The effect of two different interventions on emotional appearance, pain, and fear during respiratory panel sampling in children: A randomized controlled trial

Background This randomized controlled trial examined the effects of two nonpharmacological interventions—a palm stimulator and a stress ball—on pain, fear, and emotional appearance during respiratory panel swab collection in children. Methods Randomized controlled trial was conducted with 109 children aged 6–12 years were randomly assigned to a palm stimulator group, a stress ball group, or a control group receiving routine care. Pain was assessed using the Wong-Baker FACES Pain Rating Scale, fear was evaluated with the Children's Fear Scale, and emotional appearance was measured using the Children's Emotional Manifestation Scale before and after the procedure. Data were analyzed using robust mixed analysis of variance and nonparametric statistical methods. Results Children in the palm stimulator group demonstrated significantly lower pain and fear scores compared with both the stress ball and control groups. Post-procedural emotional appearance scores were also significantly lower in the palm stimulator group, whereas marked increases over time were observed in the stress ball and control groups. Although statistically significant differences were observed between child-, parent-, and nurse-rated outcomes, the overall pattern of group differences was consistent across raters, with the palm stimulator group demonstrating lower pain, fear, and emotional distress scores. Conclusions The palm stimulator was found to be an effective, safe, and low-cost nonpharmacological nursing intervention for reducing pain, fear, and negative emotional responses during respiratory panel swab collection in children. Implications to practice Palm stimulation may be a practical, low-cost, and nurse-led nonpharmacological intervention for reducing pain, fear, and emotional distress during respiratory panel swab collection in children. Copyright © 2026. Published by Elsevier Inc.