A dor é um evento estressante para crianças e adolescentes e pode ter consequências negativas fisiológicas, psicológicas e comportamentais ainda mais quando é acompanhada por uma doença crônica, sem possibilidades de cura. Nesse sentido, o Cuidado Paliativo Pediátrico é uma filosofia de cuidado que deve ser instituída desde o diagnóstico da doença até que esta não responda mais às intervenções curativas. Assim, o foco do cuidado passa a ser a maximização da qualidade de vida que a criança e o adolescente e seus familiares necessitam, enquanto o sofrimento e a dor são minimizados. Considerando-se o caráter único da experiência de dor da criança e do adolescente, em cuidados paliativos, optou-se por desenvolver um estudo com abordagem qualitativa. Utilizamos como referencial teórico a Teoria de Desenvolvimento Cognitivo de Piaget e, como referencial metodológico, a História Oral. Tais referenciais são fundamentais para ancorar os resultados encontrados neste estudo e responder ao objetivo geral de conhecer a experiência da criança e do adolescente em cuidados paliativos no manejo diário da dor e aos objetivos específicos de conhecer como a criança e o adolescente em cuidados paliativos descrevem a intensidade, a qualidade e a localização da dor e de conhecer como a criança e o adolescente em cuidados paliativos manejam a dor em seu cotidiano. Permitem, igualmente, que crianças e adolescentes, de 6 a 17 anos 11 meses e 29 dias, portadores de uma doença crônica que causava dor e que estavam em cuidados paliativos e matriculados em um Ambulatório de Dor e Cuidados Paliativos de um Hospital Escola Pediátrico de caráter público de nível terciário tenham voz. Crianças em idade escolar descreveram sua dor a partir de componentes sensoriais e avaliativos. Os adolescentes, por outro lado, expressaram sua dor utilizando componentes sensoriais, avaliativos, afetivos e de miscelânea. Dos seis colaboradores deste estudo, cinco ainda frequentam a escola e relacionam-se com crianças e adolescentes da mesma faixa etária. Todos os colaboradores fazem uso de medicamentos e de alternativas não farmacológicas para o alívio da dor, como massagem, hidroterapia, acupuntura e crioterapia, constatando melhora em sua dor. Alguns colaboradores precisam lidar com sua aparência física prejudicada pela doença. Apesar da dificuldade de se entrevistar crianças e adolescentes, percebemos que eles têm muito a dizer e a nos ensinar, principalmente como eles lidam com a dor em seu cotidiano. Este trabalho é importante para que os profissionais de saúde compreendam que, com um adequado manejo da dor, crianças e adolescentes conseguem ter uma vida mais próxima da normalidade, reduzindo seu sofrimento. / Pain is a stressful event for children and adolescents and can have negative consequences - physiological, psychological and behavioral ones even more when it is accompanied by a chronic disease with no possibility of cure. In this context, the Pediatric Palliative Care is a philosophy of care that must be instituted from the diagnosis until the illness no longer responds to curative interventions. Therefore, the focus of care is to provide the highest quality of life possible to children and adolescents and their families while minimizing suffering and pain. Considering the uniqueness of the experience of pain in children and adolescents in palliative care, we chose to develop a qualitative study. We used the Theory of Cognitive Development Piaget as theoretical framework and the Oral History as the methodological one. Such references are essential to support the results found in this study and to address the overall objective of knowing the experience of the child and adolescent in palliative care for the daily management of pain as well as the specific goals of knowing how the children and adolescents in palliative care describe the intensity, quality and location of pain and of knowing how children and adolescents in palliative manage pain in their daily lives. Moreover, these frameworks allow that children and adolescents (from 6 to 17 years 11 months and 29 days), suffering from a chronic disease that caused pain and in palliative care and who were enrolled in an Outpatient Pain and Palliative Care of a public tertiary Pediatric Teaching Hospital character, have a voice. School children described their pain using sensory and evaluative components. Teenagers, on the other hand, expressed their pain using sensory, evaluative, affective and miscellaneous ones. Of the six collaborators to this study, five are still in school and relate to children and adolescents of the same age. All collaborators use drugs and non-pharmacological alternatives for pain relief such as massage, hydrotherapy, acupuncture and cryotherapy, reporting improvement in their pain. Some collaborators need to deal with their physical appearance which is affected by the disease. Despite the difficulty of interviewing children and teenagers, we have realized that they have a lot to say and to teach us, especially with regard to how they deal with pain in their daily lives. The present work is important for health professionals to understand that, with adequate pain management, children and adolescents can live a life as normal as possible, thus reducing their suffering.

