NUBE 2024

Background:
Psychiatric patients presenting to the Behavioral Health Emergency Department can arrive in crisis with multiple co-occurring issues, including chronic or acute pain. Pain can cause or worsen anxiety and depression and is associated with increased disability and poorer quality of life in people with severe and persistent mental illness. Traditional pain management often relies on medication and poses risks and limitations in psychiatric care. Given the increased suicide risk associated with severe mental illness and pain, alternative non-pharmacologic approaches are imperative. Acupuncture and acupressure have been used for centuries to manage various disorders including pain.

The BH-ED supports patients during their most vulnerable time and often present in crisis. Patients come from diverse ethnic and socioeconomic backgrounds. Many patients have limited resources and utilize the ED as a place to receive treatment for their psychiatric and medical concerns.

Objective:
Assess the feasibility of nurses administering battlefield auricular acupressure (BAApress), patients' acceptance, and impact on pain and anxiety management.

Method:
Prior to initiating the study, nurses participated in the BAApress training done by BAApress Intervention initiated by AH WFBH Center for Nursing Research. Three Emergency Department nurses and study personnel received comprehensive BAApress training. The protocol consists of placing adhesive acupressure pads bilaterally on five specific auricular sites: 1) Cyngulate gyrus, 2) Thalamus, 3) Omega 2 4) Point Zero, and 5) Shen Men. These sites were selected based on the Veterans Administration Battlefield Auricular Acupressure Protocol for acute and chronic pain. This training process took approximately four hours. In this study, ten patients had five acupressure pads per ear placed at pre-selected acupoints as per battlefield auricular acupressure protocol shortly after admission and remained on patients during their stay. Patients were assessed daily for pain using Visual Analogue Scale Pain Scores and anxiety utilizing General Anxiety Disoder-7 on days 1 and 3.

Results:
Nurses were able to incorporate BAApress treatment without disruption to the nurse’s workflow. Results show 77% acceptance rate of acupressure treatment. Pain scores decreased each day (p=0.14). Anxiety scores significantly decreased (p=0.01). Nurses successfully initiated treatment in 77% of cases, with 100% patient satisfaction with pain management.

Conclusion:
Results showed substantial improvement in anxiety and modest improvement in pain, suggesting the potential for this treatment to be part of pain and anxiety management. Despite staffing challenges, nurses demonstrated ease in implementing this treatment effectively, suggesting its potential in various medical settings potentially benefiting a large group of patients. However, comprehensive large-scale studies are necessary to validate the effectiveness of battlefield auricular acupressure as an adjunct treatment in pain and anxiety management across diverse patient populations and settings.

Learning Objectives:

Determine feasibility of nurses administering BAA.

Assess effectiveness of battlefield auricular acupressure (BAA), as an adjunctive treatment for pain and anxiety.

Determine patients’ acceptance of this treatment modality.