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CHILDREN are valuable and special in the lives of the parents

Children will be the asset of nation. They are important and special in the lives of the parents. The children are frightened to come to the hospital and start crying on finding health personnel as they connect hospital and health personnel with pain. Hospitalisation constitutes a crisis in newborns life as the kid has to experience major stress like pain.

A population based mostly data on hospital entrance for children was done. Of most 79, 272 children, children aged 0-4years and males were admitted more frequently. During the one year registration amount of 79, 272 children age between 0-17 years were accepted. Among this 63. 5% was aged 0-4years, 24. 8%aged 5-9years and 11. 7% aged 10-17 years. Therefore the hospitalization rate is high among preschoolers. In India of about 1889 circumstances of children generally less than 5 years group children are getting hospitalised with various disease conditions. In all age groups, entrance rate were significantly higher among children aged 0-6years than in older age group children(6-9 years-16/1000)and 10-17years(4. 8/1000). (Johans. C. Vander, Journal list >BMC Fam Pract> vii 2010).

Venipuncture and Intravenous cannulation will be the routine types of procedures done in the ward which in turn causes pain and discomfort. A lot of the children who having intravenous cannulation may experience moderate or severe pain and elevated level of pre-procedural and procedural problems.

From the Medical Interventions Classification identified Therapeutic Play is a most purposive and also includes a primary use of toys or various other material like stuffed doll inorder to help the kids in proper communication through an efficient belief and also bettering the knowledge of the kids by helping them in gaining the mastery of the environment. (www. kido corporations. com)

Play is an outstanding activity for many children. . One of the most effective involvement is therapeutic play which include activities such as permitting the child to give an injection to a doll or stuffed toy to reduce the stress of injections.

Therapeutic play has its main target the mental well-being of the kid. It accomplishes this through the use of play and or creative arts 'the play remedy tool kit'. It might be used to treat or assist in alleviating a gentle one off mental as well as the psychological problems which is effective in restricting the child to function in a standard manner. (www. play therapy. org. uk)

NEED FOR THE STUDY

Almost all the children has dread while entering a healthcare facility and also while discovering the personnel employed in the hospital especially the personnel nurses in supplying injection. Thus it's very essential to decrease the fear and the stress of pain of the kid by distracting the mind through restorative play.

Desiree Lie. , (2002) conducted a report on minimizing needle pain in children. Study recommended that venipuncture is associated with substantial problems among children. Between 34% and 64% of children experience stress of pain from the procedure. The study recommended that 50% of children survey needle stick experiences as annoying and painful, which in turn causes subsequent high levels of anticipatory fear and distress. Worries of pain and needle phobia in children can lead to poor health effects, including medical treatment. Different strategies have been reported to reduce the distress associated with venipuncture among children. Distraction techniques such as play remedy can lessen pain in children.

William, Lopez. et. al. , (April-2008) analyzed that therapeutic play is very much indeed useful and effective in making children to get ready for painful strategies. The results of the analysis helped in improving the level of awareness of the nurses as well as the father or mother regarding the need of play, especially heilighting the effectiveness of therapeutic play as an important part in making the youngsters to get ready for painful techniques.

Pain is often associated with dread, stress, and stress. Several non-pharmacologic techniques, such as distraction, leisure, guided imagery and cutaneous stimulations, provide coping strategies that may help reduce pain perception make pain more tolerable, lower anxiety and improve the performance of analgesics. (Kachoyeanos and Friedhoff, 1993)

Behavioural changes are common indicators of pain and are specially valuable in assessing pain in nonverbal children. Children's behavioural responses to pain change with time of follow a developmental pattern. Children with an increase of positive moods can happen to be in less pain than they actually are. Children who use passive coping behavior may rate pain as more extreme than children who use dynamic coping behaviour.

Preschoolers reply more favourably to pain than youngsters to preparatory interventions such as description and distraction. Preschoolers must locate their pain and may use appropriate pain scales. (Marilyn. J. Hockenberry, Wong's Essentials of Pediatric Nursing)

The past twelve months of experience in the paediatric ward through the clinical placing many children were accepted. All the admitted babies were started with IV range. It is challenging job for nurses to start out IV range for the kids. Because of the injection the children can be more aggressive and they cry more. Therefore the nurses were finding difficulty to get started on IV line. Because of the cry and uncooperativeness with the nurses, sometimes they could get more prick. It causes worsen the problem. Also the kids will be disturbed in physical form and psychologically. It will also affect the further treatment of the kid.

