final report presentation of dissertation

1. GOOD AFTERNOON

3. “ A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE REGARDING
DISTRACTION TECHNIQUES IN BEHAVIOUR RESPONSES TO PAIN AMONG
MOTHERS OF TODDLERS RESIDING AT SELECTED RURAL AREA IN
BANGALORE WITH A VIEW TO DEVELOP A SELFINSTRUCTIONAL MODULE ”
Registration No :
RAJIV GANDHI UNIVERSITY OF HEALTH SCEIENCES,
Banglore, Karnataka
Centre: RANEBENNUR COLLEGE OF NURSING
RAMASWAMY LAY OUT,
VISHWANEEDAM POST,
ANDRAHALLI BANGALORE- 560091

4. STATEMENT OF PROBLEM
“ A Descriptive Study To Assess The Knowledge
Regarding Distraction Techniques In Behaviour
Responses To Pain Among Mothers Of Toddlers
Residing At Selected Rural Area In Bangalore With A
View To Develop A Selfinstructional Module ”

5. BACKGROUND
• Toddlers maneuvering their way at becoming social beings;
however this requires lots of assistance in managing relationships
with peers with scope to problem solving skills.
• Toddlers are not yet equipped with the complex expressive
language skills often relying on body language, gestures, single
word phrases, and physical overtures to form the basis for their
social interactions.
• All children are vulnerable to maltreatment induced behavioral
problems , developmental delays etc. & parents/caretakers have
an important role of protector.
• Distraction involves capturing child’s attention and focusing away
from the stressful situation and towards something more
pleasant.

6. Need for the study
• Younger children are particularly in need of interventions because they
report more pain and display more behavioral distress during medical
process.
• Numerous studies have reported assessment and management of infant’s
and children’s pain, the application of the findings to the practice setting has
not been systematic. This has been a serious barrier to innovative care
practice.
• The technique of distraction is one of the non-pharmacological methods that
aims to reduce pain by encouraging a patient to turn his or her attention to
some-thing other than the ongoing procedure.
• Mothers are the primary care takers of the toddlers in majority.
• Hence current study planned to do a study on knowledge regarding
distraction technique in behavior responses to pain among mothers of the
toddlers.

8. OBJECTIVES OF THE STUDY
➢ To assess the existing knowledge of mothers regarding Distraction
techniques in behavior responses to pain .
➢ To find out the association between knowledge level of mothers regarding
Distraction techniques in behavior responses to pain and their selected
demographic variables.
➢ To prepare a self-instructional module regarding Distraction techniques in
behavior responses to pain based on the evaluated level of knowledge of
mothers.

9. Hypothesis
Null Hypothesis (H0):There will be no association
between knowledge score regarding distraction
techniques among mothers of toddlers with selected
socio-demographic variables.
Alternative Hypothesis (H1) : There will be association
between knowledge score regarding distraction
techniques among mothers of toddlers with selected
socio-demographic variables.

10. Assumptions:
❖ Mothers may have some knowledge regarding Distraction
techniques in behavior responses to pain in children.
❖ Mother’s knowledge regarding Distraction techniques in
behavior responses to pain can be measured by using a structured
knowledge questionnaire.
❖ Mother’s knowledge regarding Distraction techniques in
behavior responses to pain can be improved by a self-instructional
module

11. OPERATIONAL DEFINITIONS
• Assess- Assess refers to process of the critical analysis and
evaluation and judgement of the status of mothers
knowledge regarding Distraction techniques in behavior
responses to pain.
• Knowledge- Knowledge refers to the mother’s intellect to
answer the questions regarding Distraction techniques in
behavior responses to pain.
• Distraction- It refers to an intervention that diverts
attention from a painful stimulus of the toddler.

12. OPERATIONAL DEFINITIONS continued…..
• Behavior responses- Behavioral responses are the responses
shown by the child due to immunization pain as observed by
behavioral observation scale in which the parameters observed
are look, cooperation cry, face, eye, nose, extremity, movement
respiration and posture.
• Pain- Its refers to an unpleasant sensation occurring in varying
degrees of severity as a consequence of injury, disease, or
emotional disorder.
• Mother- A women in relation to a child to whom she has given
birth and between the age of 25 to 40 years.
• Toddler-It refers to the child in between the age of 1-3 years.
• Self-instructional module- It is a self-contained instructional
module regarding Distraction techniques in behaviour responses
to pain.

