title: Predictors and use of nonpharmacologic interventions for procedural pain associated with turning among hospitalized adults.
abstract: Many hospitalized adults cannot reposition themselves in their beds. Therefore, they are regularly turned by their nurses, primarily to prevent pressure ulcer formation. Earlier research indicates that turning is painful and that patients are rarely premedicated with analgesics. Nonpharmacologic interventions may be used to help with this painful procedure. However, no published research was found on the use of nonpharmacologic interventions for turning of hospitalized patients. The objectives of this study were: 1) to describe patient pain characteristics during turning and their association with patient demographic and clinical characteristics; 2) to determine the frequency of use of various nonpharmacologic interventions for hospitalized adult patients undergoing the painful procedure of turning; and 3) to identify factors that predict the use of specific nonpharmacologic interventions for pain associated with turning. Hospitalized adult patients who experienced turning, the nurses caring for them, and others who were present at the time of turning were asked if they used various nonpharmacologic interventions to manage pain during the turning. Out of 1,395 patients, 92.5% received at least one nonpharmacologic intervention. Most frequently used were calming voice (65.7%), information (60.6%), and deep breathing (37.9%). Critical-care patients were more likely to receive a calming voice (odds ratio [OR] 1.66, p < .01), receive information (OR 1.62, p < .001), and use deep breathing (OR= 1.36, p < .05) than those who were not critical-care patients. Those reporting higher pain were consistently more likely to receive each of the three interventions (OR 1.01, p < .05 for all 3). In conclusion, nonpharmacologic interventions are used frequently during a turning procedure. The specific interventions used most often are ones that can be initiated spontaneously. Our data suggest that patients, nurses, and family members respond to patients' turning-related pain by using nonpharmacologic interventions.
authors.affiliation: Department of Neurosciences, Kaiser-Permanente Medical Center, Redwood City, California, USA. bonnie@tmbox.com
authors.forename: Bonnie
authors.initials: B
authors.lastname: Faigeles
authors.forename: Jill
authors.initials: J
authors.lastname: Howie-Esquivel
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.forename: Julie
authors.initials: J
authors.lastname: Stanik-Hutt
authors.forename: Carol
authors.initials: C
authors.lastname: Thompson
authors.forename: Cheri
authors.initials: C
authors.lastname: White
authors.forename: Lorie Rietman
authors.initials: LR
authors.lastname: Wild
authors.forename: Kathleen
authors.initials: K
authors.lastname: Puntillo
mesh_terms: D059787:Acute Pain / Q000209:etiology / Q000451:nursing / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D055805:Moving and Lifting Patients / Q000009:adverse effects* / Q000451:nursing*; D009741:Nursing Staff, Hospital; D059408:Pain Management / Q000379:methods* / Q000451:nursing*; D010147:Pain Measurement / Q000451:nursing; D011237:Predictive Value of Tests; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid