Thesis (Ph.D.) - University of Queensland, 2006. / Includes bibliography.

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Adequate pain assessment is a pre-requisite for appropriate pain management. If pain remains untreated in critically ill young children, it can have dramatic short- and long-term consequences on their health and development. Apart from humanitarian reasons, the assessment of pain has been recognised in some parts of the world as the fifth vital sign and thus should be part of standard practice of pain management. The evaluation of pain in preverbal children is, nevertheless, challenging for health professionals, as they cannot rely on self-report when making their assessment. Observational pain instruments have been developed to facilitate this task, but none of these existing instruments are appropriate for the postoperative critically ill young child. The aim of this research was to provide a clinically valid pain instrument for health professionals to use in practice for the evaluation of the pain and the effectiveness of pain treatment in critically ill young children. This thesis presents research that was conducted in three phases to (a) describe pain, (b) develop, and (c) test the pain instrument. Conceptualisation of pain and psychometric theory informed the conceptual framework for this study. An observational design was used in Phase One of the study to define pain behaviour in critically ill infants. Correlational design was used in Phase Two and Three to determine the association between the newly developed pain scale and other pain assessment instruments. Phase One of the study was conducted in the paediatric intensive care units of two tertiary referral hospitals. Eight hundred and three recorded segments were generated from recordings of five critically ill infants, aged between 0 and 9 months, who had undergone major surgery. / Results indicated significant physiological and behavioural changes in response to postoperative pain and when postoperative pain was exacerbated by painful procedures. Using the pain indicators observed in Phase One, in Phase Two the Multidimensional Assessment Pain Scale (MAPS) was developed and tested for reliability and validity in 43 postoperative preverbal children from the same settings. Internal consistency and interrater reliability were moderate and good, respectively. Concurrent and convergent validity was good. In Phase Three, the MAPS' response to analgesics and clinical utility was demonstrated in a convenience sample of 19 postoperative critically ill children aged between 0 and 3 1 months of age at a tertiary referral hospital in Western Australia. Development of a pain instrument is a complex and lengthy process. This study presents the preliminary psychometric properties that support the validity and clinical utility of the Multidimensional Assessment Pain Scale. The MAPS is a promising tool for assessing postoperative pain in critically ill young children, and its clinical validity will be strengthened with further testing and evaluation.

Acute and chronic pain conditions have a significant impact on the individual who is experiencing pain and resolution of pain continues to present a challenge to nurses and other health care professionals. It is widely accepted that pain education for nurses is necessary if nurses are to deliver effective, evidenced based pain care. Although it has been shown that participation in pain education improves nurses’ pain knowledge, very little is known about the way in which nurses use their improved pain knowledge in their practice or about the conditions that promote application of that pain knowledge. The aims of this study are (a) to explore the transfer of pain knowledge from a continuing education nursing course into practice, and (b) to investigate the impact that the nurses’ participation in action research has on their ability to improve aspects of their pain practice. Participants are 14 registered nurses who successfully completed two accredited pain course units as part of their BSc / BN degree in Nursing. The nurses formed two groups of inquiry, who used both their participation in the pain course and in action research to investigate and change aspects of pain assessment and management practices within their clinical areas. The inquiry groups were located in two different Health Board locations in Scotland. Following involvement in a pain course, the strategies used by the participating nurses to enhance their pain assessment and management practices are examined. Qualitative data was obtained through individual and group interviews, and analysis of significant incidents. An action research approach contributes to an understanding of conditions that promote application of pain knowledge into practice following participation in the course, and focuses on the possibilities for action and improvement of pain care. The findings from this study demonstrate how nurses develop a more patient-centred approach to pain care and become more accountable for their pain practice. The research also identifies a range of strategies used by nurses to improve collaborative working practices with their colleagues that help to reduce some of the obstacles to delivery of effective pain care. From the outcomes of the inquiry, it is evident that these nurses’ participation in action research has increased the possibilities of their involvement in pain practice interventions. Conditions are created through pain course participation and involvement in action research, which supports nurses’ transfer of pain knowledge into practice Additionally, findings demonstrate the potential action research has for identifying problems with pain care and its potential for helping to develop relevant and workable solutions for improving aspects of care. The findings from this study are significant because they inform teaching and learning approaches which can be used with pain education that helps to prepare nurses to deliver more effective pain care within their health care settings.

It is widely accepted that the unique painful and non-painful sensations in neuropathic pain are the result of particular mechanisms, and that specific management strategies for neuropathic pain should be applied to tackle them. Ideally, the treatment of chronic pain should be directed at eliminating the cause of pain, but in reality this is rarely possible. The management of chronic pain is therefore often limited to reducing the intensity of such pain and associated symptoms. Pain is essentially a subjective phenomenon described with patient-specific symptoms and expressed with a certain intensity. It therefore makes sense to examine the value of verbal descriptors and pain qualities as a basis for distinguishing neuropathic pain from other types of chronic pain. Work by Dubuisson and Melzack (1976) and later by Boureau et al. (1990) supported anecdotal opinion that key words might be discriminatory for neuropathic pain. In the last 5 years, much research has been undertaken to develop screening tools for this purpose. These tools are based on verbal pain description with, or without, limited bedside testing. This paper reviews the strengths and weaknesses of such tools.

