Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No.

(1) December 2020

Assessment of Pain Intensity among Preschool-age Children during Venipuncture

1Yahia Mohamed Sayed; 2 Soheir Abd-Rabou Mohamed; 3 Nagat Farouk Abolwafa

1. Master degree in Pediatric Nursing Faculty of Nursing, Minia University

2. Professor of Pediatric Nursing, Faculty of Nursing –Cairo University
3. Lecturer of Pediatric Nursing Faculty of Nursing – Minia University

Abstract
Background: Venipuncture is a devastating medical, emotional, and physical problem for pediatric patients and their
families. Blood drawing is one of the most frightening and distressing nursing procedures for hospitalized children.
Aim: To assess pain intensity among preschool children during venipuncture. Research design: A descriptive
research design was used in the current study. Sample included 60 preschool-age children undergoing venipuncture
procedures over six months. Setting of the study: - Pediatric medical unit at Minia University Hospital for Obstetrics
and Pediatrics. Tools: Tool (I): structured interview questionnaire which developed by the researcher Tool (II):
Wong-Baker Faces Pain Rating Scale Tool (III): Children's Hospital of Eastern Ontario Pain Scale (CHEOPS).
Results: The highest percentage of the studied preschool-age children experienced severe pain during venipuncture
procedure according Wong-Baker Faces Pain Rating Scale. The total mean scores of Wong-Baker Faces Pain Rating
Scale and Children's Hospital of Eastern Ontario Pain Scale were high markedly during venipuncture. There were
statistically significant negative correlations between children's age and the total mean scores of the CHEOPS and
Face Pain Rating Scale during venipuncture. Conclusion: it was concluded that preschool-age children complained
from severe pain intensity during venipuncture procedure. Recommendation: An educational training program is
mandatory for pediatric nurses about pain assessment and pain management strategy during venipuncture and other
painful procedures.
Keywords: venipuncture, preschool-age children, pain intensity