In order to obtain a good co-operation with the kid relaxation of brain of the kid is vital. Hence the utilization of therapeutic play is suited to relaxation of the child. So the researcher felt the importance of giving restorative play before doing unpleasant strategies in preschool children.

STATEMENT WITH THE PROBLEM

A study to assess the potency of restorative play during intravenous cannulation on level of pain among children admitted in a specific hospital at Salem.

OBJECTIVES

1. To get ready and validate the treatment on healing play for management of unpleasant procedures.

2. To evaluate and compare the post-test degree of pain during intravenous cannulation among children between the control group and experimental group.

3. To find out the association between your post test level of pain on the list of experimental with their selected demographic variables. (years in years, gender, behavioural respond to intravenous cannulation).

HYPOTHESES: (Degree of significance at p< 0. 05)

H1: You will see a significant reduced amount of pain among experimental group after exposed to therapeutic play than control group who've not uncovered.

H2: There will be a significant association between your post-test degree of pain among children and their picked demographic parameters in the experimental group.

H2(a): There will be a significant association between your post-test degree of pain among children and how old they are in the experimental group.

H2(b): You will see a significant association between your post-test level of pain among children and their gender in the experimental group

H2(c): There will be a significant relationship between your post-test degree of pain among children and their behavioural response in the experimental group.

OPERATIONAL DEFINITION

1. Measure the effectiveness:

It refers to the changes in the amount of pain during intravenous cannulation after healing play among preschool children.

a. Degree of pain :

It identifies a distressing experience felt by the child during invasive process which is assessed by Wong-Baker faces pain ranking range and the report was 0, 2, 4, 6, 8, 10 which is interpreted as No damage, hurts a bit, hurts a little more, hurts even more, hurts a whole lot, hurts most detrimental respectively.

2. Therapeutic play:

It refers to a kind of play which is given to the child before intravenous cannulation, this include, permitting the kid to give an treatment to a stuffed doll by using Venflon without stillet and other needed materials such as plaster, cotton balls and splint.

3. Intravenous Cannulation:

It identifies the insertion of needle into the vein of the kid, after getting admitted in the hospital for the purpose of presenting medications.

4. Demographic parameters:

(a)Time:

In this study it refers to age the child between your generation of 3-6 years who undergone intravenous cannulation.

(b) Gender:

In this analysis it refers to both son and lady child.

(c) Behavioural Reaction to intravenous cannulation:

In this review it identifies the behaviour of the kid which involves agitation, fear, relax and cry.

ASSUMPTIONS

1. The child may experience pain during unpleasant procedures.

2. The kid may achieve distraction and in so doing level of pain is reduced after therapeutic play.

ETHICAL CONSIDERATION

Written authorization was extracted from the concerned power where the review was conducted. Written consent obtained from the moms after explaining the goal of the study. All the information was kept private and used only for the present analysis.

DELIMITATION

Data collection period was delimited to 6 weeks.

The analysis was delimited to children considering intravenous cannulation only.

The research was delimited to 20 examples as control group and 20 examples as experimental group. .

The analysis was delimited to Pranav hospital in Salem.

SUMMARY

This chapter handled the introduction, dependence on the study, declaration of the situation, objectives, hypotheses, functional definitions, assumptions, ethical considerations and delimitations.

CHAPTER -II

REVIEW OF LITERATURE

Review of literature is a key part of research process. The literature review is to discover what has previously been done about the condition to be researched, what remains to be achieved, what methods have been used in other research and how the result of other research in the region can be combined to build up knowledge.

It is vital step and can be done before and after selecting the issue. It can help to know what has already been known about the topic. (A. P. Jainco. 2005)

The chapter handles review of literature, the studies researched have been assemble under the next sections,

Section-I: Studies related to therapeutic play

Section-II: Studies related to level of pain during unpleasant procedures.

