Syfte: Att undersöka om en utbildning om barn och smärta förbättrade sjuksköterskors kunskap och följsamhet till Akademiska Barnsjukhusets kvalitetsmål gällande smärta. Metod: De 23 sjuksköterskorna som ingick i studien var anställda på en barnakutmottagning och två vårdavdelningar på Akademiska Barnsjukhuset. Sjuksköterskorna besvarade frågeformulär om kvalitetsmålen om smärta och barn före och efter en utbildning. Journalgranskningar av sjuksköterskornas dokumentation av smärtskattningar genomfördes före och efter utbildningen. Skillnader med avseende på kunskap om kvalitetsmål och dokumenterade smärtskattningar före och efter utbildning analyserades med Exakt teckentest. Resultat: Dokumenterade smärtskattningar fanns i 20% av de granskade journalerna både före och efter utbildning. Sjuksköterskor rapporterade dock bättre kunskap om Akademiska Barnsjukhusets kvalitetsmål om smärta efter jämfört med före utbildning . Slutsats: Omfattning och dokumentation av barns smärtskattningar behöver uppmärksammas. Studien belyser behovet av en diskussion bland smärtgrupp, smärtombud och ledning om gemensamma strategier för implementering av uppsatta kvalitetsmål avseende barn och smärta. I ett nationellt perspektiv behöver diskussioner föras om smärta ska ingå som den femte vitalparametern och därmed jämställas med andning, blodtryck, puls och syresättning. / Aim: To study if an education about children and pain improved the knowledge of registered nurses including compliance to the quality objectives of the Uppsala University Children’s Hospital concerning pain. Methods: The 23 nurses were employed within a children’s emergency unit and in two in-wards within the Uppsala University Children’s Hospital. The nurses answered to a questionnaire about the quality objectives concerning children and pain before and after a training-intervention. The nurses’ documentation of pain measurement in hospital records were analyzed before and after the intervention. Differences before and after training were analyzed using Exact Sign Test. Findings: Assessments of pediatric pain were found in 20% of the reviewed hospital records both before and after the training-intervention. However, nurses’ knowledge of the quality objectives was improved. Conclusion: Pediatric pain assessments need to be addressed. The study highlights the need of a discussion amongst pain representatives from the staff and managers on common strategies to implement decided quality objectives concerning children and pain. In a national perspective pain should be included as the fifth vital parameter and thus treated as breathing, blood pressure, heart rate and saturation.

<p>Forskning om smärta hos barn började ta fart i mitten på 1980-talet. Innan dess fanns uppfattningar av att barn inte upplevde smärta. Resultatet av denna forskning, som fortfarande pågår, har långsamt implementerats i praktiken. Först på 1990-talet omsattes dessa resultat i praktiken, av att barn ändå kunde känna smärta. Vårdpersonal fick en ökad medvetenhet om smärta och smärtskattning hos barn. Olika smärtskattningsinstrument för att bedöma smärta hos prematura barn har sedan dess utarbetats, men de tillämpas främst i studiesyfte och används bristfälligt i vården. Det finns flera hinder för att smärtskatta, till exempel brist på kunskap och barnsjuksköterskors attityd kring smärta.</p><p> </p><p>Syftet med denna studie var att undersöka barnsjuksköterskors uppfattningar av vilka förutsättningar som bör finnas för att smärtskatta prematura barn. Som metod användes fenomenografisk forskningsansats där sex barnsjuksköterskor blev intervjuade med öppna frågor. Resultatet av studien visar att barnsjuksköterskorna anser att kunskap om smärta och smärtbedömning är en av de viktigaste förutsättningarna. Ett lättförståeligt och lättillgängligt smärtskattningsinstrument, vårdpersonalens engagemang och familjefokuserad vård är andra förutsättningar som bör finnas. För att förbättra smärtskattningen måste först och främst kunskapen öka, genom både yrkesutbildning och fortbildning.</p> / <p> </p><p>In the middle of the eighties the research of pain in children increased. Before that there were conceptions that children did not feel pain. Results of this research, which is still in progress, has slowly been implicated in practice. In the nineties these results were put into practice, that children feel pain. The awareness of pain and pain assessment in children increased in nursing staff. Pain assessment tools, for judging pain in preterm children, has since then been developed. These are mostly used in studies and not enough at bedside. There are many hinder in pain assessment, for example lack of knowledge and nurses attitudes to pain.</p><p> </p><p>The aim of the study was to describe pediatric nurses' conceptions of what conditions that is necessary around judging pain in preterm children. A phenomenografic method with an open-ended questionnaire was used on six pediatric nurses'. The results of the study showed that pediatric nurses' has conceptions that knowledge about pain and pain assessment is the most important condition. A pain assessment tool that is easy to understand and accessible, nursing staff that is responsive and family centered care is other conditions that is necessary. To improve pain assessment nurses' knowledge needs to increase through different education.</p>

