Virtual reality on pain intensity and behavioral distress during arteriovenous fistula puncture among children undergoing hemodialysis

Background Children undergoing hemodialysis (HD) are exposed to frequent arteriovenous fistula (AVF) puncture, often leading to significant pain and behavioral distress, affecting children’s well-being and treatment adherence. Virtual reality (VR) has emerged as a promising nonpharmacological nursing intervention to decrease pain intensity and behavioral distress for children. Aim The current study was to evaluate VR on pain intensity and behavioral distress during AVF puncture among children undergoing HD. Research design A quasi-experimental research design (one-group pretest–posttest) was utilized. Sample A convenient sample of 30 school-age children undergoing HD with AVF. Setting The study was carried out in Cairo University Children’s Hospital at El-Mounira section of pediatric nephrology and transplantation. Tools Three tools were used: (a) Structured interview questionnaire; (b) Pain assessment tool (Wong–Baker FACES Pain Rating Scale); (c) The Procedure Behavior Checklist Scale (PBCL). Results The current study revealed that the mean age of children was 9.80±2.16 years, during AVF puncture, which is the most prominent phase of pain intensity and behavioral distress, pain intensity pre-intervention (day 1), more than half of the children had severe pain while postintervention (days 2, 3) highest percentage of children had moderate pain with application of VR intervention. The mean scores of behavioral distress pre-intervention (day 1) were 23.77±8.15, which reduced postintervention (day 2, 3) to 16.53±7.70 and 13.77±7.61, respectively) with the application of VR intervention. There was a highly positive correlation between pain intensity and behavioral distress pre-intervention (day 1) and postintervention (days 2, 3) ( P ≤0.001). Conclusions VR is effective in reducing AVF puncture pain intensity and behavioral distress for children undergoing HD. Recommendations Integrate VR into standard children’s HD care to reduce pain and behavioral distress during AVF puncture.