Comparison of Effect of Feeding Premature Infants with Either Cup, Bottle, and Syringe on Transition to Breastfeeding, Breastfeeding Success, Weight Gain, and Duration of Hospitalization.

Objective: This study was completed with the aim of determining the effect of cup feeding (CF), bottle feeding (BF), and syringe feeding (SF) methods on the transition to breastfeeding, breastfeeding success, physiological parameters, weight gain, and discharge duration for preterm neonates in the neonatal intensive care unit (NICU). Materials and Methods: The study was designed to be randomized, controlled, and single blinded. The study was completed with 102 premature neonates between 29-34 gestational weeks abiding by the case selection criteria receiving treatment and care in the NICU. The 1st group comprised premature neonates receiving CF, the second group received BF, and the third group received SF. For collection of data, the Premature Infant Descriptive Information and Monitoring Form, Bristol Breastfeeding Assessment Tool (BBAT), and Infant-Focused Feeding Scales (IFFS) were used. Results: Comparison of mean peak heart rate in the groups found that the BF group was significantly high (p = 0.047) and comparison of mean SO2 found that the SF group was significantly high (p = 0.000). Infants in the SF group were determined to have significantly higher BBAT scores compared to the infants in the BF and CF groups (p = 0.015). In addition, SF infants were determined to transition to full enteral feeding and breastfeeding in a shorter duration (p < 0.05). There were no significant differences between the groups for weight gain and discharge duration (p > 0.05). Conclusions: The SF method was determined to more positively affect breastfeeding success, transition to full breastfeeding duration, and vital signs compared to the CF and BF methods. In line with the results obtained in the study, the use of the SF method may be recommended to increase breastfeeding success of neonates, to shorten the transition to full breastfeeding and for stable physical parameters.

Clinical validation of the infant-driven feeding scales© in Turkey.

BACKGROUND: Supporting the development of feeding skills among preterm infants is an important component of neonatal care. The selection of appropriate and supportive feeding interventions begins with a comprehensive assessment of the infant's skills. PURPOSE: This study aimed to adapt the Infant-Driven Feeding Scales© (IDFS) to the Turkish language. METHODS: This was a methodological, observational, single-center cross-sectional study. The study included 80 infants born at a gestational age ≥ 32 weeks, consecutively admitted to a tertiary Neonatal Intensive Care Unit (NICU). Research data were collected using a premature infant descriptive information form (IDIF), IDFS, and LATCH Score for Breastfeeding Assessment. For the Turkish validity-reliability of the IDF, the translate-back translate method was used with the content validity index (CVI) assessed. RESULTS: The scale had CVI values between 0.90 and 1.00 with a mean CVI = 0.96. For measures 1 and 2, there were significant positive and high-level correlations between IFDS-R and IFDS-Q correlation values (r = 0.553-0.958; p = 0.001) and significant negative, low-level correlations between IFDS-R and IFDS-Q with the LATCH scale (r = 0.439-0.532; p = 0.001). According to inter-observer compatibility analyses, the kappa value was 0.94-1.00 for the first measure and 0.96-1.00 for the second measure (p = 0.001). There were negative significant correlations between IDFS-R points with gestational age and postmenstrual age (PMA) (p = 0.001), and gestational age and PMA were explanatory factors for 13.8% of IDFS-R points (F = 7.30, p = 0.001). CONCLUSIONS: The IDFS is recommended for use as a valid and reliable tool to ease the safe and successful development of oral feeding skills in preterm infants and to plan evidence-based interventions. IMPLICATIONS FOR PRACTICE: The IDFS appears to be a beneficial measurement device for use in assessing the state of readiness of preterm infants for oral feeding and for early determination of risks that may occur due to delayed feeding independence of infants.

Pain intensity of sedated paediatric intensive care unit patients during treatment and care procedures.

