Effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography: a randomized controlled trial

Bal, Sümeyye; Kulakaç, Özen

doi:10.1590/1806-9282.20230798

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (12) • 2023 • https://doi.org/10.1590/1806-9282.20230798 copy

Effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography: a randomized controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aims to examine the effect of comfort theory-based nursing care on pain and comfort in women undergoing hysterosalpingography.

METHODS:

This randomized control trial was conducted on 126 women (42 in each intervention and control group). Virtual reality glasses group (n=42), mobile-assisted education group (n=42), and control group (n=42). The control group received only routine care. Comfort levels were evaluated at the beginning and end of the study using the General Comfort Scale and pain levels evaluated at the beginning and end of the study using the Visual Analog Scale.

RESULTS:

The comfort theory-based nursing care (virtual reality glasses and mobile-assisted education group) was effective in increasing women's comfort with painful invasive procedures such as hysterosalpingography and reducing pain.

CONCLUSION:

It is recommended that a nurse be present in the hysterosalpingography process, providing nursing care services continuously and introducing this program to working nurses.

Clinical Trial Registration Number: NCT04676932.

KEYWORDS:
Comfort; Hysterosalpingography; Nursing care; Pain; Virtual reality

Comfort	Levels
Dimensions	Relief	Ease	Transcendence
Physical	– Women stating that the pain that may occur in the perineum area and abdomen due to hysterosalpingography is low on the Visual Analogue Scale – Vital signs being within the normal range – Ensuring effective breathing – Fasting before the procedure – Ensuring elimination before the procedure – Placing the patient in a comfortable position during the procedure – Coping with post-procedure risks (bleeding, nausea, vomiting risk, infection risk, tissue integrity deterioration, etc.) – Ensuring adequate rest	– Less pain due to hysterosalpingography, ensuring that the patient can stay calm and peaceful during the procedure – Providing counseling to the mobile-assisted education group on hysterosalpingography – Allowing the virtual reality glasses group to experience less pain by diverting attention	–Increasing comfort level with nursing care based on comfort theory
Psychospiritual	– Ensuring that women can easily express their pain and fear, – Supporting participation in decisions – Informing patients – Helping women to prepare for the procedure – Showing women proper places to put their clothes – Helping women sit in the proper place where the procedure will be performed – Supporting the woman to sit down – Respecting patient decisions before and during the procedure – Treating the patients diligently before and during the procedure – Allowing patients to worship in accordance with their beliefs during the procedure – Supporting the sense of achievement after the procedure	– Providing counseling on the results of treatment for the mobile-assisted education group and providing relief during the hysterosalpingography procedure	– Increasing comfort level with nursing care based on comfort theory
Environmental	– Ensuring that the ambient temperature does not fall below 20 degrees and does not rise above 27 degrees – Ensuring that noise in the environment is kept to a minimum – Ensuring privacy – Showing nature videos to patients	– Delivery of the training booklet for the mobile-assisted education group and ensuring relief during the hysterosalpingography procedure – Ensuring virtual reality glasses group to watch nature videos and to provide relaxation by diverting their attention from the procedure	– Increasing comfort level with nursing care based on comfort theory
Sociocultural	– Informing patients – Ensuring effective communication	– Delivery of the training booklet for the mobile-assisted education group and ensuring relaxation during the procedure – Providing the necessary information to the virtual reality glasses group before and during the procedure	– Increasing comfort level with nursing care based on comfort theory

Characteristics		Virtual reality glasses (n=42)		Mobile-assisted education (n=40)		Control (n=40)		Statistical analysis
Characteristics		Number	%	Number	%	Number	%	Statistical analysis
Age
	$\bar{x}$ ±SD (min–max)	27.4±3.14 (22–36)		27.8±4.59 (19–37)		28.33±4.55 (21–40)		H=0.618 p=0.734
Duration of marriage
	1–2 years	27	64.3	30	75.0	27	67.5	x²=1.554 p=0.817
	3–4 years	8	19.0	6	15.0	6	15.0
	4 years and above	7	16.7	4	10.0	7	17.5
Education level
	Secondary school	13	30.9	14	35.0	12	30.0	x²=9.983 p=0.266
	High school	7	16.7	8	10.0	10	25.0
	University and above	22	52.4	18	45.0	18	45.0
Employment in an income-generating job
	Working	23	54.7	18	45.0	22	55.0	x²=1.051 p=0.591
	Non-working	19	45.2	22	55.0	18	45.0	x²=1.051 p=0.591
Receiving hysterosalpingography information
	Yes	32	76.2	22	55.0	29	72.5	x²=4.776 p=0.092
	No	10	23.8	18	45.0	11	27.5	x²=4.776 p=0.092
Body mass index
	Normal	27	64.3	18	45.0	20	50.00	x²=4.381 p=0.357
	Overweight	10	23.8	11	27.5	12	30.0
	Obese	5	11.9	11	27.5	8	20.0
Menarche age
	$\bar{x}$ ±SD (min–max)	13.07±1.26 (11–16)		13.38±1.46 (11–16)		13.17±1.41 (11–16)		H=0.7995 p=0.670
Menstruation pattern
	Regular	39	92.8	33	82.5	34	85.0	x²=2.114 p=0.288
	Irregular	3	7.2	7	17.5	6	15.0	x²=2.114 p=0.288
Dysmenorrhea
	Yes	22	52.4	24	60.0	25	62.5	x²=0.942 p=0.624
	No	20	47.6	16	40.0	15	37.5	x²=0.942 p=0.624
Frequency of menstruation
	$\bar{x}$ ±SD (min–max)	28.3±3.43 (24–45)		27.6±3.6 (22–40)		28.4±4.55 (21–40)		H=1.3615 p=0.506
Duration of menstruation
	$\bar{x}$ ±SD (min–max)	5.79±0.92 (4–9)		5.62±1.46 (3–9)		5.66±0.99 (4–7)		H=0.5603 p=0.755

Glasgow Coma Scale		Virtual reality glasses (n=42)	Mobile-assisted education (n=40)	Control (n=40)	Test statistic
Glasgow Coma Scale		$\bar{x}$ ±SD (min–max)	$\bar{x}$ ±SD (min–max)	$\bar{x}$ ±SD (min–max)	Test statistic
Pre-test		2.55±0.50 (1.5–3.63)^b	2.99±0.42 (1.73–3.65)ᵃ	2.65±0.47 (1.25–3.63)^b	H=22.82 p=0.000
Post-test		3.10±0.57 (1.54–3.75)^b	3.16±0.42 (1.79–3.75)ᵃ	2.44±0.69 (1.25–3.5)^c	H=26.80 p=0.000
Intra-group statistical analysis
	S / p	–304 / 0.000	–252 / 0.000	146 / 0.057
Pain levels (Visual Analog Scale)		$\bar{x}$ ±SD (min–max)	$\bar{x}$ ±SD (min–max)	$\bar{x}$ ±SD (min–max)	Test statistic
During hysterosalpingography		8.24±1.65 (5–10)	7.76±2.10 (4–10)	8.50±1.81 (4–10)	H=2.85 p=0.240
15 min after the procedure		3.00±2.22 (0–8)^b	2.76±2.50 (0–10)^c	5.14±2.70 (2–10)ᵃ	H=21.15 p=0.000
Intra-group statistical analysis
	S / p	430.5 / 0.000	410 / 0.000	410 / 0.000

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[1] *Corresponding author: sumeyyebal@gmail.com