The Effect of Passive Music Therapy and Foot Massage
Condition: Intensive Care Patients
Study type: Interventional

Summary: 
      Patients hospitalized in tertiary intensive care units are connected to mechanical
      ventilators due to multiorgan failure, chronic diseases, respiratory failure, etc.
      Endotracheal aspiration is then necessary to maintain respiratory patency. However, patients
      feel a lot of pain during this application. Pharmacological methods for pain relief are
      mostly used in intensive care units. These methods can have many complications. In this
      study, it was aimed to determine the effect of passive music therapy and foot massage, which
      are non-pharmacological methods, on hemodynamic status in relieving pain and anxiety that may
      develop due to this. Reducing the use of pharmacological methods and switching to
      non-pharmacological methods in pain relief will increase the quality of patient care and
      recovery results.

      This research will be conducted as a prospective, randomized controlled, single-blind,
      experimental. In the study, passive music therapy will be applied to one of the intervention
      groups and foot massage will be applied to the other in the tracheal aspiration process, and
      no application will be made to the control group. Passive music therapy and foot massage will
      be applied for 30 minutes during the tracheal aspiration procedure. Evaluation will be made
      before, during and after the application.

      When the literature is examined, there are few studies examining the effect of foot massage
      in intensive care patients, but no studies evaluating the effect of foot massage during the
      aspiration procedure have been found. For this reason, it is thought that passive music
      therapy and foot massage applied in the aspiration process in intensive care patients will
      reduce the level of pain and anxiety, thus positively affecting the hemodynamic status of the
      patient, increasing the comfort of the patient and improving the results of nursing care.
      Thus, it is planned to bring an original study that has not been done on the subject to the
      literature.
    

Detailed description: 
      Intensive care units are defined as all the methods used to support the patients, to treat
      the causes of the disease, and to ensure the survival of the patient until the negative
      results of the partially or completely lost system and/or organ functions are recovered
      (Şahinoğlu, 2003). Patients in need of intensive care, who have reached the limit of their
      lives due to an advanced disease, trauma, poisoning, or surgery due to an advanced disease,
      trauma, poisoning, or surgery, and who need the help of different supportive biomedical
      devices, are given continuous and high-quality care, and to provide the best outcomes. They
      are patients who require the health care team to make sacrifices and efforts (Şahinoğlu,
      2003; Hatipoğlu, 2002; Wunsch et al., 2004; Clark and Normile, 2000).

      Endotracheal tube and mechanical ventilation are life-saving applications in complicated,
      conscious and unconscious patients with multi-organ failure, who have lost their
      physiological balance (Craven et. al., 2009). Tracheotomy or the presence of an endotracheal
      tube in intensive care patients is the process of giving the air that the patient breathes
      without being filtered, heated and humidified (Ferreira, 2013). Being immobilized for a long
      time due to the use of sedation in intensive care patients can also cause loss of ciliary
      movement and cough reflex function, which are natural defense mechanisms. For these reasons,
      in patients with endotracheal tube, both the secretion of secretions in the respiratory tract
      increases and the secretions can accumulate in the respiratory tract, causing mechanical
      obstructions because the patients cannot discharge their secretions. In order to prevent
      endotracheal tube obstructions and to maintain airway patency, it is extremely important and
      necessary to aspirate according to the patient's needs (Guglielminotti et al, 2000; Majett,
      2013). However, the frequently used, invasive, life-saving endotracheal aspiration procedure
      brings many undesirable conditions in intensive care patients. The patient has many symptoms
      such as discomfort, pain, bleeding, infection, bronchospasm, cardiovascular instability,
      hypoxia/hypoxemia, tracheal or bronchial mucosal damage, change in cerebral blood flow,
      increase in intracranial pressure, decrease in dynamic lung compliance and residual capacity,
      atelectasis, hypotension, hypertension. As it may result in complications, unmanaged pain can
      also cause anxiety as physiological, psychological and behavioral stressors (Gülsoy, 2017;
      Çelik et al, 2016). Endotracheal aspiration, which is found to be the most painful
      intervention experienced by intensive care patients in the literature, causes deterioration
      of comfort, frightening and unpleasant sensations, namely anxiety. It also creates a feeling
      of suffocation or is expressed as a loss of breathing (Day et al, 2002; Pedersen et al, 2009;
      Yaman Aktaş, 2013).

