The effect of long-term COVID-19 on aetiological factors related to nocturia.

AIMS AND OBJECTIVES: This study was conducted to examine the possible aetiology of nocturia in patients with long-term COVID-19. BACKGROUND: Physical and neuropsychiatric symptoms, an increase in overactive bladder symptoms, especially from urinary system complaints, has been reported in patients with COVID-19, 10-14 weeks after the illness. DESIGN: A descriptive design. METHODS: The study consisted of 70 patients who had experienced COVID-19, had nocturia, and were followed in the State Hospital between April and July 2022. Data were collected using a patient information form, the 'TANGO' nocturia screening tool, and the Visual Analog Scale. This study was created in accordance with the STROBE Statement Checklist. RESULTS: When the nocturia effects of long-term COVID-19 were examined it was determined that the urinary tract was the 'priority' aetiological condition. It was observed that there was a significant difference between the aetiological factor groups in terms of the mean age of the patients and the number of nocturia (p < .05). According to post-hoc analysis, the mean age of patients with a dominant cardio-metabolic factor was found to be significantly younger (p < .05). In addition, when comparing the number of nocturia according to the aetiological factors of the patients, it was observed that the number of nocturia was significantly frequent in the patients with a dominant sleep factor (p < .05). CONCLUSIONS: It was found that the urinary tract aetiological factor was dominant in patients with long-term COVID-19 and nocturia, patients with a dominant cardiovascular aetiological factor were younger, and that the number of nocturia was higher in patients with a dominant sleep factor. RELEVANCE TO CLINICAL PRACTICE: Identification of the early signs and symptoms and underlying causes of nocturia in individuals with post-COVID-19 syndrome will enable nurses and health professionals to guide the early identification of different underlying problems, as well as the implementation of approaches to treat and eliminate nocturia. PATIENT OR PUBLIC CONTRIBUTION: The patients contributed to the study by agreeing to participate in the evaluation of nocturia complaints after COVID-19 infection.

Evaluation of clinical oral care outcomes according to nursing outcomes classification.

PURPOSE: This research was planned to follow the healing process of the oral mucosa in patients in intensive care with an "Impaired Oral Mucous Membrane Integrity" nursing diagnosis based on the "NOC (1100) Oral Health Assessment" outcome criteria. METHOD: This study, which was planned in a methodological and descriptive type of research, was carried out with 50 patients who were hospitalized in the intensive care clinic of a state hospital between June and December 2022, with a nursing diagnosis of "Impaired Oral Mucous Membrane Integrity." Data were collected using a Patient Information Form and the "NOC (1100) Oral Health Evaluation Scale" for the nursing outcomes classification. In the analysis of the data descriptive statistical methods, Pearson correlation test, Friedman test as well as Cohen's kappa test were used to evaluate the agreement between two independent observers. FINDINGS: In the study, content validity index value of the NOC scale was calculated to be 0.90. The examination of the participants' mean scores on the NOC (1100) Oral Health Assessment Scale showed that there were statistically significant differences in terms of the repeated evaluations, except for the NOC indicators of "Oral mucosal integrity," "Gum integrity," and "Tooth integrity" (p < 0.01). No statistically significant correlation was found between the mean NOC scale scores of the patients according to the variables of age, body mass index, mechanical ventilation time, and length of stay in the intensive care unit (p > 0.05). CONCLUSIONS: The findings showed that the Turkish version of NOC (1100) Oral Health Assessment Scale was a valid tool for monitoring the healing process of the oral mucosa in patients in intensive care. IMPLICATIONS OF NURSING PRACTICE: With the use of NOC (1100) Oral Health Assessment Scale, a common language will be formed in the evaluation for monitoring the healing process of the oral mucosa in nursing care.

Anxiety and Health Literacy Levels of Patients Undergoing Colonoscopy.

This descriptive, correlational study was conducted to determine the anxiety and health literacy levels of patients undergoing colonoscopy and the variables affecting them. The study population consisted of individuals who presented for colonoscopy to the endoscopy department of a state hospital. The sample consisted of 160 individuals who met the inclusion criteria. Three data collection tools (Identifying Information Form, State-Trait Anxiety Inventory, and Health Literacy Scale) were used to determine anxiety and health literacy levels. Findings show that the state-trait anxiety of individuals who would undergo colonoscopy for the first time was moderate, and their health literacy scores were inadequate, problematic, and weak. There was a positive and significant relationship between patients' anxiety and health literacy levels. Variables such as age, gender, marital status, education level, employment status, disease-related symptoms, a family history of cancer, and fear of colonoscopy influenced anxiety and health literacy. Based on these findings, we recommend that individuals' anxiety and health literacy status be determined before a colonoscopy procedure to improve gastroenterology nurses' management of these patients.

