Use Of Non-pharmacological Methods Research Articles

“…We never considered it important…”: a qualitative study on perceived barriers on use of non-pharmacological methods in management of labour pain by nurse-midwives in eastern Tanzania

BackgroundA significant number of women experience labour without effective pain management and thus suffer from unbearable labour pain to the extent they term labour as the most agonizing event in their lives. Unresolved labour pain can lead to stress, fear, and confusion, which may compromise placental perfusion and lead to birth asphyxia. Although various pharmacological and non-pharmacological labour pain management methods exist, the use of non-pharmacological methods (NPMs) to manage labour pain has remained low in low-resource settings. This paper explored the barriers for using NPMs to manage labour pain by nurse-midwives in eastern Tanzania.MethodsWe conducted an exploratory qualitative study with 18 nurse-midwives purposefully recruited from the labour wards of two selected district hospitals in eastern Tanzania. Qualitative content analysis guided the data analysis.ResultsTwo categories illustrating barriers to using NPMs were generated: individual-level and institutional-level barriers. Individual-level barriers include (i) limited competencies of nurse-midwives on the use of NPMs for managing labour pain, (ii) inadequate exposure to labour pain management practices, (iii) misconceptions about labour pain relief, and (iv) a lack of opportunities for knowledge acquisition. The institutional barriers include (i) a critical staff shortage amidst many clients and (ii) an unfavourable healthcare facility environment.ConclusionThe implementation of NPMs for labour pain management by nurse-midwives in eastern Tanzania faces several institutional and individual barriers. We recommend addressing both supply- and demand-side barriers. Strengthening nurse midwives’ competencies in NPMs adoption and use and improving the facility environment to ensure privacy during labour can be a starting point for addressing supply-side issues. We recommend dispelling myths and misconceptions through health promotion education to address demand-side barriers.

Prevalence of use of nonpharmacological methods of pain relief among patients following onco surgeries – A prospective, observational cohort study from a single center

Abstract Background and Aims: For the aggressive treatment of postoperative pain, nonpharmacological methods (NPMs) are gaining importance complementary to routine multimodal pain management. The primary aim of the study was to assess the incidence of use of NPMs in our hospital. Secondary objectives were to correlate the pain scores, patient satisfaction, and percentage of time the patient was in severe pain within 72 h postsurgery with the use of NPMs when in pain/not in pain. The effect of NPMs on the physical and emotional outcome of patients as per the American Pain Society Patient Outcome Questionnaire (APS-POQ) was also assessed. Material and Methods: After obtaining approval from the institutional ethics committee (IEC), the trial was registered with the Clinical Trials Registry of India (CTRI). Informed consent was obtained from adult patients on the third postoperative day of elective surgeries. Their responses to the APS-POQ and to a few additional questions about their beliefs on the use of NPM were recorded. Results: Only one-fourth of the total study population were using NPMs for pain management in the hospital. After propensity matching for surgery and postoperative analgesia, two groups were made: one using NPM for pain relief (n = 49) and the other not using NPM (n = 98). There was no significant difference among the satisfaction score (P = 0.31), least pain score (P = 0.68), and worst pain score (P = 0.43) within 72 h postoperatively in either of the groups. Emotional and physical outcomes as per the APS-POQ were similar in both the groups. Conclusion: NPMs are rarely practiced and used during postoperative pain in our hospital. No difference in pain scores, patient satisfaction, and emotional and physical outcomes of the APS-POQ was seen in the group that indulged in NPMs.

Self-management of primary dysmenorrhea-related pain: cross-sectional study on non-pharmacological interventions.

Aim: Different nonpharmacological strategies are adopted to decrease primary dysmenorrhea (PD)-related pain. The present study aimed to verify women's use of nonpharmacological methods for pain and compare them with evidence from the literature.Materials & methods: A two-step study was conducted, comprising an online survey with 9144 women to assess nonpharmacological strategies for relieving PD-related pain, and a literature review on PubMed of verify the evidence of nonpharmacological methods.Results: Many women reported using heat therapy (61.5%), tea (42.4%) and massage (30.9%) to alleviate menstrual pain. However, the literature on these methods is limited.Conclusion: Several nonpharmacological methods are used by women to relieve PD-related pain and studies with low bias risk are needed to prove their effectiveness.