Introduction &Danford, 2016). Uncontrolled pain also has a direct impact

Children are not outlandish with pain; in fact, it is a on health outcomes and more than a few effects on all areas of
part of their lives. They experience it during vaccination and life (Kahsay, 2017).
venipuncture in the early days of their births and even Venipuncture is a recurrently performed needle-
common diseases in their childhood. Irrespective of this related procedure, is one of the most alarming experiences and
universality of pain, it is yet a complex and multidimensional a common source of moderate to severe pain among children.
experience that is hard to clearly define and even more Venipuncture is a devastating medical, emotional, and
troubling when trying to understand what pain is among physical problem for both pediatric patients and their families
children (Ebrahimpour, Pashaeypoor, Salisu, (Walther-Larsen et al., 2017). Painful, invasive procedures
Cheraghi&Hosseini, 2019). are disturbing - for many children, worse than the disease
According to Becker, Navratilova, Nees, and Van itself. The seemingly endless barrage of needle sticks
Damme (2018), and the International Association of the frightens children and tears at the heart of parents, who are
Study of Pain [IASP] (2020), pain is much more than the unable to guard their children against them. One can assume
conscious perception of a sensory event. It is aversive and that the prick of a needle will hurt anyone, it is quite clear that
inseparably linked to emotion as reflected in the generally there are significant differences between children in how they
accepted definition of pain as "an unpleasant sensory and respond to noxious stimuli (Karlsson, Rydstrom,
emotional experience associated with actual or potential tissue Enskar&Englund, 2014).
damage, or described in terms of such damage". Meentken, Beynum, Legerstee, Helbing and
Emerging evidence from a recent study by Levy and Utens, (2017) documented that hospitalized children undergo
Mills (2018) emphasized that pain is considered the fifth vital multiple, cyclic procedures such as venipuncture throughout
sign. In the same context, Pancekauskaitė and Jankauskaitė their treatment course, and many describe such procedures as
(2018) pointed out that pediatric pain and its assessment and the most distressing part of their hospitalization. Management
management are challenging for health care professionals. of pain is a basic need and precise of all children; effective
Pediatric procedural pain is often underestimated and pain management requires health professionals, including
neglected because of various myths, beliefs, and difficulties in pediatric nurses, is eager to try many interventions to achieve
its evaluation and treatment. It is known that neonates and optimal results.
children can feel pain and that it has long-term effects that last Bukola and Paula, (2017); El Geziry, Toble, Al
through childhood into adulthood. Kadhi, Pervaiz, and Al Nobani, (2018) emphasized that
Pain is a substantial source of distress for unrelieved continuing pain may have untoward effects on
hospitalized children, family caregivers, and healthcare children's health, functional abilities, and quality of life.
providers alike. Pain in children can be produced from Appropriately managing the pain from vein punctures is
physical damage, disease process, invasive procedures, and associated with shorter hospital stays and lower hospital costs.
other unknown factors (Amponsah et al., 2020). Several Freedom from pain is the right of children and must be
previous studies have shown that children's common source of considered in nursing practice. Pain-reducing methods are
pain comes from medical procedures and nursing, such as grouped into two categories pharmacological and non-
immunization and venipuncture (Thrane, Wanless, Cohen pharmacological interventions or both (as integrative
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Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No. (1) December 2020
medicine). Non-pharmacological measures categorized into
biophysical interventions like massage, acupuncture, and Sample: -
transcutaneous electrical nerve stimulation (TENS), and heat The study sample consisted of all available
and cold therapy, behavioral-cognitive strategies such as preschool-age children undergoing venipuncture procedures
distraction, relaxation, play, guided imagery, therapeutic over six months (the total number was 60 children) who
touch, biofeedback, thought stopping, positive self-talk. admitted to the pediatric medical unit at Minia University
Alotaibi, Higgins, Day and Chan, (2018) documented that Hospital for Obstetrics and Pediatrics (MUHOP).
the mitigation of suffering is one of the four fundamentals of
nursing care. The pain must be detected before it can be Inclusion criteria:
alleviated, and the assessment of pain is an essential part of  Children aged 3-6 years.
nurses' responsibilities.  Children exposing to peripheral venipuncture (blood
sampling) without interventions to decrease pain
Significance of the Study during puncture.
