bahan tesis guided imagery evaluation of the magic island

290 PEDIATRIC NURSING/September-October 2009/Vol. 35/No. 5

Evaluation of the M a g i cIsland: Relaxation forK i d s Compact Disc

Managing childrens post-operative pain continues tobe a challenge becausenearly 50% of childrenreport severe pain after surgery( G a u t h i e r, Finley, & McGrath, 1998;LaMontagne, Hepworth, & Salisbury,2001). Effective post-operative painmanagement can lead to shorterlengths of stay in the hospital and bet-ter coping and emotional well beingafter discharge (Lambert, 1996).Analgesic medications are the mostcommon form of pain managementused with children post-operatively.H o w e v e r, studies re p o rt that pediatricpatients suffer moderate to severe painduring hospitalization even after re c e i v-ing analgesics (Gauthier et al., 1998;Gillies, Smith, & Parry-Jones, 1999;Plkki, Pietil, & Ve h v i l i n e n - J u l k u n e n ,

2003). The Agency for Health CarePolicy and Research and the AmericanSociety of Anesthesiologists havedeveloped guidelines that re c o m m e n dthe combination of pharm a c o l o g i c a land non-pharmacological techniquesto manage childre n s pain (Acute PainManagement Guideline Panel, 1992;American Society of Anesthesiologists,2004). Pain results from the re c i p ro c a lrelationship of sensory and aff e c t i v ecomponents of a noxious stimulus(Melzak & Casey, 1968). There f o re ,when a non-pharmacological interv e n-tion is combined with a pharm a c o l o g i cagent for the management of post-operative pain, both sensory and aff e c-tive pain may be reduced, more thanwith medication alone.

The need for interventions thatreduce childre n s acute pain on a short -t e rm basis is growing as a result of thecontinued demand for outpatient sur-g e ry, shortened hospital stays, and dif-ficulties with pain management in thehome. Non-pharmacologic cognitivei n t e rventions, such as guided imagery,

reduce or alter the pain experiencet h rough focus on a thought or image,t h e reby competing for the attention ofpainful sensations (McCaul & Malott,1984). Thus, imagery has the potentialto modify pain by diverting attention toa pleasant, non-painful stimulus.Relaxation can be used to facilitatei m a g e ry and may reduce pain bydiminishing the effects of stress, dis-tress, anxiety, or muscle tension( M c C a ff e ry & Pasero, 1999). The pur-pose of this study was to evaluate thee ffectiveness of a guided imagery CDin reducing post-operative pain andi n c reasing relaxation in children. A sec-ond goal was to evaluate the eff e c t i v e-ness of the CD to stimulate imagery inschool-age children.

L i t e r a t u re Review

Age Related to Pain and Imagery Studies have shown that school-age

c h i l d ren are able to describe their inten-sity of pain and appropriately make

Objectives and the CNE posttest can be

found on pages 296-297.

ContinuingNursingEducationSeries

Managing post-operative pain continues to elude health care professionals despite childrens reports ofsevere pain. Although research has demonstrated that guided imagery is a beneficial complementary treat-ment for pain, clinicians rarely incorporate it into their practice. This study evaluated the effectiveness of aguided imagery audio compact disc (CD) in reducing post-operative pain, increasing relaxation, and stimu-lating imagery in children by child life specialists in the clinical setting. This cross sectional study comparedpain and relaxation scores before and after the use of the CD. Sixteen children (7 to 12 years of age) report-ed pain on a 0 to 10 scale and relaxation on a 1 to 5 scale, and answered questions about what they imag-ined. Pain scores were significantly decreased, with no significant differences in relaxation scores. Findingssupport that school-age children are capable of using guided imagery, and relaxation may not be necessaryto achieve pain reduction.

Myra Martz HuthNancy M. Daraiseh

Melissa A. HensonS h a ron M. McLeod

Myra Martz Huth, PhD, RN, is AssistantVice President, Center for Pro f e s s i o n a lE x c e l l e n c e - R e s e a rch and Evidence-BasedPractice, Cincinnati Childre n s HospitalMedical Center, Cincinnati, OH.Nancy M. Daraiseh, PhD, is a Researc hAssociate, Center for Pro f e s s i o n a lE x c e l l e n c e - R e s e a rch and Evidence-BasedPractice, Cincinnati Childre n s HospitalMedical Center, Cincinnati, OH.