Post-Traumatic Stress Disorder In Children And Non-Pharmacological Therapies Strategies In Iran: A Review Study

Purpose and Background: Post-traumatic stress disorder (PTSD) is a set of symptoms that appear after a severe traumatic stress. Children and adolescents experience an increase in potentially traumatic experiences. Many children subsequently develop mental health problems. Method: A broad search was conducted in scientific databases and search engines such as Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc, and Magiran with Using the keywords “post-traumatic stress disorder”, “non-pharmacological coping strategies”, “children” alone or in combination with each other and their English equivalent was done. Articles that were published between 2000 and 2023 and were more related to the main focus of the research topic were selected.After a comprehensive review, nine studies that met the purpose of this study were selected. Findings: The most important non-pharmacological treatment strategies in children included relaxation and hypnosis, acupuncture, neurofeedback, saikokeishikankyoto (a herbal preparation) and exercise (yoga). Conclusion: Therefore, the use of non-pharmacological methods as one of the effective methods in the treatment of these children’s disorders can improve the quality of life of the family of these patients and the patient himself, as a result, administrators should encourage the patients’ families by using non-pharmacological methods.

The Effectiveness of Neurofeedback on Improving Social Interactions and Activity of Daily Living in Children with Autism Spectrum Disorder: A Narrative Review

Context: Impairment in social interactions and daily activities of autism spectrum disorder (ASD) patients is one of the negative and important consequences of ASD. Recently, the use of non-pharmacological methods to improve behavior and rehabilitation in patients with ASD has attracted the attention of researchers and specialist physicians. According to the mentioned topic, This study aimed to evaluate the effectiveness of neurofeedback (NF) in improving social interactions and activity of daily living (ADL) in children with ASD. Evidence Acquisition: This narrative review obtained the desired results by collecting previous similar studies related to the study's primary purpose. First, 182 articles were extracted through the search of MeSH (medical subject headings) terms associated with the particular objectives of the study in international reliable databases. Then, twenty-five studies were selected as final studies considering the inclusion and exclusion criteria. Results: The results of the present study showed that NF can help to improve the performance of children with ASD through brain waves as a new treatment method based on conditioning and reinforcement. NF helps identify cognitive problems and improve cognitive processes in autistic children by improving self-regulation of the brain. In addition, NF leads to better cognitive performance by increasing beta waves and decreasing theta waves. On the other hand, increasing beta waves increases alertness, concentration, and metabolism, which can improve cognitive and social functioning. Conclusions: Based on the results, NF has a positive and significant effect in improving social interactions and ADL in children with autism spectrum disorder. Therefore, this method should be used to improve behavioral disorders and strengthen the ADL of patients with ASD, considering the side effects of pharmacological intervention methods.

Assessment and management of delirium in a tertiary hospital-Improvements in cognitive screening and use of non-pharmacological strategies with a multidisciplinary approach.

This series of audits aimed to determine current best practice in delirium management in a tertiary teaching hospital and to identify strategies to improve the quality of care in delirium with a focus on prevention. We completed a series of audits following the formation of the Cognitive Impairment Reference Group, a multidisciplinary team that was created to implement delirium management guidelines and monitor compliance. Audit 1 focused on antipsychotic use in patients aged 66 years and older. Audit 2 reviewed delirium care in the Acute Medical Ward. Audit 3 included ethnographic data and investigated the use of non-pharmacological methods to prevent and manage delirium in the Geriatric Ward. Two years on, Audit 4 is a repeat of Audit 1. There were improved rates of cognitive screening between Audits 2 and 3 from 65% n = 40 to 86% n = 102, respectively. Most patients had one form of non-pharmacological strategy in place to prevent delirium however few had a multicomponent approach. Fewer patients were prescribed benzodiazepines alongside antipsychotics 28.57% n = 35 in Audit 1 compared to Audit 4 12.5% n = 32. Improved quality of care in delirium management is achievable via a co-ordinated multidisciplinary approach. These audits demonstrated improvements in both rates of cognitive screening, and use of non-pharmacological strategies prior to antipsychotic medication use and better adherence to guidelines for antipsychotic prescribing. Areas for further development in delirium prevention include the uptake of screening and individualised non-pharmacological strategies.