BACKGROUND: Although various pharmacological and non-pharmacological methods are used in the management of pain in the Paediatric Intensive Care Unit, patients experience more pain than those being treated in other units. AIM AND OBJECTIVES: This study was conducted to determine the intensity of pain during invasive patient care and dressing change procedures in sedated paediatric intensive care unit (PICU) patients and to assess the impact of analgesics and demographic factors. The study also sought to evaluate any correlation between the face, legs, activity, cry, consolability (FLACC) and COMFORT scales. DESIGN: The research was conducted as a descriptive cross-sectional study. METHODS: The total sample size consisted of 30 mild-to-moderately sedated patients under the age of 18 in the PICU of a university hospital in Turkey between September the 1st, 2016, and December the 31st, 2016. The procedures were classified in to three groups: Invasive, Patient Care and Dressing Change. The FLACC and COMFORT scales were utilized to assess pain. RESULTS: The intensity of pain did not differ according to the demographic characteristics (median [IQR]) by gender-COMFORT female: (16.05 [15.10-17.0]); male: (15.15 [14.7-16.5]) (P = .284)-age: (COMFORT: P = .165); intensive care admission indications: (COMFORT: P = .647); or administration of analgesics-COMFORT Yes: (15.90 [14.80-16.65]), No: (15.50 [14.70-16.45]) (P = .634). The invasive procedures produced the most intense pain (median [IQR]): FLACC: (5 [4-6])/COMFORT: (16 [15-20]). Patient care procedures were second in intensity of pain FLACC: (4 [3-5])/COMFORT: (15 [14-17]), while dressing changes produced significantly less pain FLACC: (3 [2-4])/COMFORT: (14 [12-17]) (P < .001). A positive correlation was noted between the pain scores observed on the FLACC and COMFORT scales (rs: Invasive procedures:0.992/Care procedure:0.991/Dressing procedures: 0.996) (P < .001). CONCLUSIONS: Besides invasive procedures, patient care and dressing changes also cause sedated PICU patients' pain. The pain management was insufficient to prevent pain for most of the procedures in the PICU. RELEVANCE TO CLINICAL PRACTICE: Besides making use of evidence-based pharmacological and non-pharmacological methods in invasive procedures, care must also be focused on preventing pain during patient care and dressing procedures so that the most effective treatment can be achieved.

The effect of kangaroo mother care applied to the healthy newborns in the early postpartum period on breastfeeding: A randomized controlled trial.

OBJECTIVES: To determine the effect of kangaroo mother care applied to the healthy newborns in the early postpartum period on breastfeeding. METHODS: The randomised controlled experimental study was conducted from June 1 to August 25, 2016, at a training and research hospital in Istanbul, Turkey, and comprised healthy newborns and their mothers equally divided into study group A and control group B. The newborns in group A were administered kangaroo mother care for 3 hours after birth, while group B newborns were cared for using the unit's standard postpartum procedure. The time the newborns in both the groups first started to breastfeed, the frequency of breastfeeding within the first 24 hours, the duration of their breastfeeding and suckling skills were evaluated. Data was analysed using the Number Cruncher Statistical System 2007. RESULTS: There were 112 sets of newborns and their mothers; 56(50%) in each of the two groups. Group A newborns started suckling at the breast sooner, for longer duration, and more frequently compared to the newborns in group B (p<0.05). There was no difference between the groups in terms of initial suckling skills (p= 0.862), but those in group A were better at suckling 24 hours later (p=0.001). CONCLUSIONS: Kangaroo mother care administered to healthy newborns immediately after birth encouraged the newborns to take to the breast sooner, more frequently, and for longer periods. It also increased their suckling skills. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04619459.

Impact of Peripheral Venous Catheter Placement With Vein Visualization Device Support on Success Rate and Pain Levels in Pediatric Patients Aged 0 to 3 Years.

BACKGROUND: Pediatric nurses should be able to use techniques that increase the success rate or shorten the procedural duration of peripheral intravenous catheterization (PIVC). OBJECTIVES: This study was performed to define the effect of the infrared vein visualization device support on the success of PIVC in pediatric patients aged 0 to 3 years. Success was determined based on the number of attempts per patient, the duration of the procedure, the success rate of first attempts, and the pain levels of the children. METHODS: The study was a randomized, controlled experimental study on 54 children aged 0 to 3 years. RESULTS: Peripheral intravenous catheterization in the study group was performed with fewer attempts (study group: 1.44 ± 0.85 [median, 1]; control group: 2.41 ± 1.99 [median, 2]; P = 0.016) and in a shorter period (study group: 44.37 ± 32.22 [median, 40 seconds]; control group: 168.89 ± 171.54 [median, 112 seconds; P = 0.001), and the first attempt success rate in the study group (74.1%) was higher than in the control group (40.7%; P = 0.028). Also, the pain level of the children in the study group was significantly lower than that in the control group (P < 0.05). CONCLUSIONS: In conclusion, PIVC supported by the infrared vein visualization device reduces the number of attempts per patient, reduces the duration of the procedure, and increases the success rate of first attempts, and there is procedural pain; therefore, vein visualization improves the success of PIVC.