Despite the up warding evidence on pain
management and the accessibility of evidence-based clinical Setting: -
guidelines, pain in children is still inadequately treated. This The current study was conducted in the pediatric
can be attributed to a lack of knowledge among health medical unit on the fourth floor at Minia University Hospital
professionals, misconceptions among children and their for Obstetric and Pediatric (MUHOP).
families, or lack of guidelines (Thrane et al., 2016).
Through empirical observations and experiences as a Data Collection Tools:
clinical instructor in the pediatric care units, it was noticed The following three tools were used to collect the required
that many children who are scheduled for venipuncture for data: -
blood sampling are exposed to varying intensity of pain.
Based on the literature review, preschool-age children were Tool I: A structured interview questionnaire in the Arabic
selected to participate in the current study because they are language was designed by the researcher after reviewing the
among the most affected age groups in the hospital. They have related literature and consists of 19 questions. It divided into
worries about the anticipation of the painful procedures, fear two parts:
of bodily injury from mutilation, bodily intrusion, body image Part 1: - Personal and social characteristics of children as age,
changes, disability, or even death. As well they perceive gender, rank, place of residence, mothers' age, and occupation.
painful procedure as a punishment for misdeeds. Part 2: - It involved 13 questions, five questions related to the
Effective procedural pain management is essential to child's medical history, such as diagnosis, history of previous
ensure adherence to the increased number of painful hospitalization, causes, and the number of prior
procedures required for health maintenance in pediatric hospitalization admissions. Also, it comprised five questions
patients and to create a cooperative and trusting relationship about past painful experiences that the child exposed to it. The
between health care providers, children, and their families. mothers of children have answered these questions as previous
Finally, most pain can be either prevented, treated, or at least painful events, factors that increase the child's pain, factors
reduced using inexpensive techniques. Despite this, most that decrease the child's pain, and the sites of the past pain.
children in our hospitals do not receive adequate treatment. This part included three questions related to the venipuncture
Thus; the aim of the current study was to assess pain intensity site, such as the site of venipuncture, numbers of vein
among preschool children during venipuncture. Ultimately, penetration, and the place where the venipuncture took place.
the results of the current study might generate attention and
motivation and evidence-base for further researches in the Tool II: - Wong-Baker Faces Pain Rating Scale, developed
field of pediatric pain as well as providing guidance and by Wong and Baker (1983). It was a self-report pain scale to
recommendations that should be reflected in pediatric nursing assess pain intensity in children aged 3 to 7 years. Each child
education and practice. was asked to choose the face that best described the intensity
of the pain being experienced. Each face was rated by number
Aim of the Study to determine the intensity of pain, which (0-10) coding as the
The aim of the current study was to assess pain following: (Face 0 = No hurt, Face 2 = Hurts a little bit, Face
intensity among preschool children during venipuncture 4 = Hurts a little more, Face 6 = Hurts, even more, Face 8 =
Hurt whole lot and Face 10 = Hurts worst). These faces were
Research question: - assigned scores from 0 to 10, with a higher score indicating a
 What is the level of pain intensity among preschool- higher severity of pain. According to a study in the Kingdom
age children during venipuncture? of Saudi Arabia, conducted by Alalo, Ahmad, and El Sayed
 What are the factors affecting the level of pain (2016) to identify pain intensity after an ice pack application
intensity among preschool-age children during prior to venipuncture among 50 school-age children that
venipuncture? modify the scoring system of Wong-Baker Faces Pain Rating
Scale to become score 0 referred to no pain, score two referred
Research design: - to mild pain, score 4-6 referred to moderate pain and score 8-
A descriptive research design was utilized to achieve 10 referred to sever pain. Apart from being acceptable and
the aim of the current study. Descriptive research seeks to straightforward, this scale had a high test-retest reliability and
provide an accurate description of observations of phenomena content validity. The scale had high reliability with a
(Grove & Gray, 2018). This design helps describe a situation Cronbach's alpha coefficient of 0.70, as tested by Drendel,
or an event in knowing the level of pain intensity among Kelly, and Ali (2011). The scale is available online without
preschool-age children during venipuncture. copyright restrictions.

