[The bioethical principlism model applied in pain management]

The relationship between Iranian women's perception of their birth team's compliance with medical ethics and their perception of labor pain

BACKGROUND

A safe and satisfactory childbirth experience with the least amount of pain constitutes one of the main domains of reproductive healthcare. The most important aspect of labor pain management is the moral and professional commitment of the health professionals and caregivers involved in creating a pleasant delivery. The present study examines the relationship between Iranian women's perceptions of their birth team's compliance with medical ethics and their perception of labor pain.

METHODS

This cross-sectional study was conducted on 200 women opting for natural childbirth. The samples were selected by convenience sampling. Three questionnaires, including a demographic information questionnaire, the perception of labor pain questionnaire, and the medical ethics attitude in vaginal delivery questionnaire, were used to collect data. The data were entered into SPSS 22 and analyzed using correlation coefficient and multiple regression tests. The significance level for data analysis was set as less than 0.05.

RESULTS

The results of the regression analysis showed that among the four principles of medical ethics, only the second and third principles (beneficence and non-maleficence) predicted the perception of labor pain (B = -0.267, P < 0.037). Among the different domains of these principles, the areas of giving the necessary information to the mother (B = -0.199, P = 0.001), respecting the mother's privacy (B = -0.194, P = 0.001), interaction with the mother (B = -0.287, P = 0.001) and assurance of fetal health (B = -0.492, P = 0.001) were predictors of labor pain perception score.

CONCLUSIONS

Compliance of the birth team with respecting the mother's privacy, having friendly interactions with the mother and giving fetal health assurance to the mother can be a predictor of the mother's decreased perception of labor pain.

Critical care nurses' use of non-pharmacological pain management methods in Egypt

AIM

To examine Critical Care Nurses' Practices of Non-pharmacological Pain Management Interventions in Egypt.

METHODS

Descriptive exploratory design was utilized in the current study with a convenience sample of 60 critical care nurses working in three intensive care units at Al Manial university Hospital, Egypt. The questionnaires included; nurses' demographic data, non-pharmacological pain management checklist utilizing likert scale, and perceived barriers to the practice of non-pharmacological pain management interventions. Comparisons were made between the nurses' responses about practices of non-pharmacological pain management and selected demographic variables.

RESULTS

The non-pharmacological methods used by few nurses were putting the patient in comfortable position, communication with the patients and their families and using comfort devices. Moreover, nurses' education, work experience and the work area showed no statistically significant association with the few of non-pharmacological pain relief interventions they used. Finally, the barriers that hindered non-pharmacological pain practices from being used by nurses were lack of nurses' knowledge, lack of time, nurses' workload and patients' instability.

CONCLUSION

Most of the critical care nurses didn't apply non-pharmacological pain interventions practices with their patients in pain. The approaches used by a few nurses were changing position and the use of some comfort devices. Moreover, no significant correlations were found between nurse' application of non-pharmacological pain measures and either educational level and work area.

RECOMMENDATIONS

Barriers need to be explored and continuing education is needed to eliminate some of these perceived barriers. Moreover, theoretical and practical non-pharmacological pain management interventions should be incorporated in nursing curricula.

Bioethical analysis to the therapeutic use of Cannabis: Integrative review

Introduction:

Despite being considered as a contravention under some countries’ legislation, the therapeutic use of Cannabis sativa has been growing in Brazil, due to the promising results observed in many pathologies. Such a scenario has fostered the need to deepen discussions on the subject and possibly revise legislation governing the substance use and access.

Objectives:

Identify the types of stigma related to the therapeutic use of Cannabis and describe the strategies people use to overcome stigma.

Methods:

This integrative review was carried out in the databases PubMed, Scopus, CINAHL, MEDLINE, PsycINFO, Web of Science, and Cochrane Library, with 565 articles being retrieved. Triads’ cross-check were done, first maintaining the “cannabis” and “therapeutic use” pair, added by “stigma,” “bioethics,” “ethics,” “social consequences,” and “legal consequences.” The final selection resulted in six articles.

Ethical Consideration:

However, the ethical issues that pervade and regulate decisions on this subject must be considered.

Results:

Different dimensions and types of stigma related to the therapeutic use of Cannabis have been identified. The bioethical principle of autonomy was an expression of citizenship and human rights, mitigating internal conflicts related to self-stigma and the effects of external stigma on the person’s life.

Conclusion:

It was possible to identify the types of stigma related to the therapeutic use of Cannabis is an internal dimension represented (self-stigma) and an external dimension, represented (social and structural stigmas) and to identify strategies adopted to face this stigma: skills training group for users, elaboration of laws and specific programs to clarify the therapeutic use of Cannabis with a greater social scope, and support for family members. Thus, contributing to the building of people’s autonomy in a broader context of decision-making autonomy and executive autonomy will provide the development of people’s capacity to perform complex tasks of self-management and, consequently, to continue promoting and preserving their decision-making process and their capacity to plan and perform tasks associated with managing their lives and their treatments.

Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

OBJECTIVE:

to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status.

METHOD:

cross-sectional study with a populational sample (n=934), conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more) was measured using a numerical scale (0-10) and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor). For the statistical analysis, the absolute frequency and percentage, CI (95%), Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%.

RESULTS:

The prevalence of chronic pain was 52.8% [CI (95%):49.4-56.1]; most frequently located in the lower limbs (34.5%) and lumbar region (29.5%); with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001) a worse self-perception of health (OR=4.2:2.5-7.0), a greater number of chronic diseases (OR=1.8:1.2-2.7), joint disease (OR=3.5:2.4-5.1) and the female gender (OR=2.3:1.7-3.0). A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001).

CONCLUSION:

the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.