A REFLECTIVE ACCOUNT – NON-PHARMACOLOGICAL MANAGEMENT OF NEONATAL ABSTINENCE SYNDROME

This reflection will use Gibbs’ Reflective Cycle to undertake a critical account of my experience as a student midwife on a busy postnatal ward caring for a woman and her newborn baby who was being assessed for neonatal abstinence syndrome. My reflection focuses on the assessment of neonatal abstinence syndrome and how newborns can be supported through withdrawal with the use of nonpharmacological methods. The use of strength-based approaches by midwives to provide effective care and support of newborn babies, and the importance of interdisciplinary working when caring for vulnerable women and families is also highlighted.

Bibliographic Analysis of Postgraduate Theses on the Use of Nonpharmacological Methods in the Management of Labor Pain in Turkey

Giriş ve Amaç: Bu çalışmanın amacı Türkiye’de doğum ağrısının yönetiminde nonfarmakolojik yöntemlerin kullanımı konusunda yapılan lisansüstü tez çalışmalarının bibliyografik analizi ile bibliyometrik parametrelerinin tespit edilmesi ile ilgili literatürün gelişim perspektifinin incelenmesidir. 
 Gereç ve Yöntemler: Bibliyografik inceleme tipindeki araştırmada 2013-2023 yılları arasında yayınlanan lisansüstü tezler incelendi. Çalışma verilerini toplamak için araştırmacılar tarafından literatür incelenerek geliştirilen, 12 maddeden oluşan veri kodlama formu kullanıldı Verilerin sayı ve yüzde dağılım analizinde SPSS, verilerin görselleştirilmesinde VOSviewer programları kullanıldı.
 Bulgular: Tarama sonucunda 2013-2023 yılları arasında doğum ağrısının nonfarmakolojik yöntemler ile yönetimi konusunda tamamlanmış 56 teze ulaşıldı. Tezlerin en sık İstanbul (%33,92) ilinde ve Ebelik Anabilim Dalı’nda (%51,78) yayınlandığı belirlendi. Tezlerde araştırılan nonfarmakolojik yöntemler incelendiğinde ilk üç sırada sırasıyla masaj (%19,64), akupressure (%12,50) ve sıcak soğuk uygulama (%10,71) olduğu saptandı. Konu hakkında yapılan tezlerin türleri incelendiğinde %58,92’sinin Yükseklisans tezi olarak yürütüldüğü kaydedildi. Yalnızca bir öğrencinin hem Yükseklisans hem Doktora Tezi’nde konu üzerinde çalıştığı belirlendi. Tezlerin araştırma tasarımları incelendiğinde %86’sının randomize kontrollü çalışma olarak yürütüldüğü, örneklem sayısının ise ortalama 120,23±66,53 olduğu belirlendi. Tezlerde en sık kullanılan ölçeğin ise Visuel Analog Skala olduğu saptandı. 
 Sonuç: Yapılan lisansüstü tezlerde doğum ağrısının yönetiminde kullanılan nanfarmakolojik yöntemlerin sıklıkla uygulandığı ve konu hakkında randomize kontrollü çalışma gibi kanıt değeri yüksek çalışmalar yürütüldüğü fakat alanda henüz aydınlanmamış alanlar bulunduğu, bu nedenle konu hakkında daha kapsamlı, daha büyük örneklemli, kanıt düzeyi yüksek çalışmalara ihtiyaç olduğu sonucuna varılmıştır.