Trata-se de um ensaio clínico com três Grupos. Avaliaram-se os efeitos da intervenção \"Treinamento, Avaliação e Registro Sistematizado de Dor\" sobre a intensidade da dor, o consumo suplementar de morfina, o tratamento de efeitos colaterais e a satisfação com a analgesia dos doentes, no pós-operatório de cirurgia cardíaca. Foram estudados 182 doentes, no Grupo I (GI, N=55), Grupo II (GII, N=66) e Grupo III (GIII, N=61). Todos receberam a mesma orientação pré-operatória e submeteram-se ao mesmo protocolo medicamentoso para o controle de dor e dos efeitos colaterais. No GI a equipe de enfermagem não recebeu Treinamento e realizou a avaliação da dor conforme rotina da instituição. Nos GII e GIII toda a equipe de enfermagem participou do Curso de Capacitação Sobre a Dor e Seu Controle (Treinamento). No GII a equipe de enfermagem utilizou a Ficha Sistematizada sobre Dor e seu Controle, a cada duas horas. No GIII a equipe de enfermagem não utilizou esta Ficha. Os doentes dos três Grupos também foram avaliados pela pesquisadora nas primeiras 30 horas, a cada 6 horas (6 Momentos). Os resultados foram analisados pelos testes de Kruskal-Wallis, Dunn, Friedman, Qui-quadrado e Verossimilhança. O nível de significância adotado foi de 5%. Os Grupos foram semelhantes quanto à idade, sexo, escolaridade, tipo de cirurgia, tipo de dreno e estado físico. A dor ao repouso e à tosse foi menos intensa no GII. Ao repouso observou-se diferença no Momento 2 (p=0,012) e à tosse, nos Momentos 2, 3, 4 e 6 (p=0,021, p=0,005, p=0,048 e p=0,001, respectivamente). Na dor à inspiração profunda não houve diferença intergrupos. No GII observou-se maior uso de morfina suplementar (p=0,002), maior número de doentes recebendo morfina (p=0,002) e maior média na relação dose de morfina/doente (p=0,022). O GI foi o que menos recebeu antiemético (p=0,019, Momento 2) mas teve a maior ocorrência de náusea e vômito (p=0,032, Momento 6). Prurido ocorreu somente uma vez e não houve depressão respiratória. A satisfação com a analgesia foi mais elevada no GII nos Momentos 2 e 3 (p=0,001 e p=0,012). O Treinamento associado à Ficha Sistematizada sobre a Dor e seu Controle incitou os enfermeiros a intervirem mais vezes para o ajuste da analgesia, melhorou o controle da dor e a satisfação dos doentes com a analgesia. Mostrou-se a melhor opção para o controle da dor no pós-operatório de cirurgia cardíaca / This paper reports on a clinical trial with three Groups. The effects of the intervention \"Training, Assessment and Registration of Pain\" on pain intensity, supplementary consumption of morphine, treatment of side effects, and satisfaction with analgesia among patients in post-operative cardiac surgery. The sample were studied 182 patients, in Group I (GI, N=55), Group II (GII, N=66) and Group III (GIII, N=61). All received the same pre-operative guidelines and submitted themselves to the same medication protocol for the control of pain and its side effects. In GI, the nursing team did not receive the Training, and carried out the pain assessment according to the routine practice of the institution. In GII and GIII, all the nursing team took part in the Curso de Capacitação Sobre a Dor e Seu Controle (Training Course on Pain and its Control). In GII the nursing team used the Ficha Sistematizada sobre Dor e seu Controle (Systematized Record of Pain and its Control) every two hours. In GIII the nursing team did not use this Record. The patients in the three Groups were assessed by the researcher every 6 hours, for the first 30 hours (6 separate moments). The results were analyzed by the Kruskal-Wallis, Dunn, Friedman, Qui-quadrado and Verossimilhança tests. The level of significance adopted was 5%. The Groups were similar, in terms of age, sex, level of education, type of surgery, type of drainage and physical state. The pain in rest and when coughing were less intense in GII. For pain in rest, a difference was observed in Moment 2 (p=0.012) and when coughing, in Moments 2, 3, 4 and 6 (p=0.021, p=0.005, p=0.048 and p=0.001, respectively). For pain on deep inspiration, there was no difference between the groups. In GII, greater use of supplementary morphine was observed (p=0.002), with a higher number of patients receiving morphine (p=0.002), and a higher average ratio