Critical care nursing clinics of North America
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Pain of critically ill patients is undertreated. Undertreatment of pain may be related, in part, to the culture of critical care practice, where nurses are challenged to meet competing patient demands. ⋯ It is, in fact, "primarily the nurses' responsibility to administer the proper drug and dose at the proper time". Fostering a culture within critical care units that promotes optimal pain management is influenced by unit leadership, the values held by the staff, nurse competency, and an effective quality program that includes process and outcome indicators of pain management.
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Crit Care Nurs Clin North Am · Jun 2001
ReviewManagement of surgical and procedural pain in a critical care setting.
Critical care nurses can serve as pain management advocates so that those patients who undergo surgery and other procedures do not suffer needless pain. Research findings indicate that surgical and procedural pain can contribute to pathologic pain states related to nerve injury, tissue inflammation, and prolonged peripheral nociceptive input. ⋯ Knowledge of analgesic interventions, including pharmacologic and nonpharmacologic techniques, is essential to the professional practice of nursing the critically ill. The critical care nurse plays a pivotal role in preventing suffering, discomfort, and long-term negative consequences related to surgical and procedural pain.
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Crit Care Nurs Clin North Am · Jun 2001
ReviewMoving to evidence-based practice for pain management in the critical care setting.
Widespread application of EBPM by bedside providers is needed to demonstrate the success of pain management strategies on patient outcomes. This goal is not easy to attain and generally requires time, patience, and a multidisciplinary team approach. Implementation and evaluation of pain interventions increase awareness and knowledge of pain management strategies and can result in an overall improvement in pain management. ⋯ Bedside practitioners need to have knowledge of the current best evidence in pain management of the critically ill patient. Barriers to implementation must be eliminated so that practitioners can conscientiously and judiciously implement strategies to relieve pain. Opinion leaders and change agents need to be available to continually champion EBPM, and prompts to ask about pain should be provided to practitioners and patients.
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Pain is common but is often undertreated in critically ill patients. A multimodal balanced analgesic approach is recommended for the management of pain in these patients. Balanced analgesia uses combined analgesic regimens, thereby reducing the likelihood of significant effects from a single agent or method. It may include several different drugs given to prevent or aggressively treat continuous and breakthrough pain as well as pain from procedures.
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Clinician involvement in critical care research will be essential if we are ever to achieve optimal patient outcomes. Educators and unit leadership play a pivotal role in facilitating, mentoring, and coaching clinicians both conduct research on important issues or problems in critical care and to ensure that practice routines are based on the latest research findings.