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Nursing Non-Pharmacologic Pain-Relieving Therapies - J. Anderson
- 1. Non-Pharmacologic Pain-Relieving Therapies JoAnn L. Anderson, MSN, RN, CCRN, CPAN
- 2. Objectives Embracing non-pharmacologic interventions Capturing Spiritual Interventions Organizing Environmental Modifications Practicing Deep Breathing Understanding Mindfulness/Relaxation and Guided Imagery
- 3. Embracing non-pharmacologic Interventions • Family & Companionship • Heat/Cold application • Back massage • Repositioning
- 4. Organizing Environment Modifications • Lighting • Sounds • Adjusting room temperature • Tightening and smoothing linens
- 5. Spiritual Interventions • Be there • Prayer • Listen actively • Use touch • Reflect and remember
- 6. Deep Breathing Exercises • Helps patient with the “fight-or-flight” response from surgery • How to practice diaphragmatic breathing
- 7. Relaxation/Guided Imagery Mindfulness Practice • Guiding patient’s through relaxation/guided imagery exercises can reduce discomfort • 30 minute Mindfulness Practice Body Scan https://www.youtube.com/watch?v=15q-N-_kkrU
Editor's Notes
- Good morning. I will be reviewing non-pharmacologic pain-relieving therapies that we can utilize to assist our ERAS patients with postoperative pain.
- Family or Companionship, this may or may not be comforting. Sometimes it is helpful if we as nurses guide family members to assist with showing them how they can help relieve their loved one’s discomfort with something other than drugs. This assists in the family member’s desire to be purposeful and helpful in creating comfort for their loved one. Have family apply a cool washcloth to their face, hold their hand. These simple thoughtful acts can help a patient feel physically comforted. When you think of our GYN patients who have surgery for endometriosis or a hysterectomy they will have; discomfort at the site of an incisions and, abdominal bloating have family place the heat packs. Heat application helps. By applying heat packs and supporting these with warm blankets these can help relax pelvic muscle spasms, reducing cramping and pain. Apply heat for 15 to 20 minutes at a time. Patient’s who have laparoscopic surgery the CO2 gas that is used to inflate the abdomen so the surgeon can see is instilled before surgery. At the end of the operation, the abdomen is allowed (and sometimes assisted) to deflate. However, it is not possible to remove all of the gas. The little bit that is left behind can irritate the peritoneum – the lining over the abdominal organs and sometimes the organs themselves. A patient may experience this as sharp or achy pains. In addition, the CO2 can settle up under the diaphragm. They might experience this as irritation in the lower chest and even all the way up into the shoulder. This type of pain can be quite uncomfortable. It will eventually resolve on its own, but can be aided by walking, moving around, laying on one side. Heat often brings relief. Try using two heating packs – one on the front and one on the back of the affected shoulder. Education of the patient and their family on these facts assists with the why this hurts for patients. For colorectal patient’s abdomen pain; Ice helps decrease swelling and pain. Use an ice pack, Cover it with a pillow case and place it on the area for 15 to 20 minutes every hour moving it around. Back massage for those patient’s who have been in the supine or lithotomy position for hours of surgery, this also reduces tension. Repositioning patient with pillows to support the surgical incision, legs, and arms. Utilize the warming gown it provides a low level of heat . Applying heat to an inflamed area will dilate the blood vessels, promote blood flow, and help sore and tightened muscles relax.
- We want to create a Therapeutic Environment: A physical environment surrounding the patient, affecting all the senses, that enhances and promotes nursing care, recovery and health Lower light and less noise in areas of post anesthesia recovery can impact not only a patient’s need for pain medication but can also improve satisfaction with their experience. These environmental changes are easy to implement, and are nursing-directed. Ear plugs for patients to keep their environment quiet, eye mask for patients who are nauseous, or the light is too strong for them Adjusting room temperature by either utilizing the patients BAIR hugger gown; turning the temperature up, or cooling, and warm blankets The physical features of a surgical cart can be soothing and provide for optimum safety and comfort by tightening and smoothing linens, utilize pillows to elevate patient’s knees We as nurses can aid in the ability of a person to to heal, by managing the environment.