of morphine dose to patient (p=0.022). GI was the group which received the least antiemetic (p=0.019, Moment 2) but had the highest occurrence of nausea and vomiting (p=0,032, Moment 6). Pruritis occurred only once, and there was no respiratory depression. Satisfaction with the analgesia was higher in GII in Moments 2 and 3 (p=0.001 and p=0.012). The Training, together with the Systematized Record of Pain and its Control led the nurses to intervene more often in adjusting the analgesia, which improved the pain control and the satisfaction of the patients with the analgesia. This proved to be the best option for the control of post-operative pain following cardiac surgery

OBJECTIVES: Pain and its disruptive impact on daily life are common reasons that patients seek primary medical care. Pain contributes strongly to psychopathology, and pain and depressive symptoms are often comorbid in primary care patients. Not all those who experience pain develop depression, suggesting that the presence of individual-level characteristics, such as positive and negative affect, that may ameliorate or exacerbate this association. METHODS: We assessed the potential moderating role of positive and negative affect on the pain-depression linkage. In a sample of 101 rural, primary care patients, we administered the Brief Pain Inventory, NEO Personality Inventory-Revised positive and negative affect subclusters, and the Center for Epidemiology Scale for Depression. RESULTS: In moderation models, covarying age, sex, and ethnicity, we found that positive affect, but not negative affect, was a significant moderator of the relation between pain intensity and severity and depressive symptoms. DISCUSSION: The association between pain and depressive symptoms is attenuated when greater levels of positive affects are present. Therapeutic bolstering of positive affect in primary care patients experiencing pain may reduce the risk for depressive symptoms.

SYFTE: Syftet är att belysa patienternas upplevelse av läkemedelsfri smärtlindring med stöd av grindteorin. DESIGN: Litteraturstudie BAKGRUND: Kunskap om hur patienterna upplever läkemedelsfri smärtbehandling baserad på grindteorin, kan göra det lättare för den enskilda sjuksköterskan att fatta beslut om användande av dessa metoder. URVAL: Vetenskapliga artiklar med empiriska studier på vuxna publicerade mellan åren 2000-2012. METOD: Databassökningar och manuella sökningar RESULTAT: 14 studier med sammanlagt 1771 deltagarevisar att smärtlindringsmetoderna med stöd av grindteorin hade avsedd effekt på smärta. De gav även patienterna lindring vad avser oro och rädsla. Några av studierna tar även upp att patienterna fick en känsla av att själv kunna påverka smärtan. Metoderna som användes var såväl hudstimulerande, som kognitiva. SLUTSATS: Smärtlindring baserad på grindteorin, såväl hudstimulering som kognitiva metoder, är något som sjuksköterskan bör ha kunskap om och använda för att lindra smärta och oro/rädsla. Metoderna är även ett sätt att låta patienten känna sig delaktig, då speciellt de kognitiva metoderna. / PURPOSE: The aim is to illuminate the patients experience of non-pharmacological pain relief with support of the gate-control theory. DESIGN: Literature review/over-view BACKGROUND: Knowledge of how the patients experience non-pharmacological pain treatment based on the gate-control theory can make it easier for the individual nurse to make decisions on the use of these methods. SAMPLE: Scientific studies with empirical studies on adults, published in articles between 2000-2012 METHOD: Database- and manual searches FINDINGS: 14 studies with in total 1771 participants show that the pain relief methods with support of the gate-control theory had the intended effect on pain. They also gave the patients relief with regard to anxiety. Some of the studies also mention that the patients got a feeling of being able to affect the pain themselves. The methods used were skin-stimulating as well as cognitive. CONCLUSIONS: Pain relief based on the gate-control theory, skin-stimulating as well as cognitive methods, is something that the nurse should have knowledge about and use to relieve pain and anxiety. The methods are also a way of letting the patient feel involved, especially the cognitive methods.