Comparison of three fall risk assessment tools in older hospitalized patients in Turkey: analysis of sensitivity and specificity.

BACKGROUND: As a result of falls, older patients experience injury and loss of function, and their length of hospital stay and care costs increase. AIM: This study was conducted to determine fall risks and compare the sensitivity and specificity of three fall risk assessment tools. METHODS: Older patients' fall risk levels were determined according to the Itaki, Hendrich-II, and Morse tools within 2 h following their admission to the wards. A methodological design was used in the study, which included 388 hospitalized elderly patients. The mean age of the patients was 72.29 ± 5.6 years, and 57.7% were female. RESULTS: According to the ROC curve values of Sensitivity and 1-Specificity, the cut-off points for the Hendrich-II, Itaki, and Morse fall tools were accepted as 27.5, 8.5, and 6.5, respectively. According to the analysis results, the ratios of the areas under the ROC curve for the Itaki, Morse, and Hendrich-II fall tools were 0.794, 0.773, and 0.724, respectively, which were found to be statistically significant for all three tools (p ≤ 0.001). CONCLUSIONS: The Itaki Fall Risk Tool was found to be the most sensitive one among the three instruments in assessing the fall risk of older hospitalized patients. The Itaki Fall Risk Tool was followed by the Morse and Hendrich-II tools, respectively, in terms of sensitivity.

The effect of relaxation exercises on burden, burnout, and anxiety levels in palliative caregivers.

PURPOSE: The purpose of this study was to assess the effectiveness of relaxation exercises on burden, burnout, and anxiety levels in palliative caregivers. DESIGN AND METHODS: The single-group pretest-posttest design was used. The sample of the study consisted of 60 caregivers. Relaxation exercises were administered to caregivers 2 times a week for 4 weeks and 8 times. Burden, burnout, and anxiety levels were evaluated on the preinterventions and postinterventions. FINDINGS: The mean age of the caregivers was 43.82 ± 10.19 years. The majority of the palliative patients were diagnosed with dementia (58.3%), the duration of diagnosis was between 1 and 5 years (70.0%). It was determined that relaxation exercises reduced to caregivers' burden, burnout, and state anxiety levels (p < 0.01). PRACTICE IMPLICATIONS: The study concluded that relaxation exercises had positive effect on caregivers' burden, burnout, anxiety levels.

"TANGO" nocturia scanning tool: Turkish validity and reliability study.

BACKGROUND: The aim of this study is to evaluate the validity and reliability of the Targeting the Individual's Aetiology of Nocturia to Guide Outcomes (TANGO) screening tool, which is used to determine nocturia etiology. METHODS: Patients hospitalized in urology, orthopedics, and general surgery clinics between September 2019 and January 2020 were included in the study. Demographic characteristics of the participants such as age, gender, drug use, and nocturia severity were assessed by the researchers. The Turkish version of the TANGO questionnaire consisting of 22 questions was filled in by the patients. The patients were asked to repeat the same test 4 weeks later. RESULTS: A total of 124 patients were included in the study. The mean age of the patients participating in the study was 51.20 ± 18.50 (38-82). The result of the reliability assessment showed that the total score intraclass correlation coefficient was 0.715 (individual item score weighted kappa coefficients, 0.696-0.731) and the Cronbach's alpha coefficient was 0.727. A total of 112 patients filled in the TANGO screening tool again after 4 weeks. The test-retest reliability analysis kappa value was 0.75 (0.68-0.83). In the validity analysis, a moderately positive correlation was observed between the TANGO-Urinary Incontinence Score and the number of nocturia (r = 0.452, P = .003). CONCLUSION: According to the validation study, the TANGO screening tool is valid and reliable to determine the nocturia etiology for the Turkish population.

The effectiveness of a non-tourniquet procedure on peripheral intravenous catheterization in older patients: A pilot study.

