Pain management nursing : official journal of the American Society of Pain Management Nurses
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Comparative Study
Validity of parent ratings as proxy measures of pain in children with cognitive impairment.
Parent-assigned pain scores have been used as proxy measures of pain for children, such as those with cognitive impairment (CI), who cannot self-report. However, the accuracy of parent-assigned pain ratings for children with CI has not been studied. This study evaluated the construct and criterion validity of parental pain scores of children with CI. ⋯ The parent underestimated the child's pain with FLACC ratings in only one case (8%), but overestimated pain in three cases (25%). This study suggests that parents of children with CI provide reasonable estimates of their child's pain, particularly when using a structured pain tool. Parents may, however, tend to overestimate their child's pain during the early postoperative period.
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The cost associated with surgical procedures has been dramatically decreased by the ability to perform these procedures on an outpatient basis. Pain and nausea, two common symptoms after anesthesia and surgical procedures, are among the greatest concerns for patients and their family members. As a result of the distress and sequelae associated with these symptoms, clinicians have attempted to determine the optimal intraoperative and postoperative symptom management for patients. ⋯ Data were collected at three specific time points (i.e., preoperatively, at 24 hours and at 7 days postoperatively). Postoperative pain and nausea were generally well managed, but improvement was needed in preoperative patient teaching, including the topics of drug and nondrug interventions. The methods used in this project have potential application for the measurement of other clinical outcomes after outpatient surgical procedures.
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The term "drug seeking" is frequently used but poorly defined. By soliciting nurses' comments and suggestions, a survey was developed to identify behaviors that may cause nurses to refer to a patient as drug seeking, to identify what nurses think the term "drug seeking" means, to explore how nurses regard the use of the term "drug seeking" in health care, and to identify differences between general nurses, emergency nurses, and pain management nurses with regard to these items. Behaviors that would cause the majority of all three nurse groups to refer to a patient as drug seeking were as follows: going to different emergency departments to get opioids, telling inconsistent stories about pain or medical history, or asking for a refill because the prescription was lost or stolen. ⋯ One-half or more for each nurse group said they used the term "drug seeking" in talking about patients, but less than 10% said they used it in charting. After completing the survey, approximately one half or more of nurses in each group were less inclined to use the term. The use of stigmatizing terms in clinical practice is addressed with suggestions for alternative approaches to patient behavior related to requesting opioids for pain relief.
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Comparative Study
Differences in postoperative opioid consumption in patients prescribed patient-controlled analgesia versus intramuscular injection.
The purpose of this study was to examine differences in opioid consumption in patients prescribed patient-controlled analgesia (PCA) versus intramuscular injection (IMI) in the early postoperative period after open abdominal surgery. A retrospective audit of 115 patients elicited demographic and clinical data. No significant differences were found between the demographic variables of the PCA and IMI groups. ⋯ This study shows that the amount of analgesia consumed during the postoperative period by patients who had abdominal surgery varied markedly depending on the mode of analgesia (PCA or IMI). The difference in analgesic consumption was also found to increase throughout the 3-day postoperative period. This divergence in the amount of opioid consumption between patients who were prescribed PCA and patients who were prescribed IM analgesia heightens the need for vigilance in assessment and management of pain during the early postoperative period, particularly in patients prescribed IM analgesia on an "as-needed" basis.