Use of Nonpharmacologic Interventions for Procedural Pain
Use of Nonpharmacologic Interventions for Procedural Pain
This report focuses on one specific turn for each of the 1,395 adult patients in the Thunder II study who were turned. Table 1 reports the demographic and clinical characteristics of these patients. Patients were predominantly white (86.3%) and male (55.3%), with a mean age of 63.5 ± 3.1 years. The majority of patients (65.9%) were in a critical care unit; 21.9% were on a specialty floor; and 12.2% were on "other" units. Most patients had a primary diagnosis that was surgical (70.4%). Most patients were turned using a drawsheet (53.6%), and most patients (69.4%) assisted with the turn. Only 12% of the patients were premedicated for the turn with an opioid analgesic.
The mean pain intensity score at the time of the turn was 4.9 ± 3.1. As shown in Table 2, except for ethnicity, significant differences were found in mean pain intensity scores for a variety of demographic and clinical characteristics. Specifically, women, specialty floor patients, and surgical and trauma or burn patients reported significantly higher levels of pain during the turn. Those who were turned with a drawsheet, those who did not assist with the turn, and those who were premedicated reported more pain.
Table 3 reports the frequency of specific nonpharmacologic interventions used during turning. The most frequently reported interventions included calming voice, information, deep breathing, gentle touch/hand holding, distraction, pillow splinting, and humor. Somewhat less frequently used were massage, presence of family/friends, therapeutic touch, progressive relaxation, ice, and "other." Infrequently used interventions were music, heat, guided imagery, TENS, acupressure, and hypnosis.
Figure 1 presents the total number of all nonpharmacologic interventions used during one particular turn. The vast majority of patients (92.5%) had at least one nonpharmacologic intervention, while over one-fourth of patients (26.3%) had five or more interventions.
(Enlarge Image)
Figure 1.
Number of nonpharmacologic interventions used during one turn (n = 1,395).
The three most frequently performed nonpharmacologic interventions were calming voice (65.7%), receiving information (60.6%), and deep breathing (37.9%). Table 4 presents the differences in use of each of these three interventions according to patients' demographics and clinical characteristics. Use of calming voice differed according to whether the patient was in a critical care unit. Patients in critical care units were more likely to receive a calming voice. Those who were turned with the use of a drawsheet and those who reported a higher pain intensity more frequently received a calming voice. Those who were in a critical care unit, who did not assist the health care provider during the turn, who had higher pain intensity, or who were nonmedical patients received information significantly more frequently. Use of deep breathing was the only nonpharmacologic intervention that was influenced by age. Those patients who used deep breathing were younger than those who did not. Deep breathing was used more frequently by those who reported a higher pain intensity score, were in a critical care unit, had a surgical versus trauma or burn diagnosis, and were premedicated with opioids.
Separate multivariate logistic regression models were constructed for calming voice, deep breathing, and information (Table 5). Because all demographic and clinical variables had significant univariate associations with at least one of the three top nonpharmacologic interventions, all demographic and clinical predictors were included in each model. Age did not predict use of any of the three nonpharmacologic interventions studied. Gender was predictive of use of a calm voice: Female patients were 1.3 times more likely than male patients to receive a calming voice (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.56–0.98). Ethnicity was predictive, with white patients 1.7 times more likely than patients of other ethnicities to receive a calming voice (OR 1.74, 95% CI 1.01–3.02) and 1.9 times more likely than patients of other ethnicities to receive information (OR 1.87, 95% CI 1.07–3.25). Those patients in critical care were more likely to receive each of these nonpharmacologic interventions than were those on a specialty floor (calming voice: OR 1.66, 95% CI 1.23–2.23; information: OR 1.62, 95% CI 1.21–2.16; deep breathing: OR 1.36, 95% CI=1.01–1.84).
Primary diagnosis predicted the use of nonpharmacologic interventions. Surgical patients were more likely than medical patients to receive information (OR 1.73, 95% CI 1.25–2.38) and deep breathing (OR 2.33, 95% CI 1.62–3.34) interventions. Patients who reported a higher pain intensity score were more likely to receive each of these nonpharmacologic interventions (calming voice: OR 1.01, 95% CI 1.01–1.02; information: OR 1.01, 95% CI 1.001–1.009; deep breathing: OR 1.01, 95% CI 1.001–1.010). For example, this means that the odds of using a calming voice was 1.01 times more likely for each 1-point increase in the 10-point NRS.