13. CONCEPTUAL FRAMEWORK
The conceptual framework of the present study is based on modified
Ludwig Von Bertanlanffy’s General system theory (1968)
 A modified Bertanlanffy’s system model is adopted by the investigator for the
present study based on general system theory.
 The four major aspects of this system are
1. Input - The sources needed by the system in current study its demographic
variables of mother.
2. Throughput - The action needed to accomplish the desired task is providing
information through self-instructional module regarding distraction techniques in
behavior responses to pain.
3. Output - End result or product of the system in current study its Knowledge of
Mothers.
4. Feedback - It is the process of communicating what found in evaluation of the
system

14. Demographic Variables
Age of Mother
Educational status,
Occupation, Religion, Per
capita monthly Income
of the family, Type of
family,
No of children’s
Evaluation on
effectiveness of
SIM regarding
distraction
techniques in
behaviour
responses to
pain among
mothers of
toddlers
Assess the knowledge
regarding distraction
techniques in
behaviour responses to
pain among mothers of
toddlers.
-Administer the Self-
instructional module to
provide knowledge
regarding distraction
techniques to the mothers
of toddlers.
Adequate
knowledge
Moderately
Adequate
knowledge
Inadequate
knowledge
Input
Mothers residing at rural area
Adminisrtration of SIM
output
Throughput
Evaluation and Feedback
Conceptual Framework

16. REVIEW OF LITERATURE
Review of literatures are mentioned under the following
headlines :
1.Review of literature related to Significant distraction techniques
used for pediatric age group.
2.Review of literature related to Effectiveness of Various distraction
techniques.
3.Review of literature related to concept of Distraction techniques in
primary care givers.

18. Methodology
Research Design:
• Descriptive research design was used to assess the knowledge regarding
distraction techniques in behavior responses to pain among mothers of
toddlers residing at selected rural area in Bangalore with a view to develop a
self-instructional module.
• The purpose of a descriptive research design is to describe the variables.
Research Approach :
• The research approach adopted for this study was a Descriptive survey
approach as the researcher assess the knowledge regarding distraction
techniques in behavior responses to pain among mothers of toddlers residing
at selected rural area in Bangalore with a view to develop a self-instructional
module.

19. Methodology( Continued )
Settings
• The setting for the present study is the
selected rural area, Bangalore.
• The reason for selecting the settings for the
present study was on the basis of geographical
proximity, feasibility of the study, and
availability of samples.

20. Methodology( Continued )
• Population :All mothers who meet the
inclusion criteria and are residing at selected
rural area in Bangalore.
• Sample size: The sample for the present study
composed of 60 mothers in selected rural area
Bangalore.
• Sampling Technique: Non probability
convenience sampling technique was used in
this study as sampling technique.

21. Methodology( Continued )
Inclusion crieteria Exclusion crieteria
▪ Mothers who are residing at selected rural
area in Bangalore.
▪ Mothers who are willing to participate in the
study.
▪ Mothers whose age limit is within 22-40
years.
▪ Mothers who are able to read and write
Kannada or English
▪ Mothers with hearing, visual &
psychological impairment.
Mothers who are selected for
pilot study.

22. Methodology( Continued )
• Variables under study
Variables are qualities, properties or
characteristics of mothers of toddlers , things or
situation that change or vary. Variables are the
concepts that have measurable changing
attributes.
• Research variables
Practice of distraction techniques to reduce Pain
experience.

23. Methodology( Continued )
• Demographic Variables
- Age, gender, family income, mother’s education,
mother’s occupation, source of information, Knowledge
of distraction techniques , Response to the painful
situation.
• Description of the tool
- Data collection is the procedure and instruments used
by the researcher to observe or measure the key
variables in research problems.
- In current study questionnaire and techniques
assessment was done.

24. Methodology( Continued )
• Data collection instrument
- Structured knowledge questionnaire.
• Reliability of the tool
- The reliability was establish by using the split half method,
which measure the coefficient of internal consistency.
- The reliability was calculated by using Karl Pearson’s
Correlation formula.
- The reliability coefficient of structure knowledge
questionnaire was r = 0.86 which showed that tool was
reliable.
• Pilot study: Conducted among 10 mothers visited the
hospital.

26. RESULTS
Organisation of findings:
SECTION I :
- This section deals with frequency and percentage distribution of data pertaining to
demographic characteristics of mothers in rural area .
SECTION II :
- Distribution of samples according to the level of pain among children immunization in
Group A (Cartoon video distraction) and Group –B (Music distraction)
SECTION – III :
- Comparison of the Effectiveness of Distraction Techniques on Pain
among mothers of toddlers (Cartoon Video Distraction) and Group B (Music
Distraction)
SECTION – IV :
- Evaluate the effectiveness of distraction techniques among mothers of toddlers.
SECTION V-
- Association between knowledge score of mothers regarding Distraction techniques in
behavior responses to pain with selected socio demographic variables.

