RESUMEN
OBJECTIVES: A culturally relevant, evidence-based pain assessment scale in Inuktitut is needed. Psychometric properties and preferences for the Northern Pain Scale (NorthPS), a revised version of the Wong-Baker FACES scale, were examined. STUDY DESIGN: This repeated-measures, within-subjects study involved 2 face-to-face interviews held 2 weeks apart. METHODS: Participants were recruited from 2 schools and a community centre in Pangnirtung, Nunavut, Canada. Three pain scales (NorthPS, FACES and a numerical rating scale) were used to rate the pain portrayed in an adapted version of the Charleston Pediatric Pain Pictures (NorthCPPP, a series of 17 cartoon vignettes). RESULTS: The study involved 188 participants ranging in age from 5 to 83 years. Compared with the established FACES and numerical scales, the concurrent validity of the NorthPS was acceptable, with all 3 pain scales producing similar scores for the North CPPP vignettes. The youngest children were slightly more accurate during the second interview; otherwise, scoring accuracy was similar during both interviews. Accuracy was also similar across pain scales. Spearman correlations between NorthPS and other scales were lowest for the "No" pain vignettes, and for the youngest children. Internal consistency was acceptable for the NorthPS when compared with FACES and numerical scales. FACES was preferred by the majority of children and NorthPS was preferred by the majority of adults. CONCLUSIONS: NorthPS, a pain scale adapted to Inuit language and culture, was validated using the NorthCPPP with children and adults. The NorthPS is a well-understood, culturally and linguistically adapted option for the assessment of pain for Inuktitut speaking children and adults.
Asunto(s)
Inuk , Dimensión del Dolor/instrumentación , Psicometría , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
In most pediatric oncology centers across Canada, it is now standard practice for children to be sedated for lumbar punctures (LPs). Although the use of sedation for LPs is well established in the pediatric oncology population, its use in other hospital units is not well documented. A patient record audit was completed to understand the types of pain management strategies used for LPs performed throughout a pediatric hospital. Fifty-nine patients aged between 3 days and 17 years underwent a total of 67 LPs. Pain management strategies varied among the different patient service units. Oncology patients were consistently sedated for an LP, whereas patients in the emergency department were less likely to be given any type of sedation. Recommendations are aimed at providing consistent best practice pain management for LPs throughout the hospital.
Asunto(s)
Analgesia/métodos , Sedación Consciente/métodos , Punción Espinal/efectos adversos , Adolescente , Analgesia/enfermería , Analgesia/estadística & datos numéricos , Actitud del Personal de Salud , Benchmarking , Niño , Preescolar , Protocolos Clínicos , Sedación Consciente/enfermería , Sedación Consciente/estadística & datos numéricos , Recolección de Datos , Servicio de Urgencia en Hospital , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Auditoría de Enfermería , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Enfermería Oncológica/educación , Enfermería Oncológica/organización & administración , Ontario , Dolor/etiología , Dolor/prevención & control , Selección de Paciente , Enfermería Pediátrica/educación , Enfermería Pediátrica/organización & administración , Guías de Práctica Clínica como Asunto , Quebec , Punción Espinal/enfermeríaRESUMEN
A continuous epidural analgesia (CEA) program was developed for pediatric patients cared for outside of a critical care environment. Stable patients can be successfully monitored in the inpatient areas provided sufficient education and support is offered to allow for safe administration, monitoring, and evaluation of patient outcomes. The CEA program was developed in collaboration with the departments of nursing, anesthesiology, and pharmacy and was introduced on a 1-year trial basis on the surgical patient service unit. A retrospective record review was conducted of patients offered CEA over the first 2 years of the program to determine the safety and efficacy of the program. This article describes the development, implementation, and evaluation of the CEA program for surgical patients in a tertiary pediatric hospital. The safety and efficacy of the program as well as the benefits, challenges, and lessons learned are discussed.
Asunto(s)
Analgesia Epidural/enfermería , Analgesia Epidural/normas , Auditoría Médica/métodos , Dolor/tratamiento farmacológico , Dolor/enfermería , Adolescente , Analgesia Epidural/efectos adversos , Presión Sanguínea , Niño , Preescolar , Trastornos de la Conciencia/inducido químicamente , Trastornos de la Conciencia/enfermería , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Movimiento/efectos de los fármacos , Neuronas Aferentes/diagnóstico por imagen , Neuronas Aferentes/efectos de los fármacos , Registros de Enfermería , Oxígeno/sangre , Enfermería Perioperatoria , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Respiración , UltrasonografíaRESUMEN
PURPOSE: This study aims to evaluate the implementation of a comprehensive program to improve pain management practices in a pediatric hospital. METHODS: The pretest posttest design used questionnaires, patient record audits, and postimplementation focus groups with 366 nurses and 8 physicians. RESULTS: Positive changes occurred in the use of pain scales and in valuing good pain management. The program was less effective in improving procedural pain management and pain documentation. PRACTICE IMPLICATIONS: Important program strengths were the "local champions" (Pain Resource Nurses) and the ongoing support and expertise of the pain committee. Systematic evaluation was important to document successes as well as areas requiring further focus.
