Cancer nursing
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The ability to quantify pain intensity is essential when caring for individuals in pain in order to monitor patient progress and analgesic effectiveness. Three scales are commonly employed: the simple descriptor scale (SDS), the visual analog scale (VAS), and the numeric (pain intensity) rating scale (NRS). Patients with English as a second language may not be able to complete the SDS without translation, and visually, cognitively, or physically impaired patients may have difficulty using the VAS. ⋯ Although all subjects were able to complete the NRS and SDS without apparent difficulty, 11 subjects (20%) were unable to complete the VAS. The mean opioid intake was significantly higher for the group that was unable to complete the VAS (mean 170.8 mg, median 120.0 mg, SD = 135.8) compared to the group that had no difficulty with the scale (mean 65.6 mg, 33.0 mg, SD = 99.7) (Mann-Whitney test, p = 0.0065). The verbally administered 0-10 NRS provides a useful alternative to the VAS, particularly as more contact with patients is established via telephone and patients within the hospital are more acutely ill.
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Pain can cause both physical and psychological distress that has a negative impact on a patient's quality of life. The purpose of this descriptive study was to determine whether cancer patients (N = 60) with pain (n = 30) had higher scores of depression, anxiety, somatization, and hostility than did cancer patients without pain (n = 30). The study was conducted in a midwestern medical center hospital during a 9-month period. ⋯ Patients with pain scored higher on all four subscales of the BSI, with significant differences occurring in somatization (t = 2.05, p < 0.05) and hostility (t = 1.93, p < 0.05). The findings suggest a relationship between pain intensity and psychological status. Nursing interventions aimed at reducing these factors may help to decrease the pain, in addition to then decreasing the psychological distress experienced by patients with cancer.
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Pain associated with cancer and its treatment continues to be a significant concern for those persons diagnosed with the illness. This article will focus on pain syndromes associated with surgical interventions for women with breast cancer. ⋯ Treatment strategies and implications for nursing interventions employed in caring for these women will also be discussed. Nurses can use information about postmastectomy pain syndromes to educate their patients, to cooperate in successfully managing effects of the disease and treatment, and to help women cope after breast cancer surgery.
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Comparative Study
Comparison of patients' ratings and examination of nurses' responses to pain intensity rating scales.
Patients' ratings of pain intensity are an important component of a comprehensive assessment of pain. Although a 10-cm visual analog scale (VAS) is recommended for quantifying subjective pain intensity, a 0 to 5 point numerical rating scale (NRS) is commonly used. These two scales are often viewed as interchangeable or mathematically equivalent, with a 2 on a 0 to 5 point scale seen as equal to a 4 on a 10-cm VAS. ⋯ Results indicated that patients do not rate their pain in a mathematically equivalent way. VAS ratings were lower than NRS ratings, and more than three quarters of patients provided ratings that were not mathematically equivalent. In addition, nurses provided with fictitious patient scenarios did not provide the same pain medication for equivalent ratings and chose smaller analgesic doses in comparison with experts.
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The reluctance of patients with cancer to report pain and to use analgesics hinders the management of their pain. In the United States, this reluctance is related to the patient's misconceptions regarding addiction and tolerance to analgesics and the desire to be a "good patient" who does not complain. Reports in the literature suggest that patients in Taiwan may have these same concerns and misconceptions. ⋯ The responses indicated that patients who were less educated were more likely to have concerns and that patients in general were most worried about tolerance. Patients who were inadequately medicated, as determined by an index of "adequate pain management" constructed for the study, had significantly higher levels of concerns. Open communication between health professionals and patients and educational programs about pain and about the concerns measured in this study could help overcome these concerns and misconceptions and improve pain management.