Section-III: Studies related to software of Gate Control Theory

Section-IV: Conceptual Framework Work Predicated on Gate Control Theory.

SECTION-I: STUDIES LINKED TO THERAPEUTIC PLAY

Zahr. , Lina Kurdahi. , (2000) an article on therapeutic play for hospitalised preschoolers in Lebanon, it exhibited that over more than 3 decades that many hospitalised children undergo emotional stress. For the preschool age child, hospitalisation is new and bewildering experience and the hospitalization brought a bad impact on the normal functioning and development of the kids who were hospitalized. Various studies possessed developed to be able to reduce the fear and the strain of hospitalization of the children who got admitted in the hospital. . Several studies examined the effect of therapeutic play on nervousness degree of hospitalised children. The today's study mainly focused on the physiological as well as the behavioural reactions to stressful clinic procedures. Since the research was conducted in Leabnon, the results of the study was quite definitely beneficiable for the experts in making an evaluation with the physiological as well as behavioural response of the children. Based on the day of admission the study method was implemented.

Schwartz, Albino, and Tedesco. , (2002) discovered that medically related therapeutic play was more effective than medically unrelated therapeutic play. The authors evaluated the effects of pre operative planning on pain decrease in 45 children aged 3&4 years. The kids were randomly given to 1 of three organizations: a control group, a medically unrelated play remedy group, and a medically related play therapy group. The medically related play included providing information to the child and parent and a role play that resembled genuine surgical procedure with hospital playthings. Results from the analysis concluded that children in this group were more cooperative and less upset than children in the other two communities, which claim that medically related play can become more effective in alleviating pain than unrelated play.

Cindy Dell Clark. , (2004) a journal issue regarding therapeutic play explain the effectiveness of the play which is often considered as an appropriate therapeutic involvement. . Play is more than subject of cognitive representation. There is no need for a play therapist to apply play. Play is effective in creating a significant field for transformative meaning engineering - there by converting vulnerability directly into painful injection in to cause for performing.

Rae, and Acquaintances. , (2004) compared the effects of play on the psychological modification of 46 children, aged 5to a decade, who had been hospitalised for an serious disorder. They randomnly allocated the children to 1 of four groups, therapeutic play, diversional play, verbal support, no treatment. The therapeutic play consisted of using medical and non-medical materials as well as puppets, dolls and toy pets. In this non-directive play, the facilitator encouraged re-enactments of activities while allowing the child to echo and interpret emotions. Results revealed that children who involved in therapeutic, non-directive play showed a significant decrease in self-reported hospital worries in comparison with children from other categories.

Fosson, Martin and Haley. , (2006) looked into the potency of guided medical play in minimizing nervousness and pain in latency get older children. 50 children, aged 5 to 9 years, were arbitrarily given to either the control group, where the child watched TV with a recreational therapist for 20 minutes or the experimental group, in which a recreational therapist facilitated medically focused play with the kid. This study found that but the mean degrees of anxiety and pain of children in the experimental group reduced more than children in the control group, the difference had not been sufficient to reach statistical significance. To be able to explain these findings, the authors known that the involvement consisted of only one 30-minute play period and the control group had usage of other kinds of play during hospitalisation.

SECTION-II: STUDIES RELATED TO DEGREE OF PAIN DURING PAINFUL PROCEDURE

Marion E. Broom. , (2000) conducted a study on children's medical doubts, coping behaviour design and pain notion during a agonizing procedure. This research explored the partnership among medical concerns, coping behaviour patterns and acute pain perceptions in 17 children who were encountering a painful medical procedure. Most the children perceived a great deal of pain through the painful method. No significant distinctions were found between the exhibited productive or passive coping behaviour and reported medical fear levels. Implications for practice relate to the need for continual preparation and support of children during a painful treatment.

Vihunen R. Sihvonen. , (2005) conducted a report, in this analysis 3-8 season old children's pain evaluation and management after IV cannulation were evaluated on two otological wards. The test consisted of 80 children. The organizations were weighed against each other; on one ward nurse used Encounters range in children's home diagnosis of pain while the other was a comparative ward. The info were analysed by cross -tabulations. 40%of children had severe or intolerable pain after IV cannulation. Children's home evaluation of pain and parent's observation correlated. Children got less pain on the ward where in fact the Faces size was found in pain analysis. However, there were distinctions in pain management methods between two wards. Nurses need more education to be able to assess and take care of children's pain adequately.

