Effect of virtual reality distraction on venipuncture pain in children in the emergency room

Introduction: Virtual reality (VR) as a distraction strategy has been used in healthcare centers; however, the evidence is inconsistent in demonstrating VR's effect on pain control during venipuncture. Objective: To describe the effect of VR on pain during the venipuncture process in children a...

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Autores:
Gómez-Neva, Maria Elizabeth
Briñez Ariza, Karol Johanna
Ibañez Rodríguez, Leidy Johana
Tipo de recurso:
Article of investigation
Fecha de publicación:
2024
Institución:
Universidad de Ciencias Aplicadas y Ambientales U.D.C.A
Repositorio:
Repositorio Institucional UDCA
Idioma:
eng
spa
OAI Identifier:
oai:repository.udca.edu.co:11158/6000
Acceso en línea:
https://repository.udca.edu.co/handle/11158/6000
https://doi.org/10.15649/cuidarte.3385
Palabra clave:
610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría
Realidad Virtual
Enfermería
Cuidado del Niño
Dolor Agudo
Rights
openAccess
License
https://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.es
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dc.title.eng.fl_str_mv Effect of virtual reality distraction on venipuncture pain in children in the emergency room
dc.title.spa.fl_str_mv Efecto de la distracción con realidad virtual en el dolor por venopunción en niños en urgencias
dc.title.por.fl_str_mv Efeito da distração com realidade virtual na dor por punção venosa em crianças na sala de emergência
title Effect of virtual reality distraction on venipuncture pain in children in the emergency room
spellingShingle Effect of virtual reality distraction on venipuncture pain in children in the emergency room
610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría
Realidad Virtual
Enfermería
Cuidado del Niño
Dolor Agudo
title_short Effect of virtual reality distraction on venipuncture pain in children in the emergency room
title_full Effect of virtual reality distraction on venipuncture pain in children in the emergency room
title_fullStr Effect of virtual reality distraction on venipuncture pain in children in the emergency room
title_full_unstemmed Effect of virtual reality distraction on venipuncture pain in children in the emergency room
title_sort Effect of virtual reality distraction on venipuncture pain in children in the emergency room
dc.creator.fl_str_mv Gómez-Neva, Maria Elizabeth
Briñez Ariza, Karol Johanna
Ibañez Rodríguez, Leidy Johana
dc.contributor.author.none.fl_str_mv Gómez-Neva, Maria Elizabeth
Briñez Ariza, Karol Johanna
Ibañez Rodríguez, Leidy Johana
dc.subject.ddc.none.fl_str_mv 610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría
topic 610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría
Realidad Virtual
Enfermería
Cuidado del Niño
Dolor Agudo
dc.subject.lemb.none.fl_str_mv Realidad Virtual
dc.subject.decs.none.fl_str_mv Enfermería
Cuidado del Niño
Dolor Agudo
description Introduction: Virtual reality (VR) as a distraction strategy has been used in healthcare centers; however, the evidence is inconsistent in demonstrating VR's effect on pain control during venipuncture. Objective: To describe the effect of VR on pain during the venipuncture process in children and adolescents in a private institution in Bogotá. Materials and methods: An unblinded, randomized, experimental study was conducted in the emergency room of a fourth-level care facility. The sample consisted of 46 children and adolescents between the ages of 7 and 14. Twenty- three were randomly assigned to the experimental group with a VR headset and 23 to the control group. The dependent variable ‘pain’ was measured before, during, and after venipuncture using the visual analog scale (VAS) of pain. Results: Perceived pain is different before and after the procedure; however, using the VR headset did not show any statistical or clinical differences during the venipuncture procedure. Discussion: Variables such as vital signs, venipuncture time, and follow-up were important in measuring symptoms such as pain at venipuncture. Conclusion: VR can be used by nurses; however, more research must be done to demonstrate its effect on pain control during venipuncture, considering a greater power of the study, type of pain, and variables such as family support and nurses’ time of experience.
