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RN-guided visualization of a safe place may ease procedural pain

Tuesday April 15, 2014
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Visualizing a safe place can help patients cope with pain and anxiety during a procedure, according to new findings.

New analysis of a recent study, which involved RNs guiding patients to focus on safe images during ablation of atrial fibrillation, was presented April 5 at EuroHeartCare, the annual meeting of the Council on Cardiovascular Nursing and Allied Professions of the European Society of Cardiology. This year’s meeting was organized with the Norwegian Society of Cardiovascular Nurses and took place April 4-5 in Stavanger, Norway.

“We ask patients to describe a comfortable safe place they want to be during the procedure,” lead author Marianne Wetendorff Nørgaard, RN, a clinical nurse specialist at Copenhagen University Hospital, Rigshospitalet, Denmark, said in a news release. “People have chosen a summer house, the beach, or the woods. During the procedure the nurse asks the patient to focus on their safe place and how it looks, smells and sounds.”

If patients express feeling pain, nurses can help them visualize a different scenario, Nørgaard said.

“For example, if the patient says ‘my chest is burning,’ the nurse may say, ‘Imagine that it’s a cold day and there is ice on your chest,’” she said in the release. “Patients tell us that being in this trance-like state with safe images makes the procedure a pleasant experience and it feels shorter.”

Nørgaard added visualization could help reduce pain and anxiety while allowing some patients to avoid general anesthesia and the associated risks.

In the first clinical study of visualization during ablation of AF, the researchers compared outcomes between 76 patients who used visualization and 71 patients who received conventional care.

All patients were awake during the 2- to 4-hour treatment and received local anesthesia plus pain relievers when they signaled the nurse using a push button. During the procedure, patients scored their pain and anxiety levels every 15 minutes and after specific painful experiences.

The researchers found patients who used visualization during the procedure were in pain less often and asked for fewer pain relievers. When the patients reported pain, there were no differences between groups in the perception of pain intensity and no differences in anxiety levels.

“Patients who used visualization expressed pain fewer numbers of times and asked for less painkillers,” Nørgaard said in the release. “Their perceived pain intensity may have been the same because we interrupted their visualization at regular intervals to record pain and anxiety levels. If they had been allowed to stay in their trance-like state during the entire procedure, their perceived pain intensity may have also reduced.”

New analysis

The investigation more closely explored the experiences of 14 patients who had used visualization during the clinical study. Qualitative interviews were conducted and subjected to inductive content analysis.

“Patients told us that visualizing their own safe place during the procedure made them feel involved and helped them cope with pain and anxiety,” Nørgaard said in the release. “Before the intervention patients were anxious and afraid of being on the operating table for a long time, but afterward they said visualization had made it seem short and that it was a positive and pleasant experience.”

Patients who used visualization also said having something else to focus on allowed them to give up the desire to be in control when in the OR, according to Nørgaard.

She said some countries, such as the U.S. and some in southern Europe, often use general anesthesia during ablation of AF, which can be risky and is more costly.

“Some of these patients could use local anesthesia and visualization instead, plus painkillers as needed,” she said in the release. “Extra nurses are not needed in the operating room, you just need to train the ones who are already there.”

Nørgaard added visualization could be helpful for patients undergoing numerous procedures in many hospital departments.

“We offer visualization to all our AF ablation patients and those who return for another procedure request it,” she said. “We also use visualization during other cardiac procedures because it works so well.”

Abstract from the first study: http://onlinelibrary.wiley.com/doi/10.1111/pace.12032/abstract


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