      Pain assessment and adequate pain management are extremely important, as pain is a major
      stressor in intensive care patients (Rotonti et al, 2002). If an effective pain management
      cannot be achieved, physiological, metabolic and behavioral responses occur due to this pain
      and pain sensation. Increases in heart rate, respiratory rate and blood pressure occur due to
      catecholamine, glucagon and steroids released due to painful stimuli. However, with the
      continuation of the painful stimulus, myocardial oxygen consumption increases, saturation
      decreases, and arrhythmias are observed (Gelinas, 2010; Dikmen, 2012).

      The American Society for Pain Management Nursing (ASPMN) reports that pain management of
      patients who experience interventional pain should be provided at an optimal level before,
      during and after the intervention, the level of pain and anxiety should be minimized and
      appropriate nursing interventions should be applied (Yaman Aktas, 2013). Pharmacological and
      non-pharmacological methods are applied in the management of patients' pain and comfort for
      invasive procedures. Pharmacological methods such as local anesthetics, non-opioid
      analgesics, opioid analgesics and interventional sedation and relaxation techniques,
      meditation, dreaming, massage, cold application, positioning, game activities and music
      therapy are used non-pharmacological methods (Eti Aslan et al, 2003; Cignacco et al. al,
      2007). Reasons for using non-pharmacological methods in the management of pain; reducing the
      need for the use of analgesics and increasing the comfort of life by reducing/eliminating the
      pain of the patient. In addition, nonpharmacological methods; it increases the sense of
      autonomy by empowering the patient (Özveren, 2011; Yaman Aktaş & Karabulut, 2015). Music
      therapy and foot massage, which are among the non-pharmacological methods that can be used to
      relieve pain caused by invasive applications, are simple, valuable and inexpensive adjuvant
      therapies used in pain control due to their ease of use (Yaman Aktaş and Karabulut, 2015).

      Since the language of music is universal, its therapeutic and healing properties have been
      used throughout history and it continues to be effective today. Music therapy, which is used
      to maintain and improve mental and physical health, is a simple and natural tool that nurses
      can apply in pain management due to its ease of use. The use of music therapy increases the
      patient's ability to endure pain by focusing attention on a stimulus other than pain. In
      addition, music therapy helps to control pain by removing unpleasant painful stimuli and
      increasing the secretion of endorphins (Eti Aslan, 2006; Özer et al, 2010; Özveren, 2011).

      In the descriptive study of Arroyo-Novoa et al. (2008), in which they investigated the pain
      levels felt as a result of endotracheal aspiration in patients treated in intensive care,
      they found that 50% of the patients experienced moderate to severe pain and that
      pharmacological and/or non-pharmacological methods were effective in relieving patients' pain
      related to endotracheal aspiration. They concluded that there is a need for further
      experimental studies. In many studies evaluating the effect of music therapy on pain and
      anxiety in intensive care patients under mechanical ventilation support, and the reflection
      of this effect on physiological parameters, it has been concluded that music therapy
      positively affects both anxiety and pain and the physiological changes caused by pain and
      anxiety (Güngör Çağlar, 2007). 2018; Şahin, 2018; Uzeli Yılmaz, 2016; Yeşim Yaman 2015; Wong
      et al, 2021; Amonda Golinda et al., 2021; Isabel et. al., 2016; Ya-Li Huang MM et al., 2021).
      In the literature, studies on music therapy applied during endotracheal aspiration are
      limited. Yaman Aktaş (2013) found that the music therapy applied to the patients under
      mechanical ventilation support during the endotracheal aspiration process controlled the
      sedation levels of the patients and reduced their pain levels. In the study of Akbaş (2021),
      after music therapy applied to intensive care patients, there was an increase in GCS values,
      a decrease in agitation, a decrease in systolic/diastolic blood pressure, pulse, respiratory
      rate, an increase in oxygen saturation values and tidal volume values in MV. and reported a
      decrease in the mean values of pain scales.