Uman, Chambers, Kisely. , (2006) conducted a report in determining the interventions that was applicable for the children with needle associated pain and also the stressful replies. . Needle associated treatment are very commonly seen in children with hospitalisation. . The study was done to assess the efficiency of cognitive-behavioural internal involvement for needle related procedural pain. A number of evidences are deciding the cognitive as well as behavioural reactions can be assessed in both children as well as the adolescents in deciding how to reduce pain and also stress which is associated with agonizing procedures.

SECTION-III: STUDIES RELATED TO Software OF GATE CONTROL THEORY

E. Ambika, (2003) to examine the potency of moist heat over dry temperature request on episiotomy of primi moms. In this analysis, Researcher determined Gate Control Theory of pain for conceptual framework. She figured dry heat is more effective than moist high temperature.

Annonymus. , (2003) conducted a report to compare the level of success of pain relief between hot and cold software in postnatal women with episiotomy in decided on clinics in Chennai. Modified Gate Control Theory of pain is used for conceptual framework.

Malathi. M. , (2006) conducted a study to assess the effectiveness of Simple rub ranch oil therapeutic massage and normal labour care on labour pain on the list of primi Para mothers in Government Clinic, Erode. In the analysis the researcher applied changed Gate control theory for conceptual construction model. She concluded that, less activation of free nerve endings because of the effect of therapeutic massage. So the samples are experiencing less pain perception in the lower belly and lumbar region.

SECTION-IV: CONCEPTUAL Body WORK PREDICATED ON GATE CONTROL THEORY

Gate Control Theory of Pain:

The Gate control theory of pain was first postulated by Melzack and Wall membrane in 1965. They will be the first to suggest that pain has an emotional and also a cognitive components along with physical discomfort. The theory advised that for pain, to pass through the gate there should be unopposed passage for nociceptive information arriving at the synapses in the substantia gelatinosa. Pain gate is also getting impulses produced by activation of thermo receptor or mechano receptors transmitted via large diameter myelinated 'A ' fibres which inhibit and ultra impose the tiny diameter impulses. Many non-pharmacological types of procedures such as massage, distraction technique such as watching television during venipuncture, effective communication, play, observing cartoons that will activate the nerve endings linked with large diameter fibres which can produce a reduced amount of pain by closing the 'pain gate'.

Based on the basic principle of gate control theory, the next conceptual construction is developed. Methods used to lessen pain on IV cannualation is by giving healing play among preschool children.

Stimulation of Pain Receptors:

The pain impulses will be carried out by the small diameter, slow conducting 'A, , C', fibres. Impulses journeyed through small diameter fibres will open the 'pain gate' and the individual feels pain.

Preschool children having more activation of pain reception during intravenous cannulation credited to inability expressing feelings related to dread and concern, misconceptions, less communication and less cooperation. Within the experimental group, a healing play is given as an involvement to reduce the pain during intravenous cannulation. It helps to promote the cognitive and interpersonal facet of development, gives a chance for the child to communicate thoughts, misunderstandings and concerns in their own vocabulary using both verbal and behavioral manifestation and to communicate the thoughts related to fear and concerns.

The amount to which a kid perceives and express pain is a result of his or her emotional state, expectations, personality and cognitive view. Cognitive strategies are part of the wholistic approach to health that the individual and a romantic relationship developed between the body, mind and soul. , cognitive strategies make use of the inner resources of mind to influence the pain experience.

Cognitive strategies work in two ways. First, they trigger the descending cortical modulating systems and second, they train the child to control, rather than be manipulated by the pain. These strategies play a substantial role in long term pain management.

Gating Mechanism:

The cognitive strategies utilizes the interior resources of head. this causes activation of descending cortical modulating system. Thus the physical pain can be controlled by relaxation, communication skill, problem solving. This may block the nociceptive circuit synapse and closes the gate of pain, thus the child perceives less pain during intravenous cannulation.

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