Peripheral venous cannulation (PVC) is a procedure often associated with discomfort that is commonly administered to paediatric patients during their hospital stay, from admission to discharge. PVC induces physiological and psychological disruptions encompassing sensations of pain, heightened anxiety and feelings of fear (Hsieh et al., 2017). This issue leads to hesitance among children and their family members when faced with medical procedures, subsequently negatively impacting the overall quality of treatment and care (Erdogan & Ozdemir, 2021; Uman et al., 2013). In addition, adverse experiences of pain have a lifelong impact on children (Taddio & McMurtry, 2015).

Cognitive behavioural interventions (CBIs) are promising non-pharmacological methods used to minimise pain, fear and anxiety associated with medical procedures performed on children (Uman et al., 2013; Yilmaz Kurt et al., 2020). Cognitive interventions encompass strategies that recognise anxiety and pessimistic thoughts related to medical procedures and subsequently replace them with constructive beliefs and attitudes, fostering the development of adaptive behaviours and coping mechanisms (Barlow et al., 2020; Birnie et al., 2018). Several cognitive interventions employed during procedural interventions include the use of cognitive distraction (Rossi et al., 2020), imagery (Hoag et al., 2022), hypnosis (Geagea et al., 2023), preparation/information (Düzkaya et al., 2021; Yilmaz Kurt et al., 2020), coping strategies (thought-stopping, coping self-statements, memory change etc.) (Ortiz et al., 2019), and parent training (Moline et al., 2022). Derived from behavioural sciences and principles of learning, behavioural interventions are strategies designed to influence the development and manifestation of particular behaviours (Barlow et al., 2020; Birnie et al., 2018). Several behavioural interventions employed during procedural interventions include behavioural distraction (Erdogan & Ozdemir, 2021), muscle relaxation, breathing exercises, modelling, rehearsal, desensitisation, positive reinforcement (Mac Giolla Phadraig et al., 2023), parent training (Moline et al., 2022), parent/staff coaching and virtual reality (Gerceker et al., 2020). A CBI is a comprehensive set of interventions encompassing both behavioural and cognitive techniques, with at least one strategy targeting behavioural changes and at least one approach addressing cognitive shifts (Barlow et al., 2020; Birnie et al., 2018).

CBIs teach children effective coping skills to diminish stress and anxiety when undergoing painful procedures (Agoston & Sieberg, 2016). Few studies have reported that combined cognitive and behavioural practices are effective in reducing pain (Miller et al., 2016; Sikorova & Hrazdilova, 2011; Yilmaz Kurt et al., 2020), fear (Hsieh et al., 2017) and anxiety (Miller et al., 2016) in painful procedures associated with venipuncture and intravenous insertion in children. In the current research, the Cognitive behavioural intervention package (CBIP) encompassed various components, including procedural preparation and information, cognitive behavioural distraction techniques, affirmative suggestions (such as anticipating reduced pain and minimal arm impact), instruction for caregivers and implementation of positive reinforcement.

Pain management in paediatric patients remains inadequate despite the dramatic increase in therapeutic research on paediatric procedural pain, effective tools for pain assessment and solution-oriented interventions based on guidelines. Implementing CBIs during paediatric procedural pain is an effective and cost-efficient approach to managing procedural pain, anxiety and fear (Hamedi et al., 2020). Birnie et al. (2018) reviewed randomised controlled trials (RCTs) that investigated the impact of psychological interventions on procedural pain and distress in paediatric and adolescent patients. They reported eight studies that employed combined CBIs for venipuncture or intravenous insertion. They concluded that data were insufficient to provide evidence for the effect of combined CBIs on procedural pain in paediatric patients (Birnie et al., 2018). The present study investigated the effect of a CBIP (preparation and information, cognitive- behavioural distraction, suggestions, caregiver training and positive reinforcement) on PVC pain, fear and anxiety in paediatric patients.

The hypotheses are as follows:

H1

The CBIP group experiences less PVC pain than the control group.

H2

The CBIP group experiences less PVC fear than the control group.

H3

The CBIP group experiences less PVC anxiety than the control group.