Background: In an older population, insertion of peripheral intravenous catheterizations (PIVCs) are more difficult because of specific problems.Aim: This study aimed to determine the initial efficacy of non-tourniquet procedure during insertion of PIVC in older patients.Design/Methods: This quasi-experimental study was conducted in 78 older patients. The initial efficacy of non-tourniquet procedure was tested during insertion of PIVC.Results: This study showed that similar pain intensity scores immediately after inserting the PIVC (p>0.05). The first-attempt success and dwell time in non-tourniquet procedure older patients were be higher/longer and phlebitis scores were lower than the control group (p<0.05).Conclusions: To increase the success of PIVC first-attempt, a longer dwell time, and lower phlebitis scores in older patients, nurses should insert PIVCs at an almost flat degree and stabilize the vein without a tourniquet.Impact statement: The non-tourniquet procedure will lead to the long dwell time and using safely of PIVC in older patients.

Efficacy of Cartoon Viewing Devices During Phlebotomy in Children: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to examine the efficacy of different cartoon viewing devices during phlebotomy in children. DESIGN: This study was a prospective, randomized controlled trial. METHODS: The study included inpatients from the Biochemical Laboratory of a private university hospital in Turkey and was conducted between September 2017 and April 2018. A computer-based random number generator was used to randomly assign the patients into three groups (virtual reality [VR], tablet, and control) with 40 children each. Data were collected using the Wong-Baker FACES Pain Rating Scale and the Children's Fear Scale. Pain and anxiety scores were reported by children, parents, and observers in tablet and control groups. In the VR group, pain and anxiety were determined only by children's reports. FINDINGS: According to the children reports, the VR group reported significantly less pain and anxiety than those in the tablet and control groups (P < .05). CONCLUSIONS: The cartoon distraction performed using a VR device reduced the perception of pain and anxiety during phlebotomy in school-age children.

Effectiveness of vialon biomaterial versus teflon catheters for peripheral intravenous placement: A randomized clinical trial.

AIM: This study was to determine the effects of the two types of catheter material (vialon biomaterial and teflon) on pain intensity, dwell time, and phlebitis score for peripheral intravenous catheter (PIVC) placement. METHODS: Participants (N = 208) were randomly assigned to the vialon biomaterial group (n = 104), the teflon group (n = 104). After the PIVC placement, the intensity of pain and phlebitis score were evaluated. Catheter dwell mean time was determined. RESULTS: The pain intensity scores were similar immediately after inserting the PIVC. No difference was observed between the pain scores in both groups (p ≥ .050). Catheter dwell mean time for the vialon biomaterial catheter group (4.72 ± 1.20 days) was significantly longer compared to the teflon catheter group (4.10 ± 0.92 days) (p ≤ .001). It was determined that the catheter was removed due to phlebitis development in 16.3% of the vialon biomaterial catheter group and 53.8% of the teflon catheter group. An advanced level of statistically significant difference was found between the two groups in terms of phlebitis development scores (p ≤ .001). CONCLUSIONS: This study concluded that vialon biomaterial catheter (BD Insyte™ Autoguard™ BC winged) demonstrates longer dwell time of PIVC, lower phlebitis rate and phlebitis score than teflon catheter (BD Venflon™).

The effects of bladder training on bladder functions after transurethral resection of prostate.

AIM AND OBJECTIVES: The aim of this was to examine the effect of bladder training on bladder functions. BACKGROUND: Urinary catheterization is frequently performed in order to evaluate the outcomes of the surgical procedures and to monitor the urine output after urology operations. DESIGN AND METHODS: This quasi-experimental study was conducted in the urology clinic in Istanbul, Turkey in which 50 males were nonrandomly assigned to either a bladder training (n = 28) or a control group (n =22). In the bladder training groups, the urinary catheters of the patients were clamped at 4-hr intervals and then were left open for 5 min on the second postoperative day. This study was created in accordance with TREND Statement Checklist. RESULTS: The first urgency time and the first voiding time were longer, and the prevoiding and the voiding volumes were higher following the removal of the catheter in the training group (p = 0.001). In addition, the evaluation of the patient bladder diaries in the first three days after the discharge period revealed that the daily frequencies of micturition and nocturia were lower (p = 0.04), the mean duration of intervals between the micturition was longer (p = 0.006), and the mean voided urinary volume was higher (p = 0.024) in the training group. CONCLUSION: At the end of the study, it is observed that bladder training performed by clamping the catheter on postoperative day 2 after Transurethral Resection of Prostate (TUR-P) operation is a significant positive effect on the storage symptoms of the patients. RELEVANCE TO CLINICAL PRACTICE: Before removing the urinary catheter, bladder training programme affects positively to patients, especially prevoiding and the voiding volumes, the daily frequencies of micturition and nocturia on postoperative periods.

