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Akarsu K. Nursing care after hand replantation based on Roy's adaptation model: A case report. Int J Orthop Trauma Nurs 2024; 52:101039. [PMID: 37778945 DOI: 10.1016/j.ijotn.2023.101039] [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: 01/27/2023] [Revised: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Hand injuries are very complex and worrying in terms of hindering activities of daily living, functionality and self-care skills. Hand injuries are caused by traumatic events, resulting in a partial or complete loss. The focus of acute treatment is surgical replantation. AIM In this study, nursing care and nursing experiences of a patient who was replanted as a result of hand trauma were discussed in the light of the Roy Adaptation Model. CASE The male patient admitted to the emergency room due to traumatic amputation was a 49-year-old farmer. He lost his hand to an agricultural tool while working the land and was taken to the hospital within 4 h. He was taken up for emergency surgery for replantation. He has a history of diabetes mellitus. Nursing follow-up and interventions were applied by evaluating the data according to four adaptation modes (physiological needs, self-concept, role function and interdependence) within the scope of the Roy Adaptation Model. CONCLUSION and Suggestions: Patients experience difficulties (loss of function, financial problems, loss of role, psychological traumas) due to disability after injury. Therefore, nurses should know the underlying physiological risks, complications, and interventions to recognize and respond to situations that cause the loss of the reattached limb. Nursing models can identify patients' needs and problems, prevent complications, provide quality care, and manage the process. This study discussed the postoperative nursing care of a patient based on Roy's Adaptation Model.
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Affiliation(s)
- Kamile Akarsu
- Lokman Hekim University Vocational School of Health Services, Ankara, Turkey.
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Van Wyngaarden JJ, Archer KR, Pennings JS, Matuszewski PE, Noehren B. Psychosocial Predictors of Chronic Pain 12 Months After Surgical Fixation for Lower Extremity Fracture: A Prospective Study. Phys Ther 2022; 102:6655886. [PMID: 35926071 DOI: 10.1093/ptj/pzac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/07/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain is a common outcome after lower extremity fracture (LEF) requiring surgical fixation. Although psychosocial characteristics have meaningful associations with adverse outcomes, no studies have evaluated how psychosocial characteristics throughout recovery are associated with pain outcomes. The primary purpose of this study was to determine whether psychosocial characteristics are early risk factors for pain outcomes in patients following LEF who have no history of chronic pain. METHODS Participants, 122 patients with a LEF, consented to this single-center, prospective cohort study. Measurements of depression, pain self-efficacy, pain catastrophizing, and fear of movement were completed at 1 week, 6 weeks, 3 months, 6 months, and 12 months after LEF. Chronic pain development and pain intensity were assessed at 12 months. Univariate analyses assessing the difference between means and corresponding effect sizes were evaluated between those individuals with and without chronic pain at 12 months. Separate logistic and linear regression models using psychosocial scores at each time point were used to determine the association with the development of chronic pain and pain intensity, respectively. RESULTS Of 114 patients (93.4%) who completed the study, 51 (45%) reported chronic pain at 12 months. In the univariate analysis, all psychosocial variables at 6 weeks, 3 months, 6 months, and 12 months were significantly different between those with and those without chronic pain at 12 months (Cohen d range = 0.84 to 1.65). In the multivariate regression models, all psychosocial variables at 6 weeks, 3 months, and 6 months were associated with chronic pain development (odds ratio range = 1.04 to 1.22) and pain intensity (β range = .05 to .14) at 12 months. CONCLUSION Psychosocial scores as early as 6 weeks after surgery are associated with pain outcomes 12 months after LEF. IMPACT Physical therapists should consider adding psychosocial screening throughout recovery after LEF to identify patients at increased risk for long-term pain outcomes.
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Affiliation(s)
- Joshua J Van Wyngaarden
- Army-Baylor University, Doctoral Program of Physical Therapy, Baylor University, San Antonio, Texas, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul E Matuszewski
- College of Medicine, Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Brian Noehren
- College of Medicine, Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA.,College of Health Sciences, Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
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Richard-Lalonde M, Feeley N, Cossette S, Chlan LL, Gélinas C. Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care: Protocol for a Randomized Crossover Pilot Trial (Preprint). JMIR Res Protoc 2022; 12:e40760. [PMID: 37163350 DOI: 10.2196/40760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice. OBJECTIVE The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients. METHODS A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients' preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery. RESULTS Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited. CONCLUSIONS Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors. TRIAL REGISTRATION ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40760.