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Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No. (1) December 2020
preschool children about their rights to withdraw from the
Tool III: - The Children's Hospital of Eastern Ontario study at any time without giving any cause and without any
Pain Scale (CHEOPS): Developed by McGrath et al. effect on the care of their children. Confidentiality was
(1985). The scale can be used to monitor the effectiveness of secured for each mother and her child, where they assured that
interventions for reducing pain and discomfort. A behavioral the study was harmless, and all the gathered data used for the
observation scale will be used to rate a child's intensity of pain research purpose only.
on six verbal and motor behaviors. Each behavior was
assigned a value according to the following criteria, 0 Procedure
(behavior that is the antithesis of pain), 1 (behavior that not Before the venipuncture procedure: -
indicative of pain, but not the antithesis of pain), two behavior The researcher gave the mothers and their children a
indicating mild to moderate pain), and 3 (behavior indicative clear and simple explanation of the aim and the content of the
of severe pain). The total score for the tool ranges from 4-13; sheet; reassuring them that the procedure is safe, and invited
a score higher than 4 indicates pain. Concerning the them to participate and written informed consent was obtained
reliability of the scale, Suraseranivongse et al. (2001) tested from mothers. The researcher interviewed the children and
the scale reliability and it was 0.80, which was considered their mothers individually to collect data related to the
acceptable. CHEOPS is available online without copyright characteristics of children who met the inclusion criteria using
restrictions. (tool 1) the interview took place in the beside area of the
medical unit where venipuncture for blood samples taken.
Validity: After explaining the purpose and during the interview the
The content validity of the data collection tool (1) researcher explained the first pain assessment scales (Wong-
was examined by three experts who were affiliated to the Baker Faces Pain Rating Scale) and the second pain scale
Faculty of Nursing, Minia, and Assuit University at the (CHEOPS) taught each child about how to use the scale. The
Pediatric Nursing Department. The tool was examined for time for the interview took about 30-35 minutes for each
content coverage, clarity, relevance, applicability, wording. child. The procedure was discussed with the responsible nurse
Based on experts` comments and recommendations, minor to gain her cooperation and to save time and effort
modifications had been made, such as rephrasing and
rearrangements of some sentences. During venipuncture: -
Only a usual venipuncture done by the assigned
Pilot Study: - nurse based on physician written order. During the
The pilot study was conducted on six children who venipuncture procedure, the researcher assessed and
met the inclusion criteria to investigate and ensure the documented the child's pain intensity using the behavioral
feasibility, objectivity, applicability, clarity, and adequacy, observation scale (CHEOPS). Immediately after the
and to determine possible problems in the methodological venipuncture, each child was asked to choose the face that
approach or tools. The results of the pilot study were used to describes his intensity of pain based on Wong-Baker Faces
test the proposed statistical and data analysis methods. The Pain Rating Scale. Data collection was conducted over 6
tools were completed without difficulty. Children who months extending from March 2019 till August 2019.
participated in the pilot study were included in the total
sample of the current study. Statistical Analysis
The collected data was coded, categorized, tabulated,
Ethical Considerations: and analyzed using the Statistical Package for Social Science
Written approval was obtained from the Research (SPSS 20.0). Descriptive statistics in the form of frequencies,
Ethics Committee at the Faculty of Nursing, Minia University. percentages for the qualitative variables, mean and standard
Written permission was granted from the director of MUHOP deviation for the quantitative variables was used. Chi square
and the chairpersons of the pediatric medical units after was used to test the association between two Qualitative
explaining the aim and nature of the study. The written variables. Spearman's rank correlation was used to assess the
informed consent was obtained from the mothers of children interrelationships among the quantitative variables. Graphs
after a complete description of the study's aim and nature to were done for data visualization using Microsoft Excel. The P
gain their acceptance and cooperation. Children and their - value of ≤ 0.05 indicates a significant result while, P value of
mothers were informed that contribution to the study was > 0.05 indicates a non-significant result.
voluntary. The researcher also informed the mothers and