Effectiveness of an Intravenous Protection Device in Pediatric Patients on Catheter Dwell Time and Phlebitis Score.

PURPOSE: The study aimed to examine the efficacy of the I.V. House UltraDressing for protecting peripheral intravenous catheters (PIVCs) in pediatric patients. METHODS: This randomized controlled trial comprised 60 pediatric patients (aged 2-24 months): 30 in the experimental group and 30 in the control group. The PIVC dwell time and phlebitis scores were also reported for both groups. The degree of phlebitis was determined using the Visual Infusion Phlebitis Scale (VIPS) and was recorded every 8 hours from the start of antibiotic therapy until catheter removal. RESULTS: The mean catheter dwell time in the experimental group (2.10 ± 1.55 days) was significantly longer than that in the control group (1.27 ± 0.45 days) (p < .01). However, there were no significant differences between the scores and signs of phlebitis in both groups (p > .05). CONCLUSION: The I.V. House UltraDressing is a useful device that can be used to increase catheter dwell time and protect and stabilize PIVCs in pediatric patients.

Efficacy of Vein Visualization Devices for Peripheral Intravenous Catheter Placement in Preterm Infants: A Randomized Clinical Trial.

The aim of this randomized controlled trial was to examine the efficacy of vein visualization devices and the routine method for insertion of peripheral intravenous catheters (PIVCs) in preterm infants. The study was conducted between June 2016 and April 2017 in the neonatal intensive care unit of Bakirköy Dr Sadi Konuk Education and Research Hospital. Participants (N = 90) were randomly assigned to the infrared group (n = 30), the transilluminator group (n = 30), or the control group (n = 30). Time to successful cannulation was significantly lower for the infrared group (8.70 ± 2.56 seconds) than for the transilluminator group (45.27 ± 30.83 seconds) and the control group (17.30 ± 8.40 seconds) (P ≤ .001). Success of the first attempt was significantly higher in the infrared and transilluminator groups than in the control group (P ≤ .05). Dwell time of the PIVC in place was significantly higher in the infrared group than in the transilluminator and control groups (P ≤ .05). Neonatal Infant Pain Scale scores were significantly higher in the transilluminator group (0.60 ± 0.855) than in the infrared (0.33 ± 0.182) and control groups (0.33 ± 0.182) while seeking an appropriate vein (P ≤ .001). The use of an infrared device provides efficacy in time to successful cannulation, success of the first attempt, length of the time the catheter is in place, and technique-related pain.

Undergraduate nursing students and the elderly: An assessment of attitudes in a Turkish university.

At times when populations are aging and nursing services for elders are needed, gerontology as a nursing specialty is not a highly sought career choice. The purposes of this study were to assess the overall attitudes of nursing students at a Turkish university toward the elderly and to identify the effects of demographic and social factors on attitudes. Using a non-experimental design, the Turkish version of the Kogan's Attitudes towards Old People (KAOP) Scale was given to undergraduate nursing students. Significant findings demonstrated that the older the student, the worse the attitude and that students willing to work with elders had significantly better total KAOP and better positive item scores than those not willing to work with elders. The findings support educational preparation as a major factor in shaping student attitudes. Geriatric education should be integral to nursing education to help ensure sustainability of nursing services for the elderly population.

Effectiveness of ShotBlocker for Immunization Pain in Full-Term Neonates: A Randomized Controlled Trial.

