The overall aim of this doctoral research was to study competitive and high performance endurance athletes’ experiences and management of exercise-induced pain (EIP), mental performance (i.e., self-regulation, mindfulness), mental health, and mental illness symptoms. A mixed methods experimental design guided by the pragmatic stance was employed across three studies to (a) investigate how elite endurance athletes experience and manage EIP (Study 1), (b) compare the effectiveness of an online self-regulation and mindfulness intervention in improving EIP catastrophizing, mental performance (i.e., self-regulation, mindfulness), mental health, and mental illness symptoms in middle-distance runners (Study 2), and (c) qualitatively examine the impact of the online intervention focusing on self-regulation or mindfulness and designed to help endurance athletes improve EIP management, mental performance (i.e., self-regulation and mindfulness), and mental health (Study 3). Study 1. With a paucity of research investigating EIP management in elite endurance sports, the purpose of Study 1 was to examine how elite endurance athletes experience and manage EIP, using an applied self-regulation lens to help inform the work of Mental Performance Consultants (MPCs). Individual semi-structured interviews were conducted with 12 female and 3 male athletes (Mage = 23.73, SD = 2.31) competing in track and field (i.e., 600-1500 m; n = 5), swimming (i.e., 200-400 m; n = 5), and canoe kayak (i.e., 500-1000 m; n = 5). Given the centrality of self-regulation and the necessity to effectively manage internal states (e.g., EIP) in elite sport, the social cognitive model of self-regulation was employed to guide Study 1. The codebook thematic analysis generated two themes and six subthemes (i.e., sensations [burning, tightness, heaviness], beliefs [detrimental, mental, progressive]) related to the experience of EIP as well as three themes and 17 subthemes (i.e., preparation [accept and commit to EIP, recall sources of self-efficacy, develop a segmented performance plan, be accountable to training partners or coach, expose yourself to EIP when training, expose yourself to EIP when warming up, use imagery, implement typical pre-performance routine; execution [direct attention away from EIP, use instructional/motivational self-talk, implement a segmented performance plan, regulate breathing and relax, accelerate pace, self-monitor]; evaluation [reflect using a training journal, identify possible explanations, talk with a coach]) related to the management of EIP. Findings suggest that the experience of EIP is highly cognitive and generally perceived as detrimental to performance if not effectively managed. Athletes used several psychological strategies to prepare to experience EIP, reduce the aversive effects of EIP while performing, and learn from their EIP management strategies to improve their coping capacity. In terms of the number of reported psychological strategies, findings suggest that those used to prepare to experience EIP seem to be a priority. In general, the most popular strategies pertained to accepting and committing to experiencing EIP and directing attention away from EIP. Novel strategies not typically reported in the literature included exposing oneself to EIP when warming up, being accountable to training partners or coaches, using imagery to rehearse reactions to EIP, and accelerating one’s pace. Importantly, combining self-regulation and mindfulness strategies appears to be key to effectively manage EIP. Study 2. No research has compared the impact of online sport psychology interventions on various outcomes affecting endurance athletes while employing an active control group. The purpose of Study 2 was therefore to compare the effectiveness of an online self-regulation and mindfulness intervention in improving EIP catastrophizing, mental performance (i.e., self-regulation, mindfulness), mental health, and mental illness symptoms in middle-distance runners. Using a pre-post experimental design, 61 middle-distance runners competing at provincial to international levels were allocated to either a self-regulation, mindfulness, or active control group using stratified randomization. They completed a pre-intervention survey measuring EIP catastrophizing, mental performance (i.e., self-regulation capacity, dispositional mindfulness), mental health, and mental illness symptoms (i.e., anxiety, depression, and eating disorder). A final sample of 52 participants (i.e., 17 self-regulation, 19 mindfulness, and 16 active control) completed the interventions and a post-intervention survey measuring the same outcomes addressed in the pre-intervention survey. Contrary to hypotheses, results