Melissa A. Henson, BS, CCLS, is a Child Life Specialist, Cincinnati Childre n s HospitalMedical Center, Cincinnati, OH.S h a ron M. McLeod, MS, CTRS, CCLS, is Senior Clinical Dire c t o r, Division of Child Life,Cincinnati Childre n s Hospital Medical Center, Cincinnati, OH.

Acknowledgments: The authors would like to acknowledge and thank Scott Byington,MHSA, CCLS, for his eff o rts in the initial stages of the study and to the children who part i c-ipated in this study.Statement of Disclosure : The authors re p o rted no actual or potential conflict of interest inrelation to this continuing nursing education art i c l e .

PEDIATRIC NURSING/September-October 2009/Vol. 35/No. 5 291

suggestions on pain-relieving methodsto their caregivers (Plkki et al., 2003).C h i l d ren use vivid imaginations in theirdaily life, and can use this skill of imag-ination and fantasy to provide thera-peutic distraction (Lambert, 1996).Childrens involvement in imagespeaks between the ages of 8 to 12years old (Olness & Kohen, 1996), andas children develop, they increase theirability to focus and pay attention(Thomas, 1985). School-age childre ncan, and do, use imagery and have thecapacity to create and becomeabsorbed in vivid mental images as ifthey were real (Huth, Van Kuiken, &B roome, 2006).

Guided ImageryI m a g e ry interventions have been

examined as methods of contro l l i n gpain and distress in children duringintrusive procedures (Broome,Rehwaldt, & Fogg, 1998; Jeffs, 2007;Pederson, 1995; Smart, 1997). Fewstudies have re p o rted the eff e c t i v e n e s sof using guided imagery or non-phar-macological techniques in the relief ofpost-operative pain in children (Huth,B roome, & Good, 2004; Lambert ,1996; Plkki, Pietil, Vehvilinen-Julkunen, Laukkala, & Kiviluoma,2008).

L a m b e rt (1996) taught 26 childre nand adolescents (7 to 19 years of age)ways to relax and use their imagina-tions before and after general surg e ry.The study consisted of 52 patients ran-domly assigned to an experimentalg roup or a control group. This tech-nique incorporated individualized childselected images into relaxation exerc i s-es, and included suggestions for heal-ing, minimal pain, and an uncomplicat-

study described pre v i o u s l y, Huth andcolleagues (2006) analyzed how chil-d ren in the treatment group usedi m a g e ry before and after surg e ry. Onan investigator developed diary, chil-d ren documented the reason for listen-ing to the imagery tape, level of re l a x-ation, and what they imagined while lis-tening to the tape. Data re p o rted fro ma subset of 36 patients showed 78% ofthe patients used the tape 24 hoursafter surg e ry most often for pain man-agement, relaxation, and sleep.C h i l d ren used the imagery tape moref requently at home after surg e ry thanb e f o re surg e ry. When children listenedto the tape, they most often imaginedgoing to the park, as suggested in thes c r i p t .

Most re c e n t l y, a randomized con-t rolled trial tested the effectiveness ofi m a g e ry and relaxation in school-agec h i l d ren (8 to 12 years) with a guidedi m a g e ry CD (Plkki et al., 2008). Sixtyc h i l d ren were randomly assigned to thet reatment or control group. The tre a t-ment group listened to a 20-minute CDthat suggested pain-relieving imageryand relaxation. Children in the tre a t-ment group re p o rted significantly lesspain than the control group immediate-ly after the intervention, but not 1 hourl a t e r. Nurses caring for the childre nw e re the data collectors, which mayi n t roduce bias. Other study limitationsinclude integrity of the treatment andlack of control for the amount and typeof opioid in effect at the time the inter-vention was given.

M e t h o d sDespite evidence in the literature

that supports the use of guidedi m a g e ry to reduce pain, anxiety, ands h o rter hospital stays, there is anabsence of re s e a rch evaluating thevalidity of a guided imagery interv e n-tion. There f o re, the overall purpose ofthe study was to establish contentvalidity for the Magic Island: Relaxationfor Kids CD (Mehling, Highstein, &D e l a m a rt e r, 1990) and substantiate itas an effective intervention in re d u c i n gpost-operative pain in children. There s e a rch questions that guided thisstudy were : Does the use of the Magic Island:

Relaxation for Kids audio CD leadto decreased pain and incre a s e drelaxation in school-age childre nwho have undergone surg e ry ?