Effects of three different methods used during heel lance procedures on pain level in term neonates.

AIM: This study aims to experimentally determine effects of three different methods (swaddling; swaddling and holding; swaddling, holding and breastfeeding) used during heel lancing on pain levels in healthy term neonates. METHODS: This study was a prospective, randomized controlled trial. The sample of newborns (n = 160) were allocated to the groups (group 1, control; group 2, swaddling; group 3, swaddling and holding; group 4, swaddling, holding and breastfeeding) by blocked randomization. The study data were obtained using an information form, and the Neonatal Infant Pain Scale (NIPS). RESULTS: The procedural pain scores of group 4 were lower than group 1, group 2 and group 3. Both the total crying time and the first calming time of the groups swaddling, holding and breastfeeding, were shorter than the swaddling, swaddling and holding and the control group. CONCLUSIONS: As a result, all the three methods are effective in reducing the pain felt during heel lancing in the newborn. However, swaddling, holding and breastfeeding is more effective than the other methods.

Meanings of the Feelings and Thoughts on Children's Hematology and Oncology Service Nurses' Experience: A Qualitative Study.

AIM: This study aimed to analyze the feelings and thoughts related to working in the pediatric hematology-oncology unit of the nurses who have worked in this unit in the past, related and the meanings they attribute to it. METHOD: In this qualitative study, 15 nurses between the age of 29 and 53 years, who had previously worked in the pediatric hematology-oncology unit and left the unit, were interviewed in depth. The interviews were held using a semi-structured interview form. Each interview lasted for 35 to 45 minutes. RESULTS: In the study, 5 main themes and sub-themes related to these were identified from the perspective of the nurses with working experience in the pediatric hematology-oncology unit in the past with regard to their feelings and thoughts about this experience. These included 1) feelings: (a) fear and anxiety, (b) desperation, mercy, and guilt, (c) exhaustion, and (d) longing; 2) coping; 3) professional attributions; 4) meanings related to life; and 5) unmet requirements and suggestions. CONCLUSION: Working in the pediatric hematology-oncology unit should be considered as a multi-dimensional condition that causes nurses to experience a wide variety of feelings and affects their perspectives on the profession and life. These findings can be used to strengthen the nurses working in hematology-oncology unit.

The Effect of External Thermomechanical Stimulation and Distraction on Reducing Pain Experienced by Children During Blood Drawing.

This study aimed to investigate the sole and combined effects of external thermomechanical stimulation and distraction in pain relief of children during blood drawing.This is a randomized clinical trial. The sample consisted of 218 children aged 6 to 12 years who were randomly assigned to 4 groups: group 1 received no intervention, group 2 received external thermomechanical stimulation using Buzzy, group 3 received distraction via DistrACTION Cards, and group 4 received a combination of both external thermomechanical stimulation and distraction. Preprocedural anxiety was assessed through observers' observations using the Children's Anxiety and Pain Scale. Children's pain levels were assessed by themselves, observers, and parents, as reported using the Faces Pain Scale-Revised. Preprocedural anxiety did not differ significantly (P > 0.05). When the 3 study groups were compared with the control group, all 3 groups had significantly lower pain levels than the control group (P < 0.001). The lowest pain level was measured in the combined condition (Buzzy and DistrACTION Cards). The mean score of the device group was lower than the distraction group.

The Effect of Individualized Developmental Care Practices in Preterm Infants.

BACKGROUND: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. METHODS: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. RESULTS: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. CONCLUSION: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.

Effects of breastfeeding and heel warming on pain levels during heel stick in neonates.

