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This study was conducted to determine the effect of breath exercise on post-operative anxiety level, pain, and nausea-vomiting after general surgery. This was a randomized, controlled experimental study. The sample comprised 149 patients who underwent laparoscopic cholecystectomy and hernia (control:73; experimental:76). One day before the operation, the participants in the experimental group were given breathing exercise training, and they were applied 5 times a day for 10 repetitions until the 30th day after the operation.
Today, surgical treatment is one of the areas where technological methods are frequently applied in the treatment of diseases and the recovery process of patients. Problems such as pain, nausea, vomiting, fear and anxiety occur after surgery, and these situations negatively affect the patient's comfort, quality of life, recovery and satisfaction; they also cause the length of hospital stay and the time allocated to nursing care to be extended and the cost to increase. Pain is a frequently seen symptom in the postoperative period. Approximately 86% of patients experience pain to varying degrees during this period. Prolonged postoperative pain paves the way for the development of various physiopathological responses such as immobility, increased oxygen consumption, atelectasis, deep vein thrombosis, tachycardia, hypertension, decreased stomach and intestinal motility, increased blood sugar, urinary retention and delayed wound healing. Anxiety plays an important role in the increase and decrease of pain after surgical intervention. Studies have determined that pain in the preoperative period increases the level of anxiety and that this situation lowers the pain threshold. Effectively managed and controlled postoperative pain; It reduces anxiety levels and facilitates keeping life parameters at an optimal level after surgical intervention.
Postoperative nausea and vomiting are seen in 20-30% of patients after general anesthesia and are the second most common complaint after pain, and this rate increases to 80% in high-risk groups. Despite antiemetic and analgesic drugs, postoperative nausea, vomiting and pain continue to be an important problem for patients today. Although postoperative nausea and vomiting is not a life-threatening complication, it is a condition that makes recovery from anesthesia difficult, causes fluid-electrolyte imbalance, increases the risk of aspiration, causes stress in patients, causes tension in the suture line and prolongs the discharge period. Many different pharmacological approaches have been developed to minimize postoperative nausea, vomiting and pain. However, the side effects of traditional antiemetics and analgesics and the high cost of drugs have increased the interest in the use of non-pharmacological methods.
Breathing exercises can be used as an effective, simple and cost-effective non-pharmacological approach to prevent or reduce the occurrence of postoperative complications. In addition, it has been shown in the literature that it also increases physical function and quality of life. However, patients have difficulty taking deep breaths due to movement restriction and pain in the postoperative period. Therefore, deep breathing exercises need to be performed regularly to support the incision site in order to ensure effective inspiration and expiration in these patients.
Oxygenation of the traumatized tissues must be sufficient for wound healing in the postoperative incisional area. This oxygen requirement is met by effective ventilation. However, after surgery, patients have difficulty in breathing deeply due to reasons such as pain and limitation of movement. Studies have shown that the practice of planned breathing exercises reduces stress in patients in the pre- and post-operative period, provides calming, and positively affects the level of pain and wound healing. In this respect, planned patient education and care to be given to patients before surgery is very effective in preventing complications related to surgical intervention.
One of the basic duties of surgical nurses is to teach and apply deep breathing and coughing exercises to the patient in pre-operative patient education. It is very important to explain the importance of these exercises to the patient and the effects of performing them at regular intervals on the quality of recovery.
However, studies have drawn attention to the fact that the rates of teaching and applying deep breathing exercises to patients are not at the desired level.