Results:
Table (1): Percentage Distribution of the Studied Children According to Their Personal and Social Data (n=60).
Personal and social data No. %
Age / years:-
3-< 4 10 16.7
4 -< 5 18 30.0
5-< 6 22 36.6
6 10 16.7
Mean ± SD 4.6 ± .9 years
Gender:-
Male 36 60.0
Female 24 40.0
The child rank within the family:-
First 22 36.7
Second 26 43.3

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Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No. (1) December 2020
Personal and social data No. %
Third 8 13.3
Fourth or more 4 6.7
Mother educational level:-
Not read and write 42 70.0
Basic education 15 25.0
University 3 5.0
Mother job:-
Housewife 51 85.0
Working outside house 9 15.0
Place of Residence:-
Rural 40 66.7
Urban 20 33.3

Table (1) presented the personal data pertinent to children and their mothers who participated in the current study. More than
one-third (36.6%) of children's age ranged from 5<6 years, and their mean age was 4.6 ± .9 years. Besides, 43.3% of them ranked as
the second child, 60% were male, and 40% were female. The highest percentage (70%) of the mothers was not read and write, and
85.0% of them were housewives.

Table (2): Percentage Distribution of the Studied Children According to Their Medical History (N=60).
Child illness history No. %
Child's diagnosis:
Pneumonia 10 16.7
Diarrhea, vomiting and dehydration 22 36.7
Favism 3 5
Post streptococcal glomernepheritis 7 11.7
Nephrotic syndrome 6 10
Diabetes mellitus 12 20
Type of the disease:-
Acute 48 80
Chronic 12 20
Previous hospital admission:-
Yes 33 55
No 27 45
If yes how many times of admission to hospital (n = 33):
1 17 51.5
2 14 42.4
3 2 6.1
Mean ± SD 1.5 ± .6
Reason for admission (n = 33):-
Emergency 27 81.8
Follow up 1 3
Medical condition 5 15.2

Table (2) pointed out that 36.7% of the studied children diagnosed with diarrhea, vomiting, and dehydration, followed by
diabetes (20%). The majority (80%) of the studies children had acute health problems. More than half (55%) of children had previous
hospital admissions, and 51.5% were admitted to the hospital for the first time. The mean of prior hospital admission was 1.5 ± .6
times, and 81.8 % from children admitted at the hospital for an emergency health problem.