AIM: To determine the effects of two different methods, breastfeeding and heel warming, during heel stick procedures on pain levels in healthy term neonates. METHODS: This study was a prospective, randomized controlled trial. The sample of the study consisted of 150 healthy newborns who matched the case selection criteria and were brought to the nursery for the heel stick procedure. Fifty neonates were randomly assigned to each group: breastfeeding (n = 50), heel warming (n = 50), and control (n = 50), using computer-based randomization. The study data were obtained using an Information Form and the Neonatal Infant Pain Scale (NIPS). RESULTS: The pre-procedural pain scores of the breastfeeding group (mean 4.44 SD 1.21 seconds) were lower than in the heel warming (mean 6.10 SD 1.07 seconds) and the control group (mean 6.42 SD 0.91 seconds) (P < 0.01). Both the total crying time and the first calming time of the breastfeeding group were shorter than the heel warming and control group. The first calming time of the heel warming group was shorter than in the control group. CONCLUSIONS: Both breastfeeding and heel warming are effective in reducing the calming time during heel stick procedures. However, breastfeeding is more effective than heel warming in reducing pain during heel stick and should be preferred as the first choice.

Efficacy of Vein Visualization Devices for Peripheral Intravenous Catheter Placement in Preterm Infants: A Randomized Clinical Trial.

The aim of this randomized controlled trial was to examine the efficacy of vein visualization devices and the routine method for insertion of peripheral intravenous catheters (PIVCs) in preterm infants. The study was conducted between June 2016 and April 2017 in the neonatal intensive care unit of Bakirköy Dr Sadi Konuk Education and Research Hospital. Participants (N = 90) were randomly assigned to the infrared group (n = 30), the transilluminator group (n = 30), or the control group (n = 30). Time to successful cannulation was significantly lower for the infrared group (8.70 ± 2.56 seconds) than for the transilluminator group (45.27 ± 30.83 seconds) and the control group (17.30 ± 8.40 seconds) (P ≤ .001). Success of the first attempt was significantly higher in the infrared and transilluminator groups than in the control group (P ≤ .05). Dwell time of the PIVC in place was significantly higher in the infrared group than in the transilluminator and control groups (P ≤ .05). Neonatal Infant Pain Scale scores were significantly higher in the transilluminator group (0.60 ± 0.855) than in the infrared (0.33 ± 0.182) and control groups (0.33 ± 0.182) while seeking an appropriate vein (P ≤ .001). The use of an infrared device provides efficacy in time to successful cannulation, success of the first attempt, length of the time the catheter is in place, and technique-related pain.

Does the Use of a Vein Visualization Device for Peripheral Venous Catheter Placement Increase Success Rate in Pediatric Patients?

BACKGROUND: Peripheral intravenous catheterization is one of the most frequently encountered medical procedures for hospitalized children and is one that can often be painful. Pediatric nurses should therefore use techniques that increase the success rate or shorten the duration of peripheral intravenous catheterization. OBJECTIVES: This study was performed with the objective of determining the effect of using a vein visualization device on the success of the procedure. Success was determined based on the number of attempts per patient, the duration of the procedure, and the first stick success rate. METHODS: This was a randomized, controlled experimental study on 129 children aged 3 to 18 years. RESULTS: The duration of peripheral intravenous catheterization was shorter in the study group (S) than in the control (C) patients (37.24 ± 20.07 vs 172.65 ± 153.21 seconds; P = 0.001), with fewer attempts (S, 1.08 ± 0.28; C, 2.23 ± 1.57; P < 0.01). The first stick success rate was higher than [corrected] the control group (S, 91.7%; C, 47.4%; P = 0.001). CONCLUSIONS: Peripheral intravenous catheterization using vein visualization device support reduces the number of attempts per patient and the operation duration but increases the rate of first stick success. We may therefore state that vein visualization device support improves the success of peripheral intravenous catheterization.

The Impact of 3 Different Distraction Techniques on the Pain and Anxiety Levels of Children During Venipuncture: A Clinical Trial.

OBJECTIVES: Invasive procedures are important causes of pain and anxiety during hospitalization. This study aimed to evaluate the effect of 3 different distraction methods on the pain and anxiety levels of children during venipuncture. METHODS: This was a randomized controlled trial conducted with 180 children of 6 to 10 years of age; data were collected in the months of August to November 2016. Participants were randomized in 4 groups; the children in group 1 watched cartoon movies (CM), the children in group 2 played video games (VG), the children in group 3 were distracted by their parents' verbal interactions (PI), whereas no distraction method was used on the children in group 4 (control group). The levels of anxiety and pain perception were evaluated independently based on the feedback from the children, the nurse observer, and the parents. The Children Fear Scale was used to evaluate anxiety levels and the Wong-Baker Pain Scale was used to evaluate the pain levels of the children. RESULT: The difference between the groups based on both the anxiety levels and pain scores during venipuncture was statistically significant (P<0.05). The lowest level of anxiety and pain perception was reported in the VG group. The scores observed both in the CM group and the PI group were significantly lower than in the control group (P<0.05). DISCUSSION: The distraction techniques of playing VG, watching CM, and PI appear to be effective in reducing anxiety and pain perception in children during the procedure of venipuncture. The most effective method was playing VG.

