Comfort Promotion: Distraction (Ambulatory) - CE/NCPD

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OVERVIEW

The pain experience is a product of a person’s values, cultural expectations, emotions, and prior pain experiences. Pain is a subjective measure and varies among patients. Nondrug pain-control measures include massage, meditation, acupuncture, relaxation breathing, distraction, guided imagery, and heat and cold application.^{undefined#ref3">3,4} Such measures should be used in conjunction with pharmacologic interventions and can reduce the amount of pain medication required. Nondrug techniques help diminish the physical effects of pain, alter a patient’s awareness of pain, and give the patient with a greater sense of control. Nondrug interventions are appropriate for patients who find them appealing or who have incomplete pain relief with drug therapy alone.^3,5

Certain diagnostic and therapeutic procedures commonly cause pain. Evidence suggests that fewer than half of patients having an operative or invasive procedure report enough postoperative pain relief.⁶ In many situations, a combination of different pain relief techniques is needed to effectively relieve pain after a procedure. Giving a pain medicine before starting a nondrug strategy, such as distraction, may help the patient with comfort. Adding nondrug techniques may improve the outcomes when addressing the biopsychosocial model of pain, which considers biological, psychological, and social factors.⁶ The patient, setting, and procedure affect the exact components of effective pain relief.⁶ Because patients respond differently to nondrug techniques, finding the most effective method can take time. A combination of techniques is often beneficial.

By introducing meaningful stimuli that can help refocus attention, the health care team member distracts the patient’s attention from feeling pain. Distraction strategies include changing activities, listening to music, reading, focusing on another person, walking, napping, writing, concentrating on a mental and physical activity at the same time (e.g., playing a musical instrument), learning something new (e.g., completing a crossword puzzle), and listening to or watching a comedy program. Therapeutic communication with the health care team member is another example of distraction. When the distraction is removed, the patient may experience a heightened awareness of pain.⁴

Distraction appears to be most effective for times of mild to moderate pain lasting from minutes to an hour, such as during a bone marrow biopsy, lumbar puncture, burn debridement, venipuncture, and discomfort experienced during childbirth.² The use of music has been shown to maximize pain control and promote healing after procedures by reducing anxiety and stress.³

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Describe distraction therapy, including its purpose and rationale, to the patient.
• Describe what is expected of the patient during the procedure.
• Describe how the patient can maximize the benefits of therapy.
• Explain that some techniques require practice before a patient achieves results.
• Explain that pain medication may be required to further reduce pain and to augment comfort-promotion measures.
• Teach the patient to rest between periods of activity because fatigue increases the perception of pain.
• Describe distraction techniques and have the patient practice them to use at home.
• Give written teachings before the patient leaves.

PROCEDURE

1. Determine if the patient has health literacy needs or requires tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
2. Review the patient’s previous experience and knowledge of distraction for comfort promotion and understanding of the care to be provided.
3. Find out the patient’s pain level using a validated pain scale.
4. Watch the patient for physiologic, behavioral, and emotional signs and symptoms of pain.
5. Look for the characteristics of pain and the underlying probable cause.
6. Review the patient’s understanding of pain and willingness to use nondrug pain-control measures.
7. Identify the patient’s home activities that promote relaxation (e.g., jigsaw puzzles, crocheting or knitting, board games, music, imagery, relaxation recordings).
8. Plan to do the distraction technique when the patient can concentrate (e.g., after voiding).
9. Prepare the environment.
   1. Control lighting in the room.
   2. Minimize distractions by health care team members.
   3. Maintain a comfortable room temperature (a sheet or light blanket prevents chilling).
   4. Give privacy.
10. Check the site of the patient’s pain or discomfort.
    1. Look for discoloration, swelling, and drainage.
    2. Feel for a change in temperature, altered sensation, painful area, areas that trigger pain, and areas that reduce pain.
    3. Check the range of motion of involved joints (if applicable).
11. Review the practitioner’s orders for pain relief.
12. Give a pain medication, if needed.
13. Rate the patient’s pain again after allowing enough time for the medication to work based on the route and the patient’s condition.
14. Turn the patient’s attention away from the pain with distraction techniques.

    Rationale: Redirection of attention alters emotional or cognitive aspects of pain.

15. Ask the patient to close the eyes or to focus on a single object in the room.

    Rationale: These actions direct attention inward and protect the patient from external distraction.

