Pain management nursing : official journal of the American Society of Pain Management Nurses
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The purpose of this qualitative inquiry was to broaden the context for understanding perceived control as a concept related to the cancer pain response in the homecare setting. Ten patient/caregiver dyads participated in semistructured interviews focused on questions pertaining to the patients' perceived control over their own pain as well as the caregivers' control over the patients' pain. Line-by-line analysis was used to code, categorize, and analyze the data. ⋯ Overall, patients and their caregivers were eager to discuss how their perceived lack of control over pain affected their daily lives. The results suggest perceived control over pain is an important aspect of the pain response in the homecare setting. Nurses should evaluate perceived control over pain in patients with cancer and their caregivers and implement and test potential methods for increasing perception of control over pain.
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Practice Guideline
Authorized and Unauthorized ("PCA by Proxy") Dosing of Analgesic Infusion Pumps: position statement with clinical practice recommendations.
The American Society for Pain Management Nursing (ASPMN), in order to address sentinel alerts issued by JCAHO in 2004 and ISMP in 2005 concerning "PCA by Proxy", has developed a position statement and clinical practice recommendations on Authorized and Unauthorized (PCA by Proxy) Dosing of Analgesic Infusion Pumps, approved by the Board of Directors in June of 2006. In short, ASPMN does not support the use of "PCA by Proxy". ⋯ Furthermore, the paper examines the ethical and safety issues and outlines the necessary screening and patient/family education needed to implement AACA. The position statement describes criteria for the use of AACA, guidelines for selection and education of the authorized agent, key prescription and monitoring recommendations during therapy, and quality improvement activities to insure safety and effectiveness.
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Despite enormous technologic advances and substantial research in the area of pain management in recent years, numerous studies indicate that postoperative pain is not relieved in most patients. Nurses are the health care professionals who spend the most time with patients in pain. ⋯ A phenomenologic mode of inquiry was used to interview three expert nurse participants. Four themes emerged during the data analysis phase: considering the whole person, the independent art of nursing, accepting what the patient says, and commitment to surgical nursing.
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Assessment is an essential, but challenging, component of any pain management plan. Nurses who care for postoperative patients quantify and document pain by use of unidimensional scales such as the numeric rating scale, the visual analogue scale, or a verbal descriptor scale. Improvements in pain ratings on these scales are viewed as a welcome result by nurses and doctors. ⋯ A unique finding of the study was that the degree of incremental shift on an NRS of pretreatment and posttreatment pain levels is not a good predictor of clinical relevance from the patient's perspective. A more accurate predictor was found by converting the changes on the NRS to percentages. An important implication of this study is the need to include a scale in pain assessment instruments for assessing the level of clinical meaningfulness of pain reduction from the patient's perspective.
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Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Although self-report is the gold standard for pain assessment, researchers have not studied young children at home with self-report measures. The purpose of this study was to describe the patterns of self-reported pain intensity and analgesic administration in 3- to 7-year-old children undergoing tonsillectomy during the operative day in the hospital and the first 2 postoperative days at home in Iceland. ⋯ In the hospital, children with pain intensity scores of 4 or 5 received prescribed morphine only 13% of the time. Children experienced clinically significant pain through the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.