Does the use of the Magic Island:Relaxation for Kids audio CD stim-ulate the imagination in school-agec h i l d ren who have undergone sur-g e ry ?

ed re c o v e ry. Children in the experimen-tal group experienced lower post-oper-ative pain ratings and shorter hospitalstays than the control group. Tw e n t yc h i l d ren indicated they used this strate-gy for pain control and sleep while hos-pitalized. A limitation of this study wasthat the amount of opioid in effect atthe time of the intervention was notc o n t ro l l e d .

In a descriptive study, 52 Finnishschool-age children were interv i e w e dafter surg e ry to obtain their experi-ences with pain relief methods whilehospitalized. Children re p o rted 13 dif-f e rent types of self-initiated methodsthey used to relieve pain. Ninety-eightp e rcent of the children used distraction,31% used imagery, and 8% used re l a x-ation (Plkki et al., 2003).

In another experimental design,Huth and colleagues (2004) randomlyassigned 73 school-age children (7 to12) having a tonsillectomy and/or ade-noidectomy to an imagery tre a t m e n tg roup or an attention-control gro u p .C h i l d ren (n = 36) in the tre a t m e n tg roup watched a professionally devel-oped videotape on the use of imageryand then listened to an audiotape 1week before surg e ry. They also listenedto the audiotape after surg e ry and athome after discharge. Results indicatedsignificantly lower pain and anxiety 1 to4 hours after surg e ry in the tre a t m e n tg roup when analgesics and trait anxi-ety were controlled. However, therew e re no significant diff e rences at home22 to 27 hours after discharge. A limi-tation of this study was the inability top rovide a sham treatment for the atten-t i o n - c o n t rol group that would not act asd i s t r a c t i o n .

Based on the larger experimental

Ta ble 1.Sample Description (N = 17)

Descriptive Demographic To t a lAv e r age Age 9.7 (S D = 1.9)R a c e W h i t e

A f ri c a n - A m e ri c a nA s i a nM u l t i - ra c i a l

11 ( 6 5 % )3 ( 1 7 % )1 ( 6 % )2 ( 1 2 % )

G e n d e r M a l eFe m a l e

8 ( 4 7 % )9 ( 5 3 % )

S u rge ry A p p e n d e c t o myTo n s i l l e c t o my / a d e n o i d e c t o myMass ex c i s i o nRight total parotidectomy / right mandible resectionFracture closureFe mur fra c t u r eE x p l o ra t o ry laparotomy/small bowel resection/

a p p e n d e c t o my

8 ( 4 7 % )3 ( 1 7 % )2 ( 1 2 % )1 ( 6 % )1 ( 6 % )1 ( 6 % )1 ( 6 % )

Evaluation of the Magic Island: Relaxation for Kids Compact Disc


DesignA cross-sectional pre / p o s t - t e s t

design was used. Children hospitalizedover a 7-month period for a variety ofs u rgeries (see Table 1) were given theguided imagery interv e n t i o n .

Participants and SettingThe setting was a 475-bed, quater-

n a ry care pediatric hospital andre s e a rch center in the midwest. A con-venience sample of 17 childre nbetween the ages of 7 and 12 years ofage who had recently undergone sur-g e ry were enrolled in the study.C h i l d ren needed to understand andcommunicate in English because theCD was re c o rded in English. Onlyc h i l d ren with significant developmen-tal delays, a diagnosed mental illness,or a neuro-muscular disorder wereexcluded from the study.

MeasuresDemographic information for the

child, including sex, age, and race,was obtained from the child and con-f i rmed in the chart. The type of surg i-cal pro c e d u re perf o rmed was alsoobtained from the childs chart.

