The Effect of a Riddle-Based Distraction Technique on Pain, Fear, and Anxiety During Cast Application in Children: A Randomized Study

Routine clinical care will be applied to the control group. No action will be taken.

Before and during the cast application, the child will be asked age-appropriate simple riddles, encouraged to actively participate through clues, and their attention will be distracted from the procedure.

Children who come to the hospital's cast room and meet the research criteria will be randomly assigned to the intervention group. The baseline scales and information forms will be filled out by the researcher through interviews with the child and parent before the cast application. Before the research, a pool of short, clear, and age-appropriate riddles will be prepared in consultation with experts, taking into account the cognitive levels of children aged 6-12. Prior to the procedure, brief communication will be established with the child to introduce the riddle game. During the cast preparation (preparing materials and positioning the extremity) and throughout the entire cast application process (wrapping, shaping, and setting the cast), the researcher will continuously ask the child riddles. The child's active participation will be encouraged by providing hints when needed and offering positive feedback. Active distraction turns the frightening cast room into an engaging space.

It is a form consisting of 4 questions in total, including the child's age, gender, previous fracture experience, and if any, how many times the child has experienced a fracture. It was prepared by the researcher in accordance with the literature.

This scale was developed by Donna Wong and Connie Moran Baker in 1981 to assess pain levels in children. Suitable for children aged 3-18 years, the scale consists of 6 facial expressions scored from '0' to '10'. A score of "0" indicates no pain, while a score of "10" represents the worst possible pain. In our study, the child will be shown the facial expressions on the scale, asked to choose the face that best describes their pain, and the corresponding score will be recorded.

Developed by McMurtry and colleagues, the Turkish validity of this scale was conducted by Gerçeker and colleagues. The changes in the facial muscles of a frightened expression were drawn by a graphic artist from a photograph of a frightened face. The scale features facial expressions scored from 0 to 4, where "0" indicates a neutral expression (no fear), "1" indicates a very low level of fear, "2" indicates a little fear, "3" indicates a greater level of fear, and "4" indicates the highest level of fear. In our study, the child will be shown the facial expressions on the fear scale, asked to select how they feel, and the corresponding score will be recorded.

Developed to measure anxiety in children, the Turkish validity of this tool was confirmed by Gerçeker and colleagues (Ayar et al.). The scale utilizes a thermometer visual with a bulb at the bottom representing a score of "0" and lines extending upwards divided into 10 sections reaching a score of "10". The child is explained that as their finger moves up from the bulb, their anxiety increases, whereas the bulb represents playing happily with friends. In our study, the child will be asked to point to the thermometer according to how they feel during the procedure, and the corresponding score will be recorded.