Pediatric Nurses’ Knowledge and Practices Related Pain Management in Children with Cognitive Impairment

This study was conducted with a cross-sectional design to determine pediatric nurses' knowledge and practices related to pain management in children with cognitive impairment. The sample of the study consisted of 65 pediatric nurses working in two different hospitals in one city. After obtaining institutionals, ethics committee permissions, and written consent from participants, the data were collected using a ıntroductory characteristics form and a questionnaire to determine knowledge and practices regarding pain management in children with cognitive impairment. Descraiptive statistics and Chi-square tests were used for data analyses. 
 The majority of the pediatric nurses reported the parameters used to assess pain among children with cognitive impairment as facial expressions and behavioral responses. Only 16.9% of nurses evaluated pain using a scale. In terms of reducing the pain of children with cognitive impairment, 55.4%, 35.4% of nurses reported that they used nonpharmacological, pharmacological methods, respectively, and 9.2% no specific methods were used in the clinic where they worked. The commonly used nonpharmacological methods were distraction, massage, cold application, etc. A significant difference was found in the use of nonpharmacological methods with respect to gender and previous training on pain management (p

Investigating the Effect of Ginger as an Adjunctive Treatment along with SSRIs to Reduce Anxiety in Patients with GAD: A Clinical Trial Study

Introduction: Generalized anxiety disorder (GAD) is characterized by exaggerated anxiety without any apparent cause of concern. The primary treatment of this disorder is usually SSRIs, which have many digestive side effects and do not provide complete treatment for the patient. The use of non-pharmacological methods may help reduce these complications. Therefore, the present study was conducted to investigate the effect of ginger as an adjunctive therapy along with SSRIs to reduce anxiety in patients with GAD. Materials and Methods: In this double-blind, controlled clinical trial study, a total of 80 patients with GAD were randomly assigned into two groups. For the intervention group, at the same time as SSRI drug, two 500-mg ginger capsules were used daily while in the control group, two starch capsules were used daily as a placebo along with SSRI. Data collection tools were Hamilton's anxiety questionnaire and a gastrointestinal symptom severity scale. Data were collected before the intervention and after the 12-week intervention. Results: There was no significant difference between the intervention and control groups in terms of average anxiety and severity of digestive symptoms before the intervention (P>0.05), but there was a significant difference between the groups after the intervention (P<0.05). Also, the average scores of anxiety and severity of gastrointestinal symptoms in the intervention group increased significantly from the beginning of the intervention to the follow-up (intragroup difference) (p<0.05). Conclusion: The results of the study showed that the use of ginger along with SSRIs reduced anxiety and released the severity of gastrointestinal symptoms in patients with GAD. In addition, in this study, it was found that ginger, along with SSRIs, can have beneficial effects on indigestion, diarrhea, and nausea in patients with GAD. However, these findings require more extensive research.

Effectiveness of maternal-targeted training on nonpharmacologic pain management on heel stick sampling: A randomized controlled trial

BackgroundHeel stick sampling, which is a common procedure in newborns, causes acute pain, and parents are aware of this. AimThe current study aimed to investigate the effectiveness of maternal-targeted training on newborn pain management, addressing the use of nonpharmacological methods and anxiety. MethodsThe study is 2-arm, parallel-group randomized controlled trial. A total of 64 mothers were included in this study. Mothers were randomly allocated to each group; intervention (n:32) and control (n=:32). Training on nonpharmacological pain management in newborns was given to the mothers in the intervention group. Data were collected with an Introductory Information Form, Nonpharmacological Pain Management Use Checklist, and State-Trait Anxiety Inventory. ResultsNonpharmacological methods were used for the procedures in the control group and the intervention group, with an absolute difference of 68.8% between groups. The difference was statistically significant (p < 0.001) and had a large effect (d = −79.222; 95% CI, −9.365 to 670.143. There was no significant difference between the groups in terms of anxiety score (p = 0.558). ConclusionDemonstrates the clinical relevance and feasibility of training targeting maternal on neonatal pain management during the heel stick sampling procedure.Practice Implications: When non-pharmacological methods in pain management of newborns were recommended by the nurse, maternal involvement in pain management increased significantly, suggesting that nurses have a key role in ensuring parental involvement.Clinical Trial Registration: NCT05173662.

