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Umberger W, Wilson M. Translating the Biopsychosocial-Spiritual Model into Nursing Practice. Pain Manag Nurs 2024; 25:1-3. [PMID: 38212091 DOI: 10.1016/j.pmn.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Wendy Umberger
- Kent State University, College of Nursing, Kent, Ohio, US.
| | - Marian Wilson
- Washington State University, College of Nursing, Washington, Spokane, US
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Swift C, Hocking C, Jones M. Exploring communication in families affected by parental chronic pain: An occupational perspective. Scand J Occup Ther 2023; 30:1224-1236. [PMID: 35298325 DOI: 10.1080/11038128.2022.2051601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Family communication about pain is an important therapeutic target when a parent lives with chronic pain. Occupational therapy literature about communication in families affected by parental chronic pain is currently lacking. AIMS/OBJECTIVES To bring an occupational perspective to communication within families affected by parental chronic pain, to generate insights for practice. MATERIALS AND METHODS Five families (total n = 19 family members) were recruited into this collective case study. The gathered data included interviews, observations, and personal documents/artefacts. A cross-case analysis of similarities and differences between families was conducted to distil insights about the relationship between occupation and communication about parental pain. RESULTS Each family develops its own style of communicating about a parent's pain. On a day-to-day basis, pain-related communication is prompted by experienced, observed and/or anticipated occupational disruption brought about by parental pain. CONCLUSIONS Occupational disruption and occupational responses need to be components of interest, when designing assessments and interventions targeted at communication in families affected by parental chronic pain. SIGNIFICANCE The findings from this study point to the importance of communication through occupation in families affected by parental chronic pain and suggest novel targets for occupational therapy intervention.
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Affiliation(s)
- Catherine Swift
- Department of Occupational Science and Therapy, Auckland University of Technology, Auckland, New Zealand
| | - Clare Hocking
- Department of Occupational Science and Therapy, Auckland University of Technology, Auckland, New Zealand
| | - Margaret Jones
- Department of Occupational Science and Therapy, Auckland University of Technology, Auckland, New Zealand
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Rønne PF, Esbensen BA, Brødsgaard A, Rosenstrøm SM, Voltelen B, Hansen CA. Barriers and Facilitators Influencing Nurses' Confidence in Managing Family Nursing Conversations in the Treatment of Chronic Noncancer Pain: A Longitudinal Qualitative Study. JOURNAL OF FAMILY NURSING 2023; 29:166-178. [PMID: 36636019 DOI: 10.1177/10748407221145963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This mixed-methods research examined the translation of a family nursing conversation intervention to the multidisciplinary treatment of patients experiencing chronic noncancer pain. The intervention required educating nurses who offered family nursing interventions to these families. The research uncovered barriers and facilitators influencing the nurses' perceived self-efficacy related to the process of incorporating family nursing conversations in their nursing care. A qualitative, descriptive, longitudinal design with three focus group interviews was implemented. A template analysis, using a priori themes based on Bandura's self-efficacy theory, illuminated a process initially predominated by barriers. Learning how to offer family nursing conversations was initially overwhelming for nurses because they were concerned about harming the family. Over time, the nurses came to understand the usefulness of the therapeutic conversation with families. Significant facilitators were the project manager's role, a strong nursing community, and the positive influence of the family intervention on the nurses' professional identity.
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Affiliation(s)
| | | | - Anne Brødsgaard
- Aarhus University, Emdrup, Denmark
- Copenhagen University Hospital, Hvidovre, Denmark
| | | | | | - Carrinna Aviaja Hansen
- University of Southern Denmark, Odense, Denmark
- Zealand University Hospital, Koege, Denmark
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Roenne PF, Horn NS, Hansen CA. Involvement of relatives in chronic non-malignant pain rehabilitation at multidisciplinary pain centres: part one - the patient perspective. Scand J Pain 2020; 21:81-94. [PMID: 33583169 DOI: 10.1515/sjpain-2019-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 09/18/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Chronic non-malignant pain (CNP) is a significant healthcare problem with considerable consequences for patients, relatives and society. CNP is a lifelong condition that calls for acceptance and self-management. Existing research indicates that the involvement of relatives improves patients' and relatives' management of CNP, but the area is, at present, scarcely described. Research is required to obtain knowledge about the patients' experiences, needs and preferences concerning the involvement of their relatives within the frame of CNP rehabilitation, which is the aim of this study. METHODS The study applied a qualitative phenomenological-hermeneutic design conducting individual interviews with 10 patients with CNP from three selected Multidisciplinary Pain Centres (MPC). The analysis was guided by Paul Ricoeur's philosophy of interpretation of the text. RESULTS The findings illuminated the patients' perspectives on the involvement of relatives within three key themes, each having two or three sub-themes. The analysis revealed that patients in CNP rehabilitation had various interpretations of the substance of involving relatives, reflecting their sparse experiences. It seemed arbitrary, who during the rehabilitation actually experienced the involvement of their relatives, leaving the impression of an area short of structure. This shortage was troublesome, due to a heartrending impact of CNP. Patients' reduced functional level, combined with their surroundings difficulties in grasping the magnitude of CNP led to a loss of relationships and a risk of social isolation. Patients' close relationships became essential but were under pressure as well. Patients living with a spouse/cohabitant experienced that the relationship was affected by a disrupted balance and pain-related emotional outbursts. The patients experienced a profound need for being understood, but the text also revealed a need for mutual understanding to acknowledge the relatives' strain as well. Particular patients with children living at home experienced to be under great strain, complicated by a deep concern for long-term consequences for their children growing up influenced by parental CNP. Experienced involvement of relatives, even to a minor extend was perceived as beneficial for the patients, who experienced increased understanding and support from the relatives. However, due to the lack of a structured service, the patients' access to the involvement of relatives became dependent on their ability to define their need and pick it out. Thus the patients also expressed a general preference for mandatory and structured involvement, yet tailored to the specific patient. CONCLUSIONS The study showed an overwhelming need for the involvement of relatives among patients with CNP, indicating that increased attention and investigation of relevant interventions are required. Despite differences between the MPC, our primary impression was that the involvement of relatives reached a minimal level of what was expected, which might entail desertion of patients scarce of resources. Individualised adjusted involvement of relatives is assumed to improve patient's management of CNP in everyday life. A family systems nursing (FSN) approach is a relevant proposal for intervention, useful in other illness areas. Still, research needs to shed light on the appropriateness of FSN when involving relatives in the rehabilitation of CNP.
