Investigation of the Relationship between Pain Level and General Comfort in Palliative Care Patients

Öz

Purpose: The aim of this study is to investigate the relationship between pain level and general comfort in palliative care patients. Methods: The study was conducted with 358 patients aged 18 years and older, conscious, open to verbal communication, with a Palliative Performance Score of 40% and above, who were hospitalized in the palliative care clinics of a public hospital between March 2019 and February 2020, and agreed to participate in the study. Data were collected with Personal Information Form, Palliative Performance Scale (PPS), Short Form - McGill Melzack Pain Questionnaire (SF-MPQ), and General Comfort Scale (GCS). Independent sample t-test, one-way analysis of variance (ANOVA), Pearson Correlation and Linear Regression analysis were used to analyze the data. Results: Of the participants, the mean age was 38.76±8.90 years, 53.4% were male, 29.6% were cancer patients, It was determined that 39.7% of them had a 4-6 day hospital stay history, and 70.7% of them had their daily life affected due to pain. It was determined that 21.2% of the patients had head extremity, 24.3% had throbbing, 36.6% had terrible pain, 45.3% had a rhythmic-periodic-intermittent pain. As a result of the research, it was determined that the pain intensity (cm) of the patients was 8.01±0.52, and the mean total score of the general comfort scale was 1.87±0.11. A high negative correlation was found between SF-MPQ and GCS (p<0.05). Conclusion: In this study, it was determined that an increase in the level of pain decreased the general comfort level in palliative care patients.

Anahtar Kelimeler

• Palliative care
• pain
• nurse.
• patient comfort

Palyatif Bakım Hastalarında Ağrı Düzeyi ile Genel Konfor Arasındaki İlişkinin İncelenmesi

Öz

Amaç: Bu araştırmanın amacı, palyatif bakım hastalarında ağrı düzeyi ile genel konfor arasındaki ilişkinin incelenmesidir. Yöntem: Çalışma, Mart 2019-Şubat 2020 tarihleri arasında kamuya ait bir hastanenin palyatif bakım kliniklerinde yatarak tedavi gören 18 yaş ve üzerinde olan, bilinci yerinde olan, sözel iletişime açık, Palyatif Performans Skoru %40 ve üzerinde bulunan ve çalışmaya katılmayı kabul eden 358 hasta ile tamamlanmıştır. Veriler, Kişisel Bilgi Formu, Palyatif Performans Skalası (PPS), Kısa McGill Melzack Ağrı Soru Formu (K-MASF) ve Genel Konfor Ölçeği (GKÖ) ile toplanmıştır. Verilerin değerlendirilmesinde Independent Sample t testi, One-Way ANOWA, Pearson Korelasyon ve Linear Regresyon analizi kullanılmıştır. Bulgular: Araştırmaya katılan hastaların yaş ortalaması 38.76±8.90 yıl, %53,4’ünün erkek, %29,6’sının kanser hastası, %39,7’sinin hastanede yatış süresinin 4-6 gün olduğu ve %70,7’sinin ağrı nedeniyle günlük yaşamlarının etkilendiği saptanmıştır. Hastaların %21,2’sinin ağrı bölgesinin baş/ekstremite, %24,3’ünün ağrı niteliğinin zonklama, %36,6’sının genel ağrı şiddetinin berbat, %45,3’ünün ağrısının zamanla ilişkisinin Ritmik-Periyodik-Aralıklı olduğu saptanmıştır. Araştırma sonucunda, hastaların ağrı şiddetinin 8,01±0,52, genel konfor ölçeği toplam puan ortalamasının ise 1,87± 0,11 olduğu belirlenmiştir. K-MASF ve GKÖ arasında yüksek düzeyde negatif yönlü bir ilişki bulunduğu saptanmıştır (p<0,05). Sonuç: Bu araştırmada, palyatif bakım hastalarında ağrı düzeyinin artmasının genel konfor düzeyini azalttığı saptanmıştır.

Anahtar Kelimeler

• Palyatif bakım
• ağrı
• hemşire.
• hasta konforu

Kaynakça

1. 1. Morin L, Aubry R, Frova L, Macleod R, Wilson DM, Loucka M, et al. Estimating the need for palliative care at the population level: A cross-national study in 12 countries. Palliat Med 2017;31(6):526-536.
2. 2. Marmot M, Bell R. Social determinants and non-communicable diseases: time for integrated action. BMJ 2019;364:1251.
3. 3. Robinson J, Gott M, Gardiner C, Ingleton C. Specialist palliative care nursing and the philosophy of palliative care: a critical discussion. Int J Palliat Nurs 2017;23(7):352-358.
4. 4. Turrillas P, Teixeira MJ, Maddocks M. A systematic review of training in symptom management in palliative care within postgraduate medical curriculums. J Pain Symptom Manage 2019; 57(1): 156-170.
5. 5. Knaul FM, Bhadelia A, Rodriguez NM, Arreola-Ornelas H, Zimmermann C. The Lancet commission on palliative care and pain relief—findings, recommendations, and future directions. Lancet Glob Health 2018;6:5-6.
6. 6. Townsend CS, Bonham E, Chase L, Dunscomb J, McAlister S. A comparison of still point induction to massage therapy in reducing pain and increasing comfort in chronic pain. Holist Nurs Pract 2014;28(2):78-84.
7. 7. Coelho A, Parola V, Sandgren A, Fernandes O, Kolcaba K, Apostolo J. The effects of guided imagery on comfort in palliative care. J Hosp Palliat Nurs 2018;20(4):392-399.
8. 8. Nuraini T, Andrijono A, Irawaty D, Umar J, Gayatri D. Spirituality-focused palliative care to improve indonesian breast cancer patient comfort. Indian J Palliat Care 2018;24(2):196-201.

