NURSING

Introduction

Canbulat and colleagues (2015, p. 33) conducted an experimental study to determine the “effects of external cold and vibration stimulation via Buzzy on the pain and anxiety levels of children during peripheral intravenous (IV) cannulation.” Buzzy is an 8 × 5 × 2.5 cm battery-operated device for delivering external cold and vibration, which resembles a bee in shape and coloring and has a smiling face. A total of 176 children between the ages of 7 and 12 years who had never had an IV insertion before were recruited and randomly assigned into the equally sized intervention and control groups. During IV insertion, “the control group received no treatment. The intervention group received external cold and vibration stimulation via Buzzy . . . Buzzy was administered about 5 cm above the application area just before the procedure, and the vibration continued until the end of the procedure” (Canbulat et al., 2015, p. 36). Canbulat et al. (2015, pp. 37–38) concluded that “the application of external cold and vibration stimulation were effective in relieving pain and anxiety in children during peripheral IV” insertion and were “quick-acting and effective nonpharmacological measures for pain reduction.” The researchers concluded that the Buzzy intervention is inexpensive and can be easily implemented in clinical practice with a pediatric population.

Relevant Study Results

The level of significance for this study was set at α = 0.05. “There were no differences between the two groups in terms of age, sex [gender], BMI, and preprocedural anxiety according to the self, the parents’, and the observer’s reports (p > 0.05) (Table 1). When the pain and anxiety levels were compared with an independent samples t test, . . . the children in the external cold and vibration stimulation [intervention] group had significantly lower pain levels than the control group according to their self-reports (both WBFC [Wong Baker Faces Scale] and VAS [visual analog scale] scores; p < 0.001) (Table 2). The external cold and vibration stimulation group had significantly lower fear and anxiety 163levels than the control group, according to parents’ and the observer’s reports (p < 0.001) (Table 3)” (Canbulat et al., 2015, p. 36).

TABLE 1

COMPARISON OF GROUPS IN TERMS OF VARIABLES THAT MAY AFFECT PROCEDURAL PAIN AND ANXIETY LEVELS

Characteristic Buzzy (n = 88) Control (n = 88) χ2
p
Sex
 Female (%), n 11 (12.5) 13 (14.8) .82
 Male (%), n 77 (87.5) 75 (85.2) .41
Characteristic Buzzy (n = 88) Control (n = 88) t
p
Age (mean ± SD) 8.25 ± 1.51 8.61 ± 1.69 −1.498
.136
BMI (mean ± SD) 25.41 ± 6.74 26.94 ± 8.68 −1.309
.192
Preprocedural anxiety
 Self-report (mean ± SD) 2.03 ± 1.29 2.11 ± 1.58 −0.364
.716
 Parent report (mean ± SD) 2.11 ± 1.20 2.17 ± 1.42 −0.285
.776
 Observer report (mean ± SD) 2.18 ± 1.17 2.24 ± 1.37 −0.295
.768

image

BMI, body mass index.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 36.

TABLE 2

COMPARISON OF GROUPS’ PROCEDURAL PAIN LEVELS DURING PERIPHERAL IV CANNULATION

Buzzy (n = 88) Control (n = 88) t
p
Procedural self-reported pain with WBFS (mean ± SD) 2.75 ± 2.68 5.70 ± 3.31 −6.498
0.000
Procedural self-reported pain with VAS (mean ± SD) 1.66 ± 1.95 4.09 ± 3.21 −6.065
0.000

image

IV, intravenous; WBFS, Wong-Baker Faces Scale; SD, standard deviation; VAS, visual analog scale.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 37.

TABLE 3

COMPARISON OF GROUPS’ PROCEDURAL ANXIETY LEVELS DURING PERIPHERAL IV CANNULATION

Procedural Child Anxiety Buzzy (n = 88) Control (n = 88) t
p
Parent reported (mean ± SD) 0.94 ± 1.06 2.09 ± 1.39 −6.135
0.000
Observer reported (mean ± SD) 0.92 ± 1.03 2.14 ± 1.34 −6.745
0.000

image

SD, standard deviation; IV, intravenous.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 37.

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Study Questions

1. What type of statistical test was conducted by Canbulat et al. (2015) to examine group differences in the dependent variables of procedural pain and anxiety levels in this study? What two groups were analyzed for differences?

2. What did Canbulat et al. (2015) set the level of significance, or alpha (α), at for this study?

3. What are the t and p (probability) values for procedural self-reported pain measured with a visual analog scale (VAS)? What do these results mean?

4. What is the null hypothesis for observer-reported procedural anxiety for the two groups? Was this null hypothesis accepted or rejected in this study? Provide a rationale for your answer.

5. What is the t-test result for BMI? Is this result statistically significant? Provide a rationale for your answer. What does this result mean for the study?

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6. What causes an increased risk for Type I errors when t-tests are conducted in a study? How might researchers reduce the increased risk for a Type I error in a study?

7. Assuming that the t-tests presented in Table 2 and Table 3 are all the t-tests performed by Canbulat et al. (2015) to analyze the dependent variables’ data, calculate a Bonferroni procedure for this study.

8. Would the t-test for observer-reported procedural anxiety be significant based on the more stringent α calculated using the Bonferroni procedure in question 7? Provide a rationale for your answer.

9. The results in Table 1 indicate that the Buzzy intervention group and the control group were not significantly different for gender, age, body mass index (BMI), or preprocedural anxiety (as measured by self-report, parent report, or observer report). What do these results indicate about the equivalence of the intervention and control groups at the beginning of the study? Why are these results important?

10. Canbulat et al. (2015) conducted the χ2 test to analyze the difference in sex or gender between the Buzzy intervention group and the control group. Would an independent samples t-test be appropriate to analyze the gender data in this study (review algorithm in Exercise 12)? Provide a rationale for your answer.

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