Publication Date


Document Type


First Advisor

Frank-Stromborg, Marilyn

Degree Name

M.S. (Master of Science)

Legacy Department

Department of Nursing


Injections--Psychological aspects; Children--Preparation for medical care; Anxiety in children


This study investigated the effectiveness of using distraction technique as a means of decreasing the anxiety response of children during the administration of intramuscular injections. Anxiety response was measured in terms of overt anxiety behavior, palmar sweat levels and pain perception. A simple breathing exercise was used as the distraction technique. It was hypothesized that the use of this breathing technique would decrease the anxiety behavior, palmar sweat, pain perception and total anxiety response of the children tested. Twenty children, aged four to seven, who received intramuscular injections at a private, semi-rural pediatric clinic were included in the study. The children were randomly assigned to the experimental or control group. The experimental group subjects participated in the breathing exercise during their injections. The control group received no intervention. Both groups were scored on three separate measurements. The Anxiety Behavior Scale tested for overt behavioral indications of anxiety and fear. The palmar sweat test measured the sympathetic nervous system response to the injection. Hester's Poker Chip Tool was used to measure the child's perception of how painful the injection was. The three scores on these tests were summed to give an anxiety response score for each subject. The mean anxiety behavior, palmar sweat, pain perception and anxiety response scores of the control and experimental groups were compared using independent t tests with .05 as the accepted level of significance. When the mean anxiety behavior score of the group which participated in the distraction exercise was compared with the no distraction group, a lower, but not significant (p=.09), mean score for the distraction group was revealed. No significant differences were found between the mean palmar sweat and pain perception scores of the groups with and without distraction. When the total anxiety response score mean of the no distraction group was compared with the respective mean of the distraction group, a significant difference (p<.05) was found. The group that utilized distraction technique during the injection process showed significantly less anxiety response than the group which received no distraction instruction. Analysis of the data suggests that distraction technique can be utilized to significantly reduce the anxiety response of children during intramuscular injections. Additional research is needed to validate the findings of this study in other clinical settings and with other types of procedures.


Includes bibliographical references.


v, 64 pages




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