The purpose of this study was to explore and describe the surgical nurses’ perceptions about the management of post-operative pain and strategies employed in management of pain in patients who have undergone total hip or knee replacement surgery in King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Qualitative, exploratory-descriptive research design was applied. Purposive nonprobability sampling was used and data collected by means of audio-recorded semistructured individual interviews. Data saturation was reached after interviewing twenty surgical nurses. Themes and categories emerged from adopting Creswell’s (2013) “data analysis spiral”. One of the key findings was that patients reportedly experience moderate to severe pain during the first three days after surgery, before it is controlled on mild to moderate levels or before the patient is pain free. Conclusions were drawn, and one of the major ones was that multimodal strategies are employed by the surgical to manage post-operative pain. Recommendations were also made from findings of this study, and one key recommendation was that expatriate nurses to have access to Arabic speakers to overcome language barriers. / Health Studies / M.A. (Health Studies)

Trata-se de um ensaio clínico com três Grupos. Avaliaram-se os efeitos da intervenção \"Treinamento, Avaliação e Registro Sistematizado de Dor\" sobre a intensidade da dor, o consumo suplementar de morfina, o tratamento de efeitos colaterais e a satisfação com a analgesia dos doentes, no pós-operatório de cirurgia cardíaca. Foram estudados 182 doentes, no Grupo I (GI, N=55), Grupo II (GII, N=66) e Grupo III (GIII, N=61). Todos receberam a mesma orientação pré-operatória e submeteram-se ao mesmo protocolo medicamentoso para o controle de dor e dos efeitos colaterais. No GI a equipe de enfermagem não recebeu Treinamento e realizou a avaliação da dor conforme rotina da instituição. Nos GII e GIII toda a equipe de enfermagem participou do Curso de Capacitação Sobre a Dor e Seu Controle (Treinamento). No GII a equipe de enfermagem utilizou a Ficha Sistematizada sobre Dor e seu Controle, a cada duas horas. No GIII a equipe de enfermagem não utilizou esta Ficha. Os doentes dos três Grupos também foram avaliados pela pesquisadora nas primeiras 30 horas, a cada 6 horas (6 Momentos). Os resultados foram analisados pelos testes de Kruskal-Wallis, Dunn, Friedman, Qui-quadrado e Verossimilhança. O nível de significância adotado foi de 5%. Os Grupos foram semelhantes quanto à idade, sexo, escolaridade, tipo de cirurgia, tipo de dreno e estado físico. A dor ao repouso e à tosse foi menos intensa no GII. Ao repouso observou-se diferença no Momento 2 (p=0,012) e à tosse, nos Momentos 2, 3, 4 e 6 (p=0,021, p=0,005, p=0,048 e p=0,001, respectivamente). Na dor à inspiração profunda não houve diferença intergrupos. No GII observou-se maior uso de morfina suplementar (p=0,002), maior número de doentes recebendo morfina (p=0,002) e maior média na relação dose de morfina/doente (p=0,022). O GI foi o que menos recebeu antiemético (p=0,019, Momento 2) mas teve a maior ocorrência de náusea e vômito (p=0,032, Momento 6). Prurido ocorreu somente uma vez e não houve depressão respiratória. A satisfação com a analgesia foi mais elevada no GII nos Momentos 2 e 3 (p=0,001 e p=0,012). O Treinamento associado à Ficha Sistematizada sobre a Dor e seu Controle incitou os enfermeiros a intervirem mais vezes para o ajuste da analgesia, melhorou o controle da dor e a satisfação dos doentes com a analgesia. Mostrou-se a melhor opção para o controle da dor no pós-operatório de cirurgia cardíaca / This paper reports on a clinical trial with three Groups. The effects of the intervention \"Training, Assessment and Registration of Pain\" on pain intensity, supplementary consumption of morphine, treatment of side effects, and satisfaction with analgesia among patients in post-operative cardiac surgery. The sample were studied 182 patients, in Group I (GI, N=55), Group II (GII, N=66) and Group III (GIII, N=61). All received the same pre-operative guidelines and submitted themselves to the same medication protocol for the control of pain and its side effects. In GI, the nursing team did not receive the Training, and carried out the pain assessment according to the routine practice of the institution. In GII and GIII, all the nursing team took part in the Curso de Capacitação Sobre a Dor e Seu Controle (Training Course on Pain and its Control). In GII the nursing team used the Ficha Sistematizada sobre Dor e seu Controle (Systematized Record of Pain and its Control) every