Asunto(s)
Benchmarking/organización & administración , Modelos de Enfermería , Personal de Enfermería en Hospital , Dolor , Enfermería Pediátrica , Actitud del Personal de Salud , Niño , Competencia Clínica/normas , Documentación/normas , Educación Continua en Enfermería , Medicina Basada en la Evidencia , Grupos Focales , Conocimientos, Actitudes y Práctica en Salud , Hospitales Pediátricos , Humanos , Evaluación en Enfermería/normas , Auditoría de Enfermería , Investigación en Evaluación de Enfermería , Registros de Enfermería/normas , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/psicología , Ontario , Dolor/diagnóstico , Dolor/prevención & control , Dimensión del Dolor/enfermería , Dimensión del Dolor/normas , Enfermería Pediátrica/educación , Enfermería Pediátrica/organización & administración , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Gestión de la Calidad Total/organización & administraciónRESUMEN
Abstract Needle procedures are a necessary component of the treatment of hospitalized children. However, for many children they can be both painful and distressing. There was concern among the nurses at our pediatric hospital that we were not adequately controlling pain from needle procedures. We were interested in obtaining more information about the incidence and types of needle procedures and the current use of topical analgesics. A survey was designed to describe the frequency, type, time to complete, and perceived ease of needle procedures. The use of topical anesthetics and other comfort measures was also examined. The most common needle procedures performed were venipunctures for blood work, followed by intravenous cannulations, capillary sticks, port-a-cath access, and intramuscular injections. In total, 387 procedures were performed over a 23-day period. The majority of the procedures were perceived as easy, and the modal time to complete the procedures was 5 minutes. A topical anesthetic was used for 74 procedures (i.e., 19%), and the majority of these procedures were performed on the medical day unit with oncology patients. Results of the survey provided information about the day-to-day practice of needle procedures in order to identify both the supports and the barriers to providing these procedures atraumatically. Examining needle procedures within a framework of atraumatic care broadened our perspective and enabled us to integrate the use of topical anesthetics as just one of a number of strategies to minimize the pain and distress associated with needle procedures.
Asunto(s)
Lesiones por Pinchazo de Aguja/enfermería , Dolor/enfermería , Dolor/prevención & control , Enfermería Pediátrica/métodos , Adaptación Psicológica , Adolescente , Anestésicos Locales/uso terapéutico , Niño , Niño Hospitalizado , Preescolar , Recolección de Datos , Humanos , Lactante , Lesiones por Pinchazo de Aguja/psicología , Dolor/psicologíaRESUMEN
Recent research has indicated that the Pain Catastrophizing Scale (PCS) is a reliable measure that taps three dimensions of a singular construct. Gender differences have been found consistently in catastrophizing, with women reporting significantly higher scores than men on the PCS. This study was designed to cross-validate the factor structure of the PCS, independently for men and women, through second-order confirmatory factor analysis. Results indicate that the second-order models provide a good fit to the data. The conceptualization of catastrophizing as a singular latent construct, within a hierarchical factorial structure that consists of three first-order factors--rumination, magnification, and helplessness, was supported for both men and women. The second research objective was to test the two models for gender equivalence. Results indicate that all constraints held across gender. Together, these findings support the psychometric soundness of the PCS and indicate that the gender differences found are not due to an inadequate fit of the measurement or structural model.
Asunto(s)
Dolor/psicología , Inventario de Personalidad/estadística & datos numéricos , Rol del Enfermo , Adolescente , Adulto , Mecanismos de Defensa , Análisis Factorial , Femenino , Humanos , Masculino , Análisis Multivariante , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Factores SexualesRESUMEN
Pain resource nurses (PRNs), who act as pain management coaches or mentors for their colleagues, can contribute to effective pain management. The PRN's role has not been well evaluated in the context of pediatric nursing. Therefore, the objective of this study was to examine the PRN's role in a pediatric setting and, more specifically, to describe the role in terms of the activities PRNs engage in, the challenges they face, and the supports that help them fulfill their role. This research was part of an evaluation of the implementation of a comprehensive pain management program in a pediatric hospital. Focus groups were conducted with 18 PRNs six months after implementation of the PRN role. The essence of the role is to provide support for best-practice pain management to nurses and the multidisciplinary team. The PRNs described seven components of their role and specific strategies to operationalize their role. In addition, the PRNs faced challenges, including feeling disappointed when their expectations for better pain management were not met, experiencing difficulty fitting the activities into their busy workdays, facilitating their colleagues' improved pain management without also alienating them, and maintaining their enthusiasm and energy for the role. Pediatric nursing staff can effectively fill the role of the PRN. The role is multifaceted, and maintaining the role required commitment and enthusiasm on the part of the nurses, as well as commitment by their related institutions.