Pain is a common symptom in cancer patients, restricts daily life activities and reduces survival time. Identification of sociodemographic, medical and psychological correlates of pain among cancer patients in Germany could help identify subgroups most in need of pain management. In this multicenter, epidemiologic cross-sectional study, we assessed pain prevalence and severity, quality of life (QoL) and psychological distress in a sample of 3,745 cancer patients across all tumor entities. In total, 37.9% patients suffered from cancer-related pain and 56.1% suffered from non-specific pain. Younger, female, less educated and unemployed patients reported pain more frequently and more severe pain (p < 0.001). Pain was associated with distress, depression, anxiety, QoL, tumor stage (p < 0.001), and time since diagnosis (p = 0.012). Pain assessment and pain management should be a routine part of cancer treatment and cancer survivorship care plans.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Pain can be a warning sign, but in surgery it is associated mainly with medical procedures. The aim of the research survey was to map out the pain rating scales that are used in practice in surgical patients, to determine the opinion of surgical nurses on these scales and patient experience. Furthermore, the paperwas aimed at the creation of a recommended procedure for evaluation of pain in surgical patients. In the empirical part of the thesis, quantitative and qualitative research was used. In the quantitative research, two questionnaires were created - for nurses (a non-standardized questionnaire) and for surgical patients (a combination of a non-standardized and standardized questionnaire). The focus group method with surgical patients and nurses was used as a qualitative method. The research survey shows that the most commonly used scale in practice is the visual analogue scale and verbal evaluation. Although these methods are widely used, our results suggest that they are not entirely sufficient. Respondents from the groups of nurses and patients wanted to add more accurate verbal description to the evaluation and increase the frequency of pain evaluation by a doctor and nurse. The most frequent symptoms of pain from the perspective of patients included: limited mobility and self-sufficiency, emotional lability, and verbal manifestations. And from the perspective of nurses: limited mobility, non-cooperation, limited self-sufficiency and verbal manifestations. Among the methods that are used most often by patientsto relieve painare medicinesprescribed by the doctor, relief positions, sleep and rest. More than 90% of patients are satisfied with the cooperation with the nurse and the doctor in the evaluation and treatment of pain. Based on the data analysis, a procedure for assessing pain in surgical patients has been proposed. Its clarity and usability were verified using the focus group method with surgical nurses and patients. Both the nurses and the patients assessed the recommended procedure quite positively. Possible pitfalls were perceived in the necessity of sufficient nurse-patient cooperation and enough time to implement the proposed assessment. The research survey was carried out in the territory of the South Bohemian region and is processed as part of thesolution of the GAJU team grant project - Use of Measuring Instruments in Nursing Practice (059/2018/S).

Bakgrund: Höftfrakturer ökar i befolkningen i takt med ökande livslängd. Äldre har skörare skelett och höftfrakturer orsakas mestadels av en lindrig fallolycka. Höftfrakturer vållar lidande, patienterna behöver omsorgsfull omvårdnad och adekvat smärtlindring redan prehospitalt.    Syfte: Att sammanställa evidens vad som är av betydelse i omvårdnaden av patienter med smärta vid misstänkt höftfraktur i akutsjukvård.  Metod: Studien är en litteraturstudie, en översikt av vetenskaplig littereratur som beskriver omhändertagandet av patienter med höftfraktur i akutsjukvård. Datainsamling från PubMed och CINAHL resulterade i 18 vetenskapliga artiklar, kvalitativa- och kvantitativa. Artiklarna kvalitetsgranskades och analyserades. Materialet kategoriserades och sammanställdes till en ny helhet. Resultat: Smärtlindringen var oftast otillräcklig och mer individualiserad vård behövdes. Patienterna upplevde att sjuksköterskorna tappade fokus från patienten. Patienternas och sjuksköterskornas upplevelser av omvårdnaden skiljde sig åt, främst inom kommunikation, information och delaktighet. Mest förekommande smärtlindring var morfin, mindre vanligt var regional nervblockad. Patienter med hög ålder eller nedsatt kognitiv förmåga fick mindre smärtlindring vilket dels kunde förklaras med att beteendebaserade smärtskattningsinstrument saknades.   Slutsats: Patientdelaktighet, tydligt strukturerad patientinformation- och kommunikation är viktigt för att samspelet mellan sjuksköterska och patient ska bli bra. Smärtlindringsmetoderna, smärtskattningen och dokumentationen behöver utvecklas och förbättras, särskilt för patienter med nedsatt kognitiv förmåga. / Introduction: The number of elderly people with hip fracture is increasing in line with the increased life expectancy. Elderly often suffer from osteoporosis and hip fractures are mostly caused by a slight fall accident. Hip fractures cause suffering, patients need careful care and adequate pain relief in prehospital care.     Objective: To compile evidence of what is important in the care of patients with pain in suspected hip fracture in acute medical care.   Method: This study is a literature review, an overview of scientific literature that describes the care of patients with hip fracture in emergency medical care. Data collection from PubMed and CINAHL was conducted, 18 articles were selected, both qualitative and quantitative. The quality of the articles was reviewed. The material was organized into categories and then synthesized.  Results: Pain relief was often inadequate and more individualized care was needed. Patients felt that the nurses lost patient focus. Patient’s and nurse’s experiences of nursing care differed, mainly in communication, information and participation. The most common pain relief was morphine, regional nerve blockade was less common. Elderly patients or patients with cognitive impairment received less pain relief that could be explained by the lack of behavioral-based pain assessment tools.   Conclusion: Patient involvement, clearly structured patient information and communication is important for good interaction between patient and nurse. Pain relief methods, pain assessment and documentation need to be developed and improved, especially for patients with cognitive impairment.

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 96-106).