature, researchers consider research questions and methods to make scientifically proven inferences. According to O’Brien et al. (2014), clarity and reporting’s completeness is enhanced when researchers’ inferences are salient. Clear and complete reporting in qualitative studies enable researchers to apply and synthesise results (O’Brien et al., 2014). In medical education, clinical and health services research, proposed guidelines by researchers have enabled them to enhance reporting quality. Authors develop their reporting criteria that exclude other approaches that are not within the context of qualitative research.
Research Setting
The research participants will be sampled through purposive sampling. Purposive sampling refers to the process of selecting informants based on their experiences (Etikan, Musa & Alkassim, 2016). In this research, the participants that will be selected are children that have been vaccinated. Purposive sampling will be applied in this research to choose members to participate in the research. There will be the use of purposive sampling to infer information about young children’s experiences during vaccination. In this qualitative research, the workload and costs will be reduced by focusing on a subset of the vaccinated population in various healthcare institutions. The subset population will provide a large sample size comprising 100 children to obtain adequate data and sufficiently address the PICO question.
The inclusion criterion will include children aged two to four years of age. The exclusion criterion is a period whereby vaccinated children not within the past one year will be excluded from the study. Based on the exclusion criteria, characteristics that will interfere with the research outcome will be eliminated. According to Patino, C. M., & Ferreira, J. C. (2018), research studies focus on inclusion and exclusion criteria to identify a study population that will provide reliable information. There will be a focus on the exclusion criteria to eliminate additional characteristics that might lead to unfavourable outcomes in the study. The sample comprising 100 children will be accessed through advanced search in healthcare organisations’ medical records. The use of proper channels will facilitate the issuance of consent or individual agreements before using the clinical research data in the qualitative study.
Data Collection
The data collection methods for this qualitative study include observations and visual analysis (Hennink, Hutter & Bailey, 2020). The data collection methods will be involved in the study due to their qualitative nature and purpose. This is qualitative research that requires in-depth study to gather the most suitable data. The focus will be on observations and visual analysis as the research participants are young children aged two to four. The efficacy of distraction techniques will be established through young children’s avoidance behaviours during vaccination. Qualitative studies are time-consuming to make observations and conclusion; hence the process takes prolonged periods (Datu, Yuen & Chen, 2018). Thereby, this qualitative research’s timeframe for data collection is six months.
Ethical consideration in the qualitative study includes confidentiality, informed consent and anonymity. Ethical considerations refer to values and principles that approve or disapprove of researchers’ conducts (Grady, 2018). In this qualitative research, ethical considerations will be addressed in two levels which include individual and societal. At the individual level, there will be a focus on the research participants’ confidentiality and anonymity. Since young children will be the research participants, informed consent will be obtained from parents or caregivers. According to Grady (2018), researchers must consider ethical principles while conducting research to protect participants from psychological and social harm. Virtuous conduct will be focused on addressing the PICO question through ethical viewpoints. Regulatory frameworks and laws control how researchers reveal personal information to eliminate risks and ethical implications (Grady, 2018).
Data Management and Analysis
The qualitative data will be managed by focusing on accuracy and maintaining copies. Effective management of the qualitative data will ensure that it is not compromised and enhance the research’s success. A digital filing system will be used to organise, label files to eliminate confusion. Information for the qualitative study will be obtained by maintaining accuracy and facilitating effective recordkeeping. According to Hackett & Strickland (2018), successive studies are attained through data management. In the qualitative study, there will be the management and organisation of data to establish a concise report. The credibility of the information provided by the research participants will be checked to ascertain whether the qualitative data is precise and authentic. There will be an update of the qualitative data in the management system before proceeding with the analysis. According to Hackett & Strickland (2018), file naming is an aspect that must be considered by a researcher when managing qualitative data. Confusions arising from ineffectiveness in the database management system hinder researchers from processing information (Hackett & Strickland, 2018). The qualitative data will be managed stepwise to prevent confusion that might hinder effective analysis. In case the participants withdraw their consent, data processing that is based on consent will be stopped.
My data analysis plan will serve as a roadmap in organising and analysing the qualitative data. The plan will also help answer the PICO question and compare data obtained from the qualitative study. My data analysis plan is provided below:

