Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
The Effect of Local Cold Application and Autogenic Relaxation Exercise on Injection Pain in Intramuscular Injection
İntramüsküler Enjeksiyonda Lokal Soğuk Uygulama ve Otojen Gevşeme Egzersizinin Enjeksiyon Ağrısı Üzerine Etkisi
Tuba KARABEYa, Şerife KARAGÖZOĞLUb
aDepartment of Nursing, Division of Fundamentals of Nursing, Gaziosmanpaşa University Faculty of Health Science, Tokat, TURKEY
bDepartment of Fundamentals of Nursing, Division of Nursing, Cumhuriyet University Faculty of Health Science, Sivas, TURKEY
Turkiye Klinikleri J Nurs Sci. 2021;13(3):590-7
doi: 10.5336/nurses.2020-79204
Article Language: EN
ABSTRACT
Objective: This study was conducted as an experimental trial to compare the effects of local cold application and autogenic relaxation exercise on pain in intramuscular (IM) injection application. Material and Methods: The research was carried out in Sivas Kılavuz Toki Family Health Center between 15 July and 15 November 2018. The population and sample of the study consisted of 150 individuals who received IM antibiotic (ceftriaxone) injection treatment between the specified dates and who met the inclusion criteria. The individuals in the sample group constituted both the control and intervention groups of the study. Approaches to reduce pain were performed by the investigator, and all injections were performed by the same clinical nurse in line with the injection administration protocol. 'Personal Information Form' and 'Visual Analogue Scale' were used for data collection. The data obtained from our study were evaluated in SPSS 22.0 for Windows program. All results were considered significant at p<0.05 and 95% confidence intervals. Friedman test was used to evaluate the data. Results: In the study, the mean pain score of the individuals after IM injection administered with the local cold application was 1.00 (0.00, 9.00) whereas their mean pain score following a standard injection administered based on the injection application protocol was 4.00 (1.00, 10.00). Also, individuals' mean post-IM injection pain score was determined to be 3.00 (0.00, 9.00). Accordingly, a statistically significant difference was found between these mean scores (p=0.001). Conclusion: In conclusion, the local cold application was found to be a more effective method in relieving IM injection- related pain compared to the autogenic relaxation exercises and the standard application administered in accordance with the injection application protocol. Besides, the autogenic relaxation exercise was determined to relieve IM injection pain considerably more than the standard method. The local cold application, alternatively autogenic relaxation exercises are recommended to relieve pain occurring due to IM injection.

Keywords: Autogenic relaxation exercise; local cold application; injection pain; intramuscular injection
ÖZET
Amaç: Bu araştırma, intramüsküler (IM) enjeksiyon uygulamasında lokal soğuk uygulama ve otojen gevşeme egzersizinin ağrı üzerine olan etkilerinin karşılaştırılması amacıyla deneysel olarak yapılmıştır. Gereç ve Yöntemler: Araştırma, 15 Temmuz ve 15 Kasım 2018 tarihleri arasında Sivas Klavuz Toki Aile Sağlığı Merkezinde gerçekleştirilmiştir. Araştırmanın evrenini ve örneklemini belirtilen tarihler arasında IM antibiyotik (seftriakson) enjeksiyon tedavisi alan ve araştırmaya dâhil edilme kriterlerine uyan 150 birey oluşturmuştur. Örneklem grubunda yer alan bireyler araştırmanın hem kontrol hem de müdahale gruplarını oluşturmuştur. Ağrıyı azaltmaya yönelik yaklaşımlar araştırmacı tarafından, tüm enjeksiyonlar ise aynı klinik hemşiresi tarafından enjeksiyon uygulama protokolü doğrultusunda gerçekleştirilmiştir. Verilerin toplanmasında 'Kişisel Bilgi Formu' ve 'Vizüel Analog Skala' kullanılmıştır. Araştırmamızdan elde edilen veriler SPSS 22.0 for Windows programında değerlendirilmiştir. Tüm sonuçlar, p<0,05 ve %95 güven aralığında anlamlı kabul edilmiştir. Verilerin değerlendirilmesinde Friedman testi kullanılmıştır. Bulgular: Çalışmamızda, bireylerin lokal soğuk uygulama ile yapılan IM enjeksiyon sonrası ağrı puan ortalaması 1,00 (0,00, 9,00), enjeksiyon uygulama protokolü doğrultusunda uygulanan standart enjeksiyon sonrası ağrı puan ortalaması 4,00 (1,00, 10,00) ve otojen gevşeme egzersizi ardından yapılan IM enjeksiyon sonrası ağrı puan ortalaması 3,00 (0,00, 9,00) olarak bulunmuş ve bu puan ortalamaları arasında istatistiksel olarak anlamlı düzeyde fark saptanmıştır (p=0,001). Sonuç: Sonuç olarak, lokal soğuk uygulamanın IM enjeksiyon ağrısını azaltmada enjeksiyon uygulama protokolü doğrultusunda uygulanan standart uygulama ve otojen gevşeme egzersizine göre daha etkili bir yöntem olduğu, bununla birlikte otojen gevşeme egzersizinin de IM enjeksiyon ağrısını standart yönteme göre önemli düzeyde azalttığı saptanmıştır. Bu bağlamda IM enjeksiyona bağlı yaşanan ağrıyı azaltılmasında öncelikle lokal soğuk uygulama ve alternatif olarak otojen gevşeme egzersizinin uygulanması önerilmektedir.