Table (3): Percentage Distribution of the Studied Children According to Their Previous Painful Experience (n=60).
Previous history of pain No. %
Previous painful experience:
Yes 60 100
No 0 0
If yes, most site of pain in the previous time:- #
Abdominal pain 48 80
Chest pain 4 6.7
Bone pain 8 13.3
Teeth pain 42 70
NET pain 42 70
Headache 25 41.7
If yes, in the home what is the most measures to decrease pain
sensation:-#
Go to Sleep and Rest 55 91.7
Taking Shower 5 8.3
Playing with friends 25 41.7
Using Analgesics 36 60
Best position feels comfortable:- #
Abdomen 14 23.3
Back 21 35
On side 1 1.7
Semi-sitting 25 41.7
Sitting 2 3.3
Things relief pain at hospital:-#
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Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No. (1) December 2020
Previous history of pain No. %
Presence of mother 60 100
Toys 32 53.3
Transitional objects 20 33.3
Play with children 33 55
# More than one answer was responded

Table (3) revealed that all (100%) of the studied children had previous painful experiences, and 80% of them suffered from
abdominal pain. The majority of children (91.7%) went to sleep and rest as home measures to relieve their pain, and 41.7% of them
felt comfort in a semi-sitting position. The mother's presence and playing with other children were the main things that reduced pain
in the hospital, as replied by 100% and 55% respectively of the studied children.

66.70%

33.30%

Dorsal hand veins Forearm veins (cephalic or basilic vein )

Figure (1): Percentage Distribution of Venipuncture Site among the Studied Children (n=60)

Figure (1) demonstrated that 66.7% of children had venipuncture in the dorsal hand veins whereas 33.3% had venipuncture
in the forearm veins.

60%
60%
50%
40%
40%

30%
20%
10%
0%
Moderate Severe pain
pain intensity
intensity

Figure (2): Pain Intensity during Venipuncture among the Studied Children According to Wong-Baker Faces Pain Rating
Scale (n=60)

Figure (2) showed that the highest percentage (60%) of the children suffering from severe pain intensity during the
venipuncture while 40%. of them suffering from moderate pain intensity during the venipuncture according to Wong-Baker Faces
Pain Rating Scale.

Table (4): Children's Hospital of Eastern Ontario Pain Scale among the Studied Children during Venipuncture (n=60).
CHEOPS No. %
Cry:
- No cry 0 0
- Moaning 30 50.0
- Silent crying 3 5.0
- Scream 27 45.0
Facial:
- Smiling 0 0
- Composed 18 30.0

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Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No. (1) December 2020
CHEOPS No. %
- Grimace 42 70.0
Verbal:

- The child talks about positive things 0 0

- No complains 0 0
- Complaints the Child about pain 25 41.7
- Child complains about pain, and other things 35 58.3
Torso:
- Neutral 0 0
- Shifting 5 8.3
- Tense 20 33.3
- Shivering 5 8.3
- Upright 4 6.7
- Restrained 26 43.3
Touch:
- Not touching 0 0
- Reach 6 10.0
- Touch 8 13.3
- Grab 18 30.0
- Restricted 26 43.3
- Reach and grab 2 3.3
Legs
- Neutral 0 0
- Squirming/ kicking 11 18.3
- Drawn 9 15.0
- Standing (kneeling) 24 40.0
- Restrained 16 26.7

Table (4) demonstrated that 50% of the studied children reacted by moaning during venipuncture. Seventy percent of them
showed face grimacing. Concerning the verbal items of CHEOPS, 58.3% of the studied children complained about pain, and about
other things. In relation to torso items of CHEOPS, 43.3% of children watched restrained. It was found that 43.3% of children their
touch was restricted during venipuncture. Relating to the legs element of CHEOPS 40% of the studied preschool-age children their
legs showed kneeling.