from multiple mixed ANOVAs indicated that while mean scores trended in the positive direction between Time 1 and Time 2, the self-regulation and mindfulness interventions did not significantly differ from the active control intervention on the targeted outcomes. Interestingly, when excluding athletes who screened positive for mental illness symptoms (i.e., anxiety, depression, and/or eating disorder), the active control intervention was more effective in reducing anxiety symptoms than the mindfulness intervention. Overall, the self-regulation and mindfulness interventions were not any more effective than the active control intervention in improving the selected outcomes. Study 3. The purpose of this study was to qualitatively examine the impact of the online sport psychology intervention from Study 2, which focused on either self-regulation or mindfulness and was designed to help endurance athletes improve EIP management, mental performance (i.e., self-regulation, mindfulness), and mental health. A sample of 16 middle-distance runners (i.e., 11 women and 5 men) aged between 18 to 25 years old (Mage = 21.31, SD = 2.18) who participated in the eight-module SI or MI were purposefully selected based on their high, moderate, and low pre-post evolution scores. The codebook thematic analysis generated three themes and 13 subthemes (i.e., EIP management [reframing, understanding, self-talk, segmented performance plan]; mental performance [attention regulation, motivation, self-monitoring, self-efficacy, acceptance, defusion]; mental health [self-compassion, autonomy, support]) related to the participants’ perceived changes as well as three themes and seven subthemes (i.e., delivery format [asynchronous, synchronous], content [applicability, audio and video files, examples, metaphors], timing [alignment with competitive season]) related to participants’ recommendations. Findings suggest that both the self-regulation and mindfulness intervention positively impacted EIP management, mental performance, and mental health. Self-regulation and mindfulness should therefore be seen as complementary rather than conflicting or incompatible approaches. Furthermore, athletes reported that their EIP literacy and EIP management skills were limited at the onset of the intervention. Consequently, an educational component should continue to be integrated in future interventions to provide an overview of EIP and relevant mental performance skills to manage it. Given the prevalence of stressors and mental health challenges in competitive and high performance sport, screening for both positive mental health and mental illness symptoms at the onset of interventions is recommended so that athletes partaking in applied sport psychology studies can obtain appropriate mental health care and support as needed. Lastly, a hybrid delivery format incorporating both asynchronous and synchronous options may be the most effective when providing online sport psychology interventions. Overall, the findings of the current doctoral research suggest that both self-regulation and mindfulness strategies positively impact EIP management, mental performance, and mental health in endurance athletes. This inquiry is also the first to quantitatively and qualitatively compare the effectiveness of an online asynchronous self-regulation and mindfulness intervention in improving key outcomes affecting endurance athletes. With increased applied research and mental performance consulting occurring virtually due to the COVID-19 pandemic, it is vital to continue examining the quality and impact of online interventions on athletes.

Bakgrund: En av de vanligaste orsakerna till att patienter söker kontakt med hälso- och sjukvård är smärta. Smärta är en individuell och subjektiv upplevelse och definieras internationellt som en obehaglig sensorisk och emotionell upplevelse associerad med faktisk och potentiell vävnadsskada, eller beskriven i termer av sådan skada. Icke-farmakologiska smärtlindring definieras genom terapi som inte involverar intag av medicin eller andra aktiva substanser. Det råder brist på information kring förekomsten av icke-farmakologisk smärtlindring prehospitalt. Specialistsjuksköterskans upplevelser av användandet av icke-farmakologisk smärtlindring prehospitalt kan bidra till att skapa nya perspektiv och kunskaper inom området.  Syfte: Syftet var att beskriva specialistsjuksköterskors erfarenheter av att använda icke-farmakologisk smärtlindring prehospitalt. Metod: Datainsamlingen genomfördes genom semistrukturerade intervjuer. Insamlade data analyserades med kvalitativ innehållsanalys. Totalt intervjuades nio specialistsjuksköterskor som arbetade kliniskt inom ambulanssjukvård. Resultat: Analysen resulterade i tre kategorier med subkategorier; professionellt bemötande, metoder och tekniker samt utmaningar med icke-farmakologisk smärtlindring.  