الفهرس 
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Abstract
Coronary artery bypass graft (CABG) surgery can cause moderate to severe postoperative sternal pain, and may lead to alteration of the physiological parameters. Moreover, if the pain and the physiological alteration are not treated properly, the patient may experience increased morbidity, a longer hospitalization stay, and higher overall costs.It was documented that nurses play a vital role in controlling postoperative pain. The previous researches have showed that nurses do not use non-pharmacological interventions as a method of choice for controlling postoperative cardiac surgery pain, but mostly deliver analgesics to relieve pain. Actually, effec-tive results can be accomplished with a combination of multiple methods in pain management by using pharmacological and more than one method of non-pharmacological interventions for best results in pain control.
Aim of the study:this study was conducted to determine the effect of tactile and auditory stimulation on physiological parameters and sternal pain in post coronary artery bypass graft surgery patients.
This study was conducted in the open heart critical care unit at Alexandria Main University Hospital that includes ten beds; this unit receives the patients of postoperative coronary artery bypass graft (CABG) surgery in the acute stage for direct care and supervision of the physiological parameters after operation. The nurse/patients ratio is 1:2 for the three shifts.
Convenience samples of 60 post CABG adult conscious patients after extubation were included in this study. Patients were assigned randomly into two groups (30 patients each). The control group who received the routine nursing care of the unit by the critical care nurses, and the intervention group who received the tactile and auditory stimulation by the researcher.
To accomplish the aim of the current study; Two toolswere used in this study for data collection.
Tool one: socio demographic and clinical data assessment.This tool was developed by the researcher after reviewing the related literature to assess the patient socio demographic and clinical data. It consists of two parts: Part I:Socio-demographic data:itwas included age, sex, marital status, occupation, and level of education”, Part II: Clinical data” it was included patient’s medical or surgical history, history of hospitalization, history and postoperative analgesic used, supplemental oxygen used, and music assessment”.
Tool two:physiological parameters and pain assessment. PartI of this tool was developed by the researcher after reviewing the related literature, part II adapted from other thesis to observe effect of tactile and auditory stimulation on physiological parameters and sternal pain in post CABG patients. It consists of two parts: Part I: physiological parameters assessment” It was included respiratory rate, SPO2, HR, SBP, DBP, mean arterial blood pressure, and GCS”,Part II: Visual analogue Pain Scale “It was used to assess sternal pain of patients with post coronary artery bypass graft surgery”.
Data collected as the following:
For the control group:
- First, the data were collected from the control group.
- Then the researcher assessed patients’ demographic data and the clinical data using part I and part II of the tool one.
- Control group received a routine nursing care, and then rested in the bed for 20 minutes while researcher was bedside them (for emotional consideration).
For the intervention group:
- The data were collected from the intervention group through three phases:
I- Preparation phase: Patients’ demographic data and the clinical data using part I and part II of tool one.
II- Intervention phase:
1- Tactile Stimulation (Massage Session): the petrissage and friction massage were done.
2- Auditory Stimulation (Music Session): assessment was done by the researcher before application of the auditory intervention, soft music was recommended to be used to relieve pain.
Both interventions were applied at the same time, twice a day for 20 min with sex hours interval for two consecutive days.
III- Evaluation phase:
- The physiological parameters and Visual Analogue Pain Scale assessed using part I and part II of tool two.
- After that the researcher compared the results of the assessed values between the control and intervention group to determine the effect of the tactile and the auditory stimulation on the physiological parameters and sternal pain post CABG surgery for the intervention group.
The main results of the current study:
It was observed that there was improvement in mean scores of respiratory rate, saturation of peripheral oxygen (SPO2), heart rate {(t= 4.684, P= <0.001), (t= 2.480, P= 0.016), (t= 4.664, P= <0.001) respectively}.It was noticed that significant change was found between the intervention and control group after tactile and auditory stimulation in the sternal pain (t= 4.696, P= <0.001).
Conclusion:
• The tactile stimulation as foot and hand massage reflexology in combination with auditory stimulation as listening to soft music applied in the early days of postoperative CABG surgery patients, twice a day for 20 min were significantly reduced the sternal pain among post CABG patients.
• The use of tactile stimulation in combination with auditory stimulation among postoperative CABG patientshad a significant effect on physiological parameters.
The most important recommendations:
• Provide the new practices about the technique of the tactile and auditory stimulation among post CABG patients to the health care providers.
• Provide continuous direct observation and assessment for the CCNs on their practice on applying tactile and auditory stimulations among post CABG patients.
• Conduct other researches to identify the effectiveness of other non-pharmacological parameters on pain and physiological parameters among post CABG surgery patients and their applicability.
• Conduct other researches on a larger study sample and in multi-centers for generalization.