16. Ask the patient to concentrate on slow, rhythmic breathing. Guide breathing or teach the patient to control and focus on breathing by thinking “in, one, two; out, one, two.”

    Rationale: Rhythmic breathing helps with relaxation by focusing on sensory perception action, thus reducing the patient’s ability to concentrate on pain.

17. Continue distraction using a chosen distraction technique.
    1. Use music of the patient’s choosing. Have the patient listen to the rhythm and adjust the volume as pain increases or decreases.

       Rationale: Focusing on an activity diverts attention from a painful sensation.

    2. Direct the patient to give a detailed account of an event or a story.

       Rationale: Stressing details of an event enhances distraction from the pain stimulus.

    3. Engage the patient in conversation.
18. Watch the patient’s respirations, body position, facial expression, tone of voice, mood, mannerisms, and expressions of discomfort.

    Rationale: Watching the patient during distraction techniques helps show the effectiveness of the technique, the level of relaxation, and the degree of pain relief. It also indicates which techniques were the most effective.

19. Watch the patient doing the pain-control measures.
20. Assess, treat, and reassess pain.

EXPECTED OUTCOMES

• Patient is relaxed and comfortable after a distraction technique.

UNEXPECTED OUTCOMES

• Patient is not able to concentrate on the distraction technique because of intense pain.

DOCUMENTATION

• Distraction technique(s) used
• Patient response to the distraction technique(s)
• Changes in patient physical condition (e.g., blood pressure, pulse, respiration, skin condition; reports of dizziness)
• Patient’s unusual responses to distraction technique(s) (e.g., uncontrolled or aggravated pain), if any
• Education
• Unexpected outcomes and related interventions

PEDIATRIC CONSIDERATIONS

• Using music or an electronic device for distraction in pediatric patients has proven to alleviate stress and pain.⁵
• Distraction techniques should be used per the pediatric patient’s developmental level (e.g., using a pacifier for an infant or toddler, listening to a recording of a favorite story for a preschool-age patient, listening to music on headphones for an adolescent patient). Play therapists are good resources for appropriate distraction techniques.
• The use of a distraction technique when giving pediatric immunizations can be highly effective in reducing the pain associated with injections.¹
• Family members help give pain relief. Family members give comfort by their presence and their conversation, as well as by holding and cuddling their child.

OLDER ADULT CONSIDERATIONS

• In many older adult patients, vision, hearing, cognitive, and motor difficulties may make the use of comfort promotion techniques, such as distraction, difficult and impair understanding of and participation in procedures. Making sure that a patient is wearing necessary assistive devices (e.g., glasses, hearing aids) may help make sure that a comfort promotion procedure is effective.
• Music can be highly effective in reducing pain, promoting healing, and decreasing agitation in patients with dementia.

REFERENCES

1. Birnie, K.A. and others. (2018). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 10, Art. No.: CD005179. doi:10.1002/14651858.CD005179.pub4
2. Lambert, V. and others. (2020). Virtual reality distraction for acute pain in children. Cochrane Database of Systematic Reviews, 10, Art. No.: CD010686. doi:10.1002/14651858.CD010686.pub2
3. Miller-Saultz, D. (2020). Chapter 8: Pain. In M.M. Harding and others (Eds.), Lewis’s medical-surgical nursing: Assessment and management of clinical problems (11th ed., pp. 102-126). St. Louis: Elsevier.
4. Rateau, M. (2020). Chapter 6: Stress management. In M.M. Harding and others (Eds.), Lewis’s medical-surgical nursing: Assessment and management of clinical problems (11th ed., pp. 76-87). St. Louis: Elsevier.
5. Rudnick, C., Sulaiman, E., Orden, J. (2018). Effect of virtual reality headset for pediatric fear and pain distraction during immunization. Pain Management, 8(3), 175-179. doi:10.2217/pmt-2017-0040
6. Small, C., Laycock, H. (2020). Acute postoperative pain management. The British Journal of Surgery, 107(2), e70-e80. doi:10.1002/bjs.11477

ADDITIONAL READINGS

Aubrun, F. and others. (2019). Revision of expert panel’s guidelines on postoperative pain management. Anaesthesia, Critical Care & Pain Medicine, 38(4), 405-411. doi:10.1016/j.accpm.2019.02.011

National Center for Complementary and Integrative Health. (2021). Relaxation techniques: What you need to know. Retrieved April 23, 2025, from https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know

Clinical Review: Suzanne M. Casey, MSN-Ed, RN

Published: June 2025