Slutsats: Den här studien visar att specialistsjuksköterskor inom ambulanssjukvård har olika erfarenheter och upplevelser av att använda icke-farmakologisk smärtlindring prehospitalt. Resultaten visar att ett professionellt bemötande och metoder, tekniker och åtgärder lindrar smärta men också att det finns utmaningar i att använda sig av icke-farmakologisk smärtlindring. Några slutsatser är att det krävs mer utbildning och forskning inom området icke-farmakologisk smärtlindring, samt ökad implementering i lokala behandlingsriktlinjer. En annan slutsats är att icke-farmakologisk smärtlindring redan används av många, om än omedvetet. / Background: Pain counts as one of the most common reasons as to why patients contact their healthcare providers in the first place. While pain constitutes an individual and subjective experience, it is defined internationally as an unpleasant sensory and emotional experience, in turn associated with actual and potential tissue damage, or described in terms of such damage. Non-pharmacological pain management constitutes forms of therapy that do not involve the administration of drugs or other active substances. There is a lack of information on the prevalence of prehospital non-pharmacological pain management. Specialist nurses’ experiences of the use of prehospital non-pharmacological pain management, can contribute to the creation of new perspectives and knowledge in the field. Aim: The aim of the study was to describe specialist nurses’ experiences of using prehospital non-pharmacological pain management. Method: Data was collected through semi-structured interviews. The collected data was then analysed, using a qualitative content analysis method. A total of nine specialist nurses, all of whom worked clinically in ambulance care, were interviewed. Results: The analysis resulted in three categories with subcategories; meeting professionalism, methods and techniques, and challenges with non-pharmacological pain management. Conclusion: This study shows that specialist nurses in ambulance care have different types of experiences and premediated knowledge of using non-pharmacological pain management methods prehospitally. The results show that a professional approach towards the administration of different methods, techniques and measures relieve pain, but also that there are challenges stemming from the use of non-pharmacological pain management methods. Consequently, an increase in both research and education is needed within the field of non-pharmacological pain management, as well as an increased implementation of local treatment guidelines. Furthermore, it can be concluded that non-pharmacological pain management methods are already being used by many healthcare providers, albeit subconsciously.

No description available.

Background: Opioids are often used in nursing homes to manage non-malignant pain, but little is known about their long-term use, initiation, and comparative safety. Methods: We used the Minimum Data Set 3.0 from 2011-2013 merged to Medicare and facility characteristics data to study opioid use and safety among older, long-stay residents. The specific aims were to examine the 1) prevalence of long-term opioid use; 2) geographic variation in the initiation of commonly used opioids (oxycodone, hydrocodone, tramadol); and 3) comparative safety of commonly used opioids and fracture hospitalizations. Results: One in seven long-stay residents were prescribed opioids long-term. There was extensive geographic variation in the initiation of commonly used opioids, with oxycodone (9.4%) initiated less frequently than hydrocodone (56.2%) or tramadol (34.5%) but varying most extensively across the United States, with the majority of variation in prescribing explained by state of residence. Compared to hydrocodone initiators (7.9 fracture hospitalizations per 100-person years), those initiating tramadol had lower rates of fracture hospitalizations (subdistribution hazard ratio [HRSD] = 0.67, 95% Confidence Interval [CI]: 0.56-0.80), whereas oxycodone initiators had similar rates of fracture hospitalizations (HRSD=1.08, 95% CI: 0.79-1.48). Conclusion: The prevalence of long-term opioid use was twice as common in nursing homes as community settings, with initiation patterns varying extensively by region and being strongly driven by state of residence. Although initiating tramadol was associated with lower rates of fractures than hydrocodone, questions on opioid risks and benefits remain and are especially pertinent given the high mortality rates in this population.

