Pain management nursing : official journal of the American Society of Pain Management Nurses
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Observational Study
Description of behaviors in nonverbal critically ill patients with a traumatic brain injury when exposed to common procedures in the intensive care unit: a pilot study.
Behavioral indicators are strongly recommended for pain assessment in nonverbal patients. Although pain-related behaviors have been studied in critically ill patients, those with a traumatic brain injury (TBI) have been either excluded or underrepresented. Because these patients also likely experience pain, research is urgently needed to generate knowledge in this field. ⋯ After educational training and using videos, the average percentage of agreement for observed behaviors between two trained research assistants was 96%. Pain in critically ill TBI patients can be detrimental to health and recovery. ICU clinicians should be aware of pain-related behaviors to enable better detection and treatment in this highly vulnerable group.
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Children continue to experience moderate to severe pain during hospitalization. This paper presents data from two modified focus groups undertaken as part of a larger study exploring pediatric pain management practices in one hospital in the south of England. Thirty nurses took part in the focus groups and were asked questions about their views about the barriers and facilitators to effective pain management in the hospital. ⋯ It appears that nurses may not take as active a role as they could do in managing pediatric pain rather seeing it as the parents and child's responsibility to let them know when they are experiencing pain. Nurses also felt that parents exaggerate their child's pain and ask for analgesic drugs before their child needs them. There is a need to explore the interactions between nurses, children and parents in this context in more detail.
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The population of individuals with severe and profound intellectual disabilities (ID) is extremely heterogeneous, and the unique pain-related behaviors of each individual might not be satisfactorily captured using a standardized checklist such as the Noncommunicating Children's Pain Checklist or the Revised Faces, Legs, Arms, Cry, and Consolability tools. There has been increasing appreciation of the importance of recognizing the idiosyncratic pain behaviors of these individuals. The investigators developed a tool, the Tailored Observational Pain Screen (TOPS), to facilitate recognition of pain in the individual who lacks verbal communication, based on caregivers' descriptions of the individual's unique pain-related behaviors. ⋯ The participants were the primary caregivers of 13 children with severe or profound ID and ongoing pain issues who were interviewed after they had used the TOPS for 6 weeks. The investigators identified themes from the interviews, including: using the TOPS to recognize and evaluate pain; using the TOPS to facilitate communication; limitations of the TOPS; and recommendations for its improvement. For clinical purposes, the TOPS shows promise as a tool for helping caregivers to share with others the ways that pain of these children can be detected.
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Patient-controlled oral analgesia (PCOA) allows patients to self-administer oral opioids for pain management. Advantages of PCOA include improved pain control with lower doses of opioids, decreased length of stay, increased patient satisfaction, and better functional outcomes than conventional nurse-administered oral analgesia. Sucessful PCOA programs are well described in the literature. ⋯ These findings were consistent with literature discussing patients' outcomes regarding PCOA. However, after education and experience these concerns decreased or resolved. It is important to address these concerns before PCOA program implementation.
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Chronic noncancer pain (CNCP) is a common and complex disorder associated with declines in physical health and functional status, emotional well-being, and quality of life. To best address the complexity of this condition, research and clinical practice for CNCP should be guided by a framework incorporating both biologic and psychologic factors. This article presents a biobehavioral model of chronic pain that hypothesizes mechanisms related to the effectiveness of a complementary therapy, guided imagery (GI), for this population. ⋯ A biobehavioral approach to nursing phenomena will advance understanding of health and health-related issues and has the potential to improve outcomes through delineation of mechanisms underlying relationships between psychologic and biologic factors. Increased consumer use of complementary therapies to treat pain, the current cost-driven health care system, and the mandate for evidence-based practice support the need to validate the efficacy of such therapies. This empirically derived model provides a framework for practice and research for nurses and other health care providers to promote health, function, and well-being in persons with CNCP.