Nonpharmacologic strategies exist to manage procedural pain in healthy newborn infants. The aim of this prospective randomized controlled trial (RCT) was to examine the efficacy of ShotBlocker for managing injection pain associated with the first intramuscular hepatitis B vaccine given to healthy full-term neonates. This randomized controlled trial study was conducted in a private university hospital in Istanbul, Turkey, in which 100 healthy term neonates were randomly assigned to either a ShotBlocker (n = 50) or control group (n = 50). The Neonatal Infant Pain Scale scores of the neonates in the ShotBlocker and control groups were compared before, during, and after the injections, and the physiological parameters were compared before and after the procedure. The pain scores of the neonates during (ShotBlocker group: 1.64 ± 0.80; control group: 2.96 ± 0.73) and after (ShotBlocker group: 0.74 ± 0.66; control group: 1.42 ± 0.76) the injection procedure were lower in the ShotBlocker group than in the control group (P = .000). The postinjection heart rate in the infants in the ShotBlocker group (145.02 ± 13.50) was found to be lower than in those for whom ShotBlocker was not used (150.24 ± 13.36) (P = .05). The use of ShotBlocker during the hepatitis B vaccine in term neonates is effective in reducing the acute pain.

Risk level analysis for deep vein thrombosis (DVT): A study of Turkish patients undergoing major orthopedic surgery.

Deep vein thrombosis (DVT) is a prevalent problem for orthopedic patients, particularly owing to the nature of operative interventions and treatment procedures, predisposing to an high risk of DVT. This descriptive study was conducted to determine the levels of risk, the risk factors, and their odds ratio for DVT in patients undergoing major orthopedic surgery. Data were collected using a Patient Information Form and the Autar DVT Risk Assessment Scale (DVTRAS) in orthopedic wards of a university hospital on postoperative day 2. Data were analyzed using descriptive, comparative analysis, and binary logistic regression. The 102 patients (mean age, 52.58 ± 21.58 years) were hospitalized for a mean of 14.35 ± 14.56. Of the sample, 53.9% were female, 65.7% had a history of previous surgery, and 54.9% had undergone total hip/knee arthroplastic surgery, 67.6% of patients wore graduated compression stockings, and 62.7% were administered liquid infusion. Those patients had moderate risk score (12.77 ± 5.66) in the Autar DVTRAS. According to binary logistic regression analysis, aging, obesity, immobility, and acute and chronic diseases were significant risk factors for postoperative DVT (p ≤ .05). This study highlights evidence on the degree of DVT risk, risk factors, and impact of venous thromboembolism in patients undergoing major orthopedic operations. For evidence-based clinical practice, these high-level risk factors should be taken into account in the prevention of DVT in orthopedic patients.

Comparison of 3 methods to prevent pain and bruising after subcutaneous heparin administration.

PURPOSE: The purpose of this study was to assess the effects of the injection duration (30 seconds) and local dry cold application (5 minutes before and after injection) on pain intensity and bruising at the injection site in subcutaneous heparin injections. DESIGN: This was a randomized controlled, prospective, experimental study. SETTING: This study was performed between February 2011 and February 2012 in the orthopedic wards of 1 university hospital. SAMPLE: The sample consisted of 60 patients receiving subcutaneous injections of heparin once a day and hospitalized in the orthopedic and trauma wards. METHODS: A computerized randomization program was used to allocate the patients to 3 experimental groups: group A (30-second injection duration), group B (30-second injection duration and 5-minute dry cold application applied locally), and group C (injection administered for 10 seconds and no dry cold application applied locally). RESULTS: This study observed statistically significant differences in pain intensity and bruising occurrence and formation measured over time among groups A and B (30-second injection duration or 30-second injection duration and 5-minute local dry cold application) and group C (10-second injection duration). CONCLUSION: It was determined that a subcutaneous injection duration of 30 seconds and 5-minute local dry cold application (before and after injection) can be effective in decreasing the intensity of pain and in reducing the occurrence of bruising.

The effect of relaxation techniques and back massage on pain and anxiety in Turkish total hip or knee arthroplasty patients.

The purpose of this study was to examine the effects of relaxation techniques and back massage on postoperative pain, anxiety, and vital signs on postoperative days 1-3 in patients who had undergone total hip or knee arthroplasty (THA, TKA). Sixty patients having a THA or TKA were randomly assigned to either a experimental group or a control group. The McGill Pain Questionnaire Short Form (MPQ-SF) and State Anxiety Inventory (SAI) were used to measure pain and anxiety, respectively. Vital signs, including blood pressure (systolic and diastolic), pulse, and respiratory rate, were also obtained. Statistically significant differences in pain intensity (F = 14.50; p = .000), anxiety level (F = 19.13; p = .000), and vital signs (F = 169.61, 9.14, 14.23, 65.64; p = .000) measured over time were found between the experimental and the control group. Results of this research provide evidence to support the use of relaxation techniques and back massage at bed rest times of patients to decrease pain and anxiety. The interventions helped them to forget about their pain for a while and improved their anxiety state. After an evaluation of the conclusions, use of these interventions should be implemented by nurses into routine plans of care for patients.

