The Effect of Multisensory Stimulation on Baby's Pain and Mother's Anxiety During Heel Blood Collection
Condition: Pain
Study type: Interventional

Summary: 
      Newborn screening programs are preventive health services that have a significant place in
      public health programs in developed and developing countries worldwide. For these scans, heel
      blood is taken from the newborn, and the heel blood collection procedure applied for
      diagnostic purposes is one of the most common painful procedures applied to the newborn.
      Pharmacological and non-pharmacological pain management may be necessary to reduce and
      minimize pain during painful procedures in the neonatal intensive care unit. One of the
      non-pharmacological applications applied during acute procedural pain in the newborn is
      sensorial saturation, which consists of multisensory stimulation (sensitive touch, massage,
      auditory, visual, sense of taste, and smell). This study aimed to examine the effect of
      multisensory stimulation applied by the mother during the heel blood collection procedure in
      newborns on reducing pain and to evaluate the effects of family-centered practice on the
      state anxiety of mothers. This study was carried out as a randomized controlled, experimental
      study. Ethical approval was obtained before starting the study. In addition, written informed
      consent was obtained from the families of the newborns in the control and intervention
      groups. The study population consisted of newborns born in a hospital in Turkey between July
      2019 and January 2020, and whose heel blood was taken for routine metabolic screening by the
      Ministry of Health. The sample group consisted of 80 randomly assigned newborns, 40 in the
      intervention group and 40 in the control group. Newborn mothers in the intervention group
      gave their babies multisensory stimulation(speech, touch, breastfeeding, eye contact,
      maternal skin odor) before, during, and after the procedure. The newborns in the control
      group underwent routine heel blood sampling in the baby room under a radiant heater. The
      Neonatal Infant Pain Scale (NIPS) was used for pain assessment. The NIPS score was evaluated
      by the researcher before the procedure, during the procedure, and 1 minute after the
      procedure. The State Anxiety Inventory was used to measure the mother's anxiety. The state of
      anxiety of the mothers in each group was evaluated before and after the procedure.
    

