Download Mrs. Merlin Mary Mathew

PROFORMA FOR REGISTRATION OF DISSERTATION
Paediatriac Nursing
Sarvodaya College of Nursing,
Bangalore – 560 079
MRS. MERLIN MARY MATHEW
1st year M. Sc. Nursing
Child Health Nursing
2008-2010
Sarvodaya College of Nursing,
Bangalore – 560 079
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME OF THE CANDIDATE & ADDRESS
Mrs. Merlin Mary Mathew
1st Year M.Sc. Nursing
Sarvodaya College of Nursing,
11/2, Agrahara Dasarahalli,
Magadi Main Road,
Bangalore – 560079.
2.
NAME OF THE INSTITUTION
3.
COURSE OF STUDY AND SUBJECT
4.
5.
DATE OF ADMISSION OF COURSE
TITLE OF THE STUDY
Sarvodaya College of Nursing,
Bangalore – 560079
1st Year M.Sc. Nursing
(Child Health Nursing)
16-04-2008
“A Study On The Effect Of Guided
Imagery On Post Operative Pain
Among Children In Selected
Hospitals, Bangalore.”
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6. BRIEF RESUME OF THE INTENDED WORK
Imagination is the ability to form mental images, or the ability to spontaneously
generate images within one's own mind. It helps provide meaning to experience and
understand to knowledge.Imagery is the most fundamental language we have.
Everything we do, the mind processes through images. When we recall events from
our past or childhood, we think of pictures, images, sounds, pain, etc. It is hardly ever
be through words. Images aren't necessarily limited to visual but can be sounds,
tastes, smells or a combination of sensations.
The management of acute paediatric pain can be accomplished using a multimodal
approach in which pharmacologic techniques and cognitive–behavioural approaches
complement one another. Traditionally, health care practitioners have approached
pain management in children and adults as an “either/or,” that is, pharmacologic
interventions or “alternative” approaches, and specialties defined which approach and
intervention were used.
Imagery has been considered a healing tool in virtually all of the world's cultures and
is an integral part of many religions. Navajo Indians, for example, practice an
elaborate form of imagery that encourages a person to "see" himself as healthy.
Ancient Egyptians and Greeks, including Aristotle and Hippocrates believed that
images release spirits in the brain that arouse the heart and other parts of the body.
They also thought that a strong image of a disease is enough to cause its symptoms. [1]
Guided imagery is a way to use our powers of creative imagination, which can be
much more immediate and effective than analytical thinking. Guided imagery is more
than listening to relaxing sounds. It’s a learning process to listen to someone’s voice,
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relax the breathing and consciously direct the ability to imagine. The effect of guided
vivid imagery sends a message to the emotional control centre of the brain. From
there, the message is passed along to the body’s endocrine, immune and autonomic
nervous systems. These systems influence a wide range of bodily functions, including
heart and breathing rates and blood pressure.[2]
Pain is an unpleasant feeling and emotional experience related to injury or damage to
child's body. It helps the child avoid more injury by warning him of the presence of a
harmful thing. Pain is usually caused by trauma, disease, medical procedure, or
surgery. It may cause other signs and symptoms in the child, such as an increased
heart rate and blood pressure. Pain may get worse when the child thinks about it
often, or when he is very sad because of his condition. The child may suffer if the
pain is too bad and always present, or if it affects his usual activities. Pain can affect
the child's appetite (ability or desire to eat), how well he sleeps, and his energy and
ability to do things.
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6.1. NEED FOR THE STUDY
Management of pain in children is often inadequate and there is no evidence to
support the idea that pain is less intense in neonates and young children due to their
developing nervous system. Children tend to receive less analgesia than adults and the
drugs are often discontinued sooner. Furthermore, it is simply not true that potent
analgesics are dangerous when used in children because of the risks of side effects
and addiction. As with all pain, successful management depends upon the
identification and treatment of all the factors that contribute, in particular fear and
anxiety.
Non-pharmacological therapies for pain may help improve the child's feelings
by making him more comfortable and relaxed. These treatments may help him as he
goes through an illness, and also prevent other medical problems from happening.
They involve methods such as teaching and guiding your child through thinking
exercises and other techniques. These therapies may also be used before and after
your child undergoes a painful experience, such as a medical procedure or surgery.