Anahtar Kelimeler: Otojen gevşeme egzersizi; lokal soğuk uygulama; enjeksiyon ağrısı; intramüsküler enjeksiyon
REFERENCES:
  1. Black MJ, Hawks Keene AM. Medical surgical nursing clinical management for postoperative outcome. Philadelphia. W.B Saunders. 2001; 351-7. [Link] 
  2. Blinderman CD, Billings JA. Comfort Care for Patients Dying in the Hospital. N Engl J Med. 2015;373(26):2549-61. [Crossref] [PubMed] 
  3. Özveren H. [Non-pharmacological methods at pain management]. Hacettepe University Faculty of Health Sciences Nursing Journal. 2011;(18):83-92. [Link] 
  4. Erden S, Çelik S. [Postthoracotomy pain and nurse's role on the use of analgesia methods]. Ankara Journal of Health Sciences. 2013;2(3):11-24. [Link] 
  5. Yavuz M. Ağrının ilaçsız yöntemlerle kontrolü. In: Eti Arslan F. Ağrı Doğası ve Kontrolü. 2nd ed. Ankara: Academician Medical Bookstore; 2014. p.161-74.
  6. Cocoman A, Murray J. Intramuscular injections: a review of best practice for mental health nurses. J Psychiatr Ment Health Nurs. 2008;15(5):424-34. [Crossref] [PubMed] 
  7. Hunter J. Intramuscular injection techniques. Nurs Stand. 2008;22(24):35-40. [Crossref] [PubMed] 
  8. Demir Y. Pain and management. In: Fundamentals of Nursing, Nursing Science and Art. 1st ed. Ankara: Nobel Publishing; 2011. p.643-7.
  9. Pamukçu G. Erişkinlerde intramüsküler yolla tetanoz aşısı enjeksiyonu öncesinde buz uygulamasının enjeksiyonun sebep olduğu ağrıya etkisi. [Specialization of Medicine Thesis]. Ankara: Gazi University; 2008. Erişim tarihi: 10.12.2018. [Link] 
  10. Hasanpour M, Tootoonchi M, Aein F, Yadegarfar G. The effects of two nonpharmacologic pain management methods for intramuscular injection pain in children. Acute Pain. 2006;8(1):7-12. [Crossref] 
  11. Chung JW, Ng WM, Wong TK. An experimental study on the use of manual pressure to reduce pain in intramuscular injections. J Clin Nurs. 2002;11(4):457-61. [Crossref] [PubMed] 
  12. Suhrabi Z, Taghinejad H. Effect of acupressure (UB32) on pain intensity in intramuscular injections. Iran J Nurs Midwifery Res. 2014;19(1):24-7. [PubMed] [PMC] 
  13. Çelik N, Khorshid L. The Use of shotblocker for reducing the pain and anxiety associated with intramuscular injection: a randomized, placebo controlled study. Holist Nurs Pract. 2015;29(5):261-71. [Crossref] [PubMed] 
  14. Susilawati S, Arhanaand BN, Subanada IB. Effectiveness of PainAway on hepatitis b. ıntarmuscularınjection in termneonates: a randomizedcontrolled trial. Paediatrica Indonesiana. 2010;50(4):214-9. [Link] 
  15. Romanò CL, Cecca E. A new method to reduce pin-prick pain of intra-muscular and subcutaneous injections. Minerva Anestesiol. 2005;71(10):609-15. [PubMed] 
  16. Kant E, Akpinar RB. The effect of music and the pressure applied on pain induced by intramuscular injection. International Journal of Caring Sciences. 2017;10(3):1313-8. [Link] 
  17. Inal S, Kelleci M. The effect of external thermomechanical stimulation and distraction on reducing pain experienced by children during blood drawing. Pediatr Emerg Care. 2020;36(2):66-9. [PubMed] 
  18. Baxter AL, Cohen LL, McElvery HL, Lawson ML, von Baeyer CL. An integration of vibration and cold relieves venipuncture pain in a pediatric emergency department. Pediatr Emerg Care. 2011;27(12):1151-6. [Crossref] [PubMed] 