Relaxation and PainAn 8-question tool was used to col-

lect data re g a rding relaxation and painlevels as well as details of what thechild imagined after listening to theCD. This questionnaire was used inp revious re s e a rch (Huth et al., 2004).Relaxation and pain scores wereobtained pre- and post-interv e n t i o n .Relaxation was assessed using a 5-point Likert scale (1 = very re l a x e dlike a limp rag doll to 5 = verytense). Pain was assessed using amodified version of the Oucher. Thenumeric scale was converted to a 0 to10 scale with the authors perm i s s i o n .The original Oucher is a self-re p o rtm e a s u re of pain intensity for childre n3 to 12 years of age that has beenused in a variety of settings (Beyer,Vi l l a rruel, & Denyes, 1995). Childre nmay use a numeric scale (0 to 100) ora 7-point picture photographic scaleof one child (Black, Hispanic, orWhite) demonstrating increasing lev-els of discomfort. In this study, all sub-jects chose the numeric scale.Psychometric studies have estab-lished the content and construct valid-ity of the original Oucher scale (Beyer& Aradine, 1986, 1987, 1988; Beyer,McGrath, & Berde, 1990). A studywith 7- to 12-year-old children whohad tonsillectomy pain demonstratesthe high test-retest reliabilities at twoseparate time points (r = 0.96 and r =0.99, respectively) (Huth et al., 2004).

ed to examine the re l a t i o n s h i pbetween pain and relaxation beforeand after listening to the CD. Post-hoce ffect size was calculated usingC o h e n s d. A Spearman corre l a t i o nc o e fficient was obtained to determ i n ethe relationship between pain andrelaxation after the interv e n t i o n .Answers to questions re g a rd i n gi m a g e ry outcomes were categorizedusing content analysis. All analysesw e re carried out at a 0.05 level of sig-n i f i c a n c e .

Results

Description of SampleNine female and 8 male childre n

with a mean age of 9.7 (S D = 1.9) par-ticipated in the study; 11 were White(65%), 3 African American (17%), 1Asian (6%), and 2 multi-racial (12%).One child assented but did not part i c-ipate. Additionally, 2 children and 3p a rents refused participation. Themost frequent type of surg e ry per-f o rmed was an appendectomy (47%,n = 8). These demographics are pre-sented in Table 1.

Pain and RelaxationComparisons of pain and re l a x-

ation scores before and after the childlistened to the guided imagery CD areshown in Figure 1. One childs pains c o res were missing. Mean pains c o res before the CD were 4.31 (S E =0.61) and after the CD were 2.75, (S E= 0.49, t[15] = 3.49, p = 0.0033). Al a rge post-hoc effect size for painreduction was calculated at 0.87(Cohen, 1988). Eleven (68.7%) chil-d ren re p o rted less pain, 4 (25%)re p o rted no change, and 1 (6.2%)child re p o rted slightly higher pain afterlistening to the CD.

Mean relaxation scores were 2.09(S E = 0.23) prior to the CD and afterthe CD were 1.66 (S E = 0.14).D e c reasing relaxation scores indicatem o re relaxation. Thus, there were nosignificant diff e rence in re l a x a t i o ns c o res (t[15] = 2.05, p = 0.0583).T h e re was a moderate effect size forrelaxation (0.51). Eight (50%) of thec h i l d ren re p o rted more re l a x a t i o nafter listening to the CD, 6 (37.5%)had no change, and 2 (12.5%) re p o rt-ed less relaxation. A corre l a t i o nbetween imagery and relaxation afterlistening to the CD indicated a medi-um relationship that was not signifi-cant (r = 0.33, p = 0.22).

ImaginationListening to the CD stimulated the

imagination of 14 (82%) of the 17

A l t e rnate reliability between three ver-sions of the Oucher pain scale in 3- to1 2 - y e a r-old children having surg i c a lor dental pain were strong (r = 0.88 to0.99), positive, and significant (Beyer& Aradine, 1986).

C h i l d ren were asked if they imag-ined themselves being on a magicisland or another place. If so, thechild was also asked, What didyou...see, hear, smell, touch, feel, andtaste? Finally, children were askedwhat they liked and disliked about theCD.

InterventionMagic Island: Relaxation for Kids

(Magic Island) is a 52-minute step-by-step audio guide using music and nar-ration to teach children how to re l a x .Beginning with a tension-release exer-cise to loosen tight muscles andrelieve physical stress, and with ab a c k g round of music, the story t e l l e rdepicts an imaginary journey by hotair balloon to a magic island. The childis encouraged to breathe deeply, toi m p rove oxygen circulation and calmthe body. Magic Island f e a t u res thre erelaxation tools: tension/release exer-cises, deep breathing, and guidedi m a g e ry to quiet the mind and expandthe imagination.