      Massage is expressed as the systematic and generally rhythmic application of hand movements
      to the soft tissues of the body. The planned and purposeful application of touch improves the
      relationship between the nurse and the patient, reduces respiratory distress, provides
      relaxation, and reduces the need for analgesia and sedation. In many studies in the
      literature examining the effects of massage on various parameters such as pain, edema,
      nausea, vomiting, fatigue and sleep in cancer, diabetes, dementia and dialysis patients and
      pregnant women, it has been concluded that foot massage is effective (Özdelikara and Tan,
      2014; Korhan et al, 2014; Soyman). , 2009). In the literature, intensive In studies examining
      the effectiveness of acupressure, back massage, and reflexology alone in reducing the
      physiological symptoms of anxiety in patients with mechanical ventilation support
      hospitalized in their units, it was determined that foot massage reduces dyspnea and anxiety
      and increases the level of comfort in patients (Guven and Karataş 2013; Tiran and Chummun,
      2005; Gökçen Gökalp 2018). ). Masoumeh Momeni et al (2021) determined that foot massage has
      an effect on delirium and consciousness level in intensive care patients. In studies
      examining foot massage in intensive care patients, it was found that it had a positive effect
      on hemodynamics such as arterial pressure, heart rate, respiratory rate and oxygen level
      (Azami et al,2015; Nyayu Nina Putri et al, 2021). Masoumeh Momeni et al. (2020) found that in
      another study examining the effect of foot massage on pain in intensive care patients, it
      significantly reduced pain scores. When the literature is examined, there are few studies
      examining the effect of foot massage in intensive care patients, but no studies evaluating
      the effect of foot massage during the aspiration procedure have been found.

      In line with this information, it is thought that passive music therapy and foot massage
      applied in the aspiration process in intensive care patients will reduce the level of pain
      and anxiety, thus positively affecting the hemodynamic status of the patient, increasing the
      comfort of the patient and improving the results of nursing care.

      This study was planned to determine the effects of passive music therapy and foot massage
      applied during aspiration on patients receiving mechanical ventilation support in the
      tertiary intensive care unit, on their hemodynamic status, pain and anxiety level.
    

Intervention name(s): passive music therapy; foot massage
Intervention type(s): Other; Other
Intervention description(s): 30 minutes before tracheal aspiration to intubated patients connected to mechanical ventilator treated in the 3rd step intensive care unit. and music between 60-74 dB will be played via headphones and MP3 player during aspiration (Şahin, 2018). This music is a 30-minute Hüseyni makam mp3 music recording . Hüseyni makam is effective in the morning and at dawn, and its effect is high between morning and noon. For this reason, passive music therapy practice in the research will be done by the researcher in the morning and afternoon. This maqam has beauty, benevolence, silence, comfort, a sense of peace and a refreshing feature. It has positive effects on the liver, heart, internal organs and spirit and unites with nature.; Massage will be applied by the researcher in the research. Towel, sponge, etc. under the foot to be worked on. The foot will be held at a 45 degree angle While applying, 1-2 drops of liquid Vaseline will be used to moisten the hand. A total of 30 minutes of foot massage will be made for each individual, 15 minutes per foot. Foot massage will start 30 minutes before the start of aspiration and massage will continue throughout the aspiration period. Since the speed of the massage movements and the number of repetitions should be at the normal frequency, the massage will be done at a speed that does not disturb the individual, has a non-stimulating and calming effect and does not tire the practitioner. In the massage, efflorescence (stroking), petrissage and friction (circular rubbing) movements that support circulation and relax the tissues will be used. Evaluations will be made before the foot massage, at the end of the foot massage and 30 minutes after the foot massage.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The research is planned as a prospective, randomized controlled, single-blind, experimental study. The research will be carried out in the 3rd Level Intensive Care Units of Ömer Halisdemir University Training and Research Hospital located in Niğde City Center. The population of this study will consist of patients receiving mechanical ventilator support, who are intubated in the 3rd Level Intensive Care Units of Ömer Halisdemir University Training and Research Hospital in the city center of Niğde. The sample of the study was 'The Effect of Foot Massage on Pain of the Intensive Care Patients:A Parallel Randomized Single-Blind Controlled' study by Momeni et al. (2020), based on pain, power :0.90, type II- error 10%, confidence When the range of 1.96 is taken as a reference, the experimental groups that should be taken as a minimum were calculated as 25 and the control group 25 as a total of 75 patients.
Masking: Single (Participant)
Primary purpose: Other
Keywords: Music therapy; Foot massage; Pain; Anxiety; Intensive care