Results
Sample
This report focuses on one specific turn for each of the 1,395 adult patients in the Thunder II study who were turned. Table 1 reports the demographic and clinical characteristics of these patients. Patients were predominantly white (86.3%) and male (55.3%), with a mean age of 63.5 ± 3.1 years. The majority of patients (65.9%) were in a critical care unit; 21.9% were on a specialty floor; and 12.2% were on "other" units. Most patients had a primary diagnosis that was surgical (70.4%). Most patients were turned using a drawsheet (53.6%), and most patients (69.4%) assisted with the turn. Only 12% of the patients were premedicated for the turn with an opioid analgesic.
Pain Intensity Reports
The mean pain intensity score at the time of the turn was 4.9 ± 3.1. As shown in Table 2, except for ethnicity, significant differences were found in mean pain intensity scores for a variety of demographic and clinical characteristics. Specifically, women, specialty floor patients, and surgical and trauma or burn patients reported significantly higher levels of pain during the turn. Those who were turned with a drawsheet, those who did not assist with the turn, and those who were premedicated reported more pain.
Frequency of Nonpharmacologic Interventions
Table 3 reports the frequency of specific nonpharmacologic interventions used during turning. The most frequently reported interventions included calming voice, information, deep breathing, gentle touch/hand holding, distraction, pillow splinting, and humor. Somewhat less frequently used were massage, presence of family/friends, therapeutic touch, progressive relaxation, ice, and "other." Infrequently used interventions were music, heat, guided imagery, TENS, acupressure, and hypnosis.
Figure 1 presents the total number of all nonpharmacologic interventions used during one particular turn. The vast majority of patients (92.5%) had at least one nonpharmacologic intervention, while over one-fourth of patients (26.3%) had five or more interventions.
(Enlarge Image)
Figure 1.
Number of nonpharmacologic interventions used during one turn (n = 1,395).
The three most frequently performed nonpharmacologic interventions were calming voice (65.7%), receiving information (60.6%), and deep breathing (37.9%). Table 4 presents the differences in use of each of these three interventions according to patients' demographics and clinical characteristics. Use of calming voice differed according to whether the patient was in a critical care unit. Patients in critical care units were more likely to receive a calming voice. Those who were turned with the use of a drawsheet and those who reported a higher pain intensity more frequently received a calming voice. Those who were in a critical care unit, who did not assist the health care provider during the turn, who had higher pain intensity, or who were nonmedical patients received information significantly more frequently. Use of deep breathing was the only nonpharmacologic intervention that was influenced by age. Those patients who used deep breathing were younger than those who did not. Deep breathing was used more frequently by those who reported a higher pain intensity score, were in a critical care unit, had a surgical versus trauma or burn diagnosis, and were premedicated with opioids.
Predictors of the Three Most Frequently Performed Nonpharmacologic Interventions
Separate multivariate logistic regression models were constructed for calming voice, deep breathing, and information (Table 5). Because all demographic and clinical variables had significant univariate associations with at least one of the three top nonpharmacologic interventions, all demographic and clinical predictors were included in each model. Age did not predict use of any of the three nonpharmacologic interventions studied. Gender was predictive of use of a calm voice: Female patients were 1.3 times more likely than male patients to receive a calming voice (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.56–0.98). Ethnicity was predictive, with white patients 1.7 times more likely than patients of other ethnicities to receive a calming voice (OR 1.74, 95% CI 1.01–3.02) and 1.9 times more likely than patients of other ethnicities to receive information (OR 1.87, 95% CI 1.07–3.25). Those patients in critical care were more likely to receive each of these nonpharmacologic interventions than were those on a specialty floor (calming voice: OR 1.66, 95% CI 1.23–2.23; information: OR 1.62, 95% CI 1.21–2.16; deep breathing: OR 1.36, 95% CI=1.01–1.84).
Primary diagnosis predicted the use of nonpharmacologic interventions. Surgical patients were more likely than medical patients to receive information (OR 1.73, 95% CI 1.25–2.38) and deep breathing (OR 2.33, 95% CI 1.62–3.34) interventions. Patients who reported a higher pain intensity score were more likely to receive each of these nonpharmacologic interventions (calming voice: OR 1.01, 95% CI 1.01–1.02; information: OR 1.01, 95% CI 1.001–1.009; deep breathing: OR 1.01, 95% CI 1.001–1.010). For example, this means that the odds of using a calming voice was 1.01 times more likely for each 1-point increase in the 10-point NRS.
