EFFECTS OF COLD PRESENTATION ON PAIN & ANXIETY DURING CHEST TUBE REMOVAL AMONG POST-OPERATIVE CARDIAC SURGERY ADULT PATIENTS: A STUDY IN (NICVD), DHAKA, BANGLADESH
Md. Zanzibul Tareq*, Abu Jafar Md. Tareq Morshed, Md. Mustafizur Rahman and Md. Rezwanul Hoque
Introduction: Chest tube removal is considered a painful technique, which may not respond well to palliative therapies. There are no standard procedures or guidelines to manage the pain associated with chest tube removal. This study aimed to examine the effects of cold presentation on pain reduction during and after chest tube removal. Objective: To assess the pain among post cardiac surgery patients during chest tube removal with and without cold presentation. Methods and Materials: In the present study Place of Department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh was my study area. The period of study were from September 2017 to August, 2019. The study sample was purposive sampling technique with random assignment of subjects into two groups: experimental group and control group. A study conducto assess the effectiveness of cold presentation on Pain & Anxiety during Chest Tube Removal (CTR) among post-operative cardiac surgery adult patients. Pre-test post-test control group experimental design was used. Post-operative cardiac surgery adult patient of the selected hospital of BSMMU were selected. Results: The sample size was 60 i.e. 30 in experimental group and 30 in control group. The control group received usual standard care during chest tube removal whereas experimental group received cold presentation with gel pack (Temp: 0-20C) after wrapping it with sterile gauze, around chest tube (5cms) for a period of 15 minutes before CTR. The tools used for the study were structured questionnaire to obtain demographic data, standardized Numerical Pain Intensity Scale (NPIS) scale to assess pain, C.D. Speilberger’s State Trait Anxiety inventory (STAI) scale to assess anxiety. The obtained data was analysed and interpreted in terms of the objectives of the study using descriptive and inferential statistics. The mean post test pain scores with cold presentation (1.13 ± 1.31; 0.27 ± 0.44; 0.27 ± 0.44) at zero minute, 15 minute and 30 minute respectively were significantly (< 0.05) lower than the mean pre-test score of 6.10 ± 1.27 in the experimental group without cold presentation. In control group, pre test mean pain score was 6.57 ± 1.12 as compared to mean post test pain score of 8.57 ± 0.49; 8.73 ± 0.57; 8.63 ± 0.48 at zero minute, 15 minute and 30 minute respectively. It indicates that cold presentation was effective to reduce pain among post operative cardiac surgery patients while removing chest tube. To evaluate the effectiveness of cold presentation on anxiety related to chest tube removal, in experimental group the mean post cold presentation anxiety scores 41.93 ± 2.21 were significantly lower (< 0.05) than the mean anxiety score of 53.47 ± 1.84 before cold presentation. In addition, the mean anxiety score were 53.31 ± 1.81 before CRT and 57.87 ± 3.21 after CRT among post operative cardiac surgery patient in control group. Conclusion: It indicates that the cold presentation on chest tube removal was effective in reducing anxiety among post operative cardiac surgery patient. Cold presentation is simple, cheap, non pharmacological anxiety and pain management strategy ensuring good results.
Keywords: Cardiothoracic Patients, Cold Presentation, Chest Tube Removal (CTR), Pain Score, Anxiety Score.
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