Stress Ball Use in Non-Invasive Mechanical Ventilation Patients

Non-invasive mechanical ventilation is the first-line ventilatory support modality for treating acute respiratory failure in patients hospitalized with type II respiratory failure. However, pain, anxiety, and impaired patient comfort experienced during treatment are among the principal factors affecting adherence to Non-invasive mechanical ventilation. These factors may shorten the duration of therapy, reduce mask tolerance, and increase pain associated with mask-related pressure.

In recent years, distraction techniques have been increasingly employed to alleviate treatment-related discomfort. One such method is the use of a stress ball. Rhythmic squeezing of the stress ball in the palm provides physical stimulation of muscles and peripheral nerve endings, thereby redirecting the patient's attention away from unpleasant stimuli. This mechanism is thought to produce an acupuncture-like effect, eliciting an analgesic response and reducing pain perception. Furthermore, stress ball use has been reported to stimulate endorphin release, contributing to reductions in anxiety, pain, and stress.

Recent nursing research has demonstrated the widespread use of stress balls as a distraction technique across patients of all age groups, particularly among individuals undergoing oncology treatments, haemodialysis, and minor surgical procedures in paediatric settings. To date, only one study has been identified that evaluated the effects of stress ball use on pain and anxiety in patients receiving Non-invasive mechanical ventilation. In Şeker's study, the intervention was applied to patients with chronic obstructive pulmonary disease; however, its effects on treatment duration and mask adherence were not investigated.

Inclusion criteria

• Physician-confirmed diagnosis of type II respiratory failure.
• Receiving non-invasive mechanical ventilation support for at least 8 hours.
• Receiving non-invasive mechanical ventilation mode.
• Awake and able to communicate between 08:00 and 24:00.
• Aged 18 years or older.
• Glasgow Coma Scale score ≥13.
• Richmond Agitation-Sedation Scale score between +2 and -1.
• Conscious and cooperative (except for transient impairment of consciousness attributable to hypercapnia).
• Able to communicate in Turkish.
• Written informed consent provided by the patient or, where applicable, the patient's legal representative.

Exclusion criteria

• Presence of delirium, active psychosis, neurological deficits, cognitive impairment, or any condition that precludes effective communication.
• Presence of infection, wounds, burns, casts, traction devices, amputation, or any other condition affecting the hands or upper extremities that would prevent squeezing a stress ball.
• Hemodynamic instability during non-invasive mechanical ventilation treatment.
• Sleeping during non-invasive mechanical ventilation treatment.
• Requirement for endotracheal intubation during the study period.
• History of facial surgery, facial trauma, facial deformity, or facial burns.
• Withdrawal from the study at the participant's own request.