Syfte: Att belysa patienters upplevelser av att leva med långvarig smärta. Bakgrund: Smärta är den vanligaste orsaken till att personer söker vård. Det är ett tillstånd som är kopplat till låg livskvalité och det är vanligt att vuxna individer lever med smärta under en längre tid. Det påverkar alla delar av en fungerande hälsorelaterad vardag. Metod: Litteraturstudien har genomförts baserat på åtta kvalitativa vetenskapliga artiklar. De inkluderade artiklarna hittades på PubMed och CINAHL. Dessa har kvalitetgranskats, analyserats och slutligen sammanställts. Resultat: Analysen resulterade i tre kategorier och åtta tillhörande underkategorier. Kategorierna är följande: Försämrad livskvalitet, Strategier för att hantera smärtan och Viktigt med stöd från omgivningen. Konklusion: Att leva med långvarig smärta bidrar till en försämrad livsvalité. Egna strategier behövs för att hantera smärtan, men det är också viktigt med stöd från omgivning och sjukvård. Litteraturstudien har betydelse för sjuksköterskan genom att öka förståelse för patienters uppleveser och därigenom också möjlighet att förbättra omvårdnaden. / Aim: The aim of this study was to describe patients´ experiences of living with chronic pain. Background: Pain is the most common cause of people seeking care. It is a condition that is linked to low quality of life and it is common for adult individuals to suffer with pain for a long period of time. It affects all parts of a functioning health-related daily life. Methods: A literature study was conducted, based on eight qualitative scientific articles. The included articles were found on PubMed and CINAHL. These have been reviewed regarding quality, analyzed and finally complied. Result: The analysis resulted in three categories and eight associated subcategories. The categories that were formed were: Deteriorated quality of life, Strategies to manage pain and Support from others is important. Conclusion: Living with chronic pain contributes to a deteriorating quality of life. Own strategies are needed to manage the pain, but support from the surrounding and healthcare is also important. This literature study may have importance for nurses to increase the understanding of patient's experiences and consequently also the opportunity to improve their care.

Background: In light of the opioid epidemic, reducing excess prescription quantities while tailoring to patient need is key. We previously created an opioid prescribing guideline using retrospective institutional data to satisfy the majority of patients’ opioid needs following inpatient colorectal surgery. Objective: This study sought to prospectively validate an institutional prescribing guideline based on previously-defined opioid consumption patterns following inpatient colorectal operations. Methods: We carried out a cohort study comparing opioid prescribing and consumption patterns before (7/18 – 1/19) and after (9/19 – 2/20) adoption of a tiered opioid prescribing guideline for inpatient elective colorectal operations (colectomies, proctectomies, and ostomy reversals) at a single tertiary care medical center. Opioid use was quantified as Equianalgesic 5mg Oxycodone Pills (EOP), and patients were grouped in three tiers based on opioid consumption in the 24-hours prior to discharge: Tier 1 (0 EOP), Tier 2 (0.1-3 EOP), and Tier 3 (>3 EOP). Our guideline recommended maximum prescriptions of 0 EOP for Tier 1, 12 EOP for Tier 2, and 30 EOP for Tier 3. Results: The study included 100 patients before and 101 after guideline adoption. Demographic and operative variables were similar before and after guideline adoption. Guideline adherence was 85%. Overall, there was a 41% reduction in mean prescription quantity and 53% reduction in excess pills per prescription with no change in opioid consumption or refill rates. Conclusion: Adoption of a tiered opioid prescribing guideline significantly reduced opioid prescription quantity with no change in consumption or refill rates. Standardization of discharge prescriptions based on patient consumption in the 24 hours prior to discharge may be an important step towards minimizing excess prescribing.

