Ph.D. Defence by Marianne W. Nørgaard

Marianne W. Nørgaard will defend her Ph.D. thesis on: "Visualization, a Strategy for Patients to Manage Pain"

Time

26.04.2018 kl. 14.00 - 26.04.2018 kl. 17.00

Description

See the invitation here

Abstract

The overall purpose of this thesis was to examine the effectiveness, meaningfulness and the feasibility of an intervention, visualization used as an adjunct to usual analgesics to manage pain and anxiety during RF ablation of atrial fibrillation and other minimally invasive proce-dures. Patients undergoing ablation of atrial fibrillation often experience significant discomfort and pain, despite pharmacological during the procedure. Visualization has been successfully used during other invasive procedures to manage pain and anxiety. By using non-pharmacological intervention in combination with conventional analgesics, potential side ef-fects and overdose of strong pain medication could be avoided, thus increasing patient safety and well-being. Study 1, a quasi-experimental study showed that use of visualization together with the usual pain medication reduced the amount of pain medication (Fentanyl) statistically significant in the intervention group compared with the control group. During the procedure, patients expressed spontaneous pain significantly fewer times in the intervention group. How-ever, there was no difference in the experience of pain intensity between the two groups and no difference was observed in measurements of anxiety, procedure length and the number of adverse events in the two groups. From study 2, a qualitative interview study two main themes were identified: "Stimulating Patients Own Resources" and "Being Satisfied without Complete Analgesia." Visualization was reported as a positive experience without serious side effects. Patients achieved some pain relief by visualization and were supported in their own individual strategies for the management and control of pain and anxiety. Results from study 3 and 4 a protocol and a systematic review with ten studies included showed that visualization was ef-fective in reducing the consumption of pain medication used during minimally invasive proce-dures despite the poor effect on pain intensity and anxiety. The studies included were difficult to compare with regard to measurements and reporting results, which excluded a meta-analysis on several "outcomes". From study 5, a mixed methods study three themes were identified: "Zero pain is not always the goal"; "Not a real procedure reduction, but a sense of time shrink-age" and "Importance of nurses' presence, visualization or not." Patients' own resources to cope with the pain were supported, but the pain intensity did not seem to be affected. The patients experienced the pain, but did not need to "go into the pain". It should therefore be questioned whether the effect of an intervention such as visualization should be measured in terms of pain intensity with a numerical rating scale. Although the patients did not experience severe anxiety during the procedure, they expressed that the close proximity of the staff was of major importance to the fact that they felt safe during the procedure. Despite a long treatment time, patients using visualization felt that they had experienced a short treatment time. From this thesis, visualization was found to be effective and meaningful for patients in pain management during ablation of atrial fibrillation. Furthermore, visualization appeared to be a feasible intervention that could be used in daily clinical practice without additional resources being required.

Address

Rigshospitalet, Auditorium 2, Blegdamsvej 9, 2100 Copenhagen

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