Table (5): Total Mean Score of Faces Pain Rating Scale and CHEOPS during Venipuncture among the Studied Children
(n=60).
Pain scales Total Mean Score ± SD
Wong-Baker Faces Pain Rating Scale. 7.2 ± 2.2
CHEOPS 12.2 ± .75

Table (5) evident that the total mean score ± SD of the faces pain rating scale among children during venipuncture was 7.2 ±
2.2 while The total mean score ± SD of CHEOPS among children was 12.2 ± .75.

Table (6): Correlational Matrix between Children's Age and the Total Mean Scores of CHEOPS, Wong-Baker Faces Pain
Rating Scale during Venipuncture (n=60).
Items Child age Total CHEOPS Total Face scale
Child age R
P- Value
Total CHEOPS R -.490-**
P- Value .000
Face scale R -.305-* .758**
P- Value .018 .000
*Statistically significant differences

Table (6) illustrated that there were statistically significant negative correlations between children's age and the total mean
score of the CHEOPS and Face Pain Rating Scale during venipuncture (r=-.490, P=<.0001 & r=-.30, P=<0.05 respectively), and the
other personal data of the studied children has no effect of their intensity of pain during the venipuncture procedure.

Discussion Sadek (2017) and Ebrahem et al. (2019) to examine the

The aim of the current study was to assess pain effect of cryotherapy on pain intensity at puncture sites among
intensity among preschool children during venipuncture. 40 children undergoing hemodialysis. The study results
Regarding the studied children's characteristics, the current confirmed that 42.5% of children ranked as the second child
study results proved that more than one-third of their ages within their families. On the contrary, in a recent Egyptian
ranged from 5-6 years, and their mean age was 4.6 ± .9 years. study conducted by Ebrahem et al. (2019) to examine the
These results were supported by an Indian study carried out by effect of cryotherapy and balloon inflation on reducing venous
Abishak (2017) who found that 40% of children's age ranged cannulation pain among 45 children undergoing hemodialysis.
from 5-6 years, and their mean age was 4.3 ± 1.09 years. It was found that the maximum percentage (46.7%) of the
The current study results revealed that 43.3% of the studied children was ranked as the first child.
studied children ranked as the second child, similarly, in an Regarding the gender of the studied children, the
Egyptian study held by El Said, Ouda, Mahmoud, and El- current study results showed that the highest percentage was
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Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No. (1) December 2020
males. These results were supported by a similar Egyptian effect before venipuncture on pain-related responses among
study held by El Said et al. (2017), who found that 60 % of 50 children. The results of the study indicated that 76% of
the studied children were males. In the same respect, Abishak studied children had previous hospital admissions.
(2017) found that 73.3% of the children were males, while In relation to the previous pain experience of studied
26.7% were female. On the contrary, a study conducted by children, the current study results revealed that all studied
Alalo et al. (2016) carried out a study to identify pain children had previous painful experiences. This result was
intensity after an ice pack application prior to venipuncture similar to a study done by Roy (2019), who summarized that
among 50 school-age children. The study summarized that 74%of studied children had previous painful experiences. The
52% of children were females, while 48% were males. results of the current study documented that 80% of them
The current study results proved that more than half suffered from abdominal pain. This result could be
of the studied children came from rural areas. This result rationalized as acute abdominal pain is one of the most
could be related to almost hospital referral of acute cases to common complaints in children. The same explanation was
MUHOP for better facilities and equipment and care for mentioned by Brusaferro, Farinelli, Zenzeri, Cozzali, and
children with various types of diseases in the Minia Esposito (2018), who documented that abdominal pain, is one
governorate and surrounding rural and semi-urban areas. In of the utmost common symptoms in children. The pain is
the same context, the United Nations Educational, often acute onset and may be due to several gastrointestinal
Scientific, and Cultural Organization [UNESCO] (2017) (GI) or extra intestinal causes.
documented that the rural population was 57% of the total According to Santillanes and Claudius (2015), as in
population worldwide. In the same line, Egypt Demographics adults, the usual site for venipuncture in infants and children is
Profile (2020) reported that the rural community was 57 % of the antecubital fossa. However, any reasonably accessible or
the total residents, and the rate of urbanization was 1.68 % easily visible peripheral vein may be used, such as those on
annual rate of change. In the same context, the results of an the hands, feet, or scalp for a tiny infant. The current study
Egyptian study carried out by Elhalafawy, Bahgat, Abd- results were in accordance with the above-mentioned
Elhafez, A., and Farag (2020) found that 80% of children empirical evidence and demonstrated that about two-thirds of
came from rural areas. children had venipuncture from dorsal hand veins, whereas the
Concerning the personal data related to the mothers rest had venipuncture from forearm veins. These results are
of the studied children, the current study results proved that similar to the findings of the study conducted by Abishak
the mothers' highest percentage (70%) were not read and (2017), who found that 60% of children metacarpal vein in
write. This result reflected the lower literacy rates among dorsal hand was punctured while 40% of them basilic vein
mothers who participated in the current study. In the same was punctured.
line, the Egypt Demographics Profile (2017) assured that Concerning the pain intensity level during
females' literacy rate was 65.5% compared to 63.5% in 2016. venipuncture site among the studied children related to Wong-
Accordingly, governmental and non-governmental Baker Faces Pain Rating Scale. The current study results
organizations' efforts should continue to focus on female showed that the highest percentage (60%) of the children
education, particularly in Upper Egypt. Because low levels of suffering from severe pain during venipuncture while 40|% of
literacy can hinder economic development in the current them had moderate pain. This result may indicate the suffering
rapidly changing, technology-driven world, this will positively of these children during venipuncture procedure.
reflect the health care system as a whole and care provided for Consistent with the current study results of El Said et
the sick child. al. (2017) who found that more than two thirds (72.5%) of
The current study results documented that more than children had severe pain during venipuncture at pre
one-third of children diagnosed as having diarrhea, vomiting, cryotherapy. A study done by Gaikwad, et al. (2017) was
dehydration, and one-fifth of them have diabetes. The current congruent with this result. They found that, the vast majority
study findings were in accordance with the World Health of them (93%) experienced severe pain. The current study
Organization (WHO) (2020), which documented that results are similar to the study's findings held by Aswathi
diarrheal disease is a chief reason for child mortality and (2015) to measure the effectiveness of local cold application
morbidity worldwide. It typically results from contaminated on pain response during intravenous cannula insertion among
food and water sources and is responsible for killing around children. The study findings concluded that the majority
525000 children every year. Severe dehydration and fluid loss (83.33%) of children experienced severe pain during
were the leading causes of diarrhea deaths. venipuncture.
A recent systematic review held by Patterson et al. This study results evident that the total mean score of
(2019) documented that the incidence rates in diabetes in the Wong-Baker Faces Pain Rating scale among children
children were available for 45% of countries (ranging from during venipuncture site was 7.2 ± 2.2.Similarly, Elhalafawy
6% in the sub-Saharan Africa region to 77% in the European et al. (2020) who found that the mean score of Wong-Baker
region). Worldwide annual incidence estimates were 98,200 Faces Pain score during fistula puncture was 7.266 and 5.667,
(128,900) new cases under 15-year (under 20 years) age- respectively, in days 1 and 2. These results are consistent with
groups. Corresponding prevalence estimates were 600,900 the results of the study conducted by Kurian (2019), who
(1,110,100) existing cases. The prevalence estimates have found that the total mean score of the faces pain rating scale
decreased in sub-Saharan Africa because allowance has been among children during venipuncture was 8.26 ± 1.36. The
made for increased mortality in those with diabetes. results of the current study were supported with that obtained
Concerning the previous hospital admissions of the by Fathalla and Bayoumi (2018), who found that total mean
studied children, the current study results showed that more score of the faces pain rating scale among children during
than half of the children had prior hospital admissions. This venipuncture was 6.28 ± .61. In the same direction, El Said et
result was similar to a quasi-experimental study conducted in al. (2017) found that the mean score of Wong-baker Faces
India by Roy (2019) to determine the local cold application's Pain Rating Scale for studied children was 8.30±1.80.

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Minia Scientific Nursing Journal (Print - ISSN 2537-012X) (Online - ISSN 2785-9797) Vol. (8) No. (1) December 2020
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