Dissertation:
To obtain a master's degree in neonatal special care nursing
Abstract
Introduction: Premature babies are subjected to many painful interventions during care and treatment, and nurses should prevent short and long-term complications caused by pain by using non-pharmacological methods without risk, so this study was conducted in order to determine the effect of swaddling on the pain caused by nasogastric tube placement in premature babies. This research is a clinical trial study of crossover design. 57 premature babies aged 28-34 weeks of pregnancy were selected by easy sampling method and randomly divided into three groups. The researcher will put all qualified infants, after obtaining informed written consent from the parents, three times under the nasogastric tube placement procedure with three routine methods, swaddling and oral sucrose, and the order of the three methods was different depending on which of the defined groups they were randomly assigned to. In all three groups, infant pain was measured at intervals of two minutes before, during, and five minutes after nasogastric tube placement using the PIPP tool.
Findings: The results showed that swaddling and oral sucrose reduce the pain response of the baby during nasogastric tube placement (p.001), but the difference between these two measures is not statistically significant.
Discussion: Since the findings of this study showed that swaddling and oral sucrose are effective on the pain caused by nasogastric tube insertion, it is recommended that nurses use it as an effective intervention in reducing the pain of infants. Cross-over design clinical trial
2-1 Research background
About 13 million preterm babies are born in the whole world every year (1). Due to the increase in progress in the last two decades, the survival of low birth weight babies and babies whose lives depend on medical treatments and long-term hospitalization is increasing (2), which causes them to be exposed to painful procedures (3, 4), so that each baby experiences an average of 115 painful procedures in the first 14 days of hospitalization, which is 16 procedures per day of hospitalization (5).
Understanding pain in a baby who lacks sufficient experience and verbal skills is an incomprehensible understanding. Babies perceive pain as complex behavioral and physiological changes and show it as arousal and disruption of adaptation to the environment and changes in vital signs. Crying and facial changes are the most common outward signs of pain (6). Previously, it was believed that babies are unable to feel pain due to insufficient myelination of sensory nerves and immaturity of pain receptors. Research has shown that almost from the 26th week of pregnancy, the physiological systems of the fetus have reached the point where they are able to feel pain, so even the fetus feels pain. Recent evidence has also shown that term and premature infants are anatomically and physiologically (functionally) able to respond to painful stimuli from birth. Infants, including infants, experience pain similar to and possibly more intense than older children and adults. They are also at risk of long-term behavioral and developmental side effects of pain, although so far not enough attention has been paid to pain relief in early life (7).
Infants perceive pain more than infants, children, and adults, and this hypersensitivity is more common in premature infants.There are various evidences that show that exposure to repeated and prolonged pain causes developmental and behavioral changes (3, 5).
Studies have shown that painful events and multiple stresses in premature infants not only cause acute changes such as acidosis, respiratory incoordination and pneumothorax, oxygen reduction, increased carbon dioxide and increased blood sugar, but may also cause permanent structural and practical changes in the infant (8), so pain prevention or treatment In infants, especially preterm infants, it is necessary for clinical and ethical reasons (5).
Nasogastric tube placement is a painful procedure in adults and similarly in infants, and causes some degree of pain and discomfort in premature infants. On average, the amount of pain caused by nasogastric tube insertion in premature infants is 9 based on the Premature Infant Pain Index (PIPP) (9, 10). This procedure is one of the most frequently performed tasks in the neonatal department (10) and ranks fifth among twenty common painful procedures (9, 11).
Kner (2004) writes: Pain is the fifth vital sign and its assessment should be done simultaneously with the control of vital signs (12). Currently, not only the amount of pain is not assessed in nasogastric tube insertion, but also no palliative measures are taken in this regard. In order to reduce pain in the intensive care unit, two methods of medicine and non-medicine are used. The use of painkillers for pain relief in infants is doubtful due to the small effect and potential side effects. In addition, due to the physiological characteristics of infants and especially premature infants, extreme caution should be observed when using pharmaceutical painkillers. Non-pharmacological methods of pain relief are not only accessible, cheap and without prescription, but babies tolerate these methods better than other methods (1, 6).
Non-pharmacological methods try to improve and organize actions in three areas: 1. Sensory stimuli (shaking, talking to the baby, massage, soft music, oral sucrose, non-nutritive sucking and cluster care), 2. Improving the environment. (reducing the light level, turning off the alarm of the devices, limiting the ringing of the phones, closing the incubators, limiting the placing of items on the incubators, covering the incubator and group discussions away from the baby's bed) and 3. Behavioral interventions (providing an environment like objects, swaddling, flexion and placing the baby in the fetal position) to prevent pain and behavioral breakdown in babies (12).
Contents & References of Comparison of the effects of swaddling and oral sucrose on the amount of pain caused by nasogastric tube placement in premature infants - Thesis for obtaining a master's degree in neonatal special care nursing
List:
Chapter One:
1-1 Research title .. 1
2-1 Research background .. 1
3-1 General goal .. 5
4-1 Specific goals .. 5
5-1 Research assumptions .. 5
1- Research assumptions .. 6
7-1 Practical goals of the research .. 6
8-1 Definition of specific words .. 7
Chapter Two:
Theoretical background of the research .. 10
A) Conceptual framework .. 10
1-2 Pain .. 10
1-1-2 Babies Prematurity and pain .. 12
2-1-2 Physiology of pain .. 13
2-1-3-3 Pain assessment .. 15
4-1-2 Pain symptoms ..17
5-1-2 Pain complications .. 20
2-1-6-6 Pain measurement tools .. 21
2-2 painful procedures...23
1-2-2 nasogastric tube placement...24
3-2 pain relief methods...24
1-3-2 drug pain relief methods...25
1-3-2 non-drug pain relief methods...27
A) Sensory methods.. 29
A - 1) Sucrose .. 31
B) Environmental methods .. 33
C) Behavioral methods .. 34
C-1) Swaddling .. 35
B) An overview of studies done .. 39
Chapter three:
1-3 research methods.. 45
2-3 types of research.. 45
3-3 research community.. 46
4-3 research environment.. 46
5-3 research samples.. 46
6-3 sample size.. 47
7-3 sampling method... 47
3-8 Inclusion criteria.. 48
3-9 Exclusion criteria.. 49
3-10 Tools and methods of data collection.. 49
3-11 Scientific credibility.. 52
3-12 Scientific trust.. 52
3-13-3 Research methods.. 53
3-14 Statistical analysis method .. 55
3-15 clinical trial flowchart .. 56
3-16 ethical considerations ..57
Chapter four:
1-4 research findings .. 58
Chapter five:
1-5 interpretation of findings.. 83
2-5 final conclusion.. 87
5-3 application of research findings.. 88
4-5 clinical and research areas.. 88
5-5 nursing management area.. 88
5-6 suggestions... 89
5-7 limitations.. 90
List of sources. .. 91
Source:
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