publishDate 2024
dc.date.accessioned.none.fl_str_mv 2024-08-09T15:38:27Z
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dc.identifier.citation.none.fl_str_mv Gómez-Neva María Elizabeth, Briñez Ariza Karol Johanna, Ibañez Rodriguez Leidy Johana. Effect of virtual reality distraction on venipuncture pain in children in the emergency room. Revista Cuidarte. 2024;15(2):e3385. https://doi.org/10.15649/cuidarte.3385
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identifier_str_mv Gómez-Neva María Elizabeth, Briñez Ariza Karol Johanna, Ibañez Rodriguez Leidy Johana. Effect of virtual reality distraction on venipuncture pain in children in the emergency room. Revista Cuidarte. 2024;15(2):e3385. https://doi.org/10.15649/cuidarte.3385
22160973
url https://repository.udca.edu.co/handle/11158/6000
https://doi.org/10.15649/cuidarte.3385
dc.language.iso.none.fl_str_mv eng
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dc.relation.citationedition.none.fl_str_mv (May., 2024) Artículo número e3385
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spelling Gómez-Neva, Maria Elizabethvirtual::272-1Briñez Ariza, Karol Johannavirtual::273-1Ibañez Rodríguez, Leidy Johanavirtual::274-12024-08-09T15:38:27Z2024-08-09T15:38:27Z2024Gómez-Neva María Elizabeth, Briñez Ariza Karol Johanna, Ibañez Rodriguez Leidy Johana. Effect of virtual reality distraction on venipuncture pain in children in the emergency room. Revista Cuidarte. 2024;15(2):e3385. https://doi.org/10.15649/cuidarte.3385https://repository.udca.edu.co/handle/11158/6000https://doi.org/10.15649/cuidarte.338522160973Introduction: Virtual reality (VR) as a distraction strategy has been used in healthcare centers; however, the evidence is inconsistent in demonstrating VR's effect on pain control during venipuncture. Objective: To describe the effect of VR on pain during the venipuncture process in children and adolescents in a private institution in Bogotá. Materials and methods: An unblinded, randomized, experimental study was conducted in the emergency room of a fourth-level care facility. The sample consisted of 46 children and adolescents between the ages of 7 and 14. Twenty- three were randomly assigned to the experimental group with a VR headset and 23 to the control group. The dependent variable ‘pain’ was measured before, during, and after venipuncture using the visual analog scale (VAS) of pain. Results: Perceived pain is different before and after the procedure; however, using the VR headset did not show any statistical or clinical differences during the venipuncture procedure. Discussion: Variables such as vital signs, venipuncture time, and follow-up were important in measuring symptoms such as pain at venipuncture. Conclusion: VR can be used by nurses; however, more research must be done to demonstrate its effect on pain control during venipuncture, considering a greater power of the study, type of pain, and variables such as family support and nurses’ time of experience.Introducción: La realidad virtual como estrategia de distracción es utilizada en los centros de atención en salud, sin embargo, la evidencia no es consistente en demostrar el efecto en el control del dolor durante el proceso de venopunción. Objetivo: Describir el efecto de la realidad virtual en el dolor durante el proceso de venopunción en niños y adolescentes, en una institución privada en la ciudad de Bogotá. Materiales y métodos: Estudio experimental aleatorizado sin cegamiento. Se realizó en el servicio de urgencias de una institución de IV nivel de atención. La muestra estuvo constituida por 46 niños y adolescente entre los 7 y 14 años. De forma aleatoria 23 estuvieron en el grupo experimental con visor de realidad virtual y 23 en el grupo control. La variable dependiente dolor fue medido antes, durante y después de la venopunción con la escala análoga para el dolor. Resultados: El dolor percibido es diferente antes o después del procedimiento, sin embargo, el uso de gafas de realidad virtual no mostro diferencias estadísticas ni clínicas durante el proceso de venopunción. Discusión: Variables como los signos vitales, tiempo de venopunción y acompañamiento mostraron ser importantes cuando se miden síntomas como el dolor en la venopunción. Conclusión: La realidad virtual puede ser usada por profesionales de enfermería, sin embargo, debe investigarse más para demostrar efecto en el control del dolor durante la venopunción, teniendo en cuenta un mayor poder del estudio, tipo de dolor y variables como acompañamiento de familiares, tiempo de experiencia del enfermeroIncluye referencias bibliográficasapplication/pdfengspahttps://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.eshttps://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)http://purl.org/coar/access_right/c_abf2https://revistas.udes.edu.co/cuidarte/article/view/3385/3080610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatríaRealidad