YETİŞKİNLERDE DİKKATİ BAŞKA YÖNE ÇEKME YÖNTEMLERİNİN AKUT AĞRI ÜZERİNDEKİ ETKİSİ: RANDOMİZE KONTROLLÜ ÇALIŞMA

Öz

Amaç Bu araştırma, yetişkin hastaların kan alma işlemi sırasında yaşadığı ağrıyı tespit edebilmeyi; görsel ve işitsel yöntemlerin rutin kan alma uygulamasına kıyasla ağrı düzeyi üzerindeki etkisini ortaya koymayı amaçlamaktadır. Gereç ve Yöntem Araştırma, randomize kontrollü bir çalışma olarak yürütüldü. 15.01.2022 tarihinde bir üniversite hastanesinin kan alma biriminde gerçekleştirildi. Toplam doksan dokuz hasta, üç gruba randomize edildi. Görsel grupta yer alan hastalara ekranda bulunan doğa fotoğrafına, işitme grubunda yer alan hastalara ise dinledikleri doğa seslerine odaklanmaları istendi. Veriler; Kişisel Bilgi Formu ve Görsel Ağrı Ölçeği kullanılarak toplandı. Verilerin analizinde; tanımlayıcı istatistiksel yöntemler, Kruskal-Wallis, Pearson Chi-Square ve Monte Carlo Exact Testi kullanıldı. Anlamlılık, p<0.05 ve p<0.001 düzeyinde değerlendirildi. Bulgular Görsel ve işitsel grup arasında istatistiksel olarak anlamlı bir farka rastlanmadı (p>0.05). Ancak bu iki grupta yer alan hastaların ağrı düzeyleri, kontrol gurubunda yer alan hastalara göre daha düşük bulundu (p<0.001). Sonuç Bu araştırma yetişkinlerde bilişsel yönetiminin akut ağrı düzeyi üzerindeki olumlu etkisini ortaya koymaktadır. Bilişsel yönetim kapsamında kullanılan görsel ve işitsel yöntemlerin güvenle kullanılabileceğini kanıtlamakta ve kanıta dayalı bilgiler sunmaktadır.

Anahtar Kelimeler

• Ağrı yönetimi
• hemşirelik
• kan alma

EFFECT OF DISTRACTION METHODS ON ACUTE PAIN IN ADULTS: RANDOMIZED CONTROLLED TRIAL

Öz

Objective This study aims to determine the pain experienced by adult patients during the bloodletting procedure and to reveal the effect of visual and auditory methods on the level of pain compared to routine bloodletting procedures. Material and Method The study was conducted as a randomized controlled trial. The study was carried out in a blood collection unit of a hospital on 15.01.2022. A total of ninety-nine patients were randomized into three groups (visual, auditory, and control groups). Visual Group patients were asked to focus on the nature photograph on the screen, and the Auditory Group patients were asked to focus on the nature sounds they listened to. Data were collected using the Personal Information Form and the Visual Analog Scale (VAS). In the analysis of the data, descriptive statistical methods, Kruskal- Wallis, Pearson Chi-Square, and Monte Carlo Exact Tests were used. The significance level was taken as p<0.05 and p<0.001. Results No statistically significant difference was found between the visual and auditory groups (p>0.05). However, the pain levels of the patients in the visual and auditory groups were found lower than the pain levels of the patients in the control group (p<0.001). Conclusion This study reveals the positive effect of distraction on the level of acute pain in adults. The study proves that visual and audial methods can be used safely within the scope of distraction methods and presents evidence-based information.