ProcedureInstitutional Review Board appro v a l

was obtained for this study, and pre -t reatment verbal consent and assentw e re obtained from parents and chil-d ren. Participants were identified andre c ruited during post-surg e ry re c o v-e ry on two designated inpatient surg i-cal units by their child life specialist.The use of guided imagery is a part ofthe standard of care in this medicalc e n t e r, and written consent is not usu-ally obtained. Child life specialistsexplained the guided imagery pro c e s sto parents and children after obtaininga g reement to participate in the study.Following documentation of an initialpain and relaxation score, the childwas provided with a headset and ap o rtable CD player to listen to theMagic Island audio re c o rding (Mehlinget al., 1990). After the CD was com-pleted, pain and relaxation score sw e re once again obtained from thechild by the child life specialist. Thenthe 8-item imagery assessment ques-t i o n n a i re was completed.

Statistical Analysis Analysis was perf o rmed using the

Statistical Analysis System (SAS 9.2).Descriptive and frequency analysesw e re used to summarize demographicvariables. A paired t-test was conduct-


c h i l d ren. Three (18%) children did notimagine being on a magic island ora n y w h e re else. The most fre q u e n t l yre p o rted senses were visual (82%),a u d i t o ry (76%), and tactile (76%). Theleast re p o rted sense was taste (29%).Table 2 lists the frequency of answerson the senses used and the imageselicited. For example, a child mayhave visualized several things such asflowers, trees, birds, and water. Inanswer to the question, What did ord i d n t you like about the CD?, eightc h i l d ren stated they liked every t h i n g ,four liked how it made them feel, andt h ree liked all of the CD. The thre ec h i l d ren who did not imagine anythingalso disliked the CD, and stated it wasannoying, weird, and didnt likewhat they were talking about. Sixc h i l d ren made comments about thep a rts of the CD they didnt like. Forexample, the beginning, thes t retching part, made me sleepy.

Figure 1.Comparison of Pain and Relaxation Scores

Ta ble 2.F r e q u e n cy of Answ e rs to the Image ry Assessment Questionnaire

Q u e s t i o n I m age s F r e q u e n cy Pe rcent RespondingWhat did you see? 8 2 %

Animals/living creaturesWa t e rP l a n t s / f l owe r sPe o p l eN a t u r eS a n d

887443

What did you hear? 7 6 %Animals/living creaturesPe o p l eWa t e r

765

What did you touch? 7 6 %A n i m a l sS a n d / b e a c hB a l l o o nR o ck sTr e e s / p l a n t s

44333

What did you fe e l ? 7 1 %Ta c t i l eA f fe c t i ve

83

What did you smell? 6 5 %Fo o dP l a n t s / f l owe r sNot know

553

What did you taste? 2 9 %N o t h i n gFo o dO c e a n

841



Two specifically commented on theending, and one child wanted to hearm o re about the island.

ValidityTo the investigators knowledge, no

studies have been conducted toassess validity of a guided imageryaudio CD (or tape) since this studysinception. There f o re, the Magic IslandCD was given to 3 guided imagerye x p e rts for review and to establishcontent validity. The group of expert sconsisted of two PhD-pre p a red pedi-atric professionals, a nurse re s e a rc h e r,a psychologist, and a highly experi-enced child life professional who cur-rently uses the Magic Island CD in herdaily practice. Overall, all thre ee x p e rts were in agreement that theaudio CD provided children with awide variety of sensory identificationo p p o rtunities. Weaknesses includedthe length of the narrative (52 min-utes, considered possibly too long)and lack of opportunities for touchand taste.

Discussion In this study, children who used an

i m a g e ry audio CD had lower self-re p o rted pain from pre- to post-inter-vention but no significantly incre a s e drelaxation. There f o re, there weremixed findings to re s e a rch question 1.The effect for pain is similar to otherfindings in which imagery re d u c e dpost-operative pain in the hospital ora m b u l a t o ry setting (Huth et al., 2004;L a m b e rt, 1996; Plkki et al., 2008).The lack of a treatment effect onrelaxation is a new finding and has notbeen previously supported or re f u t e din the literature on guided imagerywith children. Hypnotic methods donot necessarily result in re l a x a t i o nbecause a cognitive process ofabsorption occurs (Barber, 1996).Thus, it is plausible to think that chil-d ren were absorbed in the imaginativep rocess of the CD and not the re l a x-ation. It is interesting to note that 9(53%) children had difficulty under-standing the meaning of the word relaxation. Their parents often pro-vided explanations to the meaning ofthe word relaxation. Furt h e r, thelack of significance between pain andrelaxation after the intervention mays u p p o rt the previous arguments butmay also be a result of the small sam-ple size.