VirtualEnfermeríaCuidado del NiñoDolor AgudoEffect of virtual reality distraction on venipuncture pain in children in the emergency roomEfecto de la distracción con realidad virtual en el dolor por venopunción en niños en urgenciasEfeito da distração com realidade virtual na dor por punção venosa em crianças na sala de emergênciaArtículo de revistahttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionTexthttp://purl.org/redcol/resource_type/ARThttp://purl.org/coar/version/c_970fb48d4fbd8a85(May., 2024) Artículo número e3385215Revista 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jecuta públicamente en forma digital la Obra o cualquier Obra Derivada u Obra Colectiva, Usted debe mantener intacta toda la información de derecho de autor de la Obra y proporcionar, de forma razonable según el medio o manera que Usted esté utilizando: (i) el nombre del Autor Original si está provisto (o seudónimo, si fuere aplicable), y/o (ii) el nombre de la parte o las partes que el Autor Original y/o el Licenciante hubieren designado para la atribución (v.g., un instituto patrocinador, editorial, publicación) en la información de los derechos de autor del Licenciante, términos de servicios o de otras formas razonables; el título de la Obra si está provisto; en la medida de lo razonablemente factible y, si está provisto, el Identificador Uniforme de Recursos (Uniform Resource Identifier) que el Licenciante especifica para ser asociado con la Obra, salvo que tal URI no se refiera a la nota sobre los derechos de autor o a la información sobre el licenciamiento de la Obra; y en el caso de una Obra Derivada, atribuir el crédito identificando el uso de la Obra en la Obra Derivada (v.g., "Traducción Francesa de la Obra del Autor Original," o "Guión Cinematográfico basado en la Obra original del Autor Original"). Tal crédito puede ser implementado de cualquier forma razonable; en el caso, sin embargo, de Obras Derivadas u Obras Colectivas, tal crédito aparecerá, como mínimo, donde aparece el crédito de cualquier otro autor comparable y de una manera, al menos, tan destacada como el crédito de otro autor comparable.</li>
      <li>
        Para evitar toda confusión, el Licenciante aclara que, cuando la obra es una composición musical:
        <ol type="i">
          <li>Regalías por interpretación y ejecución bajo licencias generales. El Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública o la ejecución pública digital de la obra y de recolectar, sea individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), las regalías por la ejecución pública o por la ejecución pública digital de la obra (por ejemplo Webcast) licenciada bajo licencias generales, si la interpretación o ejecución de la obra está primordialmente orientada por o dirigida a la obtención de una ventaja comercial o una compensación monetaria privada.</li>
          <li>Regalías por Fonogramas. El Licenciante se reserva el derecho exclusivo de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, los consagrados por la SAYCO), una agencia de derechos musicales o algún agente designado, las regalías por cualquier fonograma que Usted cree a partir de la obra (“versión cover”) y distribuya, en los términos del régimen de derechos de autor, si la creación o distribución de esa versión cover está primordialmente destinada o dirigida a obtener una ventaja comercial o una compensación monetaria privada.</li>
        </ol>
      </li>
      <li>Gestión de Derechos de Autor sobre Interpretaciones y Ejecuciones Digitales (WebCasting). Para evitar toda confusión, el Licenciante aclara que, cuando la obra sea un fonograma, el Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública digital de la obra (por ejemplo, webcast) y de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, ACINPRO), las regalías por la ejecución pública digital de la obra (por ejemplo, webcast), sujeta a las disposiciones aplicables del régimen de Derecho de Autor, si esta ejecución pública digital está primordialmente dirigida a obtener una ventaja comercial o una compensación monetaria privada.</li>
    </ol>
  </li>
  <br/>
  <li>
    Representaciones, Garantías y Limitaciones de Responsabilidad.
    <p>A MENOS QUE LAS PARTES LO ACORDARAN DE OTRA FORMA POR ESCRITO, EL LICENCIANTE OFRECE LA OBRA (EN EL ESTADO EN EL QUE SE ENCUENTRA) “TAL CUAL”, SIN BRINDAR GARANTÍAS DE CLASE ALGUNA RESPECTO DE LA OBRA, YA SEA EXPRESA, IMPLÍCITA, LEGAL O CUALQUIERA OTRA, INCLUYENDO, SIN LIMITARSE A ELLAS, GARANTÍAS DE TITULARIDAD, COMERCIABILIDAD, ADAPTABILIDAD O ADECUACIÓN A PROPÓSITO DETERMINADO, AUSENCIA DE INFRACCIÓN, DE AUSENCIA DE DEFECTOS LATENTES O DE OTRO TIPO, O LA PRESENCIA O AUSENCIA DE ERRORES, SEAN O NO DESCUBRIBLES (PUEDAN O NO SER ESTOS DESCUBIERTOS). ALGUNAS JURISDICCIONES NO PERMITEN LA EXCLUSIÓN DE GARANTÍAS IMPLÍCITAS, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.</p>
  </li>
  <br/>
  <li>
    Limitación de responsabilidad.
