Procedure of study
cough, pain
In this study, a clinical performance nurse with more than 8 years of experience working in pediatric patient settings and needle procedures conducted the venipuncture procedure. No conflicts of interest were reported by the nurses. Pediatricians make clinical decisions regarding patients’ venipuncture. The researcher read parents and children a piece of brief information about the pain and fear tools before randomization, and both acknowledged understanding the instructions. To evaluate the level of pain and fear experienced by pediatric patients before and after the venipuncture procedure, a self-report form was used: the 0–10 WB-FACES scale for pain and the 0–4 CFS scale for fear. For all children, the second nurse performed the venipuncture procedure. Following the venipuncture procedure, the children were asked to assess their fear levels and pain severity. There were 160 children randomly assigned to four groups of 40 using opaque, sealed envelopes. After group assignments, the parents and children went to the venipuncture room.Venipuncture sessions were performed between 8:00 and 12:00 a.m. with a 5-ml injector and a 22-G needle. Parents remained with their children during venipuncture. Children in the intervention groups, prior to needle insertion, were instructed to cough, inflate the balloon, or color a picture during venipuncture procedures (Fig. Example of photos used for the intervention of “Tracking Images and Coloring Children’s Books” (TICK-B)