Helfer Skin Tap Technique For The Im Injection Pain Among Adult Patients

https://doi.org/10.33698/NRF0236-Gyan Jyoti, Smriti Arora, Bhartendra Sharma

ABSTRACT:

Background: Most of us have experienced some type of pain by intramuscular injection in our life. Pain is an unpleasant stimuli causing avoidance of drug regimens leading to non compliance. This study was conducted to compare the effect of Helfer Skin Tap Technique (HST) vs Routine Technique on the pain perception among adult patients receiving intramuscular injection (voveron). Objective: To assess the efcacy of Helfer Skin Tap Technique on reducing intramuscular injection pain among adult patients. Material and method: A Quasi-experimental study using cross over, posttest only design was conducted at surgical ward of Civil Hospital, Gurgaon, Haryana. Total 60 subjects were conveniently selected to Group I (30 subjects were rst assigned for intramuscular injection using Routine Technique followed by Helfer Skin Tap Technique) and Group II (30 subjects were rst assigned for intramuscular injection using Helfer Skin Tap Technique followed by Routine Technique). A structured interview was conducted to collect demographic data of each subject. Numerical pain rating scale was used to assess the level of pain immediately after the intervention. Results: Descriptive and inferential statistics was used. The ndings revealed that there was a signicant difference in mean pain scores of the patients while receiving intramuscular injection with Helfer Skin Tap Technique (mean ±SD=1.13 ± 0.94), compared to that with Routine Technique (mean ± SD=5.63 ± 1.20) (p<0.001). There was a signicant association of mean post-test pain scores of patients with occupation and marital status (p≤0.01) but not with gender and educational background and occupation. Conclusion: Use of Helfer Skin Tap Technique is highly effective in reducing pain perception during intramuscular injection. Key Messages: Practicing Helfer Skin Tap Technique routinely by nurses can contribute to improve patient’s comfort level by reducing the interventional pain.

Key-words: Helfer Skin Tap Technique, Intramuscular injection; Pain; Routine Technique.

Address for correspondence

Dr. Smriti Arora,

Professor, Amity College of Nursing, Amity University, Gurgaon, Haryana, smritiamit@msn.com, 9810840372

Introduction:

Every human being in the world has experienced some type of pain. A person in pain feels distress or suffering and seeks relief. The presence of pain is one of the main reasons why individuals get health care. Pain has been dened as the fth vital sign. Pain may be an extremely unpleasant and a really personal sensation will not| be shared with others; it can occupy an individual’s thinking, direct all activities and alter an individual life, yet pain may be a scary concept for a patient to communicate; a medical staff neither sees nor feels patients pain

.1Dening pain as sharp or dull, constant or intermittent, burning or aching may give the best clues to the cause of pain. These descriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a for managing pain and relieving suffering. The nurse can minimize the discomfort and pain during intramuscular injection by helping the client assume a position that will help to reduce the muscle strain.

.2 The International nurses need to be knowledgeable about Association for the study of Pain dened pain as “an unpleasant, subjective, sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

”3 There are 16 billion intramuscular  i n j ections administered annually throughout the world (WHO, 2011). In developing countries  alone, sixteen t h o u s a n d m i l l i o n i n j e c t i o n s a r e administered annually. Over 90%, are administered for therapeutic aims whereas 5 to 10% are administered for disease prevention, the foremost important side- effect associated with injections is pain.

4 Comfort is a concept central to the art of nursing and it is an important need and ensuring a patient’s comfort is a major nursing responsibility. A variety of nursing theorist refers to comfort as a basic client need for which nursing care is delivered. Nurses are ethically and legally responsible assessment of pain, current evidence based practices regarding pain. As well as, some researcher reported that nurses’ techniques in giving intramuscular injections were traditional rather than evidence based

5 Despite an abundance of research evidence and improvements  in  drug e f f e c t i v e n e s s a n d d r u g d e l i v e r y technologies are available, pain continues to be problem for the patients availing health care services. In the administration of intramuscular injections, the choice of an injection site and injection techniques are also said to be the most important factors in the pain reduction.

6 To prevent pain after injection, patient with pain.

7It is a challenge to the nurse to administer painless injection for patients scared of needles and injection. Different methods are used by the nurses to reduce pain during intramuscular injections such as taping the skin, Z- track, applying pressure, applying heat and cold. Among different physical interventions the most effective are tapping the skin. Tapping over the skin is one of the various techniques to keep the muscles relaxed. It is an accepted fact that there is reduced pain while giving injection into a relaxed muscle. Helfer skin tap technique offers a painless injection. It is a simple intervention which can bring about a great deal of change in the level of pain associated with intramuscular injection. It is an innovative idea to perform painless injection.