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Affiliation(s)
- Pernille Friis Roenne
- Department of Anaesthesia, Respiratory Support and Pain, the Neuroscience Centre, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 15, 2600 Glostrup, Denmark
| | - Nadija Schwartz Horn
- Multidisciplinary Pain Centre, Department of Anaesthesia, Respiratory Support and Pain, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Carrinna Aviaja Hansen
- Department of Anaesthesia, Respiratory Support and Pain, the Neuroscience Centre, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 15, 2600 Glostrup, Denmark.,Department of Orthopedic Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
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Testing the intergenerational model of transmission of risk for chronic pain from parents to their children: an empirical investigation of social transmission pathways. Pain 2020; 160:2544-2553. [PMID: 31393280 DOI: 10.1097/j.pain.0000000000001658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Children of parents with chronic pain have higher rates of pain and internalizing (eg, anxiety and depressive) symptoms than children of parents without chronic pain. Parental modeling of pain behaviour and reinforcement of child pain have been hypothesized to underlie these relationships. These mechanisms were tested in a sample of 72 parents with chronic pain and their children (aged 8-15 years). Standardized measures were completed by parents (pain characteristics, pain interference, and child internalizing) and children (pain catastrophizing, pain over previous 3 months, and internalizing). In a laboratory session, children completed the cold pressor task in the presence of their parent, and parent-child verbalizations were coded. Significant indirect effects of parental pain interference on child self-reported (B = 0.12, 95% confidence interval [CI]: 0.01-0.29) and parent-reported (B = 0.16, 95% CI: 0.03-0.40) internalizing symptoms through child pain catastrophizing were found (parental modeling mechanism), and were not moderated by child chronic pain status. Significant indirect effects were found between parent pain-attending verbalizations and child self-reported (B = 2.58, 95% CI: 1.03-5.31) and parent-reported (B = 2.18, 95% CI: 0.93-4.27) cold pressor task pain intensity and tolerance (B = -1.02, 95% CI: -1.92 to -0.42) through child pain-attending verbalizations (parental reinforcement mechanism). Although further understanding of the temporal relationships between these variables is needed, the current study identifies constructs (eg, parent pain interference, child pain catastrophizing, and parent reinforcement of child pain) that should be further examined as potential targets for prevention and intervention of pain and internalizing symptoms in children of parents with chronic pain.
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Higgins KS, Chambers CT, Rosen NO, Sherry S, Mohammadi S, Lynch ME, Campbell-Yeo M, Clark AJ. Child catastrophizing about parent chronic pain: A potential child vulnerability factor. Br J Health Psychol 2020; 25:339-357. [PMID: 32196873 PMCID: PMC7384016 DOI: 10.1111/bjhp.12410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/13/2019] [Indexed: 01/12/2023]
Abstract
Statement of contribution What is already known on this subject?Higher rates of pain and internalizing symptoms are observed in offspring of parents with vs. without chronic pain. Greater child and parent pain catastrophizing are associated with poorer pain‐related outcomes in children. Child catastrophizing about parent chronic pain and its association with child outcomes has not been examined.
What does this study add?Greater child catastrophizing about parent chronic pain is associated with greater child internalizing and CPT pain. These effects were seen beyond the association of child and parent catastrophizing about their own pain.
