The Effect of Helfer Skin Tap Technique on Pain Reduction and Hemodynamic Parameters During Tetanus Injection in Pregnant Women

Abstract

Abstract Aim; The study was aimed at determining the effect of the Helfer skin tap technique on pain reduction and hemodynamic variables in pregnant women during tetanus injection. Method; It was a comparative study with a randomized control group conducted in a Family Health Center between August 2021, and March 2022. The study was conducted with 65 pregnant women who got tetanus vaccine. The tetanus vaccine was administered using the Helfer skin tap techniques to 33 of pregnant women and the standard intramuscular injection (IM) technique to 32 women. Pregnant women’s pain levels were evaluated on the Number Rating Scale after vaccination by the researcher. Similarly, the hemodynamic variables of the pregnant women were examined by the same researcher before and immediately after the vaccine administration. Results; It was determined that there was a statistically significant difference between the Helfer skin tap groups and standard application group in terms of mean pain intensity in the post-intervention (p < .01). The majority of the sample (69.7%) in the Helfer skin tap group perceived mild pain and most of the participants (46.9%) in the standard application group had moderate pain in the post-intervention. Respiratory rates of the pregnant women in the Helfer skin tap group were seen to decrease significantly after the vaccine administration (p < .01), but no change was found in the other hemodynamic variables. Helfer skin tap group heart rates were significantly lower compared with those in the standard group (p < .05), while their saturation levels were significantly higher (p < .01). Conclusion; It was concluded that the Helfer skin tap technique is an effective method to reduce pain during IM tetanus vaccine administration.

Keywords

• Intramuscular injection
• pain
• Helfer skin tap technique
• hemodynamic variables

Project Number

yok

The Effect of Helfer Skin Tap Technique on Pain Reduction and Hemodynamic Parameters after Tetanus Injection in Pregnant Women

Abstract

Giriş ve Amaç: Bu çalışmanın amacı gebe kadınlarda tetanoz enjeksiyonu sırasında Helfer skin tap tekniğinin ağrının azalması ve hemodinamik değişkenler üzerine etkisini belirlemektir. Gereç ve Yöntemler: Bu çalışma Ağustos 2021 ile Mart 2022 tarihleri arasında bir Aile Sağlığı Merkezinde gerçekleştirilen, randomize kontrol gruplu karşılaştırmalı bir çalışmadır. Araştırma, tetanoz aşısı olan 65 gebe kadınla gerçekleştirildi. Tetanoz aşısı gebelerin 33'üne Helfer skin tap tekniği, 32 kadına ise standart kas içi enjeksiyon (İM) tekniği kullanılarak uygulandı. Gebe kadınların ağrı düzeyleri aşı sonrası Sayı Derecelendirme Ölçeği ile değerlendirildi. Benzer şekilde gebelerin hemodinamik değişkenleri aşı yapılmadan önce ve aşı yapıldıktan hemen sonra aynı araştırmacı tarafından incelendi. Bulgular: Helfer skin tap grubu ile standart uygulama grubu arasında müdahale sonrası ortalama ağrı şiddeti açısından istatistiksel olarak anlamlı fark olduğu belirlendi (p<0,01). Helfer skin tap grubundaki örneklemin çoğunluğu (%69,7) hafif düzeyde ağrı algılarken, standart uygulama grubundaki katılımcıların çoğunluğu (%46,9) müdahale sonrasında orta şiddette ağrı hissetti. Helfer skin tap grubundaki gebelerin solunum hızlarında aşı uygulamasından sonra anlamlı azalma görüldü (p< 0,01), ancak diğer hemodinamik değişkenlerde herhangi bir değişiklik saptanmadı. Helfer skin tap grubunun kalp hızları, standart grupla karşılaştırıldığında anlamlı derecede düşüktü (p < 0,05), satürasyon seviyeleri ise anlamlı derecede yüksekti (p < 0,01). Sonuç: Helfer skin tap tekniğinin IM tetanoz aşısı uygulaması sırasında ağrıyı azaltmada etkili bir yöntem olduğu sonucuna varıldı.

Keywords

• İntramüsküler enjeksiyon
• ağrı
• Helfer skin tap tekniği
• hemodinamik değişkenler

Supporting Institution

yok

Project Number

yok

Ethical Statement

Ethical approval was obtained from the Ethical Committee of Manisa Celal Bayar University (date: 19.08.2020 number: 20.478.486/489), and informed consent was obtained from all pregnant women. Permission was received from Manisa Local Health Authority after one year from ethical committee approval due to the COVID-19 pandemic (date: 16.08.2021 number: 49654233-604.02-02-810). All pregnant women provided written consent after being informed about the study purpose and details. The study was carried out in accordance with the ethical standards of the Declaration of Helsinki. It was also registered at the clinicaltrials.gov (Clinical Trial registration number: NCT05761340).

Thanks

The research team would like to thank all patients who participated in the study.