In the literature, many non-pharmacological applications such as acupressure, massage, breathing exercises, listening to music, chewing gum have been performed on patients after surgery and their effects on parameters such as pain, nausea-vomiting, anxiety, vital signs, early discharge, and early mobilization have been examined. There are studies on the relationship between breathing exercises and pain, anxiety, and nausea-vomiting after general surgery surgery, but they are limited. Therefore, the aim of this study is to determine the effect of breathing exercises on pain, anxiety, and nausea-vomiting in patients hospitalized in the general surgery clinic.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Grup 1 | Experimental | the group that performed breathing exercises |
|
| Grup 2 | No Intervention | the group that did not perform breathing exercises |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Breath Exercise | Other | It was provided by the researcher that the patients performed 5 repetitions of 10 breathing exercises every 3 hours a day, between 09:00am and 21:00pm, 1 day before the surgery, on the day of surgery and on the first day after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| The State-Trait Anxiety Inventory (STAI | The scale consists of two parts, the 'state anxiety scale', which is created with the aim of determining the instantaneous feelings, and the 20-item 'trait anxiety scale', which was created to determine the feelings in general. It is a four degree scale ranging from 'Nothing' to 'All'. Scores range from 20 (low anxiety) to 80 (high anxiety). | 1 day before surgery |
| The State Anxiety Inventory (SAI) | The scale consists of two parts, the 'state anxiety scale', which is created with the aim of determining the instantaneous feelings, and the 20-item 'trait anxiety scale', which was created to determine the feelings in general. It is a four degree scale ranging from 'Nothing' to 'All'. Scores range from 20 (low anxiety) to 80 (high anxiety). | On the day of surgery |
| The State Anxiety Inventory (SAI) | The scale consists of two parts, the 'state anxiety scale', which is created with the aim of determining the instantaneous feelings, and the 20-item 'trait anxiety scale', which was created to determine the feelings in general. It is a four degree scale ranging from 'Nothing' to 'All'. Scores range from 20 (low anxiety) to 80 (high anxiety). | 1st day after surgery |
| The State Anxiety Inventory (SAI) | The scale consists of two parts, the 'state anxiety scale', which is created with the aim of determining the instantaneous feelings, and the 20-item 'trait anxiety scale', which was created to determine the feelings in general. It is a four degree scale ranging from 'Nothing' to 'All'. Scores range from 20 (low anxiety) to 80 (high anxiety). | 15st day after surgery |
| The State Anxiety Inventory (SAI) | The scale consists of two parts, the 'state anxiety scale', which is created with the aim of determining the instantaneous feelings, and the 20-item 'trait anxiety scale', which was created to determine the feelings in general. It is a four degree scale ranging from 'Nothing' to 'All'. Scores range from 20 (low anxiety) to 80 (high anxiety). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gamze BULUT ÖZLÜ | Ataturk Unıversty | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Gamze BULUT | Erzurum | Palandöken | 25000 | Turkey (Türkiye) |
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| 30st day after surgery |
| Rhodes Nausea and Vomiting Index | The index's alpha internal consistency coefficient is 0.98, and the alpha internal consistency coefficients for the subgroups range from 0.83 to 0.99. The adaptation of the Rhodes Nausea and Vomiting Index to the Turkish population was done by Genç (2010). In Genç's (2010) adaptation, the internal consistency coefficient was found to be 0.95, with the alpha internal consistency for the subgroups ranging from 0.81 to 0.95. In scoring the "Nausea and Vomiting Index," items 1, 3, 6, and 7 are reverse scored. For each response, 4 indicates the highest level of distress, and 0 indicates the lowest level of distress. The patient's nausea and vomiting experiences for each of the 8 items are summed. The highest possible score is 32, indicating the most severe symptom occurrence. | 1 day before surgery |
| Rhodes Nausea and Vomiting Index | The index's alpha internal consistency coefficient is 0.98, and the alpha internal consistency coefficients for the subgroups range from 0.83 to 0.99. The adaptation of the Rhodes Nausea and Vomiting Index to the Turkish population was done by Genç (2010). In Genç's (2010) adaptation, the internal consistency coefficient was found to be 0.95, with the alpha internal consistency for the subgroups ranging from 0.81 to 0.95. In scoring the "Nausea and Vomiting Index," items 1, 3, 6, and 7 are reverse scored. For each response, 4 indicates the highest level of distress, and 0 indicates the lowest level of distress. The patient's nausea and vomiting experiences for each of the 8 items are summed. The highest possible score is 32, indicating the most severe symptom occurrence. | 1st day after surgery |
| Rhodes Nausea and Vomiting Index | The index's alpha internal consistency coefficient is 0.98, and the alpha internal consistency coefficients for the subgroups range from 0.83 to 0.99. The adaptation of the Rhodes Nausea and Vomiting Index to the Turkish population was done by Genç (2010). In Genç's (2010) adaptation, the internal consistency coefficient was found to be 0.95, with the alpha internal consistency for the subgroups ranging from 0.81 to 0.95. In scoring the "Nausea and Vomiting Index," items 1, 3, 6, and 7 are reverse scored. For each response, 4 indicates the highest level of distress, and 0 indicates the lowest level of distress. The patient's nausea and vomiting experiences for each of the 8 items are summed. The highest possible score is 32, indicating the most severe symptom occurrence. | 15st day after surgery |
