The Effect of Two Different Interventions on Emotional State, Pain, and Fear During Respiratory Panel Removal in Children: A Randomized Controlled Study

Procedural pain and fear are common challenges in pediatric clinical settings, particularly during invasive diagnostic procedures such as respiratory panel specimen collection. Children's negative emotional and behavioral responses during such procedures may lead to heightened distress, increased procedural resistance, and long-term fear of medical interventions. Therefore, the implementation of effective, safe, and developmentally appropriate non-pharmacological interventions is a priority in pediatric care.

This randomized controlled trial is designed to examine the comparative effectiveness of two tactile-based non-pharmacological interventions-a palm stimulator and a stress ball-on pain intensity, fear levels, and emotional behavior in children aged 6 to 12 years undergoing respiratory panel collection. The study adopts a parallel-group design with three arms: palm stimulator intervention, stress ball intervention, and routine care as the control condition.

Participants who meet the eligibility criteria will be randomly allocated to one of the three groups using a computer-generated randomization process. All respiratory panel specimen collections will be performed by the same trained pediatric nurse to minimize procedural variability. The interventions will be applied only during the specimen collection procedure, without altering standard clinical practice.

Pain, fear, and emotional responses will be assessed using validated pediatric measurement tools. Emotional behavior will be evaluated through structured behavioral observation before and after the procedure, while pain and fear will be assessed shortly after completion of the specimen collection. Assessments will be conducted by healthcare professionals who are not involved in the intervention delivery to reduce assessment bias.

By comparing two simple, low-cost, and easily applicable interventions with routine care, this study aims to generate evidence that can inform pediatric nursing practice and support the integration of non-pharmacological pain and fear management strategies into routine clinical procedures.

Inclusion criteria

• Children aged 6 to 12 years
• Hospitalized children scheduled for respiratory panel specimen collection
• Ability to communicate verbally, understand instructions, and follow commands
• Children not receiving sedative, anticonvulsant, or analgesic medications at the time of the procedure
• Written informed consent obtained from a parent or legal guardian
• Assent obtained from the child
• Willingness of the child and parent/legal guardian to participate in the study

Exclusion criteria

• Children who do not consent or assent to participate
• Children requiring more than one attempt for respiratory panel specimen collection
• Presence of chronic, acute, or life-threatening medical conditions
• Children with cognitive or communication impairments that prevent reliable assessment
• Children with dependence on electronic or technological devices that may interfere with the intervention