Detailed description: 
      Sensory stimuli can be easily realized with the active cooperation of the mother and, based
      on family-centered care, can help parents feel that they are playing an active role in their
      baby's care by being involved in their baby's care and can have positive effects on reducing
      the pain and stress of the baby during the heel blood collection process.As far as we know,
      there is no study in the literature investigating the effectiveness of multisensory
      stimulation applied by the mother during the heel blood collection procedure in reducing both
      the baby's pain and the mother's anxiety. It is thought that our study will provide new
      evidence to nursing care, that more than one sensory stimulus will be provided by the mother,
      will increase the baby's sense of confidence and reduce pain, contribute to the importance of
      family-centered care, and will be useful to support the results of the current study. This
      study aimed to examine the effect of multisensory stimulation applied by the mother during
      the heel blood collection procedure in newborns on reducing pain and to evaluate the effects
      of family-centered practice on the state anxiety of mothers.Before starting work, S.B.U.
      Ethical approval was obtained from the Süreyyapaşa Chest Diseases and Thoracic Surgery
      Clinical Research Ethics Committee. To start the research after the ethics committee's
      approval, T.C. Permissions were obtained from the Istanbul Provincial Health Directorate and
      the Istanbul Tuzla State Hospital management. In addition, written informed consent was
      obtained from the families of the newborns in the control and intervention groups. The
      research population consisted of all newborns born in Tuzla State Hospital in Turkey/Istanbul
      between July 2019 and January 2020 and whose infants were taken for routine metabolic
      screening by the Ministry of Health. The sample group consisted of 80 randomly assigned
      newborns, 40 in the intervention group and 40 in the control group. Randomization was
      provided according to the order of the procedure. The first newborn control group and the
      second newborn intervention group were formed. The newborns whose heel blood will be taken
      every day of the week during working hours continued from where they left off according to
      the order of the procedure. Before the procedure, the necessary materials were prepared, and
      the heel blood sheet information was filled in. The mothers of the babies whose heel blood
      was taken were informed about the heel blood screening and the research. The form containing
      the identification information of the baby and the mother was filled out. Before the
      procedure, the mother was asked to fill out the State Anxiety Scale (in both groups, the baby
      was with the mother). The newborns in the control group were taken to an open bed under a
      radiant heater, leaving the mother's side for routine heel blood collection applied in the
      hospital. First of all, the foot of the baby, who was taken to an open bed under a radiant
      heater, was warmed in the hands of the nurse for one minute, the area where the baby's heel
      blood would be taken was determined, the baby's heel was wiped with 70% alcohol with the help
      of a sponge and waited for it to dry, then heel lance was performed. The procedure was
      completed after the relevant sections on the pre-prepared heel blood sheet were filled with
      blood. A light touch was provided if necessary for the routine comfort of the baby for
      ethical reasons. The mothers of the babies whose heel blood was taken in the intervention
      group were informed about the steps of the procedure and the multisensory stimulation they
      would give to their babies (mother's voice, touching, breastfeeding, eye contact, mother's
      skin smell). The baby was started to be breastfed before the procedure and continued until
      the end of the evaluation period (1st stimulus). The mother supported her baby's back and
      bottom with one hand. He started to touch by positioning the thumb of the other hand to
      prevent the baby's nose from being blocked and the other fingers of the same hand to touch
      the baby's face (2nd stimulus). The mother started to talk with her baby in a gentle but firm
      tone, sometimes using sentences (words, lullabies, songs, etc.) that she wanted to increase
      the volume of her baby (3rd stimulus). Talking was started before the procedure and continued
      until the end of the evaluation period. The mother was in the baby's sight (4th stimulus).
      Clothes were removed as much as possible for the smell of the mother's skin (5th stimulus).
      After the baby's foot in the mother's lap was warmed in the nurse's hand for one minute, the
      area where the baby's heel blood would be taken was determined. After the baby's heel was
      wiped with 70% alcohol and a sponge and waited for it to dry, heel lance was performed. The
      procedure was completed after the relevant sections on the pre-prepared heel blood sheet were
      filled with blood. If the baby stopped sucking at any time during the procedure, the baby was
      placed back on the breast and the procedure continued from where it had left off. In the
      study, the data of the baby and the mother was prepared by the researcher mother's age,
      mother's occupation, gestational week of the baby, birth weight, gender, mode of delivery,
      etc.), the "Neonatal Infant Pain Scale (NIPS)" scale, which will be used in the assessment of
      the baby's pain, and the questionnaire form of the State Anxiety Scale to measure the
      mother's anxiety was used. NIPS score was evaluated by the researcher before the procedure,
      during the procedure, and 1 minute after the procedure. The State Anxiety Scale was
      administered to the mother before and after the procedure. The researcher calculated state
      anxiety scale scores.
    

Intervention name(s): İntervention Group
Intervention type(s): Behavioral
Intervention description(s): Before the procedure, the baby was started to be breastfed (1st stimulus). The mother supported her baby's back and bottom with one hand. He started to touch by positioning the thumb of the other hand to prevent the baby's nose from being blocked, and the other fingers of the same hand to touch the baby's face (2nd stimulus). The mother started to talk to her baby with a gentle tone of voice, sometimes using sentences (lullaby, song, etc.) that she wanted to increase the volume of her voice (3rd stimulus). The mother was in the baby's sight (4th stimulus). Clothes were removed as much as possible for the smell of the mother's skin (5th stimulus). The baby's foot in the mother's arms was warmed in the nurse's hand for a minute. The area was determined, and the baby's heel was wiped with 70% alcohol. It was expected to dry. Heel piercing was performed while the stimuli continued. Heel blood was taken. When the evaluation period is complete, the process is over.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Neonatal; Heel Lance; Multisensory stimulation; Family Centered Care; NIPS; Sensorial Saturation(SS)