8 It is an accepted fact that this offers a painless injection experience as it provides a mechanical stimulation and distraction during intramuscular injection and thus helps to reduce pain as described in gate control theory by Ronald Melzack and Patrick Wall in 1965.

9-Helfer Joanne conducted a study on painless injection t echnique; the investigator tapped the gluteus maximus muscle before inserting the needle and while removing the needle. This study concluded that by following Helfer Skin Tap Technique, patient experienced less pain while receiving intramuscular injection. Helfer reported that the perception of pain intensity is lessen when Intramuscular injection is administered using Helfer technique.

10 – John Swati conducted a post-test only control group study to assess Helfer tap technique on adults with Rheumatic Heart Disease receiving Inj. Benjathine Penicilline 1.2 MU Intramuscular. It was found to be effective in reducing the pain (p< 0.05) as compared with the routine treatment.

11-Hassnein and Solimon conducted a study on efcacy of HST on pain intensity as perceived by the patients receiving IM injection. Each patient was administered repeated IM injections at the gluteal site. Then pain level was compared with traditional technique and Helfer Skin Tapping Technique with universal pain assessment tool. The results showed that the pain perception of patients in terms of pain level of traditional technique was found to be signicantly higher than pain level of Helfer skin tapping Technique.

12 Hence, the researcher intended to assess the efcacy of Helfer Skin Tap Technique on reducing intramuscular injection pain among adult patients.

Objective:

To assess the effect of Helfer skin tap technique Vs Routine technique on the pain perception among adult patients while receiving Inj. Voveron, intramuscular injection.

Materials and Methods:

The setting selected for the study was surgical ward of Civil Hospital, Gurgaon, Haryana from November 2017 to December 2017. To accomplish the objectives of the study, quasi experimental, cross over posttest only design was used. Formal administrative written permission was taken from PMO (Principle Medical Ofcer) of Civil Hospital, Gurgaon.

The patients admitted in surgical ward, who were of either gender, age ranging from 20-60 years, receiving injection Voveron intramuscular, were included as the population for the study. Immediate post- operative patients, critically ill, unconscious and sedated adult patient with sensory perceptual alteration were excluded from the study. Sixty participants were selected using convenient sampling technique, 30 in Group I and 30 in Group II.

The hypothesis postulated for the study was “There will be a signicant difference in the mean pain scores among adult patients receiving Helfer skin tap technique and Routine technique during administration of Injection Voveron intramuscular as assessed by Numeric Rating Scale at 0.05 level of signicance.

After obtaining informed consent from each patient, they were conveniently selected to Group I and Group II and were explained the purposes of the study. Prior to the intervention, subjects were interviewed to obtain socio demographic and clinical data, assessed with interview schedule which consisted of 10 questions. Crossover design was adopted for the study. The subjects in the Group I received Inj. Voveron intramuscular with Routine Technique (RT) initially and subjects in group II received injection Voveron intramuscular with Helfer Skin Tap Technique (HST) and interventions were crossed over after 24 hours in shown in Fig

  1. Both the interventions were executed by the researcher.

Helfer Skin Tap Technique is a technique in which the researcher taps the Dorso gluteal muscle by counting 1-15 with the palmar aspect of ngers (non-dominant hand) in rhythmic manner before inserting the injection intra muscularly at 90 degree and remove the needle quickly again by tapping and counting 1-3. Routine Technique involved inserting the injection intra muscularly at 90 degree angle into Dorso gluteal muscles without tapping after cleaning with alcohol swab. Immediately after the intervention, patient’s pain perception was assessed with the help of standardized numerical pain rating scale within 1 minute of administering the intramuscular injection.

The collected data were organized and analyzed according to the objectives of the study using SPSS and level of signicance (p) was kept at 0.05 level of signicance. Appropriate descriptive statistics (mean, standard deviation and percentage) and inferential statistics (independent t test, chi square test, Fisher exact test, one way ANOVA) were used.

Results: As shown in table 1 Out of the 60 adult patients included in the study, 30 were in Group I and 30 were in Group II. The mean age of patients in group I was 29.83 and that in group II was 31.53 . Half of the participants (50%) in group I and 40% in group II were in age group of 20- 29 years. In group I 60% of the patients were male, 66.7% were Hindus, 40% were educated upto senior secondary, 30 % were businessman and 83.3% were married. In Group II, 56.7% were male, 56.7% were Hindus, 33.3% were educated upto primary level , 20% were labourers and 70% were married. In both the groups, 76.7% of adults were afraid of IM injection. There was no signicant difference between the group  injection, frequency of injection Voveron. Thus the groups were homogenous. with respect to variables like age, gender, religion, educational background, occupation, marital status, fear of IM injection, previous complication of IM

