The present study aimed to examine the pain behavior of patients on mechanical ventilation during nursing interventions. A total of 150 patients from the various ICU at governmental hospital who were receiving mechanical ventilation were recruited to the study. The current study founded that, (76%) of patients were male belonged age group between (53–69) years (35.3%). Most of the patients (35.3%) were recruited from the medical ICU and majority (88%) of patients were endotracheal tube, while (12%) of them with tracheostomy tube intubation.
The present study was congruent with a study from Asia countries [14, 15, 16) reported that most of patients were male and with intubated during evaluation. Also study from Jordan [17] demonstrates 85.4% of patient with an endotracheal tube intubation during duration of study.
The current study recorded that 35.3% of patients who were admitted on medical emergency had neurological disorders. Most (62.0%) of them had post medical history, although (92.7%) did not have post-surgical history. The result was in accepted with studies from France, Quebec and Brazilian [18, 19, 20] more than half of participants had a medical emergency when they were admitted to the intensive care unit. Moreover, studies from France and other Asia countries [18, 15, 17] mentions most of patient past medical history. And study from Egypt [21] founded that more than one third of patient admission with neurological disorder. Nevertheless, In contrast with previous studies from Saudi Arabia and America [14, 22] documents most patients had respiratory disorders when they were diagnosed pneumonia or respiratory failure as their official diagnosis. Regarding Ramsay Sedation Scale, most patients with a mean (SD) score of 4.27(1.03). Our result agreed with findings reported by [14, 22, 23] a mean score of patients was 4.43 on the Ramsay Sedation Scale.
In the current study, bed bathing, tracheal suction, oropharyngeal suction, NGT insertion, oral care, repositioning perineum care, and IV catheterization all significantly increased patients' BPS. According to the results, mouthwash and changing body position were more painful than suctioning secretions using an endotracheal tube. The current results, approved with studies from Australia and other Asia countries [24, 14, 15] demonstrate that mean pain score levels during nursing interventions were higher than mean pain score levels at rest as suctioning, mouthwash and changing body position. Contrary to the finding, studies from Asia and North American countries [6, 8, 25, 26, 27] observed that pain score of patients were significantly higher during nursing interventions were tracheal suction, oropharyngeal suction, repositioning, bed bath, oral care, NGT insertion, perineum care and IV catheterization. Contrary to the findings, studies [9, 23, 28] reported a tracheal suction significantly increased pain scores compared to rest in patients who were connected to mechanical ventilation. This due to several factors, such as nasal mucosal irritation, stimulation of the gag and cough reflex, and a significant drop in saturation rate, and increase pain score during the NGT insertion procedure [6].
In the current present study, repositioning and bed bathing caused more pain than rest of patient. This result accordance several studies from different countries [17, 24, 29, 30, 8, 31] demonstrates that, repositioning and bed bathing have been identified as two of the most unpleasant ICU treatments.
According to this study, the pain level significantly increased after oral care compared to before among ICU patients attached to MV, because a number of factors, including the use of specific medications in patients on MV, the endotracheal tube's presence, the use of patches for fixation, the disruption of tissue integrity in the mouth and surrounding tissue as a result of not taking fluid and food orally, and other factors [32, 33]. Similarly, the current study's from Asia countries [9, 17] analysis shows a significant increase in the mean BPS measured during oral hygiene.
In this study, pain score increases during IV catheterization for the patients from 3.41to 4.41 (p0.05), due to many causes as inability to access the peripheral vein, placing the catheter in a moveable joint area, having the catheter dislodge, choosing the incorrect catheter, and having the intravenous needle or catheter tip penetrate the vein wall and enter the subcutaneous tissue [6, 31]. Similar studies from Europa countries [34, 35] revealed that IV catheterization significantly increased pain.
In the current study, there was no increase in pain after the eye care intervention. Similar studies that show pain didn’t increase during eye therapy and care have been published in the literature [36, 24]. However, some studies contradict [6, 37].
This result showed mean SBP, DBP, PR, and RR parameters significantly increased after tracheal suction, oropharyngeal suction, NGT insertion, oral care, and repositioning. Because, it is well recognized that pain stimulates the sympathetic nervous system, which raises BP, PR, and RR [6, 38]. Our result consents with studies from different countries [39, 40, 41] founded the levels of BP, PR, and RR had significantly changed during suction and repositioning.
Mean DBP, PR, and RR levels significantly increased during eye care. The results of this study support by previous studies in Asia and South America countries [15, 23] reported that pain raises DBP, PR, and RR levels during eye care compared to a rest, validated this finding. According to various studies published in the literature, tracheal suction significantly raised the levels of BP, PR, and RR [23, 26, 42, 43, 44].
The mean PR levels increased significantly during IV catheterization. This finding was supported by study from North Africa country [35] observe IV catheterization increased patients' mean PR levels. According to the current study, there was a substantial rise in mean PR levels during tracheal suction, oropharyngeal suction, NGT insertion, and repositioning. The mean OS level of patients during NGT implantation was significantly lower than before, according to related research in the literature [6, 21].