The Effect of ShotBlocker and Finger Puppet on Pain and Fear During Blood Drawing in Children

Randomization in the study has been done with using a computer program (https://www.randomizer.org). To determine which children would be in the intervention and control groups, children with numbers from 1 to 90 were entered into the computer program without repetition. To avoid bias in randomisation and to increase reliability, the assignment to the intervention and control groups was made by an independent statistician.

All blood collection procedures will be performed by the same nurse. A nurse with a four-year nursing diploma working in the same blood collection unit will serve as an independent observer. The observer will evaluate the children in the experimental and control groups.

In data collection, interview and observation form created by researchers (child's age, gender, previous blood sampling experience, etc.), the Children's Fear Scale, and the Wong-Baker FACES Pain Rating Scale will be used for all groups.

This scale is rating from 0 to 4 with five drawn facial expressions representing a range from a neutral expression (0 = no fear) to a frightened face (4 = extreme fear). It may be used by parents and researchers before and during the procedure for children.

This scale is used to rate pain in children aged 3 years and older. The scale consists of facial expressions ranging from 0, indicating no pain, to 10, representing severe pain. Children are asked to select the facial expression that most accurately reflects the intensity of their pain, and then a score is assigned.

ShotBlocker was used on children in the ShotBlocker group during blood sampling. ShotBlocker device (Bionix LLC, Maumee, Ohio, USA) is a drug-free, flexible, and U-shaped, non-invasive plastic apparatus with small protrusions. It is placed directly on the skin and has a slit in the middle for inserting the needle. It is pressed firmly onto the skin, and the blunt contact points provide painless physical stimulation. This blocks the perception of pain caused by needle insertion, which is consistent with the "gate control" theory of pain.

Finger puppets were used on children in the finger puppet group during blood sampling. Finger puppets consist of plush toys featuring various animal figures that can be worn on adults' fingers. The researcher put on the finger puppet chosen by the child and spoke to the child by imitating animal sounds. After the intervention, finger puppets were given as gifts to the children who wanted them.

The same nurse will perform the blood collection procedure on the children. A nurse with a four-year nursing degree working in the same blood collection unit will become an independent observer. The observer will assess the pain and fears of the children in the experimental and control groups using scales. The researcher will give the interview and observation form to the parent to fill out before the blood drawing. The child's level of fear regarding the procedure will be recorded using the CFS by asking separate questions to the child, parent, and observer before the procedure. The child's fear of the procedure and pain will be separately assessed and recorded by the child, parent, and observer after the procedure. The child, parent, and observer independently and simultaneously evaluated the scales will be used. The ShotBlocker and finger puppet will be administered to the children in the experimental groups by the same researcher.