References

1. 1. World Health Organization (WHO), Calls for worldwide use of “smart” syringes. https://www.who.int/news/item/23-02-2015-who-calls-for-worldwide-use-of-smart-syringes. Erişim tarihi: 18.06.2024
2. 2. Zegeye AF, Tamir TT, Mekonen EG, Ali MS, Gonete AT, Techane MA, ... & Workneh BS. Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression. Human Vaccines & Immunotherapeutics, 2024, 20(1), 2352905.
3. 3. Havers FP. Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the Advisory Committee on Immunization Practices-United States, 2019. MMWR. Morbidity and Mortality Weekly Report, 69. https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm. Erişim tarihi: 18.06.2024
4. 4. Hinkle JL, Cheever KH. Brunner & Suddarth's textbook of medical-surgical nursing (13th. edition) Lippincott Williams & Wilkins; 2014.
5. 5. Blanco-Hungría A, Rodríguez-Torronteras A, Blanco-Aguilera A, Biedma-Velázquez L, Serrano-Del-Rosal R, Segura-Saint-Gerons R, de la Torre-de la Torre J, Esparza- Díaz F. Influence of socio-demographic factors upon pain intensity in patients with temporomandibular joint disorders seen in the primary care setting. Journal of medicine Patología Oraly Cirugía Bucal, 2012, 17 (6), e1034–e1041. https://doi.org/10.4317/medoral.17576.
6. 6. Hogan ME, Kikuta A, Taddio A. A systematic review of measures for reducing injection pain during adult immunization. Vaccine, 2010, 28, 1514-1521. https://doi.org/10.1016/j.vaccine.2009.11.065.
7. 7. Taddio A, Ipp M, Thivakaran S, et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine, 2012, 30, 4807-4812.
8. 8. Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca, J. Acute pain management: scientific evidence, fourth edition, 2015. Medical Journal of Australia, 204 (8), 315-317. https://doi.org/10.5694/mja16.00133.

