Pain management nursing : official journal of the American Society of Pain Management Nurses
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Randomized Controlled Trial Clinical Trial
The use of ice for pain associated with chest tube removal.
Every year more than 300,000 patients undergo cardiothoracic surgery, requiring placement of at least one chest tube. Removal of these chest tubes has been described as one of the worst intensive care unit experiences for these patients. Pain associated with chest tube removal (CTR) has been poorly controlled in many surgical patients. ⋯ Additionally, patients who received preprocedural pain medication did not differ in their levels of pain intensity or distress. Both groups used all the quality descriptors on the MPQ-SF for the sensory and affective components of pain, with cramping and gnawing as the most frequently chosen words. Continued research with larger samples is encouraged to further evaluate ice and other interventions that can be used to manage pain associated with CTR.
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After a policy change that required that lidocaine be offered to every patient before an intravenous (IV) insertion, registered nurses (RNs) in this rural acute care hospital were interviewed to determine whether they had changed their practice. This study reports on the percentage of RNs who offered lidocaine before IV insertion and explores the perceived and actual barriers for those nurses who did not routinely offer patients this option. The study sample of 30 represents 8% of the RN inpatient staff. ⋯ The reasons for not offering lidocaine included the perception that it made the procedure more difficult, an acknowledgment that it was not a part of their routine, or they did not think of it. Both the RNs who used the lidocaine and the RNs who did not use it referred to the fact that there was poor staff knowledge and skill about how to use intradermal lidocaine successfully. Recommendations are made for addressing the identified barriers.
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Clinical Trial Controlled Clinical Trial
Cardiovascular surgery patients' respiratory responses to morphine before extubation.
Analgesia is commonly withheld from cardiovascular surgery patients who are soon to be withdrawn from mechanical ventilation to prevent respiratory depression that can postpone extubation. The effects of analgesia on respiration have not been studied adequately. In this study, weaning parameter measurements were obtained to determine the respiratory impact of a low dose of intravenous morphine administered to cardiovascular surgery patients who were ready to be weaned from the ventilator. ⋯ Despite the small sample size, the results of dependent t tests revealed statistically significant improvements, using an alpha level of 0.05, in the mean tidal volume and negative inspiratory force values at the 30-minute measurement, and in the vital capacity value at the 15-minute measurement. The findings from this study help to refute the notion that a low dose of intravenous morphine will cause respiratory depression, and further suggest that the administration of morphine may enhance patients' respiratory function. If additional research supports this study's findings, both the goals of weaning postoperative patients from the ventilator and controlling pain may be achieved simultaneously.
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A role delineation study was carried out by the American Society of Pain Management Nurses (ASPMN) to determine the activities performed by nurses involved in pain management. Demographic characteristics of pain management nurses and differences in practice based on educational preparation and specialty affiliation were identified. The role delineation survey was developed based on Nursing Intervention Classifications. ⋯ Nurses with diploma and Associate Degree preparation rated assessment and nonpharmacologic management higher and communication and collaboration lower than nurses with higher educational preparation. Activities varied somewhat as a reflection of respondents' nursing specialty. The results of the study will be used to refine standards of care, develop nursing education curricula, develop research priorities, and develop a blueprint for a certification examination in pain management nursing.