The purpose of this mixed methods study was to describe the cognitive processes/knowledge sources used by Emergency Department (ED) nurses in decision-making activities regarding triage and pediatric pain assessment and management. Deficiencies persist in ED pediatric pain assessment, and management methods or approaches that might help resolve these deficiencies have not been identified previously. Methodology triangulation with sequential use of qualitative- quantitative methods provided a rich description of knowledge sources and cognitive processes used by ED nurses relative to pediatric pain assessment decisions. Based on qualitative results, a set of vignettes was developed to assess ED nurses. Data analysis using ordinal logistic regression with a cumulative logit model identified patient and nurse variables which influence triage acuity decisions. Five common themes emerged from the qualitative data; 1) Age of the child is important, 2) Behavior can tell a lot, 3) Really looking at the patient, 4) Things that help make decisions, and 5) Things that hinder decisions. Ordinal logistic regression analysis of the quantitative data identified predictor variables of infants compared to school-age children, Hispanic ethnicity, moderate number of years of ED experience (11 -20 years) and years of education that were associated with higher triage levels .The implications of this new knowledge include changes in ED triage nurse practice towards pain assessment, and increased awareness of the need for education in use of pain assessment tools. Additional implications include education related to pain management practices by ED physicians and pain medication protocols at triage. This information may enhance triage and care of the pediatric patient experiencing pain, expand the knowledge base of emergency nursing, identify areas in which to implement changes, assist in improving care provided to children experiencing pain, and provide direction for future education, training, and research.

Introduction: Chronic pain after whiplash trauma (chronic WAD) to the neck is still a common clinical problem in terms of pain management, rehabilitation and insurance claims. In contrast to the increased knowledge concerning mechanisms of chronic pain in general, no clinical guidelines exist concerning assessment, pain control and rehabilitation of patients with chronic WAD. Aim: The general aim of this thesis was to use experimental techniques to better understand the complex mechanisms underlying chronic pain after whiplash trauma. The specific aims of papers I and II were mainly to use analgesic drugs with different target mechanisms alone or in combinations to assess their effects on pain intensity (VAS). Experimental pain techniques were used in all studies to assess deep tissue sensitivity (electrical, mechanical and chemical stimuli). Paper IV aimed at assessing deep tissue sensitivity to mechanical and chemical stimulation. The aim in paper III was to investigate if biochemical changes in interstitial muscle tissue (trapezius muscle) could be detected in WAD patients. Materials and Methods: The thesis is based on three different groups of patients with chronic WAD. In paper III and IV two different groups of healthy controls also participated. All patients were initially assessed in the pain and rehabilitation centre. In paper I (30 patients) and II (20 patients) two different techniques of drug challenges were used. In paper I: morphine, ketamine and lidocaine were used as single drugs. In paper II: remifentanil, ketamine and placebo were used in combinations and together with experimental pain assessments. Microdialysis technique was used in paper III (22 patients from study IV and 20 controls). In paper IV (25 patients and 10 controls) a new quantitative method, computerized cuff pressure algometry, was used in combination with intramuscular saline. In all papers, experimental pain techniques for deep tissue assessment (except cutaneous electrical stimulation in paper I) were used in different combinations: intramuscular hypertonic saline infusion, intramuscular electrical stimulation and pressure algometry. Results and Conclusion: There are multiple mechanisms behind chronic whiplash-associated pain, opioid sensitive neurons, NMDA-receptors and even sodium channels might play a part. A significant share of the patients were pharmacological non-responders to analgesic drugs targeting the main afferent mechanisms involved in pain transmission, this implies activation of different pain processing mechanisms (i.e. enhanced facilitation or changes in the cortical and subcortical neuromatrix). Experimental pain assessments and drug challenges together indicate a state of central hyperexcitability. Ongoing peripheral nociception (paper III), central sensitization and dysregulation of pain from higher levels in the nervous system may interact. These findings are likely to be present early after a trauma, however it is not possible to say whether they are trauma-induced or actually represents pre-morbid variations. Clinical trials with early assessments of the somatosensory system (i.e., using experimental pain) and re-evaluations, early intervention (i.e. rehabilitation) and intensified pain management could give further knowledge.