27. Section I:
Table 1: Frequency and percentage distribution of samples according to
sociodemographic variables (N=60)
S No. Variable Frequency (f) Percentage (%)
1
Age
25-30 5 8.33 %
30-35 17 28.33%
35-40 23 38.33%
40-45 15 25%
2
Education
Primary 16 26.66 %
Secondary 39 65%
Graduate 5 8.34%
Postgraduate 0 0%
3
Occupation
Housewife 56 93.33 %
Private job 2 3.33%
government job 0 0%
Other 2 3.33%
4
Religion
Hindu 12 20 %
Muslim 48 80%
Christian 0 0%
Other 0 0%

28. Section I:
Table 1: Frequency and percentage distribution of samples according
to sociodemographic variables (N=60) Continued…………
5
Income
<5000 13 21.66 %
5001-10000 20 33.34%
10001-15000 20 33.34%
>15000 7 11.66%
6
Type of Family
Nuclear family 32 53.34 %
Joint family 28 46.66%
Extended 0 0%
7
No. of Children’s
One 14 23.33 %
Two 30 50%
Three 13 21.66%
More than three 3 5%

29. Section II:
To determine the behavioural responses to pain among toddler’ who are given a cartoon video (Group
A) as distraction techniques
Table 2: Behavioural Response to Pain among Cartoon Video Group - A. (N=30)
Cartoon Video Group - A
n %
Look CheerfulAnxious 16
40
04
26.7%
66.7%
Fearful 6.7%
cooperation Cooperative
Partially Cooperative
40
20
66.7%
33.3%
Uncooperative
Cry No cry
Moans or whimpers
48
10
02
80.0%
16.7%
Crying loudly 3.3%
facial experience Relaxed
No tightening 42
16
02
70.0%
26.7%
Tightening 3.3%
Eyes Normal staringOpens
eyes
46
14
76.7%
23.3%
Closes eyes with fear
Nose No broadening Slight
broadening
48
12
80.0%
20.0%
Broadened with nasalsecretions
hands fingers Normal position
Withdraws hands 40
20
66.7%
33.3%
Beats/pushes
Legs Normal positionRestless 50
10
83.3%
16.7%
Kicks vigorously
respiration Relaxed and regularIrregular
and rapid
50
10
83.3%
16.7%

30. Section II continued..
Objective 2: To determine the behavioral responses to pain among toddlers who
are given music (Group B) as a distraction technique. (N=30)
Behavioural Responses
Group B
n %
look Cheerful 04 6.7%
Anxious
Fearful
34 56.7%
22 36.7%
cooperation Cooperative
Partially Cooperative
14 23.3%
24 40.0%
Uncooperative 22 36.7%
cry No cry
Moans or whimpers
16 26.7%
18 30.0%
Crying loudly 26 43.3%
facial experience Relaxed
No tightening
08 13.3%
16 26.7%
Tightening 36 60.0%
eyes Normal staring
Opens eyes
08 13.3%
22 36.7%
Closes eyes with fear 30 50.0%
nose No broadening Slight
broadening
12 20.0%
34 56.7%
Broadened with nasal
secretions
14 23.3%
hands fingers and Normal position
Withdraws hands
10 16.7%
48 80.0%
Beats/pushes 02 3.3%
legs Normal position
Restless
14 23.3%
18 30.0%
Kicks vigorously 28 46.7%
respiration Relaxed and regular 28 46.7%

31. Section-III
Comparison of the Effectiveness of Distraction Techniques on
Pain
among mothers of toddlers (Cartoon Video Distraction) and
Group B (Music Distraction)
Group
Chi
square
test
Group A Group B
n % n %
χ2=30.46
p=0.001**
*
Mild 20 33.3% 04 6.6%
Moderat
e
34 56.7% 28 46.7%
Severe 06 10.0% 28 46.7%
Total 60 100.00% 60 100.00
%

32. Box plot of Section III Table: Comparison of the Effectiveness of Distraction
Techniques on Pain
among mothers of toddlers (Cartoon Video Distraction) and Group B (Music
Distraction)

33. Section IV
Evaluate the effectiveness of distraction techniques among
mothers of toddlers.
Max
score
Mean
pain
score
Mean pain difference
with95% Confidence
interval
Percentage of pain
difference with 95%
Confidence interval
Group A 60 13.37
6.67(4.01– 9.32)
22.2 % (13.3% –
31.1%)
Group B 60 20.03