Table 2 shows that among 60 adults patients who received intramuscular injection using

Table 2: Level of pain among patients receiving IM injection using Routine Technique (RT) and Helfer Skin Tap Technique (HST)

N=60

LEVEL OF PAIN RT

n=30 f (%)

 HST

n=30 f (%)
No Pain – 17 (28.3)
Mild 1(1.6) 43 (71.7)
Moderate 40 (66.7) –
Severe 19 (31. 7) –

 

Routine Technique, 40 (66. 7%) had moderate pain, 19 (31.7%) had severe pain and 1 (1.6%) had mild pain. Among the patients who received intramuscular injection using Helfer Skin Tap Technique, 43 (71.7%) had mild pain and 17 (28.3%) experienced no pain.

Table 3 depicts that in group I, the post-test mean and SD of Routine Technique and Helfer Skin Tap Technique are 6.16± 1.14; 1.30 ± 0.91 whereas in study group II, and post-test mean & SD of Helfer Skin Tap Technique and Routine Technique are (0.97 ± 0.96; 5.10 ± 1.02) which projects ‘t’ value of 18.16 & 16.05 which is statistically signicant at p≤0.001 level. The computed ‘t’ value shows that there is a highly signicant decrease in the level of pain perception after the application of Helfer Skin Tap  Technique in both the groups.    ( p= 0 . 001 ) . Thus, Helfer Skin Tap Technique was more effective than Routine Technique in reducing pain related to intramuscular injection. 

Table 4 depicts that the posttest mean and SD of patients receiving Routine Technique is 5.63 ± 1.20 and that of Helfer Skin Tap Technique are 1.13 ± 0.94 which projects ‘t’ value of 22.70 which is statistically signicant at p≤0.001 level. The computed ‘t’ value shows that Helfer Skin Tap Technique is more effective in reduction of pain score during intramuscular injection as there is a signicant difference found between pain score of patients during intramuscular injection with Routine Technique and Helfer Skin Tap Technique where, p value is 0.001.

Table 5 depicts that there is a signicant association found between occupation, marital status and pain score while receiving intramuscular injection with Routine Technique assessed by One way

ANOVA (p < 0.01). Adult patients who were not working and who were single felt more pain while receiving intramuscular injection with Routine Technique. Data also inferred that there is no association between selected socio demographic variables like age, gender, educational background. No signicant difference in frequency of injection Voveron and pain perception score during intramuscular injection with Routine Technique (one way ANOVA p value >0.05).

Table 6 depicts that there is a signicant association found between age, occupation, (66.7%) had perceived moderate pain with routine technique and most of the patients (71.7%) perceived only mild pain with Helfer Skin Tap Technique.

The ndings are supported by a similar marital status and pain score while study done by   T Dhanalakshmi [13]. She receiving IM injection with Helfer Skin Tap Technique assessed by One way ANOVA (p value of 0.01). Signicantly higher percentage of adult patients in age group of 20-29 years of age, not working and single felt less pain during IM injection with Helfer Skin Tap Technique as compared to their counterparts. Data also inferred that there is no association between the variables l ike gender, educational background and frequency of injection Vo v e r o n w i t h p a i n s c o r e d u r i n g intramuscular injection with Helfer Skin Tap Technique (independent t test and one way ANOVA p value >0.05).

Discussion:

Pain is the most unpleasant experience for human beings. Fear of IM injection pain leads to noncompliance of many treatment modalities, thus as healthcare worker it is our responsibility to nd ways to minimize pain and provide maximum comfort during any therapeutic or diagnostic procedure. The present study was conducted to assess the effect of HST on IM injection pain related to Injection Voveron among adult patients.

The level of pain during IM injection using Helfer skin tap technique and routine technique among adult patients was measured by Numerical Rating Scale. Findings demonstrated that there was signicant decrease in pain level by using Helfer technique than Routine technique. Among 60 patients, majority of the patients reported that majority of sample in both the experimental groups I and II (86.66%) had perceived moderate pain with standard technique. In contrast, most of the sample (90%) in experimental group I and group II perceived only mild pain with Helfer skin tap technique. Maj S Sivapriya and Col Kumari Leena 14 reported that among 100 neonates in which 86% of the neonates in the experimental group had mild pain with Helfer tap technique and 86 % of the neonates in the control group had severe pain, only 14% perceived moderate pain during Intramuscular injection by using conventional routine technique using FLACC scale. Vathani G et al 15 reported that on assessing level of pain among the patients, in experimental group, majority 49(73.33%) had no pain, 16(23.88%) had mild pain whereas in the control group majority 40(59.70%) had moderate pain. Ushanandhini et al [16] also reported that in the experimental group 28(93.3%) of them had mild pain and control group 14 (46.7%) of them had moderate and severe pain. Jose et al [17] conducted a study on effectiveness of skin tap technique in reducing pain response during DPT injection among 60 children during intramuscular injection. The study revealed that the pain response was less in experimental group. Majority (80%) of the infants in experimental group had mild pain whereas only (17%) of the infants in control group experienced mild pain.