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Bérubé M, Gélinas C, Feeley N, Martorella G, Côté J, Laflamme GY, Rouleau DM, Choinière M. Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:2018-2032. [PMID: 30840085 PMCID: PMC6784743 DOI: 10.1093/pm/pnz008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective 1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months postinjury. Design A pilot randomized controlled trial (RCT) with two parallel groups. Setting A supraregional level 1 trauma center. Methods Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities. Results More than 80% of eligible patients agreed to participate, and an attrition rate of ≤18% was found. Less than 40% of screened patients were eligible, and obtaining baseline data took 48 hours postadmission on average. Mean scores of mild pain intensity and pain interference with daily activities (<4/10) on average were obtained in both groups at three and six months postinjury. Between 20% and 30% of participants reported moderate to high mean scores (≥4/10) on these outcomes at the two follow-up time measures. The experimental group perceived greater considerable improvement in pain (60% in the experimental group vs 46% in the control group) at three months postinjury. Low mean scores of pain catastrophizing (Pain Catastrophizing Scale score < 30) and anxiety and depression (Hospital Anxiety and Depression Scale scores ≤ 10) were obtained through the end of the study. Conclusions Some challenges that need to be addressed in a future RCT include the small proportion of screened patients who were eligible and the selection of appropriate tools to measure the development of chronic pain. Studies will need to be conducted with patients presenting more serious injuries and psychological vulnerability or using a stepped screening approach.
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Affiliation(s)
- M Bérubé
- Faculty of Nursing, Laval University, Quebec City, Quebec, Canada
- Research Center of the CHU de Québec, Quebec City, Quebec, Canada
| | - C Gélinas
- Faculty of Nursing, Laval University, Quebec City, Quebec, Canada
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - N Feeley
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - G Martorella
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - J Côté
- Centre de Recherche, Centre Hospitalier de l’Université Montréal (CRCHUM), Montréal, Québec, Canada
| | - G Y Laflamme
- Hôpital du Sacré-Cœur de Montréal, Centre Intégré Universitaire du Nord de l’Île-de-Montréal, Montréal, Québec, Canada
| | - D M Rouleau
- Hôpital du Sacré-Cœur de Montréal, Centre Intégré Universitaire du Nord de l’Île-de-Montréal, Montréal, Québec, Canada
| | - M Choinière
- Centre de Recherche, Centre Hospitalier de l’Université Montréal (CRCHUM), Montréal, Québec, Canada
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Bérubé M, Deslauriers V, Leduc S, Turcotte V, Dupuis S, Roy I, Clairoux S, Panic S, Nolet M. Feasibility of a tapering opioids prescription program for trauma patients at high risk of chronic consumption (TOPP-trauma): protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2019; 5:67. [PMID: 31110776 PMCID: PMC6511175 DOI: 10.1186/s40814-019-0444-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/09/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD) and deaths related to the chronic use of opioids have increased significantly over the last two decades. Chronic consumption of opioids has been documented in many patients with traumatic injuries. Preliminary research findings have shown that interventions using cognitive-behavioral strategies were a promising adjunct in decreasing the burden associated with opioid consumption. Accordingly, the Tapering Opioids Prescription Program in Trauma (TOPP-Trauma) was developed. PURPOSE To assess the feasibility of the TOPP-Trauma intervention and its research methods; and explore the potential efficacy of TOPP-Trauma in reducing opioid consumption. METHODS A 2-arm pilot randomized controlled trial (RCT) will be conducted in patients presenting a high risk for chronic opioid consumption. Fifty participants at high risk for chronic consumption of opioid will receive either TOPP-Trauma or an educational pamphlet. The feasibility assessment of TOPP-Trauma will be based on the ability to provide its components as initially planned. Several parameters will be evaluated to determine the feasibility of the research methods, including the adequacy of the sampling pool, the dropout rate, and the ease of data collection. The morphine equivalent dose (MED) per day between both groups will be measured at 6 and 12 weeks. Pain intensity and pain interference with activities will also be evaluated at the same time points. DISCUSSION This study will provide evidence on the feasibility of a preventive program aimed at reducing chronic opioid use in high risk trauma patients. Information will also be gathered on the methods that should be used to test the efficacy of such programs. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 40263056. Registered 26 May 2018.