    <p>A MENOS QUE LO EXIJA EXPRESAMENTE LA LEY APLICABLE, EL LICENCIANTE NO SERÁ RESPONSABLE ANTE USTED POR DAÑO ALGUNO, SEA POR RESPONSABILIDAD EXTRACONTRACTUAL, PRECONTRACTUAL O CONTRACTUAL, OBJETIVA O SUBJETIVA, SE TRATE DE DAÑOS MORALES O PATRIMONIALES, DIRECTOS O INDIRECTOS, PREVISTOS O IMPREVISTOS PRODUCIDOS POR EL USO DE ESTA LICENCIA O DE LA OBRA, AUN CUANDO EL LICENCIANTE HAYA SIDO ADVERTIDO DE LA POSIBILIDAD DE DICHOS DAÑOS. ALGUNAS LEYES NO PERMITEN LA EXCLUSIÓN DE CIERTA RESPONSABILIDAD, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.</p>
  </li>
  <br/>
  <li>
    Término.
    <ol type="a">
      <li>Esta Licencia y los derechos otorgados en virtud de ella terminarán automáticamente si Usted infringe alguna condición establecida en ella. Sin embargo, los individuos o entidades que han recibido Obras Derivadas o Colectivas de Usted de conformidad con esta Licencia, no verán terminadas sus licencias, siempre que estos individuos o entidades sigan cumpliendo íntegramente las condiciones de estas licencias. Las Secciones 1, 2, 5, 6, 7, y 8 subsistirán a cualquier terminación de esta Licencia.</li>
      <li>Sujeta a las condiciones y términos anteriores, la licencia otorgada aquí es perpetua (durante el período de vigencia de los derechos de autor de la obra). No obstante lo anterior, el Licenciante se reserva el derecho a publicar y/o estrenar la Obra bajo condiciones de licencia diferentes o a dejar de distribuirla en los términos de esta Licencia en cualquier momento; en el entendido, sin embargo, que esa elección no servirá para revocar esta licencia o que deba ser otorgada , bajo los términos de esta licencia), y esta licencia continuará en pleno vigor y efecto a menos que sea terminada como se expresa atrás. La Licencia revocada continuará siendo plenamente vigente y efectiva si no se le da término en las condiciones indicadas anteriormente.</li>
    </ol>
  </li>
  <br/>
  <li>
    Varios.
    <ol type="a">
      <li>Cada vez que Usted distribuya o ponga a disposición pública la Obra o una Obra Colectiva, el Licenciante ofrecerá al destinatario una licencia en los mismos términos y condiciones que la licencia otorgada a Usted bajo esta Licencia.</li>
      <li>Si alguna disposición de esta Licencia resulta invalidada o no exigible, según la legislación vigente, esto no afectará ni la validez ni la aplicabilidad del resto de condiciones de esta Licencia y, sin acción adicional por parte de los sujetos de este acuerdo, aquélla se entenderá reformada lo mínimo necesario para hacer que dicha disposición sea válida y exigible.</li>
      <li>Ningún término o disposición de esta Licencia se estimará renunciada y ninguna violación de ella será consentida a menos que esa renuncia o consentimiento sea otorgado por escrito y firmado por la parte que renuncie o consienta.</li>
      <li>Esta Licencia refleja el acuerdo pleno entre las partes respecto a la Obra aquí licenciada. No hay arreglos, acuerdos o declaraciones respecto a la Obra que no estén especificados en este documento. El Licenciante no se verá limitado por ninguna disposición adicional que pueda surgir en alguna comunicación emanada de Usted. Esta Licencia no puede ser modificada sin el consentimiento mutuo por escrito del Licenciante y Usted.</li>
    </ol>
  </li>
  <br/>
</ol>