| Rhodes Nausea and Vomiting Index | The index's alpha internal consistency coefficient is 0.98, and the alpha internal consistency coefficients for the subgroups range from 0.83 to 0.99. The adaptation of the Rhodes Nausea and Vomiting Index to the Turkish population was done by Genç (2010). In Genç's (2010) adaptation, the internal consistency coefficient was found to be 0.95, with the alpha internal consistency for the subgroups ranging from 0.81 to 0.95. In scoring the "Nausea and Vomiting Index," items 1, 3, 6, and 7 are reverse scored. For each response, 4 indicates the highest level of distress, and 0 indicates the lowest level of distress. The patient's nausea and vomiting experiences for each of the 8 items are summed. The highest possible score is 32, indicating the most severe symptom occurrence. | 30st day after surgery |
| Brief Pain Inventory | The Turkish validity and reliability study was conducted by Dicle et al. The Brief Pain Inventory, which has high validity and reliability in different patient groups, has been translated into various languages. This short, simple, and understandable inventory consists of seven items related to the severity of pain and the extent to which pain interferes with daily activities. The pain severity measurements include the worst, least, average, and current pain over the last 24 hours. Pain severity is measured using a numerical pain scale (0 = no pain, 10 = unbearable pain). The dimensions of pain expressed by the individual measure the general activity status, emotional status, relationships with others, walking ability, exercise, sleep, and enjoyment of life due to pain over the past 24 hours. The Cronbach's alpha coefficient was found to be 0.79 for pain severity and 0.80 for the impact of pain. | 1 day before surgery |
| Brief Pain Inventory | The Turkish validity and reliability study was conducted by Dicle et al. The Brief Pain Inventory, which has high validity and reliability in different patient groups, has been translated into various languages. This short, simple, and understandable inventory consists of seven items related to the severity of pain and the extent to which pain interferes with daily activities. The pain severity measurements include the worst, least, average, and current pain over the last 24 hours. Pain severity is measured using a numerical pain scale (0 = no pain, 10 = unbearable pain). The dimensions of pain expressed by the individual measure the general activity status, emotional status, relationships with others, walking ability, exercise, sleep, and enjoyment of life due to pain over the past 24 hours. The Cronbach's alpha coefficient was found to be 0.79 for pain severity and 0.80 for the impact of pain. | On the day of surgery |
| Brief Pain Inventory | The Turkish validity and reliability study was conducted by Dicle et al. The Brief Pain Inventory, which has high validity and reliability in different patient groups, has been translated into various languages. This short, simple, and understandable inventory consists of seven items related to the severity of pain and the extent to which pain interferes with daily activities. The pain severity measurements include the worst, least, average, and current pain over the last 24 hours. Pain severity is measured using a numerical pain scale (0 = no pain, 10 = unbearable pain). The dimensions of pain expressed by the individual measure the general activity status, emotional status, relationships with others, walking ability, exercise, sleep, and enjoyment of life due to pain over the past 24 hours. The Cronbach's alpha coefficient was found to be 0.79 for pain severity and 0.80 for the impact of pain. | 1st day after surgery |
| Brief Pain Inventory | The Turkish validity and reliability study was conducted by Dicle et al. The Brief Pain Inventory, which has high validity and reliability in different patient groups, has been translated into various languages. This short, simple, and understandable inventory consists of seven items related to the severity of pain and the extent to which pain interferes with daily activities. The pain severity measurements include the worst, least, average, and current pain over the last 24 hours. Pain severity is measured using a numerical pain scale (0 = no pain, 10 = unbearable pain). The dimensions of pain expressed by the individual measure the general activity status, emotional status, relationships with others, walking ability, exercise, sleep, and enjoyment of life due to pain over the past 24 hours. The Cronbach's alpha coefficient was found to be 0.79 for pain severity and 0.80 for the impact of pain. | 15st day after surgery |
| Brief Pain Inventory | The Turkish validity and reliability study was conducted by Dicle et al. The Brief Pain Inventory, which has high validity and reliability in different patient groups, has been translated into various languages. This short, simple, and understandable inventory consists of seven items related to the severity of pain and the extent to which pain interferes with daily activities. The pain severity measurements include the worst, least, average, and current pain over the last 24 hours. Pain severity is measured using a numerical pain scale (0 = no pain, 10 = unbearable pain). The dimensions of pain expressed by the individual measure the general activity status, emotional status, relationships with others, walking ability, exercise, sleep, and enjoyment of life due to pain over the past 24 hours. The Cronbach's alpha coefficient was found to be 0.79 for pain severity and 0.80 for the impact of pain. | 30st day after surgery |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D020250 | Postoperative Nausea and Vomiting |
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D009325 | Nausea |
| D012817 | Signs and Symptoms, Digestive |
| D014839 | Vomiting |
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D001945 | Breathing Exercises |
| ID | Term |
|---|---|
| D026441 | Mind-Body Therapies |
| D000529 | Complementary Therapies |
| D013812 | Therapeutics |
| D026241 | Exercise Movement Techniques |
| D026741 | Physical Therapy Modalities |
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