Week 5 Synthesis Project: Part 1 Practice Problem and PICO Question Paper

Week 5 Synthesis Project: Part 1 Practice Problem and PICO Question Paper
The BSN training requires students to develop research skills using the PICO format,
including evidence-based practice questions. PICO is an acronym for patient/population,
intervention, comparison, and outcomes. The PICO format is arguably one of the most widely
known strategies for framing a “milieu” research question. According to Aslam & Emmanuel
(2010), a PICO question is a critical step for facilitating evidence-based and informative clinical
research. Breaking the question into four separate elements can allow a researcher to identify and
document relevant information and population about a specific clinical/practice problem,
propose a treatment plan, compare it with existing therapies to establish which one is effective,
and measure the impact of the treatment. Therefore, the purpose of this paper is to identify a
clinical/practice problem (pain management in pediatrics during vaccination), discuss its
significance, formulate a PICO question, and examine the four elements of the PICO
(population, intervention, comparison, and outcome) using empirical evidence.

Significance of the Practice Problem

The discovery of vaccines ushered in a new era of disease management, allowing
scientists and clinicians to eliminate previously deadly diseases. Despite immunization
unquestionably improving children’s health and quality of life, concerns have been raised about
vaccines’ efficacy, safety, costs, and potential side effects. Additionally, the vaccination process
(injections) has been a significant source of pain and trauma to children – although compared to
its benefits, this has not been a major ethical issue to cancel the routine programs. Although
overlooked for the longest time, researchers are now exploring the potential adverse effects of
vaccination injections on children, their parents, and clinicians (pediatricians) administering the
drugs. Research shows that the pain associated with these injections is a primary source of

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trauma and distress for young children, clinicians, and parents. If not addressed, the distress and
pain can result in needle fears, preprocedural anxiety, and nonadherence to immunization
appointments. Evidence shows that approximately 25 percent of adults fear needles, and most of
these fears develop in childhood. Roughly 10 percent of the population avoid immunization and
other needle-related procedures (Taddio et al., 2010). Researchers are now looking for better
ways to reduce pain and improve immunization clinical experiences and outcomes, including
adherence. More positive immunization experiences can also build and promote trust in
clinicians (MacKenzie et al., 2021).

PICO Question

In young children from birth to year (P), do distraction techniques during immunization using
toys(I), compared to no intervention (C), result in lower pain scores (O)?
Population/Problem
The population in question is “young children” eligible for immunization. The CDC
recommends that school children be vaccinated against life-threatening but preventable diseases
like chickenpox, diphtheria, influenza, measles, human papillomavirus (PV), hepatitis A,
hepatitis B, whooping cough, tetanus, rubella, and polio. Following this recommendation, all
states in the US mandate that K-12 schoolchildren are immunized against chickenpox, rubella,
measles, polio, whooping cough, tetanus, and diphtheria (DeSilver, 2021). Additionally, all states
except Iowa require compulsory vaccination against mumps for schoolchildren. Despite its
benefits, immunization is a significant source of iatrogenic pain in children, from infancy to
childhood to adolescence. According to Taddio et al. (2010), iatrogenic pain associated with
immunization injection is the primary source of trauma and distress for young children,

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clinicians, and parents. If not managed appropriately, it can result in needle fears, preprocedural
anxiety, and nonadherence to immunization schedules.
Intervention
The intervention is “distraction techniques during immunization.” To alleviate pain
during immunization or pre-needle distress, the researcher assigns “toys” to distract children.
Distraction tools have effectively been used as non-pharmacological approaches to lower pain
and distress in children and infants. The idea is to encourage children, for example, to play, view,
or listen to sound-producing or image-displaying toys. A pain scale, such as the FLACC (Face,
Leg, Activity, Cry, & Consolability), is then used to record children’s responses and their level of
pain pre- and post-vaccination (Gedam et al., 2013).
Comparison
The comparison group is “no intervention.” Unlike the intervention/experimental group,
the comparison group is not exposed to the “distraction techniques during vaccination.” The
comparison group can also be called the control group because it is the benchmark to which the
intervention group is compared (Gedam et al., 2013).
Outcome
The outcome is “lower pain scores.” Distraction techniques using toys have been shown
to lower “pain scores” in children during and after immunization. For example, a 2013 study by
Gedam et al. found a significantly lower pain score on the FLACC pain scale for the intervention
group (kids encouraged to play with sound and light producing toys) before (score 2.3) and after
(score -3) vaccination compared to the control group (children immunized without any
distraction) (before 3.65; after 6.20). Distractions techniques can also create positive child

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experiences, reduce long-term needle phobia/fears, and improve adherence to vaccination
schedules and other injection-based or needle-based therapies.
Conclusion

This study seeks to answer the PICO question: In young children from birth to year (P),
do distraction techniques during immunization using toys(I), compared to no intervention (C),
result in lower pain scores (O)? Answering this PICO question can allow the researcher to
determine whether distraction techniques during vaccination can lower pain levels in young
children compared to using “no distractions.”

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References

Aslam, S., & Emmanuel, P. (2010). Formulating a researchable question: A critical step for
facilitating good clinical research. Indian Journal of Sexually Transmitted Diseases and
Aids, 31(1), 47-50. doi: 10.4103/0253-7184.69003
DeSilver, D. (2021, Oct 8). States have mandated vaccinations since long before COVID-19.
Pew Research Center. https://www.pewresearch.org/fact-tank/2021/10/08/states-have-
mandated-vaccinations-since-long-before-covid-19
Gedam, D. S., et al. (2013). Effect of distraction technique during immunization to reduce
behavior response score (FLACC) to pain in toddlers. Journal of Nepal Pediatric Society,
33(1).
MacKenzie, N. E., et al. (2021). Factors associated with parents’ experiences using a knowledge
translation tool for vaccination pain management: A qualitative study. BMC Health
Services Research, 21(355). https://doi.org/10.1186/s12913-021-06326-2
Taddio, A., et al. (2010). Reducing the pain of childhood vaccination: An evidence-based clinical
practice guideline. Canadian Medical Association Journal, 182(18), 843-855. doi:
10.1503/cmaj.101720