Auricular Acupressure Effectively Reduces Labor Anxiety in Primigravidae by Increasing β-Endorphin Levels

Highlights: 1. Auricular acupressure at the Shenmen point is effective in reducing anxiety.2. Auricular acupressure is more practical than body acupressure since it does not interfere with expectant mothers' mobilization.3. As a non-pharmacological method, auricular acupressure is cost-effective, efficient, and effective in overcoming maternal anxiety during labor Abstract Anxiety is a common psychological symptom in expectant mothers, particularly among primigravidae during labor. There is a link between excessive anxiety and prolonged labor. One of the options to manage anxiety is the use of non-pharmacological methods. Numerous studies have investigated the effectiveness of auricular acupressure to treat anxiety, but few have examined its effect on anxiety biomarkers. Thus, the objective of this study was to analyze the effect of auricular acupressure targeting the Shenmen point on the levels of β-endorphins and anxiety among primigravidae during the first stage of labor. This experimental study used a pretest-posttest control group design. The research subjects were primigravidae in the first stage of labor at the independent midwife practice of Yefi Marliandiani in Surabaya, Indonesia. Among 40 primigravidae, 34 individuals met the inclusion criteria and were then equally divided into treatment and control groups using a simple randomization. The treatment group received auricular acupressure at the Shenmen point every 30 minutes for a duration of 5 minutes, while the control group practiced deep breathing relaxation. The anxiety levels were assessed using the Hamilton Anxiety Rating Scale. The β-endorphin levels were measured by drawing 3 cc of venous blood before (4 cm cervix dilation) and after (9–10 cm cervix dilation) treatment. The obtained data were analyzed using paired- and independent-samples t-tests. A decrease in the mean anxiety level was observed in the treatment group (18.59±7.52) relative to the control group (19.76±7.11), albeit not significant (p=0.64). Simultaneously, the average β-endorphin levels of the treatment group (355.4±224.7) increased compared to the control group (225.1±127.5), with a significant difference observed between the two groups (p=0.04). In conclusion, while both auricular acupressure at the Shenmen point and deep breathing relaxation are effective in reducing anxiety, the former is more prominent in its ability to increase β-endorphin levels.

Evaluation of the role of transcutaneous electrical nerve stimulation for postoperative pain relief in laparoscopic cholecystectomy: a prospective comparative study

BackgroundPostoperative pain after laparoscopic cholecystectomy still remains a fairly common challenge for the anesthesiologist. Commonly used drugs such as NSAIDs and opioids have their own side effects requiring a need to substantially evaluate the use of non-pharmacological methods like TENS as adjuvants to conventional methods of pain control. We studied the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain in laparoscopic cholecystectomy. The primary objective was to compare postoperative analgesia between TENS and placebo groups using visual analog scale (VAS). The secondary objectives were to compare the requirement and dosage of rescue analgesia, hemodynamic parameters (blood pressure and heart rate), and incidence of nausea and emesis between placebo and TENS groups. A total of 64 patients of age group 18 years to 60 years of either gender posted for elective laparoscopic cholecystectomy were randomly allocated into two groups using a computer-generated sequence of random numbers: Group P (n= 32): placebo TENS and Group A (n= 32): active TENS. Statistical analysis was performed by the SPSS program for Windows, version 17.0 (SPSS, Chicago, Illinois). Unpaired t test, Mann-Whitney U test, chi-square test, and Fisher’s exact test were used for statistical analysis.ResultsThe two groups were statistically similar in terms of age, gender, and weight. The VAS scores were significantly lower in patients in the active TENS group for up to 2 h after surgery, and the total weighted dose of diclofenac consumed over 8 h in the active TENS group was significantly lower as compared to the placebo TENS group. Patients who received TENS showed significantly less rise in blood pressure and heart rate and remained hemodynamically stable. Total episodes of nausea and emesis though less in the active TENS group were statistically insignificant.ConclusionWe conclude that TENS is an effective adjuvant non-pharmacologic modality for postoperative pain relief after laparoscopic cholecystectomy.