Patients' discharge information needs after total hip and knee arthroplasty: a quasi-qualitative pilot study.

PURPOSE: Discharge information needs are known to be common problems for total hip and knee arthroplasty (THA, TKA) patients due to surgical and technological developments of arthroplasty, treatment procedures, and reducing the duration of hospitalization. The purpose of this study is to collect individual interviews about information needs of patients who have had THA or TKA for the first time. DESIGN/METHODS: This quasi-qualitative study was conducted in orthopedic wards of a university hospital in Turkey. Descriptive data were collected using a Patient Information Form and the Patient Learning Needs Scale (PLNS). Individual interviews data were collected by open-ended questions related to PLNS subscales 24-48 hours before discharge. FINDINGS: The mean age of the 37 patients studied was 64.97 ± 13.66, 70.3% were female, 56.8% had THA for the first time. Similar to individual interviews, the patients reported that the most important learning needs were about treatment and complications, activities of living, and enhancing quality of life. In addition, patient's age had a significant impact on PLNS scores. CONCLUSIONS: This study sought to determine Turkish THA or TKA patients' priority of learning needs on discharge. CLINICAL RELEVANCE: After an evaluation of the conclusions, healthcare professionals can contribute to the development of scheduling programs for patients who are discharged following THA or TKA surgical procedures.

Evaluation of night-time pain characteristics and quality of sleep in postoperative Turkish orthopedic patients.

This descriptive, correlational study was conducted to determine orthopedic patients' night-time pain characteristics, their quality of sleep and the contributing factors to poor sleep experiences, and the relationship between pain and sleep. Data were collected by using the McGill Pain Questionnaire-SF (MPQ-SF) and Pittsburgh Sleep Quality Index (PSQI) on the second postoperative day. Data were analyzed using the SPSS version 10.0 for Windows. Mean age of the 75 patients was 49.55 ± 21.10 years and were hospitalized in the orthopedic wards for 10.56 ± 14.74 days. Of the sample, 65.3% were female and 36% had hip/knee arthroplasty surgery. Pain (45%) and noise (23%) were found to be the most cited factors affecting the sleep of patients in postoperative periods. They experienced "external" pain at the surgical site and verbalized their pain as "stabbing" and "tiring-exhausting." Patients' night-time pain was determined to be severe (6.59 ± 1.62); their quality of sleep was also poor (9.24 ± 3.53). A statistically significant correlation was found between patients' pain intensity and quality of sleep (p≤.05).

Postoperative pain characteristics in Turkish orthopedic patients.

Postoperative pain is a subjective concept that can only be defined by the individual experiencing it. This research was planned as a descriptive study to make postoperative pain assessments of patients who have undergone major orthopedic surgery. The study sample consisted of 150 patients who met the inclusion criteria and agreed to participate in the study. Data were collected using a questionnaire form that included sociodemographic, postoperative pain characteristics, and the McGill Pain Questionnaire. The data obtained were assessed using the SPSS 10.0 program. The mean age of the patients was 54.13 +/- 18.12 years, 67.3% were female, 72.7% of the patients had a history of previous surgery, 43.3% had had hip prosthesis surgery, and 70.7% when their analgesic medications were taken on PRN basis. They experienced "external" pain at the surgical site and in pressure areas according to type of surgery and verbalized their pain at the highest percentages as "throbbing," "tiring," "troublesome," and "nagging." In addition the majority of the patients (95.3%) stated that their pain was decreased with analgesic medication administration, and 78.7% stated that position change and physical therapy (69.3%) increased their pain. In the assessment of pain severity on the third postoperative day, the Present Pain Intensity was determined to be a mean of 1.75 +/- 1.02 (on a scale of 0 to 5), and 78.7% had "intermittent" pain. In addition, worst/severe pain severity was determined to be a mean of 4.55 +/- 0.70 on the third postoperative day. Statistically significant differences were found between patients' pain severity scores (p