Comfort Promotion: Distraction (Ambulatory)
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The pain experience is a product of a person’s pain experiences, values, cultural expectations, and emotions. Pain is a subjective measurement and varies among patients. Nonpharmacologic pain-control measures include massage, meditation, acupuncture, relaxation breathing, guided imagery, and heat and cold application.undefined#ref3">3,4 Such measures should be used in conjunction with pharmacologic interventions and can reduce the amount of analgesic medication required. Nonpharmacologic techniques help diminish the physical effects of pain, alter a patient’s perception of pain, and provide the patient with a greater sense of control. Nonpharmacologic interventions are appropriate for patients who find them appealing or who have incomplete pain relief with drug therapy alone.3,5
Certain diagnostic and therapeutic procedures commonly cause pain. Evidence suggests that fewer than half of surgical patients report adequate postoperative pain relief.6 Many times, multimodal regimens for postoperative pain relief are required. The administration of an analgesic before implementing a nonpharmacologic strategy, such as guided imagery, may help the patient gain a level of comfort. Adding nonpharmacologic interventions may enhance the effects consistent with the biopsychosocial model of pain.6 The patient, setting, and surgical procedure affect the exact components of effective pain relief.6 Because patients respond differently to nonpharmacologic techniques, finding the most effective methods can take time. In most cases, a combination of techniques is beneficial.
By introducing meaningful stimuli that can help refocus attention, the health care team member distracts the patient’s attention from the sensation of pain. Distraction strategies include changing activities, listening to music, reading, focusing on another person, walking, napping, writing, concentrating on a mental and physical activity simultaneously (playing a musical instrument), learning something new (completing a crossword puzzle), and listening to or watching a comedy program. Therapeutic communication with the health care team member is another example of distraction. When the distraction is removed, the patient may experience a heightened awareness of pain.4
Distraction appears to be most effective for acute episodes of mild to moderate pain lasting from minutes to an hour, such as during bone marrow biopsy, lumbar puncture, burn debridement, venipuncture, and discomfort experienced during childbirth.2 The use of music has been shown to optimize pain control and promote healing after surgery by reducing anxiety and stress.3
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Rationale: Redirection of attention alters emotional or cognitive aspects of pain.
Rationale: These actions direct attention inward and protect the patient from external distraction.
Rationale: Rhythmic breathing promotes relaxation by concentrating on kinesthetic action, thus reducing the patient’s ability to concentrate on pain.
Rationale: Focusing on an activity diverts attention from a painful sensation.
Rationale: Stressing details of an event enhances distraction from the pain stimulus.
Rationale: This evaluation determines the effectiveness of the procedure, the level of relaxation, and the degree of pain relief. It also indicates which procedures were the most effective.
American Nurses Association (ANA). (2018). Position statement: The ethical responsibility to manage pain and the suffering it causes. Retrieved March 2, 2023, from https://www.nursingworld.org/~495e9b/globalassets/docs/ana/ethics/theethicalresponsibilitytomanagepainandthesufferingitcauses2018.pdf
Aubrun, F. and others. (2019). Revision of expert panel’s guidelines on postoperative pain management. Anaesthesia, Critical Care & Pain Medicine, 38(4), 405-411. doi:10.1016/j.accpm.2019.02.011
Joint Commission, The. (2018). R3 report: Pain assessment and management standards for ambulatory care. Retrieved March 2, 2023, from https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3_14_pain_assess_mgmt_ahc_6_20_18_final.pdf
National Center for Complementary and Integrative Health. (2021). Relaxation techniques: What you need to know. Retrieved March 2, 2023, from https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know
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