Chronic pain remains a prevalent problem across the United States. Chronic pain does not seem to have a function and relief of this symptom remains elusive for many sufferers. Virtual reality has been used as an adjunct therapy to decrease acute pain with promising results, but there is little research on whether virtual reality could be used as a successful intervention for those with chronic pain. Virtual reality has few side effects, so it warrants consideration for the treatment of chronic pain. There is growing evidence that there is potential for virtual reality to produce desired results with patients having chronic pain, but without more research this intervention cannot be confidently recommended (Garrett, Taverner, & McDade 2017). This thesis reviewed published research on the use of virtual reality in those with chronic pain. A total of seven studies that addressed virtual reality and chronic pain were analyzed and integrated into this literature review. All studies used virtual reality as a distraction to improve chronic pain. Three studies included patients with chronic back pain, one study included patients with chronic neck pain, and the remaining three studies addressed other types of chronic pain including chronic postoperative breast cancer pain, chronic neuropathic pain, and chronic generalized pain. All studies reviewed reported improvement of chronic pain symptoms. This literature review provides evidence to support the use of virtual reality for those with chronic pain. More rigorous research with larger sample sizes is needed to increase the generalizability of results to help people suffering with chronic pain from a variety of causes. This literature review used the search terms "chronic pain" and "virtual reality" and the following databases: EBSCOhost, Medline, CINAHL Plus with Full Text, PsycINFO, Academic Search Premiere, and Applied Science & Technology Source.

Patients’ recovery after surgery is one of the most important health processes in planned hospital healthcare and has a direct impact on welfare and welfare systems. Therefore, what nurses do in the im­mediate postoperative period is of vital importance. This thesis addresses the question of understanding how nurses work in managing post-operative pain by exploring their daily nursing practices and experiences in responding to the patient in pain within a Thai cultural context. The project applied a qualitative methodology where the local culture and its day-to-day practices of pain management were studied by using observations, focus groups, in-depth interviews and a critical incident interview approach with nurses. Informants were recruited at a public hospital in Bangkok in a surgical ward. In all, 100 hours of observations, 39 interviews and 69 descriptions of critical incidents related to nurse’s pain management were gathered. The data analysis followed the principles of qualitative research. The findings showed that, although there is a clearly defined approach to pain management, the response system followed by the nurses to address patients’ pain is complex and includes much lead time between assessing patients’ pain and the nurses responding to the pain. Furthermore, nurses are caught in what is labeled a patient pa­radigm, where evidence of pain often is double- and triple-checked by scoring and recording signs that are then subject to confirmation by a third party. Underpinning this is a culture of pain management cultivated between the nurses that rests first and foremost on their own experiences and a working/professional culture where nurses offer each other practical help in urgent situations, but seldom discuss event-based strategies together. Nevertheless, when nurses described situations when they were successful in practicing pain management, they considered their own engagement and their availability of time, space and therapeutic options to be important. Keywords: Culture of nursing, Nursing in pain management, Pain assessment, Perception of pain, Pain management, Pain post-operative

Chronic pain is a condition that impacts millions of men and women around the globe. It is a compelling disease that particularly impacts quality of life (QOL) for many veterans with undertreated or untreated pain. The focus of this systematic literature review was the appraisal of articles and clinical practice guidelines to better understand best-practice nonpharmacological strategies for management of chronic pain. Key words used in the literature search included chronic pain and veterans, complementary alternative medicine (yoga, tai chi, music therapy, acupuncture, and massage), and cognitive behavioral therapy (CBT). The articles included in the review were limited to those pertaining to adults over the age of 18 with non-cancer musculoskeletal chronic pain. The review excluded articles pertaining to patients reporting headache, cancer-related pain, fibromyalgia, mental health problems, or gynecological pain. Polit and Beck's levels of evidence were used to appraise each article. The Stetler model was used as the change model for this project. Thirty-six articles met the criteria and were included. Nine clinical practice guidelines were appraised. Four articles were pilot studies, 3 met the criteria for Evidence Levels V-VII, 3 met the criteria for Levels III-IV, 8 were Level II, and 18 were systematic reviews of randomized controlled trials (Level I). The analysis of evidence supported the use of yoga, CBT, acupuncture, and massage therapy as best-practice methods of personalized nonpharmacological pain management. This project is important for those who care for veterans and other adult chronic pain patients. Application of the findings may lead to changes in chronic pain management that will enhance social change and improve QOL for veterans and others living with untreated or undertreated chronic pain.