9. 9. Fuoto A, Turner KM. Palliative care nursing communication: An evaluation of the COMFORT model. J Hosp Palliat Nurs 2019;21(2): 124-130.
10. 10. Coelho A, Parola V, Escobar-Bravo M, Apostolo J. Comfort experience in palliative care: A phenomenological study. BMC Palliat Care 2016;15:1-8.
11. 11. Rolin-Gilman C, Fournier B, Cleverley K. Implementing best practice guidelines in pain assessment and management on a women's psychiatric inpatient unit: exploring patients' perceptions. Pain Manag Nurs 2017;18(3):170-178.
12. 12. Kaluza L, Meents JE, Hampl M, Rösseler C, Hautvast PAl, Detro-Dassen S, et al. Loss-of-function of Nav1. 8/D1639N linked to human pain can be rescued by lidocaine. Pflügers Arch 2018;470(12): 1787-1801.
13. 13. Ramanayake R, Dilanka G, Premasiri L. Palliative care; role of family physicians. J Family Med Prim Care 2016;5: 234-237.
14. 14. Hertanti NS, Huang MC, Chang CM, Fetzer SJ, Kao CY. Knowledge and comfort related to palliative care among Indonesian primary health care providers. Aust J Prim Health 2021;26(6):472-478.
15. 15. Arslan M, Albaş S, Küçükerdem H, Pamuk G, Can H. The evaluation of the effectiveness of palliative pain management in cancer patients with visual analogue scale. Family Practice and Palliative Care 2016;1(1): 5-8.
16. 16. Pidgeon T, Johnson CE, Currow D, Yates P, Banfield M, Lester L, et al. A survey of patients’ experience of pain and other symptoms while receiving care from palliative care services. BMJ Support Palliat Care 2016;6(3):315-322.
17. 17. Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative performance scale (PPS): A new tool. J Palliat Care 1996;12(1):5-11.
18. 18. McDonald DD, Weiskopf CS. Adult patients' postoperative pain descriptions and responses to the Short-Form McGill Pain Questionnaire. Clin Nurs Res 2001;10(4):442-452.
19. 19. Yakut Y, Yakut E, Bayar K, Uygur F. Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis. Clin Rheumatol 2007;26(7):1083-1087.
20. 20. Kolcaba KY. Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome. Adv Nurs Sci 1992;15(1): 1-10.
21. 21. Kuğuluoğlu S, Karabacak Ü. Genel konfor ölçeğinin Türkçe'ye uyarlanması. Florence Nightingale Hemşirelik Yüksekokulu Dergisi 2008;16(61):16-23.
22. 22. Al-Ansari AM, Abd-El-Gawad WM, AboSerea SM, ElShereafy EES, Ali FAS, ElSayed MAE. The pattern of change in opioid and adjuvant prescriptions for cancer pain before and after referral to a comprehensive program in the Palliative Care Center in Kuwait. BMC Palliat Care 2021;20:1-12.
23. 23. Doğan A, Saritaş S. The effects of neuro‐linguistic programming and guided imagery on the pain and comfort after open‐heart surgery. J Card Surg 2021;1-9.
24. 24. Black A, McGlinchey T, Gambles M, Ellershaw J, Mayland CR. The ‘lived experience’of palliative care patients in one acute hospital setting–a qualitative study. BMC Palliat Care 2018;17(1):1-10.
25. 25. Uysal N, Şenel G, Karaca Ş, Kadıoğulları N, Koçak N, Oğuz G. Palyatif bakım kliniğinde yatan hastalarda görülen semptomlar ve palyatif bakımın semptom kontrolüne etkisi. Ağrı 2015;27(2):104-110.
26. 26. Karabulut N, Gurcayır D, Aktas YY, Yılmaz D, Gökmen V. Patient satisfaction with their pain management and comfort level after open heart surgery. Australian J Adv Nurs 2015;32(3):16-24.
27. 27. Niyomrat W, Masingboon K, Kunsongkeit W. Relationships between comfort and pain, anxiety, and social support in acute respiratory failure patients with non-invasive ventilator support. Thai Pharmaceutical and Health Science Journal 2018;13(4):179-186.
28. 28. Currow DC, Ward AM, Plummer JL, Bruera E, Abernethy AP. Comfort in the last 2 weeks of life: relationship to accessing palliative care services. Support Care Cancer 2008;16:1255-1263.
29. 29. Çelebi D, Yılmaz E, Şahin ST, Baydur H. The effect of music therapy during colonoscopy on pain, anxiety and patient comfort: A randomized controlled trial. Complement Ther Clin Pract 2020;38:101084.
30. 30. Miller KR, Patel JN, Symanowski JT, Edelen CA, Walsh D. Acupuncture for cancer pain and symptom management in a palliative medicine clinic. Am J Hosp Palliat Care 2019;36(4):326-332.