T h e re is little empirical evidencethat supports childre n s imagery abili-ty and content. Our findings supportre s e a rch question 2. Others have alsofound that school-age children are

a variety of coping methods toa d d ress the stress of pain, illness, andhospitalization.

Health care professionals mayneed a training session on administra-tion of any imagery CD that is used.For example, information on deepb reathing, muscle relaxation, imagery,and listening to the CD will provide thehealth care professional with the abili-ty to answer questions from childre nand their parents (Huth et al., 2006).Assessment of the childs likes anddislikes, current distress/anxiety level,and past coping strategies used duringpain will help prevent distress whenlistening to the CD. Olness and Kohen(1996) have stressed the import a n c eof letting children know they canimagine going any place. In fact, let-ting a child tailor the imagery contentmay increase their imaging ability. Inthe event a child does become dis-t ressed when listening to the CD, thechild and parent can be instructed tot u rn off the CD and notify the healthc a re professional (Huth et al., 2006).Documentation of the childs re a c t i o nto the CD and current pain level isn e c e s s a ry because this is a therapeu-tic intervention. Using an imagery CDre q u i res minimal time from healthc a re professionals (Lambert, 1996).F u rt h e r, an imagery CD is a low-costi n t e rvention that has the potential toresult in improved coping and painmanagement both in the hospital andat home.

Health care professionals shouldencourage children and parents to usecognitive-behavioral pain-re l i e v i n gmethods, such as imagery, re l a x a t i o n ,and breathing techniques. Eff e c t i v epain management can lead to short e rlengths of stay and better coping andemotional well being after discharg e .These techniques can be re i n f o rced atd i s c h a rge and used at home. Thesep re l i m i n a ry findings can be used toe n s u re that health care pro f e s s i o n a l sa re using a guided imagery interv e n-tion that is supported by empirical evi-dence. Future re s e a rch could focus oncomparing imagery CDs that are indi-vidualized to the childs favorite placeor activity to a standardized imageryCD. Research that explored capturingc h i l d re n s attention capacity duringtimes of stress and pain would alsoadvance pediatric nurses knowledgeand understanding of imagery.

ConclusionThis study examined the efficacy of

a commercial guided imagery CD inreducing school-age childre n s post-operative pain, increasing re l a x a t i o n ,

able to imagine their favorite or famil-iar people, places, and animals (Huthet al., 2006; Lee & Olness, 1996;S m a rt, 1997). The findings from thisstudy indicate that 82% of the childre nre p o rted being on a magic island. Thisis similar to previous re p o rts in whichthe majority of children imaginedgoing to the place suggested in theaudio tape or CD (Huth et al., 2006;S m a rt, 1997). Children in this studyw e re able to deviate from the CDbecause they imagined other content,such as flora, animals and pets, andpeople. Likewise, Huth and colleagues(2006) re p o rted that children imagineanimals and pets, but also imaginedfamiliar places, sports events, andspecial events. Children in this studyw e re able to use their senses to see,h e a r, touch, feel, smell, and taste. Asidentified by the content experts andcollaborated by the children in thiss t u d y, taste was a weakness of thesenses re p resented on the CD.I m a g e ry evokes mental images thatinvolve the senses (Naparstek, 1994).The frequency of senses used byschool-age children during imageryhas not been previously re p o rt e d .A d d i t i o n a l l y, the content validity of aguided imagery audio CD has notbeen established. There f o re, theseresults can help ensure that healthc a re professionals use an interv e n t i o nthat has pre l i m i n a ry validity testing.

LimitationsSeveral limitations should be con-

s i d e red when interpreting these find-ings. Most importantly is the lack ofrandomization and lack of a contro lg roup. Second, there was no contro lfor the medications given, the type ofs u rg e ry, or the number of days sincethe surg e ry and intervention. Finally,the small sample size limits generaliz-a b i l i t y. Intere s t i n g l y, power analysesafter data collection indicated thate ffect size for the reduction of painwas large and moderate for re l a x a t i o n .