Every year, millions of Americans suffer from either chronic or acute pain that results in tremendous healthcare cost, rehabilitation, and loss of work productivity. Pain is an unpleasant sensation associated with sensory and emotional experiences that can cause potential or actual tissue damage. One plausible solution to managing pain is the use of nonpharmacological modalities such as guided imagery. The purpose of this project was to determine if there was a difference in pain scores following pharmacological interventions and the use of guided imagery among postoperative same day surgical patients. Guided imagery is a nonpharmacological modality that uses pictures, music, and imaginary scenes to help heal the body in addition to using relaxation techniques and mental images for the management of pain. This project included the translation of evidence into practice using guided imagery on a 25-bed same day surgery unit (N = 34 patients), guided by Kolcaba's comfort theory. The findings of this project included using guided imagery for same day surgery patients who rated their pain greater than 4 on the traditional pain scale of one to ten, with one equaling no pain and ten equaling worst pain. The results of the evaluation showed a significant decrease in pain scores between premedication to postmedication (p < 0.001), premedication and postguided imagery (p < 0.001), and postmedication and postguided imaginary (p < 0.001). Guided imagery has been demonstrated to be efficient and cost effective methods to reducing pain. This project indicated that use of nonpharmacological and pharmacological interventions working together could be more effective for pain management in same day surgical patients.

The thesis deals with a definition of pain management issues, role of nurses working with patients in pain and, particularly, perception of pain of patients by nurses. The objective of the research was to identify and to study pain management procedures and, at the same time, to present how nurses perceive and experience the care of patients in pain. The empirical part of the thesis was performed through qualitative investigation using semi-structured interviews with nurses and patients. The respondents included 12 nurses and 8 patients. Based on results of the investigation covert participatory observation was selected as a complementary method. 6 nurses were observed while taking care of patients during a post-surgery period. Most frequently, nurses rate pain of patients by means of VAS (Visual Analogue Scale), however, they quite often assess the value subjectively. Nurses then record the found values regularly into the patient´s chart. Nurses would also appreciate more cooperation with physicians in order to increase efficiency of pain rating. Nurses are able to respond very well to patient´s verbalization of pain and they perceive differences in communication in such situations. The majority of nurses choose pro-active approach to pain alleviation. Nurses have the basic knowledge about non-pharmacological pain alleviation. Perception of pain by nurses is partly affected by length of their practice and by their own experience with pain. Nurses perceive negatively those situations when pain management interventions are not sufficiently effective, when they cannot contact physicians or when they cannot act based on their own discretion. In such situations nurses demonstrate signs of distress. This problem aggravates when nurses work with patients suffering from chronic pain. Nurses have only limited opportunities to improve their education in pain management and communication with patients in pain. Patients in pain mostly see the care provided by nurses positively but they have also provided numerous recommendations for the nurses. The empirical research has shown that nurses meet with patients in pain nearly every day while performing their nursing practice and that assessment of pain plays an important role in pain alleviation. In most cases the exposure of nurses to patients in pain causes their negative emotional experience, such as sadness or fear of complications. Their experience is affected by several factors. In general, the issues of pain perception by nurses in comparison with pain management techniques are often neglected. Nevertheless, from the viewpoint of mental stress, pain perception is an indisputable factor that deserves more detailed investigation.

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Nurses are at increased risk for job burnout, which can lead to psychological and physical problems, decreased quality of care, and premature exit from the profession. Studies have found common predictors of burnout in multiple service occupations, but there are important differences across settings. The current study used embedded mixed-method analyses to explore burnout in a sample of nurses that work with patients with chronic abdominal pain. Thirty-two nurses participated in focus groups and data analyses revealed the following six themes: negative pain beliefs, barriers to effective pain management, nurse empathy/compassion, moral distress, coping methods, and burnout. These themes were evaluated with proposed theoretical frameworks and the extant literature to build the Pediatric Chronic Pain Nurse Burnout model. The constructs in this model were then evaluated quantitatively via measures completed by 41 nurses. Analyses provided partial support for the model and highlighted areas for further evaluation of burnout in nursing.

ABSTRACT Background: To serve the patients information and to relieve pain post-operatively is largely the nurse's responsibility. Studies suggest a correlation between the preoperative information and the pain and anxiety. Previous studies suggest that the preoperative information affect the postoperative pain in a positive direction. Aim: The aim of this study was to investigate the correlation between preoperative paininformation, anxiety and pain in patients who have undergone elective and acute orthopedic surgery. A further aim was to see if there was a difference between elective and acute orthopedic surgical wards and also investigate if there were something the patients were missing in the preoperative pain-information. Method: A quantitative survey was conducted with a descriptive correlative design. The study was carried out in two different orthopedic wards in a hospital in Sweden. The study included a total of 27 participants, 12 elective and 15 acute patients. Reslut: The result showed that there is a significant correlation between the patients preoperative anxiety and postoperative pain (r=0,398, N=27, p=0, 04). The result also showed a significant correlation between patient’s postoperative anxiety and postoperative pain (r=0,601, N=27, p=0,001). Patients with high anxiety also had high levels of pain. No significant difference was seen between the elective and acute group, but the elective group estimated the preoperative information higher (M=6, 17) than the acute group (M=4, 53). The study did not show evidence that preoperative information about the pain leads to lower postoperative painscores, however the preoperative information is important so the patient feel well prepared for the operation. A total of 6 (22%) patients did not obtain preoperative pain-information. Conclusion: Anxiety and pain are two factors that affect each other. To be responsive as a nurse and capture anxious patients, as well as alleviate this concern , the postoperative pain would be alleviated . Patients undergoing acute surgery do not receive preoperative information to the same extent as those undergoing elective surgery. To develop a quality document about how and when preoperative information about pain should be given , could ensure that patients are well informed before surgery. To share this information is largely the nurse's role, and it is important as it would lead to increased well-being and less suffering for the patients.

