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A randomised clinical trial in a single centre. This study was performed to compare the effect of white noise, facilitated tucking, and their concerted application during heel-stick sampling on pain in term babies.
The study was conducted on 90 babies. Using stratification and blocking method, 30 babies were included in the white noise group (1st Group), 30 in facilitated tucking group (2nd Group), and 30 in white noise + facilitated tucking group (3rd Group). Pain scores of the babies in all groups before, during, and after the procedure were evaluated by two nurses independent from each other using Neonatal Infant Pain Scale (NIPS).
Aims and objectives: This study was performed to compare the effect of white noise, facilitated tucking, and their concerted application during heel-stick sampling on pain in term babies.
Design: A randomised clinical trial in a single centre. Methods: The study sample size was determined by the free-software G* Power. Based on the power analysis performed prior to the study in order to determine the number of babies to be included in the sample group (with β=0.14087 and α=0.05 risk, Power=0.85913), according to the study by Karakoc and Turker (2014), it was found that 27 neonates should be included in each group. The study was conducted on 90 babies, between July 1, 2017 - August 9, 2017. Using stratification and blocking method, 30 babies were included in the white noise group (1st Group), 30 in facilitated tucking group (2nd Group), and 30 in white noise + facilitated tucking group (3rd Group). Pain scores of the babies in all groups before, during, and after the procedure were evaluated by two nurses independent from each other using Neonatal Infant Pain Scale (NIPS).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| White Noise | Experimental | The "white noise" used in our study is a fragment called "Bebeğiniz ağlamasın-2" from "Kolik" album of Buzuki Orhan Osman, which was used in similar studies (Balci, 2006; Karakoc & Turker, 2014; Kucukoglu et al., 2016).Since the white noise is a continuously monotonous sound, which is in the form of a hum, it resembles the sounds in mother's womb (Balci, 2006). |
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| Facilitated Tucking | Experimental | Facilitated tucking is the procedure of holding the baby's arms and legs in a flexed position close to the midline of the torso, and the baby is able to move his/her extremities during this procedure (Caglayan, 2011). |
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| White Noise+Facilitated Tucking | Experimental | Both applications performed together. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| White Noise | Other | The white noise was initiated 50 cm away from the baby, with the decibel meter set to an average of 55 decibels. The baby was exposed to white noise for 2 minutes before the procedure. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain severity (scores) | Pain was evaluated separately by NIPS by two individuals, one investigator and one nursing nurse. The scores given by the investigator and the nurse were used to determine pain scores before, during and after heel blood collection. Pain severity was expressed as mean score NIPS.Neonatal Infant Pain Scale (NIPS) was used in the evaluation of the pain of the neonates. This scale was developed by Lawrence et al. (1993). The validity and reliability of the Turkish version of the test were assessed by Akdovan (1999). There are six variables in the scale. These are baby's breathing pattern, wakefulness, crying, facial movements and arm and leg movements. These variables are scored between 0-1. Only crying is scored between 0-2. The total score is between 0-7. The resulting score is directly proportional to the severity of the pain. That is, as the score increases, the severity of the pain increases (Akdovan, 1999). The study was completed with 90 infants. | 2 MONTHS |
| Measure | Description | Time Frame |
|---|---|---|
| Crying time | The researcher recorded the crying time in second (sec) during and after heel blood collection. The study was completed with 90 infants. | 2 MONTHS |
| Measure | Description | Time Frame |
|---|---|---|
| Physiological Changes: Heart rate | The pulse oximetry probe was attached to a non-heeled foot to measure heart in second (sec) before, during and after heel blood collection in each infant. The study was completed with 90 infants. | 2 MONTHS |
| Physiological Changes: Oxygen saturation |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Çankırı Karatekin Üniversitesi | Çankiri | 18200 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24559599 | Background | Karakoc A, Turker F. Effects of white noise and holding on pain perception in newborns. Pain Manag Nurs. 2014 Dec;15(4):864-70. doi: 10.1016/j.pmn.2014.01.002. Epub 2014 Feb 20. | |
| 27751753 | Background | Kucukoglu S, Aytekin A, Celebioglu A, Celebi A, Caner I, Maden R. Effect of White Noise in Relieving Vaccination Pain in Premature Infants. Pain Manag Nurs. 2016 Dec;17(6):392-400. doi: 10.1016/j.pmn.2016.08.006. Epub 2016 Oct 15. |
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| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D060867 | Facilitated Tucking |
| ID | Term |
|---|---|
| D007224 | Infant Care |
| D002654 | Child Care |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
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White Noise Group:
The white noise was initiated 50 cm away from the baby, with the decibel meter set to an average of 55 decibels. The baby was exposed to white noise for 2 minutes before the procedure.
Facilitated Tucking Group:
The baby's arms and legs were held in flexed positions close to the midline of the torso in side-lying position, so the baby was able to move his/her extremities. The baby was held in facilitated tucking position for one minute before the procedure.
White Noise+Facilitated Tucking Group:
The baby was exposed to white noise for 1 minute before the procedure. The white noise was initiated 50 cm away from the baby, with the decibel meter set to an average of 55 decibels. At the second minute, when the white noise still continued to play, facilitated tucking was performed at the same time and the baby continued to listen to the white noise for 1 minute while in facilitated tucking position.
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Pain scores of the babies before, during and after the procedure were evaluated independently by the researcher and the nurse other than the one who performed heel-stick sampling. Cohen's Kappa test was performed in the evaluation of the NIPS pain scores to test the concordance of the scores given to the same situation by 1 nurse and 1 researcher and it was found that the concordance of the scores given by 2 nurses was perfectly concordant (almost completely concordant) (Kappa Coefficient=0.953, p=0.027).
| Facilitated Tucking | Other | The baby's arms and legs were held in flexed positions close to the midline of the torso in sidelying position, so the baby was able to move his/her extremities. The baby was held in facilitated tucking position for one minute before the procedure. |
|
| White Noise+Facilitated Tucking | Other | The baby was exposed to white noise for 1 minute before the procedure. The white noise was initiated 50 cm away from the baby, with the decibel meter set to an average of 55 decibels. At the second minute, when the white noise still continued to play, facilitated tucking was performed at the same time and the baby continued to listen to the white noise for 1 minute while in facilitated tucking position. |
|
The pulse oximetry probe was attached to a non-heeled foot to measure oxygen saturation in percent (%) before, during and after heel blood collection in each infant. The study was completed with 90 infants. |
| 2 MONTHS |
| Physiological Changes: Respiration | The researcher recorded the respiration in minute (min) before and after heel blood collection. The study was completed with 90 infants. | 2 MONTHS |
| Background | Caglayan, N. (2011). The effect on pain of manipulating the preterm neonate into the facilitated tucking during drawing of blood from the heel. Turkey: Unpublished Master Thesis. Istanbul University Health Sciences Institute, Istanbul. Retrived from https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp |
| Background | Balci, S. (2006). Effect of white noise in colicky baby. Turkey: Unpublished Master's Thesis, Marmara University Institute of Health Sciences, Istanbul. Retrived from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp |
| Background | Akdovan, T. (1999). Assessment of pain in healthy newborns, investigation of the effect of the sucking and holding method. Turkey: Unpublisched Master's Dissertation. Marmara University Institute of Health Sciences, Istanbul. Retrived from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp |
| 8413140 | Background | Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993 Sep;12(6):59-66. |