two hours. In GIII the nursing team did not use this Record. The patients in the three Groups were assessed by the researcher every 6 hours, for the first 30 hours (6 separate moments). The results were analyzed by the Kruskal-Wallis, Dunn, Friedman, Qui-quadrado and Verossimilhança tests. The level of significance adopted was 5%. The Groups were similar, in terms of age, sex, level of education, type of surgery, type of drainage and physical state. The pain in rest and when coughing were less intense in GII. For pain in rest, a difference was observed in Moment 2 (p=0.012) and when coughing, in Moments 2, 3, 4 and 6 (p=0.021, p=0.005, p=0.048 and p=0.001, respectively). For pain on deep inspiration, there was no difference between the groups. In GII, greater use of supplementary morphine was observed (p=0.002), with a higher number of patients receiving morphine (p=0.002), and a higher average ratio of morphine dose to patient (p=0.022). GI was the group which received the least antiemetic (p=0.019, Moment 2) but had the highest occurrence of nausea and vomiting (p=0,032, Moment 6). Pruritis occurred only once, and there was no respiratory depression. Satisfaction with the analgesia was higher in GII in Moments 2 and 3 (p=0.001 and p=0.012). The Training, together with the Systematized Record of Pain and its Control led the nurses to intervene more often in adjusting the analgesia, which improved the pain control and the satisfaction of the patients with the analgesia. This proved to be the best option for the control of post-operative pain following cardiac surgery

A dor é um evento estressante para crianças e adolescentes e pode ter consequências negativas fisiológicas, psicológicas e comportamentais ainda mais quando é acompanhada por uma doença crônica, sem possibilidades de cura. Nesse sentido, o Cuidado Paliativo Pediátrico é uma filosofia de cuidado que deve ser instituída desde o diagnóstico da doença até que esta não responda mais às intervenções curativas. Assim, o foco do cuidado passa a ser a maximização da qualidade de vida que a criança e o adolescente e seus familiares necessitam, enquanto o sofrimento e a dor são minimizados. Considerando-se o caráter único da experiência de dor da criança e do adolescente, em cuidados paliativos, optou-se por desenvolver um estudo com abordagem qualitativa. Utilizamos como referencial teórico a Teoria de Desenvolvimento Cognitivo de Piaget e, como referencial metodológico, a História Oral. Tais referenciais são fundamentais para ancorar os resultados encontrados neste estudo e responder ao objetivo geral de conhecer a experiência da criança e do adolescente em cuidados paliativos no manejo diário da dor e aos objetivos específicos de conhecer como a criança e o adolescente em cuidados paliativos descrevem a intensidade, a qualidade e a localização da dor e de conhecer como a criança e o adolescente em cuidados paliativos manejam a dor em seu cotidiano. Permitem, igualmente, que crianças e adolescentes, de 6 a 17 anos 11 meses e 29 dias, portadores de uma doença crônica que causava dor e que estavam em cuidados paliativos e matriculados em um Ambulatório de Dor e Cuidados Paliativos de um Hospital Escola Pediátrico de caráter público de nível terciário tenham voz. Crianças em idade escolar descreveram sua dor a partir de componentes sensoriais e avaliativos. Os adolescentes, por outro lado, expressaram sua dor utilizando componentes sensoriais, avaliativos, afetivos e de miscelânea. Dos seis colaboradores deste estudo, cinco ainda frequentam a escola e relacionam-se com crianças e adolescentes da mesma faixa etária. Todos os colaboradores fazem uso de medicamentos e de alternativas não farmacológicas para o alívio da dor, como massagem, hidroterapia, acupuntura e crioterapia, constatando melhora em sua dor. Alguns colaboradores precisam lidar com sua aparência física prejudicada pela doença. Apesar da dificuldade de se entrevistar crianças e adolescentes, percebemos que eles têm muito a dizer e a nos ensinar, principalmente como eles lidam com a dor em seu cotidiano. Este trabalho é importante para que os profissionais de saúde compreendam que, com um adequado manejo da dor, crianças e adolescentes conseguem ter uma vida mais próxima da normalidade, reduzindo seu sofrimento. / Pain is a stressful event for children and adolescents and can have negative consequences - physiological, psychological and behavioral ones even more when it is accompanied by a chronic disease with no possibility of cure. In this context, the Pediatric Palliative Care is a philosophy of care that