Assessment and Management of the Trauma Patient in Pain

Pain Assessment and Management in Critically Ill Intubated Patients: a Retrospective Study

• Background Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally.

• Objectives To describe (1) pain indicators used by nurses and physicians for pain assessment, (2) pain management (pharmacological and nonpharmacological interventions) undertaken by nurses to relieve pain, and (3) pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are intubated.

• Methods Medical files from 2 specialized healthcare centers in Quebec City, Quebec, were reviewed. A data collection instrument based on Melzack’s theory was developed from existing tools. Pain-related indicators were clustered into nonobservable/subjective (patients’ self-reports of pain) and observable/objective (physiological and behavioral) categories.

• Results A total of 183 pain episodes in 52 patients who received mechanical ventilation were analyzed. Observable indicators were recorded 97% of the time. Patients’ self-reports of pain were recorded only 29% of the time, a practice contradictory to recommendations for pain assessment. Pharmacological interventions were used more often (89% of the time) than nonpharmacological interventions (<25%) for managing pain. Almost 40% of the time, pain was not reassessed after an intervention. For reassessments, observable indicators were recorded 66% of the time; patients self-reports were recorded only 8% of the time.

• Conclusions Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.

A controlled trial of psycho-educational interventions in preparing Chinese women for elective hysterectomy

The objective of this study was to investigate the effect of a cognitive intervention (distraction and reappraisal) with information given pre-operatively on post-operative outcomes of Chinese women having an abdominal hysterectomy. Using a controlled trial, 48 Chinese women having elective hysterectomy received the cognitive intervention with information (experimental group). A control group (n=48) received information alone. Outcome measures used in the study were post-operative anxiety and pain, requests for analgesia and patient satisfaction. The results show that women in the experimental group reported lower post-operative anxiety scores, lower pain scores and higher levels of satisfaction than women in the control group. There were no statistically significant differences in post-operative requests for analgesia between the groups. It is concluded that a cognitive intervention such as distraction and reappraisal may have significant clinical benefits and improve the care of women having an elective hysterectomy.

Evidence-based care of Chinese men having transurethral resection of the prostate (TURP)

AIM OF STUDY

To measure the effect of specific preoperative information on postoperative anxiety, satisfaction with information, and demand for analgesia, of Chinese males having transurethral resection of the prostate (TURP).

DESIGN

A controlled experimental design. The researchers allocated all patients (n = 30) undergoing TURP in a general hospital in Hong Kong, during a 3-month period, to one of two groups. The experimental group (n = 15) received a specific information pamphlet and a general preoperative counselling video. The control group (n = 15) received a video alone. PROCEDURE AND MEASURES: Following ethical approval, a researcher took baseline measures of state and trait anxiety using the Chinese State-Trait Anxiety Inventory (C -STAI). Five days after surgery the researcher administered the C-STAI (A-State), a patients' satisfaction questionnaire, and, recorded requests for analgesia during the first 5 postoperative days.

RESULTS

Experimental subjects reported significantly lower anxiety levels post-operatively and a significantly higher level of satisfaction with the preoperative information, than controls. Postoperative demand for analgesia did not significantly differ between groups.

CONCLUSIONS

The findings support the importance of providing patients with specific, written preoperative information about their surgery and its effects to minimize their postoperative anxiety levels, and improve their satisfaction with the care provided.