In the current study, there is a signicant decrease in the level of pain perception after the application of Helfer Skin Tap Technique in both the groups. (p=0.001). In group I, the mean & SD of Routine Technique & Helfer Skin Tap Technique are (6.16± 1.14; 1.30 ± 0.91) whereas in study group II, and mean & SD of Helfer Skin Tap Technique & Routine Technique are (0.97 ± 0.96; 5.10 ± 1.02). The obtained ‘t’ value of 18.16 & 16.05 is statistically signicant at p<0.001 level. The mean score and SD of Routine Technique were 5.63 ± 1.20 and the mean score and SD of Helfer Skin Tap Technique were 1.13 ± 0.94 (p<0.001 as per t test).

These ndings are congruent with Serena 18 who reported that overall mean pain intensity by using Helfer skin tap technique (1.5±1.1) was much lower than the conventional technique and was signicant at p < 0.001. Study revealed that the effectiveness of Helfer Skin Tap Technique has produced a statistically signicant reduction in pain during intra muscular injection among patients. Manju19 done a study to evaluate the effectiveness of Helfer skin tap technique on pain during intramuscular injection among infants which revealed that experimental group experienced less (‘t’=11.78, p=0.000) pain in experimental group and in control group the post-test mean score 5.567 and SD 1.2780. The calculated ‘t’ value of 9.97 was statistically signicant at p<0.05 level. Therese et al22 reported that on the day 1, the obtained t value was 2.01 at p level of 0.05. On the day 2, the obtained t value was 2.33 at p level of 0.02. On the day 3 & 4, the obtained t value was 2.76 at p level of 0.01. It indicated that Helfer skin tap technique is statistically signicant than routine technique on all the 4 days. Lakhani Rita et al23 conducted a study on the effect of skin tapping technique on pain perception in 30 r espondents with RHD r eceiving intramuscular injection Penidura 12 lacs IU. The result showed that the average intensity of pain recorded in both the control and experimental groups were 3.6 and 3.47 respectively on the pain rating scale.

In the current study, there is a signicant association found between occupation (not working) & marital status (single i.e. not married) and pain score during IM injection with Routine Technique & Helfer Skin Tap Technique but no association found between selected variables l ike gender, educational background, frequency of injection than  control  group.  Austin Isac20   also  Voveron and pain perception score. This revealed that the average pain score from   study ndings are supported with the study usual  standard  technique  is  2.6  and  the       by Sivapriya14 which revealed that there mean pain score from Helfer skin tapping technique is 1.01. The nding shows that the overall mean pain intensity by using were signicant statistically differences correlations between occupation, marital status with total pain score where, (p value Helfer skin tap technique is 65.9% lower < 0.02). A study by PV Abhija24 revealed than the usual standard technique. Nivedha et al21 conducted a study on post-test pain level among adults during IM injection in experimental and control group. The post- test mean value was 2.333 with SD 0.8442 that there was a signicant association between the levels of pain associated intramuscular injection among hospitalized adults with their selected demographic variables such as occupation. Nivedha et al21 also reported that there was a signicant association between the selected demographic variables like occupation with pain score at p<0.05 level. A study by Shah S, Narayanan A1 which revealed that there was no association between pain perception scores of subjects receiving intramuscular injection with Helfer Skin Tap and selected socio  demographic  variables.  This study nding  are  consistent  with  the  study by [Cited 2017 Apr 16]. Available from: https://www.ninds.nih.gov/Disorders/. ../Hope-Through-Research/ Pain- Hope-Through Hinkle JL, Cheever KH. Brunner & Suddarth’s Text book of Medical- Surgical Nursing. New Delhi: Wolters Kluwer Pvt Ltd Publication; 2010.

World Health Organization. Injection Omima25 which revealed that there were safety: Health Topics A to Z. signicant statistically differences correlations between occupation, marital status with total pain score (p < 0.05).

Conclusion:

The ndings of study revealed that the Helfer Skin Tap Technique is more effective measure in decreasing level of pain in patients receiving injection Voveron intramuscular as compared to Routine Technique. Hence it is recommended to incorporate this technique in routine practice while administering IM Injections. Further studies can be planned on a large sample size, different age groups, in different settings and with drugs which are more painful.

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