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Affiliation(s)
- Kristen S Higgins
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Natalie O Rosen
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Simon Sherry
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Somayyeh Mohammadi
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Mary E Lynch
- Dalhousie University, Halifax, Nova Scotia, Canada.,QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Alexander J Clark
- Dalhousie University, Halifax, Nova Scotia, Canada.,QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain. Pain 2019; 159:298-305. [PMID: 29016461 DOI: 10.1097/j.pain.0000000000001085] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Having a parent with chronic pain (CP) may confer greater risk of persistence of CP from childhood into young adulthood. Social learning, such as parental modeling and reinforcement, represents one plausible mechanism for the transmission of risk of CP from parents to offspring. Based on a 7-day pain diary in 154 pediatric patients with functional abdominal CP, we tested a model in which parental CP predicted adolescents' daily average CP severity and functional impairment (distal outcomes) via parental modeling of pain behaviors and parental reinforcement of adolescent's pain behaviors (mediators) and adolescents' cognitive appraisals of pain threat (proximal outcome representing adolescents' encoding of parents' behaviors). Results indicated significant indirect pathways from parental CP status to adolescent average daily pain severity (b = 0.18, SE = 0.08, 95% confidence interval: 0.04-0.31, P = 0.03) and functional impairment (b = 0.08, SE = 0.04, 95% confidence interval: 0.02-0.15, P = 0.03) over the 7-day diary period via adolescents' observations of parent pain behaviors and adolescent pain threat appraisal. The indirect pathway through parental reinforcing responses to adolescents' pain did not reach significance for either adolescent pain severity or functional impairment. Identifying mechanisms of increased risk of pain and functional impairment in children of parents with CP ultimately could lead to targeted interventions aimed at improving functioning and quality of life in families with CP. Parental modeling of pain behaviors represents a potentially promising target for family-based interventions to ameliorate pediatric CP.
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Swift C, Hocking C, Dickinson A, Jones M. Facilitating open family communication when a parent has chronic pain: A scoping review. Scand J Occup Ther 2018; 26:103-120. [PMID: 29984588 DOI: 10.1080/11038128.2018.1486885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND When a parent has chronic pain, family communication can become strained. Clinicians are encouraged to identify and support families struggling with open communication. Occupational therapists are commonly involved in the provision of pain management services but their role in facilitating open communication in families affected by this condition has not been clearly articulated. OBJECTIVE To develop a comprehensive understanding of what is being done and/or thought to be helpful for facilitating open communication in families affected by chronic pain, in order to articulate the role of occupational therapy in this area of care. METHODS A scoping review was conducted and 24 items analyzed using qualitative content analysis. RESULTS The facilitation of open communication in families affected by parental chronic pain is dependent on a variety of factors, including the skills that members possess and occupations which they perform individually and together. It can also be prompted by relationship tension or a family accessing professional support. Occupational therapy literature on the matter is currently limited and focused on assertiveness training. CONCLUSION AND SIGNIFICANCE There is scope for occupational therapist to extend their role beyond assertiveness training and use occupation-centered interventions to facilitate communication within families affected by parental chronic pain.
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Affiliation(s)
- Catherine Swift
- a Department of Occupational Science and Therapy , Auckland University of Technology , Auckland , New Zealand
| | - Clare Hocking
- a Department of Occupational Science and Therapy , Auckland University of Technology , Auckland , New Zealand
| | - Annette Dickinson
- b School of Clinical Sciences, Auckland University of Technology , Auckland , New Zealand
| | - Margaret Jones
- a Department of Occupational Science and Therapy , Auckland University of Technology , Auckland , New Zealand
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Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model. Pain 2017; 157:2628-2639. [PMID: 27380502 DOI: 10.1097/j.pain.0000000000000637] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.
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Umberger WA, Risko J. "It didn't kill me. It just made me stronger and wiser": Silver Linings for Children and Adolescents of Parents with Chronic Pain. Arch Psychiatr Nurs 2016; 30:138-43. [PMID: 26992861 DOI: 10.1016/j.apnu.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
Chronic non-cancer pain (CNCP) is a disease that affects adults in their child-rearing years and is often incurable and of indefinite duration. Children and adolescents who live with parental CNCP can endure multiple adversities and experience subsequent emotional and somatic difficulties. Resilience is the ability to overcome adversity and even experience growth. This study is a secondary analysis of qualitative data, which sought to gain a deeper understanding of the ways in which children and adolescents rebound and grow from experiences living with parents who suffer with CNCP. Young adult children (N=30) of parents with CNCP were interviewed. Content analysis yielded five ways in which their experiences led to areas of positive growth: (a) expanded ways of understanding; (b) cultivated a strong character; (c) aided in the development of important skills; (d) instilled a commitment to live well, and; (e) nurtured spirituality. Clinicians who work with children and adolescents whose parents are disabled with CNCP can create environments that foster resilience and serve as a guide by helping these youth recognize potentials that have not yet been actualized and promoting positive change and growth over time.
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Affiliation(s)
| | - Judy Risko
- Kent State University, College of Nursing, Kent, OH, USA
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Christian BJ. Translational Research-Enhancing the Health of Children and their Parents. J Pediatr Nurs 2015; 30:516-8. [PMID: 25939568 DOI: 10.1016/j.pedn.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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