They may bring comfort to your child during a long standing condition or illness.
Guided imagery is a therapeutic technique that allows a person to use his or
her own imagination to connect their body and mind to achieve desirable outcomes
such as decreased pain perception and reduced anxiety. In guided imagery the child is
taught to imagine that he is in his favorite place and doing his favorite things. By
imagining that he is in his favorite place, he may feel safe and relaxed, and pain may
be decreased. This may also take his mind off his pain.
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When children undergo surgery they often experience a loss of control and
feel they become a victim instead of a participant. Their emotions may be disarray.
Anxiety, fear of the unknown, fear of pain, dependency, uncertainity and helplessness
are prominent. These emotions can intensify the perception of pain associated with
invasive medical procedures. Physical and psychologic stress contribute to perceived
surgical
pain,
prolonging
postoperative
recovery
time
and
enhancing
immunosuppression.
Guided imagery uses audio tapes to create mental images that bring about a
state of focused concentration. This state, in turn allows relaxation and produces a
sense of physical and emotional well being. The ability to relax, to clear the mind, and
to engage in healing images enhances both physiologic and psychologic wellness. In
this way, guided imagery can help patients control their reactions to anxiety
depression, and stressful situations and may also strengthen the immune system,
which potentially also strengthen the immune system, which potentially enables
patients to enhance their own healing.[3]
Clinical studies have also shown that children who use relaxation and guided
imagery have fewer complications, reduced bleeding, are more comfortable after
surgery, and spend less time in the hospital. Pre-operative preparation for paediatric
surgical patients has been found helpful in improving children following instructions
in the hospital. It can also reduce problems at home after the surgery. Reducing
children’s anxiety, and increasing their sense of control is also beneficial – leading to
shorter hospital stays, shorter procedure time, and less need for some medications.[4]
A study conducted on children who have successfully used hypnosis/guided
imagery to significantly reduce the pain associated with invasive procedures and to
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improve selected medical conditions. The purpose of this study was to examine the
effect of hypnosis/guided imagery on the postoperative course of paediatric surgical
patients. Fifty-two children (matched for sex, age, and diagnosis) were randomly
assigned to an experimental or control group. The experimental group was taught
guided imagery by the investigator. Practice of the imagery technique included
suggestions for a favourable postoperative course. Significantly lower postoperative
pain ratings and shorter hospital stays occurred for children in the experimental group.
State anxiety was decreased for the guided imagery group and increased
postoperatively for the control group. This study demonstrates the positive effects of
hypnosis/guided imagery for the paediatric surgical patient.[5]
Paediatric nurses are often present with children who are in discomfort or
pain, and are essential to successful management of this pain. Selected
nonpharmacologic techniques are effective in reducing children's discomfort and pain,
and thus have value in nursing practice. Considering the positive effect of guided
imagery in postoperative children the researcher felt it necessary to conduct this study
and to relieve pain.
HYPOTHESIS
H1 There is a significant reduction in the degree of post operative pain among
children in the experimental group than the control group.
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6.2REVIEW OF LITERATURE
The review of literature is a summary of current knowledge about a particular
problem and includes what is known and not known about the problem. The literature
is reviewed to summarize knowledge for use in practices or provide a basis for
conducting the study.
An experimental study was conducted recently to investigate the effect of
guided imagery on 130 patients undergoing colorectal surgery. A control group
received standard surgical care. Another group listened to a guided imagery tape to
help them become calm and focused. The guided imagery tape included soft, soothing
music, and a story that brought patients to a "special place" in their mind - a place that
was safe, secure, protected, supported, and relaxed. The imagery story encouraged
patients to confront and work through any feelings of fear, anxiety, and negativity.