- 1 Be there My favorite Author Dr. Brené Brown writes, “Empathy has no script. There is no right way or wrong way to do it. It’s simply listening. Holding space. Withholding judgment. Emotionally connecting, and communicating that incredibly healing message of ‘you’re not alone.’” 2. Prayer Ask the patient if they would like a visit from the hospital chaplain. 3 Listen actively Encourage the patient to talk by affirming what he or she says, asking open-ended questions, and offering reflective comments. When a patient expresses a spiritual concern, acknowledge this by saying, “That sounds troubling. Help me understand what you mean.” 4. Use touch Gentle touch is reassuring and comforting. When you touch your patient, you provide comfort, warmth, and connection. But first make sure the patient is open to physical touch. Ask, “Do you mind if I take your hand?” 5 Reflect and remember Help your patient think about previous experiences. Ask “What types of things have comforted you in past situations like this?” Help the patient remember the support he or she has received in the past from family, friends, or spiritual beliefs. Dr. Shane Sinclair Assistant Professor, Canada’s Cancer Care Research noted; If you could hear the patients articulate what spiritual support they would want from you, their nurse, you would hear common sense encouragements, such as “Be kind. Be authentic. Be open. Be patient. Be accepting of the differences between you as the nurse and us, the patients and family. Seek to listen empathically. Demonstrate compassion always. Strive for empathy. Ask us about ourselves, our lives, our relationships, our faith, our religion—and not just to check it off some clinical checklist. Ask what gives us hope. Inquire about what it is we value. Know that we are trying, but we’re not our best selves right now. For you, this is your every day at work, but for us, this is an unwelcome and frightening interruption into our everyday routine. We are scared. We don’t know what to expect. We fear the worst. Try to understand us.”
- Deep breathing helps patients with the "fight-or-flight" response to their stressful post surgical situation.. In these situations, your body's automatic systems are on high alert and signal your heart to beat faster and breathing rate to increase. By assisting the patient to consciously become aware of his or her breathing and regulating its depth and rate, the likelihood of spiraling into panic or anxiety is lowered. Have the patient Place one hand on their upper chest and the other hand on your stomach. Inhale, taking a deep breath from your abdomen as you count to three. As you inhale you should feel your stomach rise up. The hand on your chest should not move. After a short pause, slowly exhale while counting to three. Your stomach should fall back down as you exhale. If you wish, you can say a phrase as you exhale such as "calm." Continue this pattern of rhythmic breathing for five minutes.
- Relaxation/guided imagery: These helps guide your patient through relaxation exercises and can often reduce discomfort. Nonpharmacological therapies, such as music, guided imagery, mindfulness practice may help decrease unpleasant signs and symptoms and promote healing. Such therapies can ameliorate the adverse experience of postsurgical stress and discomfort in countless ways: decreased anxiety and discomfort; lowered heart rate, respiratory rate, and blood pressure; decreased levels of stress hormones. Mindfulness is the awareness that arises by paying attention on purpose, in the present moment, and non-judgmentally. I encourage you all to listen to the hyperlink which I have attached and see how you can incorporate them into your patient’s recovery. This can be pulled up on YouTube on the patient’s iPhone and a earplugs utilized for them to focus and relax.
- Non-pharmacologic interventions to me represent those nursing interventions that represent warmth. You know like babies, we adults also need warmth-psychological warmth. Physical too; sometimes we need someone to just hold our hand. But mostly we need someone to talk to, someone who we know will take care of us. For our patients; Warmth then becomes a metaphor. It is no longer just a biological necessity, it is a quality they see in their nurses’ eyes, hear in their voice, sense in the way their nurse greets them. Thank you.