Att omhänderta patienter med akuta smärtor kan vara en utmaning för sjuksköterskor då detta ställer krav på god kunskap och förståelse över det individuella behovet av smärtlindring. För att säkerställa en god smärtlindring behöver sjuksköterskor ta hänsyn till patientens subjektiva upplevelse av smärta jämsides med vitalparametrar och allmänt hälsotillstånd. Syftet var att beskriva patienters upplevelse av smärtlindring vid akuta smärtor inom prehospital akutsjukvård. Metoden som användes följer en litteraturöversikt med systematisk ansats. Litteraturöversikten innehåller både kvalitativa och kvantitativa artiklar från databaserna PubMed och CINAHL. Totalt har 9 vetenskapliga artiklar inkluderats och analyserats utifrån en integrerad innehållsanalys. I resultatet framkom två huvudkategorier utifrån fyra underkategorier. De två huvudkategorierna benämndes; att bli sedd som patient och att få smärtlindring. Underkategorierna var; vikten av kommunikation, känsla av delaktighet, rädsla för läkemedelsbiverkan och svårigheter att förstå smärtbedömning. Patienterna uttryckte att delaktighet i form av att bli sedd och bekräftad samt involverad i sin vård och behandling främjade upplevelsen av smärtlindring. När sjuksköterskan såg till hela patienten, inte enbart behandlade de fysiska symtomen utan även tog hänsyn till den känslomässiga delen upplevde patienterna trygghet och tillit. Icke farmakologiska åtgärder såsom trygghet, positionering och såromläggningar kunde användas som alternativ till smärtlindring. Slutsatsen var att patienterna uttryckte att en lyckad smärtlindring bland annat innefattade delaktighet och ömsesidig kommunikation mellan patient och sjuksköterska. Genom att ta hänsyn till patienters upplevelse av akuta smärtor samt de känslomässiga aspekterna vid akuta smärtor kunde hälsa och välbefinnande främjas. / Caring for patients with acute pain can be a challenge for nurses as this requires good knowledge and understanding of the individual need for pain relief. To perform good pain relief, nurses need to take into consideration the patients' subjective experience of pain alongside vital parameters and general health. The aim was to describe patients' experience of pain relief for acute pain in prehospital emergency care. The method used follows a literature review with systematic approaches. The literature review contains both qualitative and quantitative articles from the databases PubMed and CINAHL. A total of 9 scientific articles have been included and analyzed based on an integrated content analysis. The results revealed two main categories of which four subcategories. The two main categories were: to be seen as a patient and to receive pain relief. The subcategories were: the importance of communication, sense of participation, fear of medication side effects and difficulty understanding pain assessment. The patients expressed that participation in the form of being seen and confirmed and involved in their own care and treatment promoted the experience of pain relief. When the nurse looked at the whole patient, not only treating the physical symptoms but also took into consideration the emotional part, the patients experienced safety and trust. Non-pharmacological measures such as safety, positioning and wound dressings could be used as alternatives to pain relief. The conclusion was that the patients expressed that successful pain relief includes, among other things, participation and mutual communication between patient and nurse. By taking into consideration the patients' experience of acute pain and the emotional aspects of acute pain, health and well-being could be promoted.

Trigeminal neuralgia is a painful neuralgia with a complicated pathology that is not clearly understood. Due to the ambiguity of the condition, patients often have to search for medical providers that specialize in trigeminal neuralgia, and even with the guidance of a specialist, some patients do not respond well to treatment.1 Despite the uncertainty surrounding the specifics of the disease, there are treatments available that can provide some level of pain relief for patients suffering from this disorder. When a patient does not respond well to medical therapy, surgery can be the next appropriate step in patient care management.2 However, while surgery can provide significant pain relief for patients who qualify, non-surgical treatments are needed during the interim, in the event of relapse, or for individuals who do not qualify for surgery. Cognitive behavioral therapy (CBT) is a well-researched treatment for chronic pain resulting from various diseases and disabilities.3 A systematic literature review was performed to identify if CBT decreases pain and improves the quality of life for patients diagnosed with classical, secondary, or idiopathic trigeminal neuralgia. More research is needed, but there is promising evidence in the literature that cognitive behavioral therapy can be useful for patients with trigeminal neuralgia to help them cope with their pain. In addition, there may be evidence that, while somewhat effective alone, cognitive behavioral therapy may be more effective in conjunction with another treatment such as medication. These results are encouraging for patients suffering with the chronic pain of trigeminal neuralgia, and future studies should further investigate the benefits of cognitive behavioral therapy for patients with trigeminal neuralgia.