must be instituted from the diagnosis until the illness no longer responds to curative interventions. Therefore, the focus of care is to provide the highest quality of life possible to children and adolescents and their families while minimizing suffering and pain. Considering the uniqueness of the experience of pain in children and adolescents in palliative care, we chose to develop a qualitative study. We used the Theory of Cognitive Development Piaget as theoretical framework and the Oral History as the methodological one. Such references are essential to support the results found in this study and to address the overall objective of knowing the experience of the child and adolescent in palliative care for the daily management of pain as well as the specific goals of knowing how the children and adolescents in palliative care describe the intensity, quality and location of pain and of knowing how children and adolescents in palliative manage pain in their daily lives. Moreover, these frameworks allow that children and adolescents (from 6 to 17 years 11 months and 29 days), suffering from a chronic disease that caused pain and in palliative care and who were enrolled in an Outpatient Pain and Palliative Care of a public tertiary Pediatric Teaching Hospital character, have a voice. School children described their pain using sensory and evaluative components. Teenagers, on the other hand, expressed their pain using sensory, evaluative, affective and miscellaneous ones. Of the six collaborators to this study, five are still in school and relate to children and adolescents of the same age. All collaborators use drugs and non-pharmacological alternatives for pain relief such as massage, hydrotherapy, acupuncture and cryotherapy, reporting improvement in their pain. Some collaborators need to deal with their physical appearance which is affected by the disease. Despite the difficulty of interviewing children and teenagers, we have realized that they have a lot to say and to teach us, especially with regard to how they deal with pain in their daily lives. The present work is important for health professionals to understand that, with adequate pain management, children and adolescents can live a life as normal as possible, thus reducing their suffering.

No description available.

This study examined the experiences of Hospice Bereavement Coordinators (HBCs) and Hospice Chaplains working with grief narratives from patient-family units exhibiting signs of anticipatory or complicated grief. While a significant amount of research has been conducted on Hospice employees, no qualitative studies have examined the interpretation of meaning from employees whose primary role focused on the psychosocial-spiritual aspects of clients exhibiting anticipatory or complicated grief. The researcher identified shared meaning of death, trauma, and loss from six participants in the context of a high stress and high loss environment. This study‘s findings revealed ten central themes: Death is an earthly transition to immortality; Death is an intense progression; Trauma is an interpretive response to a bad experience; Trauma highlights quality of life; Loss is an adaptation to change; Loss highlights self-awareness about mortality; Cases impact views of death, trauma, and loss; Influences of spirituality; Stressful aspects of working in hospice settings; and Methods of coping. Through this study, the researcher captured five elements of the shared phenomena: the conflicting nature of anticipatory or complicated grief with the participant‘s interpretation of death; the acknowledgement of loss as the next stage for survivors of the deceased; the instability patient-family units exhibiting anticipatory or complicated grief faced; the role of faith; and the proactive efforts of participants to create a balance between work and their personal life. These meanings contributed to the continued need for future qualitative studies whereby the lived experiences of Hospice employees could be expressed to assist with the development of structured training programs specific to the requirements outlined by the nature of their work.

The purpose of this current study is to examine the impact of non-pharmacologic pain interventions administered by trained Child Life professionals in an emergency department on pain perception in children. Results showed no significant decrease in children's pain report during the medical procedure compared to before the medical procedure. However, pain after the medical procedure is significantly less than pain during the medical procedure.