An investigation on the pain behavior experienced by patients on mechanicalventilation during nursing interventions

The present study was conducted in a descriptive design in order to investigate pain behavior of patients under mechanical ventilation during nursing interventions. The study was carried out between October 2017 and March 2018 at Neurology Intensive Care Unit and Anesthesiology and Reanimation Intensive Care Unit of Ege University Medical Faculty Hospital. The study sample consisted of 165 patients aged 18 and over who were receiving mechanical ventilation. The data of the study were collected using "Case Report Form", "Behavioral Pain Scale" and "Ramsay Sedation Scale". Within the scope of the study, pain assessment was made before and after 284 nursing interventions applied on patients. Data analysis was performed using numerical and percentage distributions as well as Wilcoxon Signed Ranks and Kruskal Wallis tests. Written approval was obtained from the intensive care clinics where the study was conducted and from Ege University Medical Faculty Hospital Clinical Research Ethics Committee. As a result of the study, it was found that 45.4% of the patients participating in the study aged over 65 with the highest scores, 59.4% were males, 66.1% had a chronic disease, 27% were in hospital due to intracerebral hemorrhage and 23% due to respiratory failure, 81.8% did not receive any kind of sedatives, and Ramsay Sedation Scale score of 36,3% was 5. Nursing interventions evaluated within the scope of the study are positioning (19,7%), bed bath (11.6%), eye and oral care (10.2%), dressing change (9.2%), perineal care (8.5%), finger prick blood sampling (%7), tracheal aspiration (6%), oropharyngeal aspiration (4.2%), IV catheter placement, nasotracheal catheter placement and tracheostomy cannula care (2.8%), nasotracheal aspiration (2.5%) and urethral catheter placement (1.1%) respectively. Mean pain score prior to interventions provided to the patients in the study is 3.52±0.83, and mean pain score during interventions is 4.94±1.78. It was determined that mean pain scores during nursing interventions increased at p<0.001 level during bed bath, oral care, endotracheal, oropharyngeal and nasotracheal aspiration, positioning, perineal care and dressing change; and at p<0.05 level during eye care, nasogastric catheter placement and intravenous catheter placement; while no significant increase was found in pain levels during urethral catheterization, finger prick blood sampling and tracheostomy cannula care (p>0.05). The analysis performed between the mean pain score differences according to the interventions provided in the study showed that a significant difference exists in pain levels of patients by nursing interventions and that the largest and smallest differences between pain scores before and during interventions were in nasogastric catheter placement and eye care respectively. It was also found that all physiological parameter values increased significantly during bed bath, perineal care and NG catheter placement (p<0.05); none of the physiological parameters changed significantly during tracheostomy cannula care, nasotracheal care and urethral catheterization (p>0.05); and physiological parameters except for oxygen saturation increased during oropharyngeal aspiration, tracheal aspiration, nasogastric catheterization, positioning and dressing change practices (p<0.05). Keywords: Mechanical Ventilation, Pain, Behavioral Symptoms