Asunto(s)
Actitud del Personal de Salud , Enfermeras Clínicas , Rol de la Enfermera , Personal de Enfermería en Hospital , Dolor/enfermería , Enfermería Pediátrica , Benchmarking/organización & administración , Niño , Educación Continua en Enfermería , Grupos Focales , Hospitales Pediátricos , Hospitales de Enseñanza , Humanos , Capacitación en Servicio , Satisfacción en el Trabajo , Modelos de Enfermería , Motivación , Evaluación de Necesidades , Enfermeras Clínicas/educación , Enfermeras Clínicas/organización & administración , Enfermeras Clínicas/psicología , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Ontario , Enfermería Pediátrica/educación , Enfermería Pediátrica/organización & administración , Apoyo Social , Gestión de la Calidad TotalRESUMEN
BACKGROUND: Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is recognized as severely compromising, in both adjustment after injury and quality of life. Studies indicate that chronic pain in SCI is associated with great emotional distress over and above that of the injury itself. Currently, little is known about the SCI patient's perception of the impact of living with chronic neuropathic pain. OBJECTIVES: The purpose of this study was to explore the experience of CNP in SCI patients in relation with physical, emotional, psychosocial, environmental, informational, practical and spiritual domains, and to identify effective and ineffective pain coping strategies. METHODS: Three focus groups were conducted that included 24 SCI individuals living in the community. Participants were selected to maximize variation in terms of type of SCI, Frankel classification, years since onset of SCI, age and sex. The sessions were audiotaped and tapes were transcribed. A qualitative analysis of data involved a constant comparison approach, in which categories and themes were identified. RESULTS: Many complex themes emerged including: nature of pain; coping as process and product; medication failure; and the impact of CNP on physical, cognitive, emotional, interpersonal, social and life activities. CONCLUSIONS: Medication failure was identified as a common outcome, while strategies including use of warm water, swimming, increased activity and distraction provided temporary pain relief. Learning to live with the pain appeared to be related to acceptance of pain, which in turn seemed to facilitate adjustment. Further research is warranted to determine the process by which SCI patients learn to live with CNP and coping strategies that facilitate adjustment to CNP in SCI patients.
Asunto(s)
Manejo del Dolor , Dolor/psicología , Satisfacción del Paciente , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/terapia , Adaptación Psicológica/fisiología , Adulto , Anciano , Enfermedad Crónica , Femenino , Grupos Focales/métodos , Humanos , Masculino , Persona de Mediana Edad , Dolor/complicaciones , Dimensión del Dolor/métodos , Dimensión del Dolor/psicología , Satisfacción del Paciente/estadística & datos numéricos , Calidad de Vida/psicología , Traumatismos de la Médula Espinal/complicacionesRESUMEN
Before implementing a pain education program, the Canadian Association of Nurses in Oncology conducted a national survey on cancer pain management. The survey focused primarily on adult cancer pain and a second survey was undertaken to describe the supports in place across Canada for best practice pediatric cancer pain management. Twenty-eight pediatric cancer centers responded to a survey that was composed of 48 questions about the types of supports that are in place related to pain assessment, management, and pain-related staff and family education. Results of the survey indicated that, for the most part, children have access to the components of best practice pain management. In addition, areas of strength and areas that need to be further developed were identified and the implications for the findings discussed.
Asunto(s)
Neoplasias/complicaciones , Servicio de Oncología en Hospital/estadística & datos numéricos , Manejo del Dolor , Dimensión del Dolor/métodos , Adolescente , Canadá , Niño , Preescolar , Encuestas de Atención de la Salud , Humanos , Enfermería Oncológica , Dolor/etiología , Cuidados Paliativos/estadística & datos numéricos , Apoyo SocialRESUMEN
OBJECTIVE: The purpose of this study was to provide a baseline description of the prevalence of pain and pain management strategies in a pediatric hospital and to compare the prevalence of pain in this hospital to that in published reports in the literature. METHODS: Two hundred thirty-seven children ranging in age from 10 days to 17 years and 223 parents participated in an 8-hour survey on 5 inpatient units. Information about pain intensity and pain affect was collected from the children older than 6 years of age and from parents of those who were younger at 4 2-hour intervals. Information about procedural pain was collected from children, parents, and health care professionals over this 8-hour period. The type and amount of analgesia were also noted. RESULTS: More than 20% of the children had clinically significant pain at each of the 2-hour intervals, and 7 had pain scores of 5/10 or greater for the majority of the study day. At least 50% of the children were found to be pain-free during the 4 intervals, and there was a high level of agreement between parents and children's pain-intensity ratings. One hundred fifty-seven children had medication ordered and 80 children had no analgesia ordered. There was no significant correlation between characteristics of the patients and amounts or types of medication given. No analgesia was administered via intramuscular or subcutaneous injection. DISCUSSION: Although these results are encouraging in that a significant portion of the children were pain-free during the study day, the number of children who had clinically significant pain was too high. The results of this study compare with others in that a significant number of children were inadequately treated for pain. Clinical implications are discussed.