Patients were instructed to listen to the tape without interruption twice per day, once
in the morning and once in evening, for three days before the operation and for six
days after. During surgery and in the recovery room they listened to a tape with only
the music. Those who listened to guided imagery tapes fared much better--both before
and after surgery. Before surgery, anxiety increased in the control group but decreased
in the guided imagery group. After surgery, pain and anxiety levels were significantly
lower for the imagery patients. They needed only about half the amount of narcotic
pain medications as the control group and their bowel function also returned much
more quickly.[6]
A questionnaire survey was conducted on Acute and postoperative pain in
children. All anesthesia, ENT, surgery, pediatric surgery, orthopedic, general pediatric
and plastic surgery departments were sent questionnaires to sample both nurse and
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physician perspectives of acute pain in children. The response rate was 75%. Reasons
for inadequate management most often mentioned were inadequate prescription,
children's anxiety, and parents' fears. Pain assessments were regularly performed in
43% of departments and 74% of departments had access to a doctor who worked at
least part time on pain management.[7]
A study was conducted to investigate the effectiveness of imagery, in addition
to routine analgesics, in reducing tonsillectomy and/or adenoidectomy pain and
anxiety after ambulatory surgery and at home. Seventy-three children, aged 7–12,
were recruited from five AS settings. Thirty-six children randomly assigned to the
treatment group watched a professionally developed videotape on the use of imagery
and then listened to a 30-min audio tape of imagery approximately 1 week prior to
surgery. They listened to only the audiotape 1–4 h after surgery, and 22–27 h after
discharge. The 37 children in the attention-control group received standard care. Pain
and anxiety were measured at each time-point in both groups. Measures of sensory
pain were the Oucher and amount of analgesics used in AS and home; affective pain
was measured with the Facial Affective Scale. Pre-operative preparation for paediatric
surgical patients has been found helpful in improving children’s following
instructions in the hospital. It can also reduce problems at home. Reducing children’s
anxiety, and increasing their sense of control is also beneficial – leading to shorter
hospital stays, shorter procedure time, and medications.[8]
A study to test the efficacy of imagery and relaxation in hospitalised children's
postoperative pain relief was conducted. Sixty children aged 8-12 years who had
undergone appendectomy or upper/lower limb surgery and had been randomly
assigned to the experimental group listened to an imagery trip CD, whereas those in
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the control group received standard care. An investigator-developed questionnaire
was used, and the intensity of pain was assessed using a visual analogue scale: before,
immediately after, and 1 hour after intervention or standard care. The children in the
experimental group reported having significantly less pain than the control children
based on a comparison of VAS pain scores. There were no significant differences in
nurse-assessed pain scores. The type and time of operation were related to pain
intensity in children. The nurses underestimated the pain of paediatric patients. The
imagery trip CD can be used to reduce children's postoperative pain in a hospital
setting, although its effect is short lasting.[9]
A study was conducted on Guided imagery, which uses the power of thought
to influence psychologic and physiologic states. Some studies have shown that guided
imagery can decrease anxiety, analgesic requirements, and length of stay for surgical
patients. Group 1 received standard perioperative care, and Group 2 listened to a
guided imagery tape three days preoperatively; a music-only tape during induction,
during surgery, and postoperatively in the recovery room; a guided imagery tape
during each of the first six postoperative days. Both groups had postoperative patientcontrolled analgesia. All patients rated their levels of pain and anxiety daily, on a
linear analog scale of 0 to 100. Guided imagery significantly reduces postoperative
anxiety, pain, and narcotic requirements of colorectal surgery and increases patient
satisfaction. Guided imagery is a simple and low-cost adjunct in the care of patients
undergoing elective colorectal surgery.[10]
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6.3.OBJECTIVES OF THE STUDY
1. To assess the degree of pain on post operative chidren in the experimental and
control group.
2. To compare the post operative pain between experimental and contol group
after guided imagery.
3. To find out the association between degree of pain and selected demographic
variables among experimental group and control group.
OPERATIONAL DEFINITION
Effect : It refers to the extent to which the guided imagery has achieved the desired
effect in reducing the pain in post operative children as assessed by pain scale.
Guided Imagery: It refers to an audio assisted relaxation and stress-reduction
technique which uses positive thoughts and images to relieve pain, slow the heart rate,
and stimulate the body's healing responses used in two sessions for three consecutive
days from the first day after surgery.
Post Operative : It refers to children between 11- 18 years who under went major
surgery of Gastro- intestinal, cardiac and musculoskeletal system on the first day of
surgery.
VARIABLES
Independent Variable
- Guided Imagery
Dependent variable
-Post operative pain
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Demographic Variable
- Age
-Sex
-Type of surgery
-Education
-Source of information
7.MATERIALS AND METHODS
7.1SOURCE OF DATA
Data will be collected from children who have undergone surgery in selected hospitals
Bangalore.