34. Section V-
Association between knowledge score of mothers regarding Distraction
techniques in behavior responses to pain with selected socio demographic
variables.
S.No
Socio demographic
variables
Df
Chi-
square
Value
Table
value
Level of
significance
1 Age 12 13.15 21.03 0.05
2 Education 12 3.38 21.03 0.05
3 Occupation 12 1.487 21.03 0.05
4 Religion 12 6.63 21.03 0.05
5 Income 12 3.886 21.03 0.05
6 Type of Family 8 3.248 15.51 0.05
7 No of children’s 12 5.406 21.03 0.05

36. DISCUSSION
• Demographic variables:
– Age: majority 23(38.33%) subjects were from age group of 35- 40 years followed by
17(28.23%) were from the age group of 30-35 years, 15(25%) were from the age
group of 40-45of years and remaining 5(8.33%) were from the age group of 25-30
years.
– Education : Majority 39(65%) subjects had secondary education, 16(26.66%) had
primary education, 5(8.33%) had graduate education and 0(0%) had postgraduate.
– Family : Majority 32(53.33%) subjects were belonging nuclear family, 28(46.66%)
subjects were belonging to joint family and 0 (0%) subjects were belongs to
extended family.
– Job: Majority 56(93.33%) subjects were housewife, 02(3.33%) subjects were doing
private job, 02(3.33%) subjects were doing other work and 0 (0%) subjects were
doing government job.
– Religion: Majority 48(80%) subject were Muslim, 12(20%) subjects were Hindu and
0(0%) subjects were Christian.
– Income: Majority 20(33.33%) subjects were having income 10,001 to 15,000,
20(33.33%) subjects were having income 5,001 to 10,000, 13(21.66%) subjects
were having

37. DISCUSSION continued….
• The over all behavioral responses to pain among
toddlers who are given a distraction technique is
as follows,
- 33.3% of the toddlers were having mild pain,
- 56.7% of them were having moderate pain
- 10.0% of them were having severe pain.
• Statistically there is a significant difference
between Behavioral responses to pain in Group A
and Group B.
• Group A had less pain than group B. It was
confirmed by using chi square test.

38. DISCUSSION continued….
• Considering Group, A toddlers, they are having 13.37pain score
and in group B toddlers they are having 20.03 score.
• Difference is 6.67 pain score.
• The difference between Group A and Group B pain score is large
and it is statistically significant. It was analyzed using student
independent t-test.
• Group A toddlers are having reduced 22.2% more pain than
group B Differences between Group A and Group B was analysed
using mean difference with 95% CI and percentage difference of
pain with 95%CI.
Evaluation the effectiveness of distraction techniques among mothers of toddlers
Evaluation the effectiveness of distraction techniques between Group A & B

39. DISCUSSION continued….
• Association between knowledge score of
mothers regarding Distraction techniques in
behaviour responses to pain with selected socio
demographic variables.
• From the statistical observation it is seen that
calculated value is less than table value at 0.05
level of significance, hence null hypothesis (Ho) is
accepted.

41. Conclusion
• From the data table it is seen that calculated value is less than
table value at 0.05 level of significance, hence null hypothesis
(Ho) is accepted.
• But the study suggests that the nonpharmacological distraction
techniques are beneficial in the pain management in toddlers
during medical procedure like vaccine shots .
Association between knowledge score of mothers regarding
Distraction techniques in behavior responses to pain with selected
socio demographic variables.

42. Implications for Nursing Education:
1. Education helps nursing students to develop more insight
on new concepts, which will enable them to take care of
children effectively.
2. Nonpharmacological management of pain to the children
should be included in the nursing curriculum and in
formulating procedures in the manual of nursing procedures.
3. Nursing educators should provide knowledge and the
information to their students to help them understand the
important of non-pharmacological pain management by
using distraction in toddlers.
4. Pain has been considered as the fifth vital sign.
Comprehensive assessment of pain in infants and children are
assessed through various standardized scale like numeric pain
scale, FLACC behavioral pain scale ouches face scale and
these should be insisted to all nursing students.

43. Limitation of the study
• This study is limited to rural area mothers only.
• Study is limited to 4 to 6 weeks
• Sample size is N=60

44. Recommendations
• The study can be replicated with large & multiple area samples
for better generalization.
• An experimental study can be under taken with a control group
for effective comparison.
• A comparative study may be conducted to find out the
effectiveness between VAT (Video Assisted Teaching) and other
teaching methods regarding the same topic.
• A study can be conducted to identify the problems
encountered by the mothers about the knowledge of pain.