Background: Pain management is a major issue in post-operative care. Little is known about the pain management experiences of parents and adolescents following discharge from inpatient surgery. Studies examining pain outcomes following day surgery suggest that children often experience severe pain and parents are challenged in providing pain care. Objective: To explore the pain management experiences of parents and adolescents following discharge from hospital after inpatient surgery. Results: Thematic analysis found that parents and adolescents were challenged in providing pain care. School return was more difficult than anticipated yet parents and adolescents were unsure how to navigate pain at school. Discharge education focused on analgesic management, leaving participants to discover non-pharmacological strategies on their own. Conclusions: Recovery from post-operative pain following inpatient surgery is challenging; nurses and healthcare professionals need to better prepare parents and adolescents to meet pain care needs following discharge.

Introdução: A dor é o principal motivo de procura ao atendimento médico. Organizações internacionais de saúde indicam o alívio da dor como um direito humano básico. A literatura indica subutilização de opioides devido ao conhecimento insuficiente, o receio quanto ao potencial de adição, efeitos adversos e mitos persistentes sobre estes analgésicos por parte dos profissionais de saúde. Objetivo: Avaliar grau de conhecimento de profissionais de saúde no manejo da dor e no uso de opioides em três unidades pediátricas (Pediatria, UTI e Oncologia). Metodologia: Estudo transversal realizado em um hospital universitário do Sul do Brasil. Um questionário autoaplicável foi entregue para 182 profissionais (médicos, enfermeiros, farmacêuticos, técnicos e auxiliares de enfermagem), entre dezembro de 2011 e março de 2012. Resultados: A taxa de retorno foi de 67% (122). O percentual médio de acertos foi de 63,2 ± 1,4%. Os erros mais frequentes foram: um opioide não deve ser utilizado sem se saber a causa da dor (47%; 54/115); pacientes desenvolvem depressão respiratória frequentemente (42,3%; 22/52) e confusão entre os sintomas da síndrome de abstinência, tolerância e dependência (81,9%; 95/116). Apenas 8,8% (10/114) relataram o uso de escalas de dor para reconhecer a dor em crianças. A barreira para o controle da dor mais citada foi a dificuldade de medir e localizar a dor em pacientes pediátricos. Finalmente, 50,8% (62/122) não receberam nenhum treinamento sobre dor. Conclusões: Foram identificados problemas nos processos de identificação, mensuração e tratamento da dor. Os resultados sugerem a necessidade de investimento na formação continuada dos profissionais e no desenvolvimento de protocolos que busquem aperfeiçoar a terapia analgésica, impedindo um aumento desnecessário do sofrimento da criança. / Introduction: Pain is the main reason to seek medical care. Health international organizations indicate pain relief as a basic human right. The literature indicates underuse of opioids due to insufficient knowledge, fears about the potential for addiction, side effects and persistent myths about these analgesics by health professionals. Objective: To assess degree of knowledge and attitudes of health professionals about management of pain in three pediatric units (Pediatric, ICU and Oncology). Methods: Cross-sectional study in a teaching hospital in southern Brazil. A self-administered questionnaire was delivered to 182 professionals (doctors, nurses, pharmacists, technicians and nursing assistants), between December 2011 and March 2012. Results: The rate of return was 67% (122). The average percentage of correct responses was 63.2 ± 1.4%. The most frequent errors were: an opioid should not be used without knowing the cause of pain (47%, 54/115); patients often develop respiratory depression (42.3%, 22/52); and confusion between symptoms of the syndrome withdrawal, tolerance and dependence (81.9%, 95/116). Only 8.8% (10/114) reported using pain scales to recognize pain in children. The barrier to pain control most cited was the difficulty to measure and locate the pain in pediatric patients. Finally, 50.8% (62/122) received no training on pain. Conclusions: The study identified problems in the process of recognizing, measuring and treating pain. The results suggest the need for investment in training to health care team and development of protocols that seek to optimize analgesic therapy, preventing an unnecessary increase the suffering of the child.