7.2METHODOLOGY OF THE STUDY
i.
Research design -True Experimental Design
ii.
Sample
- Children who have underwent major surgeries
on Gastro-intestinal, cardiac and musculoskeletal system.
iii.
Sample criteria
Inclusion Criteria
1. Children with post operative pain who have underwent
major surgeries on Gastro- intestinal, cardiac and
musculoskeletal system
2. Who are willing to participate
3. Who are available at the time of study
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4. Who can speak and understand English
5. Children between the ages of 11- 18 years
Exclusion Criteria
1. Children who are physically and mentally disabled.
2. Children who are not willing to participate.
3. Children who cannot speak or understand English
iv. Sample technique
- Simple Random Method
v. Sample size
- 30 control and 30 experimental group
vi. Method of data collection - Self Administered Rating Scale
vii. Tool for data collection
- Numerical Pain Scale
viii. Method of data analysis - The researcher will use appropriate statistical
technique for data analysis and present in the form of tables, graphs and
diagrams
Frequency and percentage distribution will be used for the demographic
profile.
Students t test will be used to compare the postoperative pain between the
experimental and control group.
Chi- Square will be used to determine the association between the
postoperative pain and selected variables.
ix. Duration of the study
-4 weeks
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7.3Does the study requires any investigation or intervention to be conducted on the
patient or other human beings or animals?
No
7.4Has ethical clearance has been obtained from your institution
YES, ethical clearance report is herewith enclosed.
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LIST OF REFERENCE:
1. Wikipedia The Free Encyclopedia (online); (cited on 2008 October 3):
Available on: URL://www.en.wikipedia.org/wiki/imagination
2. UCL Institute of Child Health Research and Development (online) (cited on
2008October3) Available
URL:http://www.ich.ucl.ac.uk/research_and_development
3. Alternative therapies (online) (cited on 2008 October 2): Available on:
URL:http://holisticonline.com/guidedimagery
4. Victoria Menzies; Ann Gill Taylor, Cheryl Bourguignon. The Journal of
Alternative and Complementary Medicine, January 1, 2006,12 (1), 23-30(cited
on 2008 September 24). Available on
URL:http://www.liebertonline.com/doi/abs/10.1089/acm.2006.12.23.
5. Lambert SA, “ The Effect of Hypnosis\ Guided Imagery on the Post Operative
Course of Children”. J Dev Behav Pediatr: 1996 Oct; 17(5): 307-10. Cited on
(2008 September 30): Available On: URL:http:www.pubmed.com
6. David.S. Sobel “ Guided Imagery Speeds Surgical Recovery”. Institute for the
Study of Human Knowledge. 1998; (cited on 2008 September 25):
URL:http://www.healthy.net/scr/Article.asp?ID=414
7. Karling M, Renstorm M, Lyungman G, “ Acute and post operative pain in
children” Blackwell Synergy- scand J caring science. Volume 17.Issue 4.Page
373(cited on 2008 September 24) Available on URL.http.//www.Blackwellsynergy.com/doi/abs/10
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8. Huth. M. Broome, M. Good. “ Imagery reduces Children’s Post-operative
Pain”. Health Science Journals, Volume 110, Issue 1-2, Pages 439-448. (Cited
on2008Sept21)
Available
from:
URL:
http://www.linkinghub.elsevier.com/retrieve/pii/s0304395904002009.
9. Diane.L.Tusek, James. M. Church, Scott.A.Strong, Jeffrey. A. Grass and
Victor. W. Fazio. “ Guided Imagery A Significant Advance In The Care Of
Patients Undergoing Elective colorectal Surgery”. Diseases of the Colon and
Rectum: Springer New York. Volume 40, number 2 1997. Feb: 172-178.
Available from URL:
http://www.linkinghub.elsevier.com/retrieve/pii/S0304395904002209
10. Polkki T, Pietila AM, Vehvilainen Julkunen K, Laukkala H, Kiviluoma K.
“Imagery-induced relaxation in children's postoperative pain relief: a
randomized pilot study.” J. Pediatr Nurs. 2008 June; 23(3): 217-24. (Cited on
2008 September 21) Available From URL:http://www.pubmed.com.
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