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Background: Children undergoing treatment with hemodialysis are exposed frequently to pain and anxiety which are caused by the insertion of large-gauge needles into an arteriovenous fistula. Non pharmacological pain management methods such as virtual reality and guided visualization are used to manage pain and pain related anxiety. Aim: to evaluate the effect of virtual reality compared to guided visualization on arteriovenous fistula cannulation pain and pain anxiety among hemodialysis children. Setting: the study was carried out at the Tanta Main University Hospital, Pediatric Medical Department, Dialysis Unit, Tanta City, Egypt. Sample: a convenience sampling of thirty children undergoing hemodialysis with arteriovenous fistula were included from the previously mentioned setting. Tools: there were three tools used: Tool I: Structured interview schedule, consisting of three components: sociodemographic characteristics of the children, data about the caregiver of the child and data related to the disease and fistula. Tool II: Wong–Baker faces pain rating scale for children. Tool III: Pain Anxiety Symptom Scale Short Form which was developed by McCracken (2002). Results: 53.33% and 33.33% of the studied children had moderate and severe pain anxiety symptoms pre-intervention respectively while 73.33%and 46.67%of them had mild pain anxiety symptoms during application of virtual reality and guided visualization respectively. Conclusion: visual reality was the preferred method which given the greater relief of pain and pain anxiety than guided visualization. Recommendations: visual reality should be used and disseminated to other hemodialysis centers as a strategy to reduce pain and pain anxiety among those children undergoing hemodialysis.

Effect of Virtual Reality compared to Guided Visualization on Arteriovenous Fistula Cannulation pain and pain anxiety among hemodialysis children