Anahtar Kelimeler

• Bloodletting
• nursing
• pain management

Kaynakça

1. 1. Jancy J. Effect of cold needle on perception of pain during intra muscular injection. Asian Journal of Nursing Education and Research. 2019;9(4):483-87. Doi:10.5958/2349- 2996.2019.00101.0.
2. 2. McMurtry CM, Taddio A, Noel M, Antony MM, Chambers CT, Asmundson GJG, et al. Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research. Cogn Behav Ther. 2016;45(3):217-35. Doi:10.1080/1 6506073.2016.1157204.
3. 3. Lescop K, Joret I, Delbos P, Briend-Godet V, Blanchi S, Brechet C, et al. The effectiveness of the buzzy device to reduce or prevent pain in children undergoing needle-related procedures: The results from a prospective, open-label, randomised, non-inferiority study. Int J Nurs Stud. 2020;113:103803. Doi: 10.1016/j.ijnurstu.2020.103803.
4. 4. Chen HC, Shaw JS, Lee JF, Wu SF. Study on fast needle puncture to reduce pain. In 2019 IEEE International Conference on Architecture, Construction, Environment and Hydraulics. 2019;128-32. Doi:10.1109/ICACEH48424.2019.9041931.
5. 5. Kowalsky JM, Conatser R, Ritz T, Fransa CR. Effects of respiratory and applied muscle tensing interventions on responses to a simulated blood draw among individuals with high needle fear. J Behav Med. 2018;41(6):771-83. Doi:10.1007/s10865- 018-9925-8.
6. 6. McMurtry CM, Noel M, Taddio A, Antony MM, Asmundson GJG, Riddell RP, et al. Interventions for individuals with high levels of needle fear: Systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin J Pain. 2015;31(10):109. Doi:10.1097/AJP.0000000000000273.
7. 7. AminiSaman J, Karimpour HA, Hemmatpour B, Mohammadi S, Darvishi S, Kawyannejad R. Effect of transcutaneous electrical nerve stimulation on the pain intensity during insertion of needle in patients undergoing spinal anesthesia: A randomized controlled study. Journal of Acupuncture and Meridian Studies. 2020;13(3):83-6. Doi:10.1016/j.jams.2020.03.062.
8. 8. Raghibi A, Salar A, Askari H, Keykha R. Investigating the effect of arnica ointment and distraction on the pain caused by fistula needle insertion in hemodialysis patients: A clinical trial. Medical- Surgical Nursing Journal. 2018;7(2):e85338. Doi:10.5812/ msnj.85338.

