• Ann Marie McCarthy, Charmaine Kleiber, Kirsten Hanrahan, M Bridget Zimmerman, Anne Ersig, Nina Westhus, and Susan Allen.
• Ann Marie McCarthy, PhD, RN, FNASN, FAAN, is Professor; and Charmaine Kleiber, PhD, RN, FAAN, is Associate Professor, College of Nursing, University of Iowa. Kirsten Hanrahan, DNP, RN, ARNP, is Project Director, University of Iowa Health Care, University of Iowa. M. Bridget Zimmerman, PhD, is Clinical Professor, Director, Department of Biostatistics, University of Iowa. Anne Ersig, PhD, RN, is Assistant Professor, College of Nursing, University of Iowa. Nina Westhus, PhD, RN, is Associate Professor, School of Nursing, Saint Louis University, Missouri. Susan Allen, MSN, RN, PNP, is Nursing Manager of Emergency Department, PICU, Internal Resource Team, Blank Children's Hospital, Des Moines, Iowa.
• Nurs Res. 2014 Nov 1;63(6):397-407.

BackgroundParents often want to provide support to their children during medical procedures, but not all parents are effective in providing distraction after brief training.ObjectiveThe aim of this study was to investigate the effects of three doses of distraction intervention for children at high and medium risk for procedure-related distress.MethodsChildren undergoing scheduled intravenous insertions for diagnostic or treatment purposes and their parents participated. A computerized application, Children, Parents and Distraction, was used to predict distress risk. Doses of intervention were basic (parents trained on providing distraction), enhanced (basic training plus tailored instructions, environmental modifications, and support and guidance from the research assistant), and professional (a trained research assistant provided distraction). Outcome measures were Observational Scale of Behavioral Distress-Revised for behavioral distress, Oucher for self-reported pain, parent report of child distress, and salivary cortisol for physiological distress.ResultsA total of 574 children, ages 4-10, and their parents participated. The Children, Parents and Distraction predicted that the risk for distress was high for 156 children, medium for 372, and low for 46. Children predicted to have higher risk for distress displayed more behavioral distress (p < .01). Children in the medium-risk group who had the professional intervention displayed significantly less behavioral distress (p < .001). Children in the high-risk group tended to have less behavioral distress when receiving the professional intervention (p = .07). There were no significant group differences for self-report of pain, parent report of distress, or cortisol levels.DiscussionSome parents may need additional training in providing distraction to their children during procedures, and some children at medium and high risk for distress may need professional support. Parents should be asked about their preferences in acting as the distraction coach and, if willing, be provided as much training and support as possible in the clinical situation.

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