Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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Review Comparative Study
Trauma pain protocol: an interdisciplinary approach to process improvement.
The trauma pain protocol was developed in response to nursing staff concerns regarding pain management practices and hospital-wide goals. Data collected on pain management practices within the trauma patient population identified inconsistencies with the transition of patient-controlled analgesia (PCA) to oral (PO) and intravenous (IV) pain medications. Nursing staff cited concerns with the frequent need for calls to clinicians to obtain additional pain medication orders following discontinuation of PCA. ⋯ Data collected from a 4-month pilot of the protocol demonstrated a reduction in changes made to PO/IV medications following discontinuation of PCA. Nursing response to the protocol included increased satisfaction with pain management practices and a perception of time saved through reduced need for calls to clinicians for additional pain medication modifications. We conclude that this protocol results in a more individualized, evidence-based transition from PCA to PO/IV.
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Increased intracranial pressure (ICP) is a challenging complication to treat within a critical care setting. It is imperative that clinicians use a stepwise approach in developing a diagnosis, as to be comprehensive and decrease morbidity and mortality related to increased ICP. This article provides an algorithm that can be used as a clinical guideline when assessing a patient who has an ICP monitor in place and is presenting with increased ICP. The algorithm is inclusive and composed of a history of present illness, review of systems, physical assessment, labs, and further testing.
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Family presence during resuscitation (FPDR) is an option occurring in clinical practice. National clinical guidelines on providing the option of FPDR are available from the American Association of Critical-Care Nurses, American Heart Association, Emergency Nurses Association, and Society of Critical Care Medicine. The FPDR option currently remains controversial, underutilized, and not the usual practice with trauma patients. ⋯ Examples of real clinical challenges faced by the researchers are described throughout this article. Research challenges include design, sampling, inclusion/exclusion criteria, human subjects, and procedures. Recruitment of family members who participated in the FPDR option is a complex process, especially after admission to the critical care unit.
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Comparative Study
Chronic pain at 4 months in hospitalized trauma patients: incidence and life interference.
Many studies report on the incidence of chronic pain. However, deficiencies exist in prior research making it difficult to generalize results to trauma patients. ⋯ The incidence of chronic pain was present in 79.2% of trauma patients 4 months posttrauma and a strong positive correlation (n = 80, r = 0.79, P < 0.001) existed between chronic pain severity and the effect on life interference. Chronic pain is prevalent and causes significant life interference in traumatically injured patients.