9. 9. Czech O, Wrzeciono A, Rutkowska A, Guzik A, Kiper P, Rutkowski S. Virtual reality interventions for needle-related procedural pain, fear and anxiety-A systematic review and meta- analysis. Journal of Clinical Medicine. 2021;10(15):3248. Doi:10.3390/jcm10153248.
10. 10. Akın ME. Effect of music on anxiety and pain during ultrasound- guided core needle breast biopsy: A randomized controlled trial. Diagnostic and Interventional Radiology. 2021;27(3):360. Doi:10.5152/dir.2021.20132.
11. 11. Random.org. What's this fuss about true randomness? [Internet]. 2023 [Erişim Tarihi 12 Şubat 2023]. Erişim adresi: http://www.random.org.
12. 12. Berthelot JM, Nizard J, Maugars Y. The negative Hawthorne effect: Explaining pain overexpression. Joint Bone Spine. 2019; 86(4): 445-449. Doi:10.1016/j.jbspin.2018.10.003.
13. 13. Yılmaz D, Güneş ÜY. The effect on pain of three different nonpharmacological methods in peripheral intravenous catheterisation in adults. J Clin Nurs. 2018;27(5-6):1073-80. Doi:10.1111/ jocn.14133.
14. 14. Jönsson T, Ekvall Hansson E, Thorstensson CA, Eek F, Bergman P, Dahlberg LE. The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy- an intervention study with a reference group. BMC Musculoskelet Disord. 2018;19(1):1-11. Doi:10.1186/s12891-018-2098-3.
15. 15. Taddio A, Riddell RP, Ipp M, Moss S, Baker S, Tolkin J, et al. Relative effectiveness of additive pain interventions during vaccination in infants. CMAJ. 2014;189(6):E227-34. Doi:10.1503/ cmaj.160542.
16. 16. Kim, E, Lee JE, Sohn M. The application of one-hour static qigong program to decrease needle pain of korean adolescents with type 1 diabetes: A randomized crossover design. Journal of Evidence-based Complementary & Alternative Medicine. 2017;22(4):897-901. Doi:10.1177/2156587217722473.
17. 17. McLenon J, Rogers MA. The fear of needles: A systematic review and meta‐analysis. J Adv Nurs. 2019;75(1):30-42. Doi:10.1111/jan.13818.
18. 18. van Dijk, J.F.M., Zaslansky, R., van Boekel, R.L.M., Cheuk-Alam, J.M., Baart, S.J., Huygen, F.J.P.M., Rijsdijk, M. Postoperative pain and age: A retrospective cohort association study. Anesthesiology. 2021;135(6):1104-19. Doi:10.1097/ ALN.0000000000004000.
19. 19. Yoon SL, Scarton L, Duckworth L, Yao Y, Ezenwa MO, Suarez ML, et al. Pain, symptom distress, and pain barriers by age among patients with cancer receiving hospice care: Comparison of baseline data. Journal of Geriatric Oncology. 2021;12(7):1068-75. Doi:10.1016/j.jgo.2021.04.008.
20. 20. Küçük U, Karadeniz H. Yaşlanmaya bağlı bireylerde görülen fizyolojik, ruhsal, sosyal değişiklikler ve korunmaya yönelik önlemler. Yaşlı Sorunları Araştırma Dergisi. 2021;14(2):96-103. Doi:10.46414/yasad.877517.
21. 21. Bimpong K, Thomson K, Mcnamara CL, Balaj M, Akhter N, Bambra C, et al. The gender pain gap: gender inequalities in pain across 19 european countries. Scand J Public Health. 2021;50(2):1403494820987466. Doi:10.1177/140349482098746.
22. 22. Lloyd EP, Paganini GA, ten Brinke L. Gender stereotypes explain disparities in pain care and inform equitable policies. Policy Insights from the Behavioral and Brain Sciences. 2020;7(2):198-204. Doi:10.1177/237273222094289.
23. 23. Bartley EJ, Palit S, Kuhn BL, Kerr KL, Terry EL, DelVentura JL, et al. Natural variation in testosterone is associated with hypoalgesia in healthy women. Clin J Pain. 2015;31(8):730-9. Doi:10.1097/AJP.0000000000000153.
24. 24. Archey M, Goldey K, Crockett E, Boyette-Davis J. An investigation of the effects of testosterone and behavioral expressions of pain on sex/gender differences in pain perception. Psychol Rep. 2019;122(3):826-40. Doi:10.1177/0033294118781320.
25. 25. Chin SH, Huang WL, Akter S, Binks M. Obesity and pain: A systematic review. International Journal of Obesity. 2020;44(5):969- 79. Doi:10.1038/s41366-019-0505-y.
26. 26. Zhang JM, An J. Cytokines, inflammation and pain. Int Anesthesiol Clin. 2017;45(2):27-37. Doi:10.1097/AIA. 0b013e318034194e.
27. 27. Duncanson E, Le Leu RK, Shanahan L, Macauley L, Bennett PN, Weichula R, et al. The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review. Plos One. 2021;6(6):e0253048. Doi:10.1371/ journal.pone.0253048.
28. 28. Cimpean A, David D. The mechanisms of pain tolerance and pain-related anxiety in acute pain. Health Psychology Open. 2019;29(2):205510299865161. Doi:10.1177/2055102919865161.
29. 29. Markfelder T, Pauli P. Fear of pain and pain intensity: meta- analysis and systematic review. Psychological Bulletin. 2020;146(5):411-50. Doi:10.1037/bul0000228.
30. 30. Korkut S, Ülker T. The effect of pain experienced during the covıd- 19 infection on the fear of pain and quality of life. Pain Manag Nurs. 2021;23(1):31-7. Doi:10.1016/j.pmn.2021.08.007.
31. 31. Wani AL, Ara A, Bhat SA. Blood injury and injection phobia: The neglected one. Behavioural Neurology. 2014;7. Doi:10.1155/2014/471340.