The Effect of Passive Music Therapy and Foot Massage on Hemodynamic Status, Anxiety and Pain Level Applied to Intensive Care Patients ın Tracheal Aspiration Process

Intensive care units are defined as all the methods used to support the patients, to treat the causes of the disease, and to ensure the survival of the patient until the negative results of the partially or completely lost system and/or organ functions are recovered (Şahinoğlu, 2003). Patients in need of intensive care, who have reached the limit of their lives due to an advanced disease, trauma, poisoning, or surgery due to an advanced disease, trauma, poisoning, or surgery, and who need the help of different supportive biomedical devices, are given continuous and high-quality care, and to provide the best outcomes. They are patients who require the health care team to make sacrifices and efforts (Şahinoğlu, 2003; Hatipoğlu, 2002; Wunsch et al., 2004; Clark and Normile, 2000).

Endotracheal tube and mechanical ventilation are life-saving applications in complicated, conscious and unconscious patients with multi-organ failure, who have lost their physiological balance (Craven et. al., 2009). Tracheotomy or the presence of an endotracheal tube in intensive care patients is the process of giving the air that the patient breathes without being filtered, heated and humidified (Ferreira, 2013). Being immobilized for a long time due to the use of sedation in intensive care patients can also cause loss of ciliary movement and cough reflex function, which are natural defense mechanisms. For these reasons, in patients with endotracheal tube, both the secretion of secretions in the respiratory tract increases and the secretions can accumulate in the respiratory tract, causing mechanical obstructions because the patients cannot discharge their secretions. In order to prevent endotracheal tube obstructions and to maintain airway patency, it is extremely important and necessary to aspirate according to the patient's needs (Guglielminotti et al, 2000; Majett, 2013). However, the frequently used, invasive, life-saving endotracheal aspiration procedure brings many undesirable conditions in intensive care patients. The patient has many symptoms such as discomfort, pain, bleeding, infection, bronchospasm, cardiovascular instability, hypoxia/hypoxemia, tracheal or bronchial mucosal damage, change in cerebral blood flow, increase in intracranial pressure, decrease in dynamic lung compliance and residual capacity, atelectasis, hypotension, hypertension. As it may result in complications, unmanaged pain can also cause anxiety as physiological, psychological and behavioral stressors (Gülsoy, 2017; Çelik et al, 2016). Endotracheal aspiration, which is found to be the most painful intervention experienced by intensive care patients in the literature, causes deterioration of comfort, frightening and unpleasant sensations, namely anxiety. It also creates a feeling of suffocation or is expressed as a loss of breathing (Day et al, 2002; Pedersen et al, 2009; Yaman Aktaş, 2013).

Pain assessment and adequate pain management are extremely important, as pain is a major stressor in intensive care patients (Rotonti et al, 2002). If an effective pain management cannot be achieved, physiological, metabolic and behavioral responses occur due to this pain and pain sensation. Increases in heart rate, respiratory rate and blood pressure occur due to catecholamine, glucagon and steroids released due to painful stimuli. However, with the continuation of the painful stimulus, myocardial oxygen consumption increases, saturation decreases, and arrhythmias are observed (Gelinas, 2010; Dikmen, 2012).

The American Society for Pain Management Nursing (ASPMN) reports that pain management of patients who experience interventional pain should be provided at an optimal level before, during and after the intervention, the level of pain and anxiety should be minimized and appropriate nursing interventions should be applied (Yaman Aktas, 2013). Pharmacological and non-pharmacological methods are applied in the management of patients' pain and comfort for invasive procedures. Pharmacological methods such as local anesthetics, non-opioid analgesics, opioid analgesics and interventional sedation and relaxation techniques, meditation, dreaming, massage, cold application, positioning, game activities and music therapy are used non-pharmacological methods (Eti Aslan et al, 2003; Cignacco et al. al, 2007). Reasons for using non-pharmacological methods in the management of pain; reducing the need for the use of analgesics and increasing the comfort of life by reducing/eliminating the pain of the patient. In addition, nonpharmacological methods; it increases the sense of autonomy by empowering the patient (Özveren, 2011; Yaman Aktaş & Karabulut, 2015). Music therapy and foot massage, which are among the non-pharmacological methods that can be used to relieve pain caused by invasive applications, are simple, valuable and inexpensive adjuvant therapies used in pain control due to their ease of use (Yaman Aktaş and Karabulut, 2015).

Since the language of music is universal, its therapeutic and healing properties have been used throughout history and it continues to be effective today. Music therapy, which is used to maintain and improve mental and physical health, is a simple and natural tool that nurses can apply in pain management due to its ease of use. The use of music therapy increases the patient's ability to endure pain by focusing attention on a stimulus other than pain. In addition, music therapy helps to control pain by removing unpleasant painful stimuli and increasing the secretion of endorphins (Eti Aslan, 2006; Özer et al, 2010; Özveren, 2011).