Realidade Virtual como estratégia de alívio da dor no trabalho de parto: protocolo revisão scoping

Introduction During labour, pain can affect the health of the mother and the foetus, and its relief is a right of the mother and a duty of the professionals. In the promotion of a positive experience of labour, it is crucial that nurses specialised in maternal and obstetric health give priority to pain assessment and the use of non-pharmacological methods for pain relief, providing the necessary resources and empowering parturients to use them. Among said methods, virtual reality stands out due to its ease of use and for allowing the reduction of pain levels by diverting attention from the real world, using computers and other devices. Since it is a new approach that is not yet implemented in delivery rooms in Portugal, it is important to map the facilitating factors and barriers associated with its use, so that the dissemination of existing knowledge and its transfer to skilled nursing care during the first stage of labour can be planned. Objective To map the research evidence on the facilitating factors and barriers in the use of VR as a non-pharmacological strategy for pain relief during labour in hospital settings. Methods This protocol follows the guidelines published by the Joanna Briggs Institute. The databases MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and MedicLatina through the EBSCOhost platform, the Joanna Briggs Institute EBP Database, through the Ovid platform are considered for the search and, the grey literature is also included. As inclusion criteria, qualitative, quantitative and mixed studies that address virtual reality as a pain relief strategy during labour in hospital settings (based on the mnemonic PCC - Population, Concept and Context), published in Portuguese, French, Spanish or English language between 2017 and 2022 are considered. The titles and abstracts of identified references will be independently reviewed and assessed for eligibility by two reviewers. In the event of a tie, a third reviewer will be used. Full text studies and data will be extracted using a form. The data extraction table will show the mapped data in a descriptive way answering the research questions. Discussion The results will allow summarising the barriers and facilitating factors in the use of Virtual Reality for pain relief during labour and thus contribute to decision making in planning the dissemination of this strategy to pregnant women and health professionals and its implementation in delivery rooms. Systematic Review Record Open Science Framework : osf.io/4b2sj

Parental Participation in Their Infants’ Procedural Pain Alleviation with Nonpharmacologic Methods in Estonia

BackgroundAim: To describe parent's participation in their infants’ procedural pain alleviation using nonpharmacologic methods in neonatal and neonatal intensive care units. MethodA descriptive cross-sectional survey study was carried out in four Estonian hospitals between 2019 and 2020. Data were collected by using a validated questionnaire comprised of three sections: (1) background information of parents and infants; (2) nonpharmacologic methods used by parents; and (3) parental guidance by nurses on the methods. Altogether 280 questionnaires were distributed to parents and 232 of them were received back. Finally, 189 of them were included in the study (response rate 67.5%). The data were analyzed using descriptive and analytical statistics. Analysis of open-ended questions followed principles of inductive content analysis. ResultsMost participants reported using nonpharmacologic methods, such as holding and placing the infant in a more comfortable position, nearly always/always (61%, 62%, respectively). However, rarely used methods included skin-to-skin contact (7%), breastfeeding the infant (7%), and listening to recorded music (3%). While studying a correlation between the parents’ use of nonpharmacologic methods and their guidance, we found a correlation among all nonpharmacologic methods. However, almost half (48%) of the parents reported that the nurses advised them “sometimes” or “nearly always/ always” to go elsewhere during painful procedures rather than participating in alleviation of the infant´s pain. ConclusionsThe parents reported using mostly the nonpharmacologic methods that were easy to implement and did not require thorough instructions in preparation. In addition, it seemed that parents wanted to be more involved in their infant's pain alleviation, but they were advised not to take part in painful procedures and pain alleviation for various reasons. Therefore, more attention should be paid to the principles of family-centered care. As health care providers, we should welcome all families as team members to involve in their infants’ pain alleviation in the neonatal and neonatal intensive care units.

Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project

BackgroundIn 2015, a quality improvement project—the “Adequate Childbirth Project” (Projeto Parto Adequado, or PPA)—was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals.MethodsCross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test.Results4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including “oral fluid and food”, “maternal mobility and position”, “monitoring of labor”, “use of non-pharmacological methods for pain relief” and “epidural analgesia for pain relief” in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors.ConclusionsThere was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges.

Comparison of the Impacts of Benson Relaxation Technique and Foot Reflexology Massage on Sleep Quality of Patients with Systolic Heart Failure: A Randomized Clinical Trial.

Cardiovascular diseases can affect sleep quality. The use of non-pharmacological methods to improve the sleep quality of heart failure patients is essential. Therefore, this study compared the effects of the Benson relaxation technique and foot reflexology massage on sleep quality of those patients. In this clinical trial study, 93 patients with systolic heart failure referred to Javad Al-Aeme heart clinic in Torbat Heydarieh were selected with purposive sampling method and divided into the foot reflexology massage, Benson relaxation technique, and control groups using the balanced blocking randomization method. The Benson relaxation technique and the foot reflexology massage were performed for 20 and 30 minutes three days per week for four weeks, respectively. The control group only received routine care. Sleep quality was measured by the Pittsburgh sleep quality index and then compared among the groups before and after the intervention. The data were analyzed using ANOVA, Tukey's post hoc tests, paired t test, and Chi-square at the significant level of p < 0.05. After interventions, the mean (SD) quality of sleep significantly increased in both intervention groups (Reflexology: pre-intervention 10.80 (3.40), post-intervention 6.60 (3.10), Benson relaxation: pre-intervention 15.50 (2.40) post-intervention 12 (2.60), compared to the control group (pre-intervention 10.50 (1.90) post-intervention 9.40(1.70) (p < 0.001). There was no significant difference between the two intervention groups (p = 0.53). The interventions improved the quality of sleep in patients with systolic heart failure. Therefore, these methods can be used as a suitable complementary treatment to improve the quality of sleep by nurses and midwives.

The Role of Midwives in the Course of Natural Childbirth-Analysis of Sociodemographic and Psychosocial Factors-A Cross-Sectional Study.

An important role in the course of natural childbirth is played by midwives, who should effectively work on relieving pain. This study aims to present the opinions of midwives on non-pharmacological methods of relieving labor pain; the frequency of their use and reasons for their abandonment; and the relationship between the use of non-pharmacological methods of relieving labor pain and perceived job satisfaction, burnout, and self-efficacy of the midwife. The study was conducted online, with the participation of 135 Polish midwives working in the delivery room. The author's survey questionnaire, the Generalized Self-Efficacy Scale (GSES), the LBQ Burnout Questionnaire, and the Scale of Job Satisfaction were used. Among the surveyed midwives, 77% use vertical positions in work with a patient giving birth. Almost all respondents consider vertical positions as an example of a non-pharmacological method of relieving labor pain; those with master's degree felt more prepared for their use (p = 0.02). The most common reason for abandoning their use was disagreement on the part of co-workers (p = 0.005). An association was observed between the use of vertical positions and the level of burnout (p = 0.001) and a significant correlation between preparation for their use and self-efficacy assessment, burnout, and job satisfaction. Our research shows that it would be important to conduct additional training on the use of non-pharmacological methods to relieve labor pain and to present their benefits. In contrast to other research results, our results showed that midwives feel well prepared to use these methods; however, similar to other research, we found that they often feel disagreement from colleagues and a lack of support from their leaders. The use of vertical positions is related to burnout.