9. 9. Zargham-Boroujeni A, Elsagh A, Mohammadi Zadeh M. The effects of massage and breastfeeding on response to venipuncture pain among hospitalized neonates. Iranian Journal of Nursing and Midwifery Research, 2017, 22 (4), 308. https://doi.org/10.4103/ijnmr.IJNMR_119_13.
10. 10. Ramadan RH, Soliman HM, Othman WN. Effect of Cryotherapy versus Heifer Technique on Pain Intensity among Adult Patients Receiving Intramuscular Injection. Journal of Nursing and Health Science, 2018, 7 (6), 79-95. https://doi.org/10.9790/1959-0706027995.
11. 11. Kochman A, Howell J, Sheridan M, Kou M, Ryan EES, Lee S, Yoder L. Reliability of the faces, legs, activity, cry, and consolability scale in assessing acute pain in the pediatric emergency department. Pediatric Emergency Care, 2017, 33 (1), 14-17. https://doi.org/10.1097/PEC.0000000000000995.
12. 12. Helfer JK. Painless injections: Helfer skin tap technique. Journal of Surgery and Surgical Research, 2021, 7 (1), 017-019. https://doi.org/10.17352/2455-2968.000129.
13. 13. Bhuvaneswari G, Thulasiya V. Assess the effectiveness of helfer skin tapping techniques on pain during vaccination intramuscular injection among the infants in primary health centre neamam. Research Journal of Pharmacy and Technology, 2018, 11 (6), 2599-2602. https://doi.org/10.5958/0974-360X.2018.00481.X
14. 14. Vathani G, Kumari MJ, Pandit VR. (2017). Effectiveness of Helfer skin tap technique on pain reduction among the patients receiving intramuscular injection. International Journal of Current Research, 9 (9), 57185-57189.
15. 15. Arora S. Helfer’s Skin Tap Technique for IM Injection Pain. International Journal of Nursing Science Practice and Research, 2015, 1 (2), 19-20.
16. 16. Kaur S, Kaur S, Kaur S. An Experimental Study to Assess the Effectiveness of Helfer Skin Tap Technique on Procedural Pain among Patients in Selected Civil Hospitals of Punjab. International Journal of Health Sciences and Research, 2019, 9 (9), 103-109.
17. 17. Güven Ş, Çelik GK, Calpbinici P. Effect of Helfer skin tap technique on pain associated with intramuscular injection among adult: A randomized controlled study. International Journal of Nursing Didactics, 2020, 10 (02), 72-75. https://doi.org/10.15520/ijnd.v10i02.2820
18. 18. Meera P, Yogesh, K, Gurneet K. A Study to Assess the Effectiveness of Helfer Skin Tap Technique during Immunization in Infants in Selected Hospital and Anganwadi of Ambala, Haryana. Journal of Nursing Science & Practice, 2014, 4 (3), 1-2.
19. 19. Sivapriya S, Kumari LA. Study to Assess the Effectiveness of Helfer’s Skin Tap Technique on Pain during Intramuscular Injection among Neonates Born in Labour Room of a Selected Tertiary Level Hospital. International Journal of Science and Research, 2015, 4, 547-52.
20. 20. Negi P. Effectiveness of Helfer skin tap technique on pain reduction during intramuscular injection among infants. International Journal of Advanced Research and Development, 2019, 4 (3), 34-39.
21. 21. Rautela M, Thomas S, Rita PD. A true experimental study to assess the effectiveness of helfer skin tap technique on the level of pain during ıntramuscular ınjection of tetanus toxoid among antenatal mothers in a selected hospital of Delhi. International Journal of Nursing Education, 2020, 12 (1), 46-50. https://doi.org/10.5958/0974-9357.2020.00010.0
22. 22. Therese AM, Devi S. Effectiveness of Helfer skin tap technique and routine technique on pain reduction among patients receiving intramuscular injection at Government General Hospital, Puducherry. International Journal of Science and Research, 2014, 3 (10), 1446-1449.
23. 23. Lord B, Woollard M. The reliability of vital signs in estimating pain severity among adult patients treated by paramedics. Emergency Medicine Journal, 2011, 28 (2), 147-150. https://doi.org/10.1136/emj.2009.079384
24. 24. Ledowski T, Reimer M, Chavez V, Kapoor V, Wenk M. Effects of acute postoperative pain on catecholamine plasma levels, hemodynamic parameters, and cardiac autonomic control. Pain, 2012, 153 (4), 759-764. https://doi.org/10.1016/j.pain.2011.11.002.
25. 25. Pour HA. Association between acute pain and hemodynamic parameters in a postoperative surgical intensive care unit. AORN Journal, 2017, 105 (6), 571-578. https://doi.org/10.1016/j.aorn.2017.04.006
26. 26. Gélinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators. The Clinical Journal of Pain, 2007, 23 (6), 497– 505. https://doi.org/10.1097/AJP.0b013e31806a23fb
27. 27. Cohen J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Routledge. https://doi.org/10.4324/9780203771587
28. 28. Shah Dr S, Narayanan Ms A. Effect of Helfer Rhythmic skin tap technique on procedural pain among patients receiving intramuscular injection. Manipal Journal of Nursing and Health Sciences, 2016, 2(1), 3-9.
29. 29. McWilliam PL, Botwinski CA, La Course JR. Deltoid intramuscular injections and obesity. Medical Surgical Nurses, 2014, 23 (1), 4-7.
30. 30. Chaudhari Hemangi et al, International Journal of Innovative Studies in Sociology and Humanities (IJISSH) ISSN 2456-4931 (Online) www.ijissh.org Volume: 3 Issue:12; December 2018, P. No. 73-75
31. 31. Kanika K. Effect of massage on pain perception after administration of, Intramuscular Injection among adult patients. Nursing and Midwifery Research Journal, 2011, 7 (3), 130-138.
32. 32. Dimpleshree K, Ramasambasivan R, Mahariba SK, Princy K. Effectiveness of helfer skin tap technique on pain experience among the patients receiving intramuscular injection. Journal of Medical & Surgical Nursing, 2020, 8 (1), 24-30.
33. 33. Pio G, De Jesus R, Belvis ND, Lucas D, Daza H, Martin S, Ramos B. Reducing tetanus vaccine pain in filipino pregnant women: Helfer skin tap technique efficacy. British Journal of Nursing Studies, 2024, 4 (1), 88-93. https://doi.org/10.32996/bjns.2024.4.1.8
34. 34. Karabey T, Karagözoğlu Ş. The Effect of helfer skin tap technique and shotblocker application on pain in deltoid muscle injection. Clinical and Experimental Health Sciences, 2021, 11 (4), 721-726. https://doi.org/10.33808/clinexphealthsci.861801
35. 35. Jyoti G, Arora S, Sharma B. Helfer Skin Tap Tech Technique for the IM injection pain among adult patients. Nursing & Midwifery Research Journal, 2018, 14 (3), 18-30. https://doi.org/10.1177/0974150X20180304
36. 36. Ledowski T, Pascoe E, Ang B, Schmarbeck T, Clarke MW, Fuller C, Kapoor V. Monitoring of intra-operative nociception: skin conductance and surgical stress index versus stress hormone plasma levels. Anaesthesia, 2010, 65, 101–106 https://doi.org/10.1111/j.1365-2044.2010.06480.x
37. 37. McCarthy A. Psychosocial aspects of pain and fatigue. In: Rogers-Clark C, McCarthy A, Martin-McDonald K, eds. Living with illness: psychosocial challenges for nursing. Sydney: Elsevier Australia, 2005, 117.
38. 38. Bledsoe BE, Myers J. Pain & comfort: the pathophysiology of pain & prehospital treatment options. Journal of Eta Maritime Science, 2003, 28 (6), 50-67.
39. 39. Devine EC. Somatosensory function, pain, and headache. In: Porth C, ed. Pathophysiology: concepts of altered health states. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2005, 1175.
40. 40. Roatta S, Mohammed M, Passatore M. Detecting activation of the sympathoadrenal axis from haemodynamic recordings, in conscious rabbits exposed to acute stress. Acta Physiologica, 2011, 201 (3), 323–337. https://doi.org/10.1111/j.1748-1716.2010.02179.x
41. 41. Janig W. The sympathetic nervous system in pain. The European Journal of Anaesthesiology (Suppl), 1995, 10, 53–60.
42. 42. Burke KM, Mohn-Brown EL. Eby L. Medical Surgical Nursing Care. 3rd edition. Pearson: USA. 2011, ISBN-13: 9780136080046.