Bakgrund: Patienter med en demenssjukdom har en nedsättning av den kognitiva förmågan och svårigheter att kommunicera. Detta resulterar i att denna patientgrupp har svårigheter i att förmedla sin smärta till sjuksköterskan, vilket försvårar smärtbedömningen. Syfte: Syftet var att belysa sjuksköterskans möjligheter till att utföra individuell smärtbedömning av patienter med en demenssjukdom. Metod: Studien var en litteraturstudie. 12 artiklar inkluderades varav 3 artiklar var kvalitativa och 9 artiklar var kvantitativa. Alla artiklar granskades och analyserades och svarade mot studiens syfte. Resultat och konklusion: Det är en utmaning att bedöma smärta hos patienter med en demenssjukdom. Sjuksköterska bör observera patientens uttryck och beteenden för att finna tecken på smärta. Ett helhetsintryck av den enskilde individens smärtuttryck är avgörande för att sjuksköterskan ska kunna utföra en korrekt smärtbedömning. Med hjälp av olika smärtbedömningsinstrument kan smärtbedömningen underlättas. Sjuksköterskan bör avgöra vid varje enskilt patientfall, vilket bedömningsinstrument som lämpar sig bäst. Implikation: Sjuksköterskor bör enligt yrkesprofessionen uppdatera sin kunskap med aktuell forskning och sprida kunskapen vidare till arbetskollegor. Mer forskning om smärta och smärtbedömning är nödvändigt, samt att tydliga riktlinjer utformas så att sjuksköterskan kan utföra en korrekt smärtbedömning. / Background: Patients with dementia have a reduction in cognitive ability and difficulty communicating. The result is that this patient group has difficulty in communicating their pain to the nurse, which complicates pain assessment. Aim of the study: the aim of the study was to illuminate the nurse opportunities to perform an individual pain measurement of patients with dementia. Method: the study was a literature review. 12 articles were included, 3 articles were qualitative and 9 articles were quantitative. All articles were reviewed and analyzed and met the study’s purpose. Results and conclusions: It is a challenge to assess pain in patients with dementia. Nurses should observe the patient's expressions and behaviors in order to find signs of pain. An overall impression of the individual's pain expression is essential for the nurse to perform an accurate pain assessment. With the help of various pain measurement tools can pain-assessment be facilitated. The nurse should determine in each individual patient, which assessment instruments that are best suited Implication: Nurses should according to their profession, always update their knowledge of current research and disseminate knowledge on to colleagues. More research on pain and pain assessment is necessary, and that clear guidelines are designed so that the nurse can perform an accurate pain assessment.