Trots likartade operativa ingrepp upplever vi att det kan skilja mycket mellan behovet av smärtlindring postoperativt. Kanske erhåller patienten otillräcklig preoperativ information vilket skulle kunna resultera i onödig oro, som i sin tur kan påverka den postoperativa smärtupplevelsen. Målsättningen med den postoperativa smärtbehandlingen bör vara att förebygga smärtan snarare än att lindra den. Det är viktigt att förhindra att postoperativ smärta uppstår överhuvudtaget vilket medför minskad risk för uppkomst av kroniska smärtsyndrom. En förberedd och välinformerad patient kan hantera den postoperativa situationen bättre. Syftet med litteraturstudien var att undersöka forskning om sambandet mellan preoperativ information till patienten och patientens upplevelse av postoperativ smärta. Sammanställningen av 10 vetenskapliga och kvalitetsgranskade artiklar resulterade i en analys där fem olika kategorier kunde urskiljas. Resultatet visade att preoperativ information ledde till minskad postoperativ smärta men andra vinster kunde också identifieras. Andra vinster var minskad oro, ökad rörlighet och en känsla av bättre preoperativ förberedelse. Vid snabbare mobilisering sågs ett samband med tidigare hemgång. Inför utskrivning efterfrågades mer information för att hantera smärta och eventuella komplikationer. Dessutom visade resultatet att patienten önskade mer information om vem som skulle kontaktas vid eventuella frågor eller komplikationer. I takt med att ett förändrat informationssamhälle utvecklas, kommer sannolikt nya informationsmetoder att behövas. / Despite similar surgical procedures, it is our experience that it may differ greatly between the need for postoperative pain relief. Perhaps the patients receive inadequate preoperative information, which could result in unnecessary anxiety, which in turn may affect the postoperative pain experience. The aim of the postoperative pain treatment should be to prevent the pain rather than alleviating it. It is important to prevent postoperative pain in general, result in reduced occurrence of chronic pain syndromes. A well prepared and informed patient can manage the postoperative situation better. The aim of this study was to examine research on the relationship between preoperative patient information and patient experience of postoperative pain. The compilation of 10 scientific and peer-reviewed articles resulted in an analysis in which five different categories could be discerned. The results showed that preoperative education led to reduced postoperative pain, but other gains were also identified. Other benefits were reduced anxiety, increased mobility and a sense of being better preoperative prepared. The rapid mobilization was associated with earlier discharge. Before leaving hospital, patients requested more information to manage pain and possible complications. In addition, results showed that the patient wanted more information about who should be contacted with any questions or complications. As a changing information society develops, new methods of information will likely be needed in practice.

Intresset för komplementära smärtlindringsmetoder växer, både hos sjukvårdspersonal och hos patienter. Idag finns det en stark trend mot mer skonsamma alternativa behandlingsmetoder, framförallt vid kroniska sjukdomar där allvarliga biverkningar av konventionell läkemedelsterapi är stor. Syftet med studien var att undersöka vilka smärtlindringsmetoder som sjuksköterskan kan använda sig av inom palliativ vård och dess effekter. Studien bygger på elva vetenskapliga artiklar. Resultatet gav flera olika behandlingsmetoder som kategoriserades under tre rubriker: distansbehandlingar, manuella behandlingar samt fysikaliska behandlingar. Samtliga behandlingsmetoder kan utövas av sjuksköterskan. Komplementära metoder behövs för att på bästa sätt kunna möta patienten på både det fysiska, psykologiska, sociala och existentiella planet behövs. De presenterade komplementära metoderna har visat sig ofarliga och kan även vara kostnadseffektiva om de används rätt. / The interest for complementary methods for pain relief is increasing among professionals as well as patients. Today, there is a strong trend towards more merciful complementary therapies, above all at chronical diseases where serious adverse effects from conventional medical therapy are substantial. The purpose with the study is to investigate which complementary pain relieving methods a nurse can use within palliative care and also the effects of the treatments. The study consisted of eleven scientific articles. Several different treatment methods were categorized into three main headings: distant treatments, manual treatments and physical treatments. All of these methods of treatment can be used by the nurse. Complementary methods are needed in the treatment of palliative patients in order to meet he patient in both the physical, psychological, social and existential level. The complementary methods that has been presented are safe to use and they also have the potential to be cost effective if implemented correctly.