Pain management nursing : official journal of the American Society of Pain Management Nurses
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Arterial punctures for arterial blood gases (ABGs) analysis are described as the most painful laboratory procedure and are performed without the benefit of pain management. This study originated from one nurse's concern about the level of pain her hospitalized patients endured when she drew their ABGs. A review of the literature found that ABG pain relief has not been studied in hospitalized patients. ⋯ Results showed that, although lidocaine and buffered lidocaine are effective in reducing the pain associated with the arterial puncture, plain lidocaine was the only intervention in which the pain rating score for the overall experience was significantly diminished. This study is limited by partial randomization, small sample size, and patient duress; however, it provides a foundation for further nursing research that explores methods to reduce the pain associated with this very painful procedure. Future studies should be directed at larger, diverse populations, multiple operators, and comparison of interventions to topical analgesics and nonpharmacological measures.
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Multicenter Study
Mild, moderate, and severe pain in patients recovering from major abdominal surgery.
Pain interferes with various activities, such as coughing, deep breathing, and ambulation, designed to promote recovery and prevent complications after surgery. Determining appropriate cutpoints for mild, moderate, and severe pain is important, because specific interventions may be based on this classification. The purpose of this research was to determine optimal cutpoints for postoperative patients based on their worst and average pain during hospitalization and after discharge to home, and whether the optimal cutpoints distinguished patients with mild, moderate, or severe pain regarding patient outcomes. ⋯ A substantial proportion of patients experienced moderate to severe pain. The results suggest a narrow boundary between mild and severe pain that interferes with function. The findings indicate that clinicians should seek to aggressively manage postoperative pain ratings greater than 3.
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Nurses play a crucial role in the evaluation and treatment of pain in the critically ill patient. This responsibility is all the more critical with this particular population because many may not be able to self-report their pain level and the typical behavioral signs of pain may be subtle or absent. According to recent recommendations, vital signs should not be used as primary indicators of pain but rather considered as a cue to begin further assessment. ⋯ Current NIRS techniques have well recognized limitations which must be considered carefully during the measurement and interpretation of signals. Thus, its clinical use is yet to be fully established. Nonetheless, cerebral NIRS technique as an approach to assess brain activity in response to pain should not be abandoned.
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The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. ⋯ The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.