CHARACTERISTICS OF THE PSYCHO-EMOTIONAL STATE OF PARENTS OF CHILDREN WITH PARALYTIC SYNDROMES AND ITS CHANGES DURING REHABILITATION MEASURES

Abstract. The current strategy for the treatment of chronic pain in children with paralytic syndromes and neurological lesions, defined by the WHO recommendations in 2012. These recommendations provide a multimodal approach of analgesia for the chronic pain treatment, including the widespread use of non-pharmacological methods and pharmacological therapy. Aim. Assessing the subjective vision of parents of children with paralytic syndromes regarding the impact of physical rehabilitation on chronic pain and their psycho-emotional state. Materials and methods. Data from 64 children and their mothers (64 persons) were included in the study. The age of the children ranged from 1 to 6 years, the median age was 3 years and 3 months. Results. The changed psycho-emotional state of parents of children with paralytic syndromes is determined. If the child has chronic pain, the parents: "Concern about the treatment of the child" is doubled (RR=2.1; p=0.0024), "Hyperopia of the child" - twice (RR=1.9; p=0.0094), "Intolerance to observe the suffering of the child" - one and a half times (RR=1.6; p=0.0017), and increases one and a half times "Sadness and anger when a child cries" (RR=1.5; p=0.0122), "Internal tension" (RR=1.5; p=0.0029), "Insomnia" (RR=1.5; p=0.0215), "Inability of the child to lead a normal image life "(RR=1.5; p=0.0035), "Search for compassion or understanding" (RR=1.5; p=0.0446), "Inner anxiety, feeling of possible trouble" (RR=1.5; p=0.0074). After receiving rehabilitation measures, the psycho-emotional state of the parents of children with paralytic syndromes was determined to decrease: "It is intolerable to observe the child's condition" decreased by 31.3% (p=0.0012); "Feelings of inner anxiety" decreased by 24.5% (p=0.0125); "I fall asleep badly due to the child's condition" decreased by 20.6% (p=0.0109); "Internal tension" decreased by 19.6% (p=0.0269); "Sleepless nights due to the condition of the child" decreased by 18.6% (p=0.0401). Conclusion.The authors consider that physical rehabilitation in children with paralytic syndromes reduces the incidence of moderate chronic pain and improves the emotional state of parents. So, we think that new approaches to rehabilitation should be applied with daily management of the children with paralytic syndromes’ needs and their families with increased psychological and social support. Perhaps the searching for new approaches that optimize more intensive and effective rehabilitation strategies using the family reserve will provide the potential for adaptability of nerve plasticity and recovery in such a contingent of children and prospects for the future.

EVIDENCES ON EFFECTIVENESS OF NON-PHARMACOLOGICAL MANAGEMENT OF PROCEDURAL PAIN AMONG CHILDREN.

Background -Evidence as “the integration of best research evidence with clinical expertise and patient values”. Evidence Based practice in nursing is a process of locating, appraising, and applying the best evidence from the nursing and medical literature to improve the quality of clinical nursing practice. Research ndings, knowledge from basic science, clinical knowledge, and expert opinion are all considered "evidence"; however, practices based on research ndings are more likely to result in the desired patient outcomes across various settings and geographic locations. Method (Searching strategies ) -Online articles and databases like PubMed ,CINHAL ,Medline ,Cochrane , Google Scholar Area of search -Evidences on Effectiveness of Non –pharmacological management of procedural pain among children .Various non –pharmacological Methods of pain management like non-nutritive sucking ,music ,swaddling ,positioning ,olfactory ,multi-sensorial stimulation ,maternal touch ,acupuncture, skin-to-skin contact”, “sucrose”, “massage “and “breastfeeding during nursing procedures like venepuncture ,immunization and other therapeutic procedure on children . Evidence hierarchy: levels of evidence on this area will be Systematic Review, Single RCT ,Single Non-Randomized Trial (quasi –experimental) ,Single prospective /cohort study ,Single case –control study ,Single cross –sectional study ,Single indepth Qualitative study , Expert opinion, case reports, etc. There are various research st Result – udies that shows that pain among children of various age group during procedure can be reduced or managed effectively by use of non-pharmacological methods only. After getting various level of evidence on non –pharmacological management of procedur Conclusion – al pain among children nurses in various setting of children care like NICU, PICU and paediatric ward can use the evidences and technique in providing effective care.