Provoked Vestibulodynia (PVD) is a common form of chronic genital pain, affecting approximately 12% of premenopausal women. Even though knowledge of vulvodynia has been present in the medical field for many years, it was previously thought to be of psychogenic origin and has never been thoroughly investigated for the purpose of pain classification. When investigating any pain condition, one of the most important distinctions to make is whether or not the pain is neuropathic. Even though this possibility has never been investigated in women with PVD, some have claimed that PVD pain contains elements of neuropathy, even treating this pain with medication created for neuropathic pain conditions. The purpose of this study was to use standardized measures and determine whether PVD may have a neuropathic component. Women with PVD completed an online survey assessing various pain and psychosocial variables. Their responses were compared with those of pain-free controls and women experiencing an established neuropathic pain condition, post-herpetic neuralgia (PHN). Women with PVD scored above established cut-offs on measures of neuropathic pain (NP). Further, for some NP measures there was no difference in scores between PVD and PHN women. Women with PVD also had similar psychosocial profiles as those with PHN, although women with PHN reported poorer health-related quality of life. Interestingly, the number of NP symptoms did not predict pain/psychosocial disturbance, or vary as a function of pain duration or intensity. Overall, these results lend support to the argument that PVD is a chronic pain condition. Further, these results indicate that women with PVD likely experience some form of NP. These results add to the understanding and classification of PVD, justifying further investigation, for example, via psychophysical testing and functional magnetic resonance imaging. / Thesis (Master, Psychology) -- Queen's University, 2011-09-21 16:25:34.216

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Bakgrund: Smärtan är subjektiv och det innebär att det är en individuell upplevelse. Den kan upplevas olika beroende på vilka tidigare erfarenheter patienterna har. Ingen annan än patienterna själva kan beskriva den upplevda smärtan. Det är viktigt att patienternas upplevelse av smärta uppmärksammas för att sjuksköterskor ska kunna bemöta deras behov på bästa sätt och därmed minska lidande. Syfte: Syftet var att belysa patienternas upplevelser av postoperativ smärta. Metod: Studien är en litteraturöversikt som är baserad på både kvalitativa och kvantitativa artiklar. Resultat: Resultatet redovisas i fyra olika teman: Att lida av smärta, Betydelse av information och rädsla för läkemedelsberoende, Att vara osäker och inte vilja vara till besvär, Osäkerhet inför framtiden. Smärta är en individuell upplevelse och den postoperativa smärtan kan innebära ett lidande för patienten. De upplever inte alltid att sjuksköterskorna respekterar deras uttryck för smärta och känner sig bortglömda då de saknar att få ta del av information kring framtiden. Slutsats: Det är viktigt för patienterna att få vara involverade i sin vård, smärtlindring och att få tydlig information om vad som berör den postoperativa vården. De behöver stöttning av anhöriga men framförallt av sjuksköterskorna för att kunna lindra både psykiskt och fysiskt lidande. / Background: Pain is subjective and it means that it is an individual experience. It may feel different depending on the previous experience of the patient. No one other than the patient himself can describe the perceived pain. It is important that patients' experience of pain observed for nurses to be able to respond to their needs in the best way and thus reduce suffering. Purpose: The aim is to highlight patients' experience of postoperative pain. Method: The study is a literature review which is based on both qualitative and quantitative articles. Results: The results are reported in four different themes: To suffer from pain, Importance of information and fear of drug dependence, being worried and do not want to be a bother, to feel insecure in front of the future. Pain is an individual experience and postoperative pain may cause suffering for the patient. They do not always experience that nurses respect their expressions of pain and therefore feel forgotten because of their lack of access to information about the future. Conclusion: It is important for patients to be involved in their care, to receive pain relief and to get clear information about what affects the postoperative care. They need support from relatives but especially from all the nurses to decrease both mental and physical suffering.

