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Distraction had a positive effect on children's distress behavior across the populations represented in this study. The effect of distraction on children's self-reported pain is influenced by moderator variables. Controlling for age and type of painful procedure significantly increased the amount of explained variance, but there are other unidentified moderators at work.

The Iowa Model-Revised remains an application-oriented guide for the EBP process. Intended users are point of care clinicians who ask questions and seek a systematic, EBP approach to promote excellence in health care.

ELA-Max, applied for 30 minutes before IV cannulation, has an anesthetic effectiveness similar to EMLA applied for 60 minutes. Some children rated IV insertion pain fairly high for both hands (eg, 60 on a 0- to 100-point scale) despite anesthetic treatment. Preprocedural anxiety may affect the perception and/or rating of pain. There were no differences between hands that were treated with EMLA or with ELA-Max for success of IV insertion.

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This study evaluates the impact of parent-provided distraction on children's responses (behavioral, physiological, parent, and self-report) during an IV insertion. Participants were 542 children, 4 to 10 years old, randomized to an experimental group that received a parent distraction coaching intervention or to routine care. Experimental group children had significantly less cortisol responsivity (p = .026). Children that received the highest level of distraction coaching had the lowest distress on behavioral, parent report, and cortisol measures. When parents provide a higher frequency and quality of distraction, children have lower distress responses on most measures.Virtually all children undergo invasive medical procedures. Whereas some children only experience preventative immunizations, others require diagnostic tests and therapeutic treatments for serious illnesses. These experiences can provoke various levels of anxiety, fear, and pain in the child and a range of child behavioral responses from calm and controlled to panic and flailing. When a child is distressed, families and health care providers often experience anxiety, helplessness, and guilt. The procedure may then become technically more difficult (i.e., more attempts), further adding to everyone's discomfort. Experiencing stressful medical procedures in childhood can have long-term consequences, impacting the individuals' reaction to later painful events and acceptance of health care interventions in adulthood (von Baeyer, Marche, Rocha, & Salmon, 2004).Distraction is a cognitive-behavioral intervention that is effective in reducing pain and distress for many children undergoing painful medical procedures (Kleiber & Harper, 1999;Uman, Chambers, McGrath, & Kisely, 2008). Distraction diverts attention from an adverse stimulus by redirecting attention to something else such as a book, toy, or nonprocedural Correspondence should be addressed to Ann Marie McCarthy, College of Nursing, University of Iowa, NB 344, Iowa City, IA 52242. ann-mccarthy@uiowa.edu. NIH Public Access Author ManuscriptChild Health Care. Author manuscript; available in PMC 2011 June 2. talk. An effective distractor stimulates the senses, is developmentally appropriate, easily implemented, acutely engaging, and able to compete with negative stimuli to capture the child's attention (Cavender, Goff, Hollon, & Guzzetta, 2004). Evidence suggests that distraction may help the child to cope not only with the immediate medical procedure, but may also buffer memories of the experience so that the individual remembers less of the negative aspects, which may impact future responses to painful medical procedures (Cohen et al., 2001;Salmon, Price, & Pereira, 2002).Young children generally need help or "coaching" to use distraction effectively. Professionals such as child life specialists, nurses, and psychologists typically provide distraction coaching, but the availability of these professionals to provide the intervention is limited in most practice settings. At the same time, many...