Discussion
cooperativeness, anxiety, pain
This randomized clinical trial found that an IVR intervention incorporating distraction and procedural information, rather than standard care alone, substantially reduced self-reported pain, self-reported anxiety, and length of procedure among pediatric patients undergoing venipuncture. Additionally, a statistically significantly higher level of staff satisfaction was noted in the IVR group than in the control group. Although the IVR group showed a smaller increase in heart rate and a greater reduction in salivary cortisol than the control group after the procedure, statistical significance was not observed.This trial extended previous studies and, to our knowledge, was the first randomized clinical trial to distract pediatric patients while simultaneously offering procedural information during venipuncture using IVR. Overall results showed that the IVR intervention effectively mitigated pain and anxiety in children undergoing venipuncture, which is concordant with previous studies that provided distraction using VR.Previous studies have used IVR across a broad age range and various needle-related procedures, of which only a few studies have tailored contents according to medical procedures and the developmental level of the children.This trial used an objective measure of salivary cortisol to assess children’s stress levels before and 30 minutes after venipuncture. However, we did not find significant between-group differences in the changes of salivary cortisol. Similarly, a previous study comparing the effects of pharmacological (jet lidocaine) and nonpharmacological interventions (the Buzzy, bubble-blowing, and inhalation aromatherapy) in children undergoing phlebotomy found no between-group difference in salivary cortisol levels collected 25 minutes after the procedures.The current study found that IVR intervention shortened the length of procedures and improved staff satisfaction with the procedures. A probable explanation is that patients were fully engaged in IVR and demonstrated higher procedural compliance and cooperativeness, which led to reduced procedure duration and increased health care professional satisfaction. Similar findings were noted in previous studies showing that VR decreased the need for restraining pediatric patients during needle-related procedures and increased health care professional satisfaction.