Implications for PracticeAnd Research

Despite these limitations, this studyp rovides evidence that children ages7- to 12-years-old were able to useguided imagery in the hospital setting.Cognitive distraction is a fre q u e n tcoping strategy used by school-agec h i l d ren. There f o re, health care pro-fessionals should use this interv e n t i o nto give children a sense of control andassist them in coping during hospital-ization. Both imagery and re l a x a t i o non the CD may provide the child with


and stimulating imagery. Imagery wase ffective in reducing childre n s re p o rt-ed pain but was ineffective in incre a s-ing relaxation. These findings supportthat relaxation is not necessary forpain reduction. Children were able touse their senses and imagine going toa magic island when listening to theCD. Thus, there is pre l i m i n a ry contentvalidity for this guided imagery CD.Health care professionals need to beeducated to administer non-pharm a-cologic interventions, such as guidedi m a g e ry. It is hoped that this pilotstudy will assist health care pro f e s-sionals in implementing therapeutici n t e rventions for children who contin-ue to suffer pain. Children and pare n t sshould expect and demand carebased on re s e a rch findings.

R e fe r e n c e sAcute Pain Management Guideline Pa n e l .

( 1 9 9 2 ) . Acute pain management ini n fa n t s, children, and adolescents:O p e ra t i ve and medical procedures.Q u i ck reference guide for clinicians. Vo l9 2 - 0 0 2 0 . R o ck v i l l e, MD: Agency fo rHealth Care Policy and Research,P u blic Health Serv i c e, U. S. D e p a rt m e n tof Health and Human Serv i c e s.

A m e rican Society of Anesthesiologists.( 2 0 0 4 ) . P ractice guidelines for acutepain management in the peri o p e ra t i ves e t t i n g : An updated report by theA m e rican Society of Anesthesiologists.Task Force on Pain Management.A n e s t h e s i o l o g y, 100, 1573-1581.

B a r b e r, J. ( E d . ) . ( 1 9 9 6 ) . A brief introduction tohypnotic analgesia. Hypnosis and sug -gestion in the treatment of pain ( p. 7 ) .N ew Yo rk : N o rt o n .

B eye r, J., & Ara d i n e, C. ( 1 9 8 6 ) . Content va l i d-ity of an instrument to measure yo u n gc h i l d r e n s perceptions of the intensity oftheir pain. J o u rnal of Pe d i a t ric Nursing,1, 386-395.

B eye r, J., & Ara d i n e, C. ( 1 9 8 7 ) . Pa t t e rns ofp e d i a t ric pain intensity: A methodologi-cal investigation of a self-report scale.The Clinical Journal of Pain, 3( 3 ) , 1 3 0 -1 4 1 .

B eye r, J.E., & Ara d i n e, C. R . (1988) Conve r-gent and discriminant validity of a self-r e p o rt measure of pain intensity for chil-d r e n . C h i l d r e n s Health Care, 16( 4 ) ,2 7 4 - 2 8 2 .

B eye r, J.E., McGrath, P. J., & Berde, C. B.( 1 9 9 0 ) . Discordance between self-r e p o rt and behav i o ral pain measure inchildren aged 3-7 years after surgery.J o u rnal of Pain and SymptomManagement, 5(6), 350-356.

B eye r, J.E., V i l l a r ruel, A.M., & Denye s, M.J.( 1 9 9 5 ) . The Oucher: U s e r s manual andtechnical report. Bethesda, MD:Association for the Care of ChildrensH e a l t h .

B r o o m e, M.E., Rehwaldt, M., & Fogg, L.( 1 9 9 8 ) . Relationships between cognitiveb e h av i o ral techniques, tempera m e n t ,o b s e rved distress, and pain reports in

Plkki, T, Pietil, A., Ve h v i l i n e n - Ju l k u n e n ,K., Laukkala, H., & Kiviluoma, K. ( 2 0 0 8 ) .I m a g e ry-induced relaxation in childrensp o s t o p e ra t i ve pain relief: A ra n d o m i ze dpilot study. J o u rnal of Pe d i a t ric Nursing,2 3(3), 217-224.

S m a rt, G. ( 1 9 9 7 ) . Helping children relax dur-ing magnetic resonance imaging.M a t e rnal-Child Nursing Journal, 22( 5 ) ,2 3 7 - 2 4 1 .

T h o m a s, R.M. ( 1 9 8 5 ) . C o m p a ring theories ofchild development (2nd ed.). B e l m o n t ,C A : Wa d swo rt h .

children and adolescents during lumbarp u n c t u r e. J o u rnal of Pe d i a t ric Nursing,1 3(1), 48-54.