Background: The majority of patients requiring medical attention experience some degree of pain. The nurses´ assessment of pain is crucial in reducing the patients suffering in a proper and timely manner. Previous studies have shown that the treatment of pain in a emergency situation is poorly managed. The patients´ pain experience is often under assessed and undertreated which leads to increased suffering for the patient. This results in higher costs for the health care system due to prolonged hospitalization. Aim: The purpose of this study is to define the ambulance nurse´s pain assessment of patient in the field and the affecting factors their evaluation. Method: A qualitative interview study with a descriptive design was conducted including seven emergency services nurses. Both male and female participants were involved with varying degrees of education as well as durations of employment. Result: Pain assessment by emergency personnel in the field was broken down into four categories for analysis as follow: communication (both verbal and nonverbal), measurable components, environment and evaluation of diversities. Verbal communication with appraisal of patients´ body language and facial expression was the most frequent factors in assessing pain. Measurable components such as vital signs and generalized symptoms were also accounted. VAS and NRS scales where most frequently used by nurses in rating pain among patients. The result suggested differences in pain assessment with respect to gender, age and cultural background. Conclusion: The participating nurses in this study describe verbal and nonverbal communication as the most influential factors in pain assessment of patients. In rating pain, the most frequently used tool was the NRS scale providing the nurses with what they consider to give the best understanding of patients´ pain experience. A risk has been identified in the analysis of patients´ vital signs which could lead to an under assessment and restrictive treatment of pain. The authors of this study believe that lack of knowledge in pain assessment and how to implement pain rating tools could contribute to this fact, and would therefore appreciate an improvement in skills assessing pain and a better understanding in the use of pain tools for emergency service nurses. This could lead to a better caliber of patient care for those suffering with pain. / Bakgrund: En stor andel av patienter som söker akutsjukvård upplever smärta. Smärtbedömning är en viktig del i sjuksköterskan arbetsuppgifter för att minska lidandet för patienten. Tidigare studier har visat på att smärtbehandlingen inom akutsjukvården varit dålig. En anledning till detta kan vara en underskattning och underbehandling av patientens smärta som i en förlängning kan leda till ett ökat lidande för patienten samt ökade samhällskostnader i form av längre vårdtider. Syfte: Syftet med uppsatsen var att beskriva hur sjuksköterskan i ambulanssjukvården bedömer smärta hos patient prehospitalt och vad som påverkar smärtbedömningen. Metod: En kvalitativ intervjustudie med deskriptiv design genomfördes med sju stycken sjuksköterskor som var verksamma inom ambulanssjukvården. Informanternas anställningsår och utbildningsnivå skilde sig åt, både män och kvinnor har deltagit i studien. Resultat: Resultatet beskrivs i fyra kategorier, kommunikation, mätbara observationer, miljö och bedömning av mångfald. Kommunikation innefattar verbal och icke-verbal kommunikation. Verbal kommunikation tillsammans med bedömning av patientens kroppsspråk och ansiktsuttryck (non- verbal kommunikation) användes mest frekvent för att bedöma patientens smärtupplevelse. Även mätbara observationer som vitalparametrar och allmän påverkan bedömdes. VAS-skala och NRS-skala var smärtbedömningsinstrumenten som sjuksköterskan använde mest frekvent. Resultatet visade även på skillnader i smärtbedömning gällande kön, ålder och kulturell bakgrund. Diskussion: Sjuksköterskorna som deltog i studien beskrev verbal och icke-verbal kommunikation som viktiga faktorer för att smärtbedöma patient. Sjuksköterskorna beskrev att numerisk skattnings skala (NRS-skala) var det smärtskattningsinstrument som används mest frekvent för att skapa en förståelse om patientens smärtupplevelse. En risk som identifierades var sjuksköterskornas bedömning av vitalparametrar, som kunde leda till att smärtupplevelsen hos patienten kunde underskattas eller överskattas. Författarna anser att kunskapsbrist i smärtbedömning och hur man använder smärtskattningsinstrument kan vara en bidragande orsak. Författarna anser att mer kunskap om smärtbedömning och användandet av smärtskattningsskalor som arbetsverktyg för sjuksköterskor inom ambulanssjukvården, skulle leda till bättre omhändertagande för patienter som lider av smärta.

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