Relationship Between Coping Strategies, Religious Attitude, and Optimism of Mothers of Children With Cancer.

INTRODUCTION: The purpose of this study was to examine the relationship between coping strategies, religious attitude, and optimism of mothers of children with cancer. METHOD: The sample was 97 mothers of children with cancer. To collect data, the Coping Strategy Questionnaire, Religious Attitude Scale, and Life Orientation were used. RESULTS: There were positive correlations between the total score of Coping Strategy Questionnaire and emotional scores of Religious Attitude Scale ( r = 0.170, p = .04). The correlation relationship between mothers' coping, religious tendencies, and optimism tendencies was not significant ( p > .05). There were also positive correlations between Coping Strategy Questionnaire Social Support Seeking subscale and the total scores of Religious Attitude Scale ( r = 0.189, p = .03) and Life Orientation Test ( r = 0.183, p = .03). DISCUSSION: Mothers with a higher religious attitude had bettter social support and were more optimistic. These results will contribute to understanding the influence of religion in different cultures.

Reliability and validity of the Bristol Breastfeeding Assessment Tool in the Turkish population.

BACKGROUND: breast milk is a natural source of nourishment, with a high level of bioefficacy that is easily digestible, easy to deliver, providing all the fluids, energy and nutrients that are needed for the optimum growth and development of a newborn. OBJECTIVE: this research aims to conduct a reliability and validity study of the Bristol Breastfeeding Assessment Tool (BBAT) in the Turkish population. DESIGN: the research was conducted in methodological design. SETTING: the Child Health Follow-up Polyclinic of a university hospital in Istanbul. PARTICIPANTS: the participants were 217 breastfed infants and their mothers. FINDINGS: the internal consistency of the Turkish version of Breastfeeding Assessment Tool (Cronbach's alpha = 0.77) and the intraclass correlation level are high (ICC = 0.89). Breastfeeding Assessment Tool displayed a high correlation with LATCH (Latch Audible, Swallowing, Type of Nipple, Comfort of Breast/Nipple, H-Hold/Position) (Pearson r = 0.76; p = 0.000). CONCLUSIONS: Breastfeeding Assessment Tool was successfully adapted into Turkish as a reliable and valid breastfeeding assessment tool that can be quickly and easily administered, and it was shown that the instrument could be readily adapted into other languages as well. IMPLICATIONS FOR PRACTICE: the Turkish version of Breastfeeding Assessment Tool is now available to Turkish midwives and nurses, who will be able to employ an instrument for breastfeeding assessment that has been proven effective. More studies are needed to demonstrate the efficacy of the instrument.

Pain and factors that affect its definition as defined by preschool age children: a qualitative study

The aim of this study was to determine the definitions of pain by pre-school age children and factors that affect these definitions. The study was conducted on children aged between four and six years (N=146) in the city of Karaman in Turkey. Qualitative and quantitative research design were used together in this study. This study's qualitative tradition method was phenomenologic research. The data were assessed using descriptive statistics and thematic analysis. The children's definitions of pain were found to be affected by their hospital and daily life experiences. The preschool age children generally defined pain in similar ways, and everything that made children feel pain made them think about it. Sometimes their family members, hospital equipment, and health staff lead them to think about pain.

Factors associated with breastfeeding initiation time in a baby-friendly hospital in Istanbul.