  19. Russell K, Nicholson R, Legge L, Leauanae E, Olsen A, Marsh S, Naidu R, Reducing the pain of Bicillin injections in the Rheumatic Fever population of CMDHB. Counties Manukau District Health Board: Paediatric Pharmacy, 2011. [Link] 
  20. Soliman HM, Hassnein AA. Efficacy of helfer skin tapping technique on pain intensity as perceived by the patients receiving intramuscular injection. International journal of Nursing Didactics. 2016;6(2):12-22. [Crossref] 
  21. Nivedha Nidhishaand SJ, Pushpakala J. Effectiveness of helfer skin tap technique vs usual standard technique in reducing pain during intramuscular injection among adult patients in selected hospital. Kelambakkam, Kanchipuram District. 2016;5(7):90-1. [Link] 
  22. Nicoll LH, Hesby A. Intramuscular injection: an integrative research review and guideline for evidence-based practice. Appl Nurs Res. 2002;15(3):149-62. [Crossref] [PubMed] 
  23. Kara D, Yapucu Güneş Ü. The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. Int J Nurs Pract. 2016;22(2):152-9. [Crossref] [PubMed] 
  24. Omima Said Shehata MH. Effects of helfer skin tapping and z - track techniques on pain intensity among hospitalized adult patients who receiving intramuscular injection. International Journal of Novel Research in Healthcare and Nursing. 2016;3(3):77-94. [Link] 
  25. Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database Syst Rev. 2006;(2):CD004843. [Crossref] [PubMed] 
  26. Mawhorter S, Daugherty L, Ford A, Hughes R, Metzger D, Easley K. Topical vapocoolant quickly and effectively reduces vaccine-associated pain: results of a randomized, single-blinded, placebo-controlled study. J Travel Med. 2004;11(5):267-72. [Crossref] [PubMed] 
  27. Kwekkeboom KL, Gretarsdottir E. Systematic review of relaxation interventions for pain. J Nurs Scholarsh. 2006;38(3):269-77. [Crossref] [PubMed] 
  28. Zore G, Ragina D. Effectiveness of nursing interventions on pain associated with intramuscular injection. Int J Sci Res. 2014; 3(6):1995-2000. [Link] 
  29. Selby PJ, Chapman JA, Etazadi-Amoli J, Dalley D, Boyd NF. The development of a method for assessing the quality of life of cancer patients. Br J Cancer. 1984;50(1):13-22. [Crossref] [PubMed] [PMC] 
  30. Eti Arslan F. Ağrı Doğası ve Kontrolü. 2nd ed. İstanbul: Academician Bookstore; 2014. [Link] 
  31. Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nurs Res. 1992;41(6):378-80. [Crossref] [PubMed] 
  32. Khanra S, Lenka A. Helfer skin tap technique on pain associated with intramuscular injection among adult patients. International Journal of Nursing Education. 2018;10(3):12-7. [Crossref] 
  33. Ogston-Tuck S. Intramuscular injection technique: an evidence-based approach. Nurs Stand. 2014;29(4):52-9. [Crossref] [PubMed] 
  34. Greenway K. Using the ventrologluteal site for intramuscular injection. Nurs Stand. 2004;18(25):39-42. [Crossref] [PubMed] 
  35. Şahin M, Eşer İ. Effect of the Buzzy Application on pain and injection satisfaction in adult patients receiving intramuscular injections. Pain Manag Nurs. 2018;19(6):645-51. [Crossref] [PubMed] 

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