Journal of pain and symptom management
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J Pain Symptom Manage · Sep 2012
ReviewEmpirical review supporting the application of the "pain assessment as a social transaction" model in pediatrics.
Despite decades of research, national mandates, and widespread implementation of guidelines, recent reports suggest that the quality of pain assessment and management in hospitalized children remains suboptimal. The mismatch between what is advocated and what is done in practice has led experts to argue for a conceptual shift in thinking, where the pain assessment process is viewed from a complex social communication or transaction framework. This article examines the empirical evidence from the recent pediatric pain assessment and decision-making literature that supports adaptation of Schiavenato and Craig's "Pain Assessment as a Social Transaction" model in explaining pediatric acute pain management decisions. ⋯ Gaps in knowledge related to nurses' clinical pain management decisions are identified, and the importance of children's and parents' preferences and roles and the influence of risks and adverse events on decision making are identified. This review highlights the complexity of pediatric nurses' pain management decisions toward the clinical goal of improving comfort while minimizing risk. Further study evaluating the propositions related to nurses' decisions to intervene is needed in pediatric clinical settings to better synthesize this model for children.
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J Pain Symptom Manage · Sep 2012
Review Meta AnalysisThe experiences of relatives with the practice of palliative sedation: a systematic review.
Guidelines about palliative sedation typically include recommendations to protect the well-being of relatives. ⋯ Relatives' experiences with palliative sedation are mainly studied from the perspective of proxies, mostly professional caregivers. The majority of relatives seems to be comfortable with the use of palliative sedation; however, they may experience substantial distress by the use of sedation.
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J Pain Symptom Manage · Sep 2012
Dignity in end-of-life care: results of a national survey of U.S. physicians.
Debates persist about the relevance of "dignity" as an ethical concept in U.S. health care, especially in end-of-life care. ⋯ U.S. physicians view the concept of dignity as useful. Those views are associated with their judgments about common end-of-life scenarios in which dignity concepts may be relevant.
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J Pain Symptom Manage · Sep 2012
Decision making and outcomes of a hospice patient hospitalized with a hip fracture.
Hospice patients are at risk for falls and hip fracture with little clinical information to guide clinical decision making. ⋯ Despite being on hospice services, the majority underwent surgery with improved survival. Sixty-six percent of all individuals on hospice at the time of the fracture died in the first six months, with the majority returning to hospice services.