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Affiliation(s)
- M. Bérubé
- Faculty of Nursing, Laval University, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6 Canada
- Research Center, CHU de Québec, Quebec City, QC Canada
| | - V. Deslauriers
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
| | - S. Leduc
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - V. Turcotte
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - S. Dupuis
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC Canada
| | - I. Roy
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - S. Clairoux
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC Canada
| | - S. Panic
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
| | - M. Nolet
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montreal, QC Canada
- Department of Anesthesiology, Faculty of Medicine, Université de Montreal, Montreal, QC Canada
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Martorella G, Graven L, Schluck G, Bérubé M, Gélinas C. Nurses' Perception of a Tailored Web-Based Intervention for the Self-Management of Pain After Cardiac Surgery. SAGE Open Nurs 2018; 4:2377960818806270. [PMID: 33415209 PMCID: PMC7774353 DOI: 10.1177/2377960818806270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/18/2018] [Indexed: 01/12/2023] Open
Abstract
Background Cardiac surgeries rank among the most frequent surgical procedures and present a risk of chronic postsurgical pain (CPSP). A continuum approach is required to prevent the development of CPSP. As a first step, a tailored web-based intervention was developed and successfully tested to tackle pain management during hospitalization. Before proceeding to further development, preliminary acceptability of the intervention including the postdischarge phase must be evaluated. Purpose The purpose of this study was to examine nurses’ perception of a tailored Web-based intervention for pain management in the early recovery phase. The objectives were to evaluate intervention’s acceptability and to identify ways to enhance its acceptability. Methods A parallel mixed methods approach was used to assess the acceptability of the intervention in the early recovery phase (first month after surgery). Results In total, 249 participants completed the online survey and 10 participants were individually interviewed. Overall, the intervention was rated as acceptable. No difference was found in acceptability ratings by demographics. The intervention was rated as appropriate to very much appropriate by 79% of participants. Although nurses seemingly would recommend it to their patients, they did not perceive that their patients would be as highly willing to use it. Interviews highlighted several strengths of the intervention, such as postoperative pain awareness, customization of content, and flexible dosage and schedule. However, the main weakness was related to patient adherence. Opting for a hybrid format and integrating individual preferences could enhance the coaching experience. Conclusion The innovative intervention was judged as acceptable for pain management in the early recovery phase. Considering that the intervention has demonstrated positive effects on the pain experience in the first week after cardiac surgery, it seems logical to explore its potential impact after discharge on the transition to CPSP.
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Affiliation(s)
- Geraldine Martorella
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, FL, USA
| | - Lucinda Graven
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Glenna Schluck
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Mélanie Bérubé
- Ingram School of Nursing, McGill University, Montreal, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, Canada.,Centre for Nursing Research, Jewish General Hospital, Montreal, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
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Bérubé M, Gélinas C, Feeley N, Martorella G, Côté J, Laflamme GY, Rouleau DM, Choinière M. A Hybrid Web-Based and In-Person Self-Management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma: Feasibility and Acceptability of iPACT-E-Trauma. JMIR Form Res 2018; 2:e10323. [PMID: 30684418 PMCID: PMC6334695 DOI: 10.2196/10323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/11/2018] [Accepted: 04/14/2018] [Indexed: 12/31/2022] Open
Abstract
Background A transition from acute to chronic pain frequently occurs after major lower extremity trauma. While the risk factors for developing chronic pain in this population have been extensively studied, research findings on interventions aiming to prevent chronic pain in the trauma context are scarce. Therefore, we developed a hybrid, Web-based and in-person, self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma). Objective This study aimed to assess the feasibility and acceptability of iPACT-E-Trauma. Methods Using a descriptive design, the intervention was initiated at a supra-regional level-1 trauma center. Twenty-eight patients ≥18 years old with major lower extremity trauma, presenting with moderate to high pain intensity 24 hours post-injury were recruited. Feasibility assessment was two-fold: 1) whether the intervention components could be provided as planned to ≥80% of participants and 2) whether ≥80% of participants could complete the intervention. The rates for both these variables were calculated. The E-Health Acceptability Questionnaire and the Treatment Acceptability and Preference Questionnaire were used to assess acceptability. Mean scores were computed to determine the intervention’s acceptability. Results More than 80% of participants received the session components relevant to their condition. However, the Web pages for session 2, on the analgesics prescribed, were accessed by 71% of participants. Most sessions were delivered according to the established timeline for ≥80% of participants. Session 3 and in-person coaching meetings had to be provider earlier for ≥35% of participants. Session duration was 30 minutes or less on average, as initially planned. More than 80% of participants attended sessions and <20% did not apply self-management behaviors relevant to their condition, with the exception of deep breathing relaxation exercises which was not applied by 40% of them. Web and in-person sessions were assessed as very acceptable (mean scores ≥3 on a 0 to 4 descriptive scale) across nearly all acceptability attributes. Conclusions Findings showed that the iPACT-E-Trauma intervention is feasible and was perceived as highly acceptable by participants. Further tailoring iPACT-E-Trauma to patient needs, providing more training time for relaxation techniques, and modifying the Web platform to improve its convenience could enhance the feasibility and acceptability of the intervention. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 91987302; http://www.controlled-trials.com/ISRCTN91987302 (Archived by WebCite at http://www.webcitation.org/6ynibjPHa)
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Affiliation(s)
- Mélanie Bérubé
- Centre intégré universitaire du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Trauma Program and Department of Nursing, Montreal, QC, Canada.,Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Centre for Nursing Research, Jewish General Hospital, Montreal, QC, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Centre for Nursing Research, Jewish General Hospital, Montreal, QC, Canada
| | | | - José Côté
- Faculté des sciences infirmières, Université de Montréal, Montreal, QC, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - G Yves Laflamme
- Centre intégré universitaire du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Department of Surgery, Université de Montréal, Montreal, QC, Canada
| | - Dominique M Rouleau
- Centre intégré universitaire du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Department of Surgery, Université de Montréal, Montreal, QC, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Department of Anesthesiology, Université de Montréal, Montreal, QC, Canada
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