Qualitative data analysis plan
PICO Question Stage Activity
In young children aged between 2-4 years old, do distraction techniques during vaccination administration using toys help overcome pain compared to usual interventions such as soothing?” Data collection Observing and documenting qualitative data
Data Reduction Selecting research participants based on inclusion and exclusion criteria
Data display Summarising data in tables and graphs
Drawing conclusions Making realistic assumptions based on the qualitative data
Potential Implications and Practice
The implemented research will improve practice by underpinning clinicians’ professional learning to enhance their knowledge about distraction techniques during vaccination. According to Scott et al. (2020), end goals are achieved through research, but researchers have to persevere challenges and remain determined. A study that provides unbiased information is usable in clinical practices (Scott et al., 2020). Data gained from the research participants provide valuable information needed by clinicians administering vaccinations programs in clinical settings. Pain reduction during vaccination is a goal that most clinicians aim at since needle phobia leads to young children’s reluctance to be vaccinated (Boerner et al., 2015).
The implemented research will also improve practice by helping find solutions to problems arising during young children’s vaccination. This qualitative research will provide valid data to answer the research question that distraction techniques are effective than soothing strategies employed by parents during young children’s vaccination. According to Kaur & Dufour (2019). Researchers exploring the use of distraction techniques have provided evidence-based information about their efficacy. For example, McLenon & Rogers (2019) upholds that distraction techniques have enabled healthcare professionals to improve the delivery of quality care. Based on the view provided by McLenon & Rogers (2019), distraction techniques such as the use of toys are effective as they enable young children to reduce pain experienced during vaccination. Therefore, the implementation of distractions techniques in healthcare will enable clinicians to eliminate young children’s phobia, hindering them from being vaccinated.
Conclusion
In summary, distraction techniques are interventions used by clinicians to improve immunisation experiences for young children. Clinicians use toys in medical settings to help children who cannot finish their immunisation schedules conquer their avoidance behaviours. The Standards for Reporting Qualitative Research (SRQR) will be used to analyse qualitative data as a tool. Purposive sampling will be used to select participants for the study. The inclusion criterion is based on age, while the exclusion criterion is based on a time in which vaccination data now within the previous year will be eliminated. Observations and visual analysis by the SRQR tool will be used to gather data for this qualitative research. Confidentiality, informed consent, and anonymity are ethical considerations that are likely to arise in qualitative research. These ethical considerations will be addressed by abiding by the ethical framework. This qualitative study will provide reliable information to address the research question of whether distraction techniques are more successful than soothing methods used by parents during vaccinations for young children. Therefore, the ethical framework will guide the researchers’ practices throughout the qualitative study to gather data from participants and answer the PICO issue from a moral standpoint.

References
Ahmadpour, N., Weatherall, A. D., Menezes, M., Yoo, S., Hong, H., & Wong, G. (2020). Synthesising Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study. Journal of Medical Internet Research, 22(7), e19752. https://pubmed.ncbi.nlm.nih.gov/32706671/
Bergin, T. (2018). An introduction to data analysis: Quantitative, qualitative and mixed methods. Sage.
Boerner, K. E., Birnie, K. A., Chambers, C. T., Taddio, A., McMurtry, C. M., Noel, M., … & Riddell, R. P. (2015). Simple psychological interventions for reducing pain from common needle procedures in adults: a systematic review of randomised and quasi-randomised controlled trials. The Clinical Journal of Pain, 31(Suppl 10), S90. https://pubmed.ncbi.nlm.nih.gov/26352921/
Birnie, K. A., Noel, M., Chambers, C. T., Uman, L. S., & Parker, J. A. (2018). Psychological interventions for needle‐related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, (10). https://pubmed.ncbi.nlm.nih.gov/30284240/
Datu, J. A. D., Yuen, M., & Chen, G. (2018). Exploring determination for long-term goals in a collectivist context: A qualitative study. Current Psychology, 37(1), 263-271.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4.
Grady, C. (2018). Ethical principles in clinical research. In Principles and Practice of Clinical Research (pp. 19-31). Academic Press.
Hackett, A., & Strickland, K. (2018). Using the framework approach to analyse qualitative data: a worked example. Nurse researcher, 26 (3).
Hennink, M., Hutter, I., & Bailey, A. (2020). Qualitative Research Methods. Sage.
Kaur, G., & Dufour, J. (2019). Highlighting the importance of medical research: School of Medicine medical student research program. The Southwest Respiratory and Critical Care Chronicles, 7(29).
Lescop, K., Joret, I., Delbos, P., Briend-Godet, V., Blanchi, S., Brechet, C., & Cartron, E. (2021). The effectiveness of the BuzzyⓇ device to reduce or prevent pain in children undergoing needle-related procedures: The results from a prospective, open-label, randomised, non-inferiority study. International Journal of Nursing Studies, 113, 103803. https://pubmed.ncbi.nlm.nih.gov/33212328/
McLenon, J., & Rogers, M. A. (2019). The fear of needles: A systematic review and meta‐analysis. Journal of Advanced Nursing, 75(1), 30-42. https://pubmed.ncbi.nlm.nih.gov/30109720/
Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies: definitions and why they matter. Jornal Brasileiro de Pneumologia, 44(2), 84-84.
Scott, A. M., Kolstoe, S., Ploem, M. C., Hammatt, Z., & Glasziou, P. (2020). Exempting low-risk health and medical research from ethics reviews: comparing Australia, the United Kingdom, the United States and the Netherlands. Health Research Policy and Systems, 18(1), 1-8.
Smith, G. D., Gelling, L., Haigh, C., Barnason, S., Allan, H. T., & Jackson, D. (2018). The position of reporting guidelines in qualitative nursing research. Journal of Clinical Nursing, 27(5-6), 889-891.
Yesodharan, R., Renjith, V., & Jose, T. T. (2018). Improving nursing research reporting: a guide to reporting guidelines. Indian Journal of Public Health Research & Development, 9(2), 301-306.


Appendix
Data Collection Tools
In this qualitative study, the tools for data collection include focus groups and observations. The tools will serve as instruments that will enable the researchers to collect information from the participants. Data will be collected based on variables of interest to answer the PICO question. Measuring qualitative data is challenging; hence observation will lead to insights about young children’s reactions or attitudes to vaccination programs.

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