''The Effect of Skin-to-Skin Contact and Gentle Touch Method Applied During Blood Collection on Early Detection of Pain and Physiological Parameters''
Condition: Venipuncture; Pain; Touch
Study type: Interventional

Summary: 
      37. babies under the gestational week are considered preterm babies, and babies between 32-37
      gestational weeks are considered late preterm babies (WHO, 2023). Dec. While the preterm
      birth rate in the world is 10%, this rate is 13% in Turkey. The life rate of preterm babies
      has increased in recent years and they are subjected to many painful interventions for
      diagnosis, treatment and preventive purposes. At the time of birth, they experience painful
      interventions such as vitamin K, hepatitis B vaccine administration, heel blood collection.
      Painful interventions cause an increase in cortisol levels, resulting in impaired blood sugar
      in infants, impaired brain development, impaired growth and development (Akyildiz et al.,
      2023). In the short term, they may give signs of a decrease in oxygen saturation, an increase
      in heart rate, metabolic acidosis( Akcan et al., 2017). Procedural pain management is also
      important for the neurological development of preterm infants (Perg et al., 2018). For these
      reasons, the pain of the newborn due to interventional procedures should be managed well.
    

Detailed description: 
      Newborns are often exposed to acute or chronic pain due to different invasive interventions
      (Akcan and Polat, 2017). The American Pain Society (APS) accepts pain as the fifth
      physiological parameter (McCharty et al., 2013). The American Academy of Pediatrics (AAP)
      recommends minimizing pain due to invasive procedures (Aydın et al., 2016). Reducing pain
      first requires accurate assessment of pain and treatment with
      pharmacological/non-pharmacological interventions (Hussein, 2015). Pharmacological methods
      have risks such as drug-related side effects. For this reason, non-pharmacological methods
      are primarily preferred in acute pain (Hashemi et al., 2016).

      Non-pharmacological methods for pain management are diverse. In recent years,
      non-pharmacological methods such as distraction, wrapping, positioning, aromatherapy, music,
      games, massage, kangaroo care, and oral sucrose have been used together or separately to
      reduce pain and/or stress-related behaviors (Abdallah et al., 2013).

      In another application, the tent-to-skin contact method, the newborn is laid face down on the
      parent's chest. The newborn's back is covered to prevent heat loss. It is thought that this
      situation will relax the newborn and therefore perceive the pain as milder (Mayfield, 2019).

      Gentle Human Touch is one of the therapeutic touch methods. Gentle touch, which is a simple
      and applicable method in newborns, is a non-invasive touch technique that does not require
      special equipment and technology. The gentle touch method is a sensitive tactile stimulation
      applied to the skin, without caressing or massage, and provides a relaxing effect on the baby
      (Dur et al., 2020; Fatohallazade, 2020).

      Newborns need their parents, especially their mothers, to be with them during all kinds of
      interventions. For this reason, the parent should be with the newborn during the invasive
      interventions and take a primary role in the non-pharmacological interventions; It provides
      optimum comfort for the nurse, newborn and caregiver. It is important to benefit from the
      family-centered care model when using non-pharmacological methods. Family-centered care is a
      care model based on collaboration between health professionals and children's families in the
      planning, delivery and evaluation of health services. Its general goal is to increase the
      quality of health services for children and families, increase the satisfaction of families
      and health professionals, and ensure the effective use of personnel (Yılmaz and Gözen, 2019).

      It was planned as a randomized controlled experimental design type in order to determine the
      importance of the family-centered care model and parents' participation in the procedures and
      to determine the effect of non-pharmacological methods applied to preterm newborns by their
      mothers on the pain occurring during blood collection and the effect on preterm physiological
      parameters.
    

Intervention name(s): Skin To Skin; Gentle Human Touch
Intervention type(s): Other; Behavioral
Intervention description(s): Skin to Skin Contact Group The temperature of the environment where kangaroo care will be carried out will be adjusted between 22-26 degrees C. The mother will be allowed to disinfect her hands and warm them until her hand temperature is at least 34 C. Only the baby's diaper, hat and socks will be left behind, and the baby will be placed face down on the mother's chest, with its head upright and its legs under the breasts in a frog position. The baby's face will be turned towards the mother and eye contact will be made. The baby will be in an upright position between the mother's breasts and skin to skin with the mother.
Skin-to-skin contact will begin 5 minutes before blood collection, continue throughout the procedure, and kangaroo care will continue until 5 minutes after the procedure.; Experimental Group (Gentle Touch/Gentle Human Touch-GHT); After the mother is dressed in a clean apron, her hands are washed and disinfected, and it is safe to warm the hand temperature with a non-contact thermometer device until the measured value is 34 ºC. The mother, who was previously informed about the method, will be placed on the eyebrow line with the crown piece that will separate the fingertips and tuft of one hand, while the other hand will be placed on the lower abdomen, which will mark the waist and hips (Figure 1). The blood collection amount of GHT application will be started 5 minutes before, make sure that the blood collection is done and the blood collection will continue until 5 minutes later.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Premature babies who apply to the blood collection room to take blood, were included in the gentle human touch, skin to skin and control groups. Randomization occurred on: www.randomizer.org
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: pain; pretem; physiological findings; gentle human touch; skin to skin; touch