ARTICLE INFO

Article Type

Original Research

Authors

Mohammadpour   A. (1 )
Basiri Moghadam   M. (2 )
Tabe’ei   M. (* )






(* ) ”Student Research Committee” and “Nursing Department, Nursing & Midwifery Faculty”, Gonabad University of Medical Sciences, Gonabad, Iran
(1 ) Internal Sergical Department, Nursing & Midwifery Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(2 ) “Social Health Research & Development Center” and “Nursing Department, Nursing & Midwifery Faculty”, Gonabad University of Medical Sciences, Gonabad, Iran

Correspondence

Address: No. 24, Raja’ei 13th, Raja’ei Street, Ferdows, South Khorasan, Iran. Postal Code: 9771996136
Phone: +985342222801
Fax: +985342222806
m35tabey@gmail.com

Article History

Received:  August  3, 2014
Accepted:  September 5, 2014
ePublished:  September 23, 2014

BRIEF TEXT


… [1-13] Self-Monitoring of Blood Glucose (SMBG) procedure is the glucose control process done by the patient in home using Glucometer device [14]. Self-monitoring procedure should be arranged according to the diet and physical activity in order to prevent and treat glucose reduction or increase [15]. Only 40% of type I diabetes patients and 33% of type II diabetes patients utilize SMBG program [16]. Despite the fact that finger blood sampling is the best technic in capillary blood taking [13], the patients’ will to utilize long-term SMBG program weakens due to pain caused by Lancet [17]. It is assumed that samplings from the palm of the hand, thigh, upper arm, forearm, abdomen, and legs have less pain and lead to patients’ higher willingness to SMBG. … [18-21]

Pain caused by Lancet in finger is more than pain in the hand palm and arm and pain in the former is lesser than pain in the latter [22]. Pain in arm (61% no pain and 30% minimum pain) is less than pain in figure [23]. Pain severities of SMBG in figure and hand palm are the same. However, the patients prefer figure than the hand palm due to finger availability and easy blood drop out [21]. There are few studies about the patients’ satisfaction as the most encouraging factor to utilize SMBG in other parts of the body.

The aim of this study was to compare between pain severity and the patients’ satisfaction of finger and leg blood taking.

This is an analytical-comparative study.

Over 20 years old patients with diabetes definitely diagnosed and without advanced neuropathy or identified skin lesions were studied in the medical wards of Gonabad 22 Bahman Hospital and Ferdows Chamran Hospital (Iran) in 2013-2014.

260 patients were selected, using convenience sampling method. Exclusion criteria were the patient’s unwillingness to participate and more than 5 years diabetes. Based on a pilot study on 10 participants, the sample size was computed 80 persons, using mean comparison formula.

A demographic questionnaire was used containing age, gender, marriage status, weight, height, education level, diabetes duration, underlying diseases, times of SMBG, and satisfaction level. The pain assessment visual scale was used to assess pain felt in different parts of body. The standard 10-degree pain assessment visual scale is from zero (no pain) to 10 (the severest pain). Its reliability and validity have been confirmed [24]. The patients’ satisfaction level was assessed using a researcher-made questionnaire. There were 10 questions about “awareness” in Likert’s 4-degree scale from “completely satisfied” (3 scores) to “unsatisfied” (zero scores). Total scores of each questionnaire were between zero and 30. 0-10, 10.1-20, 20.1-30 scores were classified as “low satisfaction”, “moderate satisfaction”, and “high satisfaction”, respectively. The viewpoints of 7 faculty members were considered to confirm content validity of the questionnaire. Reliability was computed through Test-Retest method with a 15-patient group in one weak interval and correlation of the replies was 0.78. After 97% ethanol disinfection, the Lancet of GL40 Glucometer device (Beurer; Germany) was put completely in tangent with the skin. Finger SMBG having been done through the outer edge of the middle finger of the left hand and leg SMBG having been done in the 1/3 middle of the muscle, the pain assessment scale was immediately given to both groups in order to assess pain severity. Data was analyzed, using SPSS 14.5 software, Chi-square test (to compare between the patients’ satisfaction levels based on the points of sampling and to assess the correlation between satisfaction from point of sampling and the education level index), Paired-T test (to compare between felt pains in two points), Spearman Correlation test (to investigate the correlation between satisfaction of point of blood-taking and age and diabetes duration indices), and Mann-Whitney test (to investigate the correlation between pain severity and age and gender indices).

Mean age of the participants was 52.8±8.9years. 156 persons (60%) were female. 228 persons (87.7%) were married (Table 1). Leg blood-taking satisfaction levels of 110 patients (42.3%) and 106 patients (40.8%) were high and moderate, respectively. Finger blood-taking satisfaction levels of 65 patients (25%) and 148 patients (58.9%) were high and moderate, respectively. Leg blood-taking satisfaction level was significantly higher than finger blood-taking satisfaction level. There were no significant correlations between the patients’ satisfaction from leg blood-taking and age and diabetes duration variables. There were no significant correlation between the patients’ satisfaction from finger blood-taking and age and diabetes duration variables. There was a significant correlation between the education level and leg blood-taking satisfaction level showing an increase in satisfaction with higher educational level. There was no significant correlation between the education level and finger blood-taking satisfaction. Felt pain due to leg blood-taking (7.46±1.31) was significantly lesser than pain felt due to finger blood-taking (8.15±0.83). There was no significant correlation between finger pain severity and age. There was no significant correlation between leg pain severity and age. There was no significant correlation in the felt pain due to finger sampling between female and male participants. There was no significant correlation in the felt pain due to leg sampling between female and male participants.

There was less pain in leg in the female and male patient with type II diabetes than hand finger. There is less pain in the palm of hand during SMBG than pain in finger [22]. Finger pain is higher than pain in other parts up to 60% [25]. During Lancet utilization, hand finger pain is twice the arm pain [23]. The results are consistent with the result of the present study. During blood glucose sampling, pain in the forearm is less than pain severity in finger [26]. There is no difference in pain severities in finger and palm of the hand [21]. There was a significant correlation between finger and leg blood-taking satisfaction levels. Patient with diabetes prefer forearm blood-taking due to less pain than finger blood taking [27]. The result is consistent with the results of the present study. There is less satisfaction from the palm of hand due to insufficient blood drops and less blood flow out than finger [21]. There was easier blood flow out due to leg hung from knee that led to patients’ higher satisfaction level, as well as less felt pain. There are no significant correlations between satisfaction and gender, age, and educational level [21], which is a result consistent with the results of the present study. There were no significant correlations between pain and gender, age, and educational level. The result is similar to the results of another study [23].

Healthy persons should be studied to compare their pain severity with pain severity of the patients with diabetes.

Undiagnosed neuropathy in the participants and no possibility to exclude patients formerly used auto-lancet on body surface, e. g. on finger, were of the limitation for the present study.

There is less pain in the leg due to SMBG resulting in a higher satisfaction level in patients with type II diabetes.

The researchers appreciate the personnel of the medical wards of Gonabad 22 Bahman Hospital and Ferdows Chamran Hospital and the participating patients.

Non-declared

All procedures were approved by Ethics Committee of Gonabad University of Medical Sciences.

The study was confirmed by Graduate Education Council and Research Council of Gonabad University of Medical Sciences.

TABLES and CHARTS

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