AIM: To investigate perinatal factors that affect breastfeeding of newborns delivered at a baby-friendly public hospital in Turkey, including the time of the first physical examination by a pediatrician, the first union with their mothers, and the first breastfeeding time after delivery. METHOD: The research was conducted from May 2nd through June 30th, 2011, in a baby-friendly public hospital in Istanbul. The sample consisted of 194 mothers and their full-term newborns. The data were collected via an observation form developed by the researchers. In analyzing the data, the average, standard deviation, minimum, maximum values, Chi-square, and percentages were used. RESULTS: The results revealed that the first physical examinations of the newborns were performed approximately 53.02±39min (range, 1-180 min) after birth. The newborns were given to their mothers approximately 69.75±41min (range, 3-190 min) after birth. Consequently, the first initiated breastfeeding took place approximately 78.58±44min following birth, and active sucking was initiated after approximately 85.90±54min. A large percentage of the newborns (64.4%) were not examined by a specialist pediatrician within half an hour of birth, and 74.7% were not united with their mothers within the same period. Also, the newborns who initiated breastfeeding within the first half hour had significantly earlier success with active sucking and required significantly less assistance to achieve successful breastfeeding. CONCLUSION: The newborns in our study met with their mothers late in the birth ward because examinations of the newborns were delayed. The newborns began initial sucking later, and this chain reaction negatively impacted the breastfeeding success of the newborns.

The effects of healthy lifestyle behaviors of mothers on obesity in preschool children.

OBJECTIVE: To determine the relationship between healthy lifestyle behaviours of mothers and obesity in their pre-school children. METHODS: The cross-sectional study was performed in a district of Istanbul, Turkey, between April and June 2011, and comprised children aged 4-6 years attending public pre-schools and their mothers.. Data was obtained using a questionnaire and Healthy Lifestyle Behaviours Scale-II. Number Cruncher Statistical System 2007 was used for statistical analysis. RESULTS: Of the 531 children in the study, 246(46.3%) were girls. Overall prevalence of overweight was 136(25.6%), obesity 77(14.5%)Overweight mothers were 126(23.7%), and obese mothers were 31(5.8%). The mothers of obese children obtained lower scores in the physical activity (p<0.05) and nutrition (p=0.001) subscales, and their total score was also lower (p<0.05).. CONCLUSIONS: Lifestyle behaviours of mothers, especially with respect to nutrition and physical activity, may influence obesity among preschool children. Strategies should be developed to improve the physical activity and eating habits of mothers.

Determination of methods used by the neonatal care unit nurses for management of procedural pain in Turkey.

OBJECTIVE: To determine the pharmacological and non-pharmacological methods used by neonatal intensive care unit nurses to reduce procedural pain. METHODS: The cross-sectional study was conducted from September 2011 to June 2012 and comprised nurses employed in the paediatric departments, consisting of neonatal intensive care units and newborn units, of 15 hospitals in various cities of Turkey: 8 in Istanbul, 3 in Izmir and two each in Antalya and Edirne. Data was collected using a questionnaire and analysed using SPSS 15. RESULTS: The mean age of the 486 nurses was 28.19±5.14 years; 316(65%) had bachelor's degrees; 278(57.2%) had nursing experience greater than 6 years; and 322(72.5%) had newborn nursing experience greater than 6 years. Overall, 364(74.9%) nurses used non-pharmacological methods, and 145(29.8%) used pharmacological methods for pain relief. The most commonly used non-pharmacological methods were skin touch 364(75%) and giving a pacifier 269(55.3%). The most commonly used pharmacological methods were paracetamol and ibuprofen by 145(29.8%) nurses. A statistically significant difference was found between the level of education and use of pharmacological and non-pharmacological methods for pain relief (p< 0.05). CONCLUSIONS: Among the nurses in both groups, very little pain management was used for invasive procedures. Educational programmes for pain management in newborns should be arranged to develop an institutional culture. Guidelines for these patients' pain management should also be established.

The effect of combined stimulation of external cold and vibration during immunization on pain and anxiety levels in children.

PURPOSE: Procedures involving needles are the most common and major sources of pain in children. External cold and vibration via Buzzy (MMJ Labs, Atlanta, GA) is a method that combines cooling and vibration. DESIGN: This study investigated the effect of the combined stimulation of skin with external cold and vibration via Buzzy on the pain and anxiety levels in children during immunization. METHODS: This study was a prospective, randomized controlled trial. Children were randomized into two groups: experimental (external cold and Buzzy) and control (no intervention). The pain and anxiety levels of the children were assessed using the Wong-Baker FACES scale and Children Fear Scale. FINDING: The experimental group showed significantly lower pain and anxiety levels than the control group during immunization. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The combined stimulation of skin with external cold and vibration can be used to reduce pain and anxiety during pediatric immunization.