Cohen, J. ( 1 9 8 8 ) . Statistical power analysisfor the behav i o ral sciences (2nd ed.).H i l l s d a l e, NJ: L awrence Erl b a u m .

G a u t h i e r, J., Finley, G., & McGrath, P. J.( 1 9 9 8 ) . C h i l d r e n s self-report of postop-e ra t i ve pain intensity and treatmentt h r e s h o l d : D e t e rmining the adequacy ofm e d i c a t i o n . The Clinical Journal of Pa i n ,1 4(2), 116-120.

G i l l i e s, M.L., Smith, L.N., & Pa r ry - J o n e s, W. L .( 1 9 9 9 ) . Po s t o p e ra t i ve pain assessmentand management in adolescents. Pa i n ,7 9(2-3), 207-215.

Huth, M.M., Broome, M.E., & Good, M.( 2 0 0 4 ) . I m a g e ry reduces childrensp o s t - o p e ra t i ve pain. Pain, 110( 1 - 2 ) ,4 3 9 - 4 4 8 .

Huth, M.M., Van Ku i ken, D.M., & Broome,M . E . ( 2 0 0 6 ) . P l aying in the park : W h a tschool-age children tell us abouti m a g e ry. J o u rnal of Pe d i a t ric Nursing,2 1( 2 ) , 1 1 5 - 1 2 5 .

J e f f s, D. A . ( 2 0 0 7 ) . A pilot study of distra c t i o nfor adolescents during allergy testing.J o u rnal of Society of Pe d i a t ric Nursing,1 2(3), 170-185.

L a m b e rt, S. A . ( 1 9 9 6 ) . The effects of hy p n o-sis/guided imagery on the postopera t i vecourse of children. D evelopmental andB e h av i o ral Pe d i a t ri c s, 1 7(5), 307-310.

L a M o n t a g n e, L.L., Hepwo rth, J. T., &S a l i s bu ry, M.H. ( 2 0 0 1 ) . Anxiety andp o s t o p e ra t i ve pain in children whoundergo major orthopedic surgery.Applied Nursing Research, 14(3), 119-1 2 4 .

L e e, L.H., & Olness, K.M. ( 1 9 9 6 ) . E f fects ofself-induced mental imagery on autonom-i c reactivity in children. D eve l o p m e n t a land Behav i o ral Pe d i a t ri c s, 17(5), 323-3 2 7 .

M c C a f fe ry, M., & Pa s e r o, C. ( 1 9 9 9 ) . Pain clin -ical manual (2nd ed., pp. 417, 585). S t .L o u i s, MO: M o s by.

McCaul, K.D., & Malott, J. M . ( 1 9 8 4 ) .D i s t raction and coping with pain.Psychological Bulletin, 95(3), 516-533.

Mehling, B., Highstein, M., & Delamart e r, R.( 1 9 9 0 ) . Magic island: Relaxation fo rk i d s. (CD recording number MIR-FKCD1) Califo rnia Publ i c a t i o n s.

M e l z a ck, R., & Casey, K.L. ( 1 9 6 8 ) . S e n s o ry,m o t i vational and central control deter-minants of pain: A new conceptualm o d e l . In D. Kenshalo (Ed.), The skinsenses ( p p. 4 2 3 - 4 4 3 ) . S p ri n g f i e l d :C h a rles T h o m a s.

Naparstek, R. ( 1 9 9 4 ) . S t aying well with guid -ed imagery. N ew Yo rk : Wa rner Books.

O l n e s s, K., & Kohen, D. P. ( 1 9 9 6 ) . H y p n o s i sand hy p n o t h e ra py with children ( 3 r de d . ) . N ew Yo rk : G u i l ford Press.

Pederson, C. ( 1 9 9 5 ) . E f fect of imagery in chil-d r e n s pain and anxiety during cardiacc a t h e t e ri z a t i o n . J o u rnal of Pe d i a t ri cNursing, 10(6), 365-374.

Plkki, T., Pietil, A., & Ve h v i l i n e n - Ju l k u n e n ,K . ( 2 0 0 3 ) . H o s p i t a l i zed childrensd e s c riptions of their ex p e riences withpostsurgical pain relieving methods.I n t e rnational Journal of NursingS t u d i e s, 40(1), 33-44.


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