Pain distress : the negative emotion associated with procedures in ICU patients

The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects. A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure. Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.Peer reviewe

Trajectories and Predictors of Self-Reported Anxiety and Depression in Women with and Without Pain Who Undergo Surgery for Breast Cancer

Depression and anxiety are common emotional symptoms in women with breast cancer and are frequently grouped under the term psychological distress. However, preoperative levels and postoperative trajectories of anxiety and depression might be influenced by distinct factors. This study's purpose was to identify how anxiety and depression in women with breast cancer changed from the time before surgery and for up to six months after, and to investigate whether specific variables predict initial levels and trajectories of anxiety and depression during the same period. Variables were selected following the UCSF Symptom Management Model. This descriptive, longitudinal study enrolled patients from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. A total of 396 women with breast cancer agreed to participate and completed questionnaires prior to surgery, and at 1, 2, 3, 4, 5, and 6 months after surgery. Descriptive statistics and hierarchical linear modeling were used for data analyses. Findings from this study suggest that more than a quarter of the patients (28%) reported pain in their breast prior to surgery. In addition, a significant percentage of women, regardless of pain status, experienced anxiety and depressive symptoms prior to surgery for breast cancer. However, both state anxiety and depression declined over the six month period following surgery. Despite the overall decline in state anxiety and depression, variance components suggested substantial interindividual variability in the patterns of adjustment. Only one demographic (i.e., marital status), and one clinical (i.e., general health status) characteristic predicted baseline levels of depression and trajectories of state anxiety respectively. In contrast, characteristics with independent contributions were symptom characteristics (i.e, trait and state anxiety, attentional fatigue, sleep disturbances, appetite changes, number of hours in pain), and psychosocial adjustment characteristics (i.e., sense of control, life satisfaction, difficulty coping, uncertainty about the future, sense of isolation, fear of metastasis, amount of distress at initial diagnosis and importance of spiritual activities). Nurses may use this information to identify and educate high-risk patients about how anxiety and depression may change following surgery for breast cancer

The long-term impact of resilience-building interventions in nurses: A review of the evidence

The purpose of the study was to provide data on the long-term impact of resilience interventions in nurses as measured via RCTs. Only four studies included long-term follow-up assessments after resilience-building interventions. In two of the studies longer duration treatment was employed (8 or 12 weeks). The other two studies used shorter interventions such as a 90 min duration lecture on stress and resilience or a 3-hour sensory awareness class. There is preliminary evidence that resilience demonstrated improvements 3 months after the intervention even when there was no improvement right after the implementation. These findings imply that time might be a critical component for the resilient response to develop, and that intervention studies need to plan for multiple follow-up assessments. Furthermore, the conclusions of the review aim to draws attention to the conceptual definition of resilience as an outcome compared to the previous of resilience as a characteristic of the individual (trait)

Associations between the spiritual well-being (EORTC QLQ-SWB32) and quality of life (EORTC QLQ-C30) of patients receiving palliative care for cancer in Cyprus

Background: Spiritual well-being is increasingly investigated in relation to patients’ perceived quality of life and is generally thought as having the potential to support patients with cancer who receive palliative care. Until recently, questionnaires used to assess spiritual well-being were developed mainly in the US. The purpose of this study was to translate and use the EORTC- SWB32, a newly developed tool, validated recently in 4 continents, 14 countries, and in 10 languages, to explore relationships of spiritual well-being with quality of life in patients with cancer. Methods: One hundred four patients participated in this study with an average age of 59 years. Of those, 79% were dealing with metastatic cancer. Data collection took place in three oncology centers from two large cities in Cyprus. The acceptability of the translated items was tested. Two questionnaires were employed for the assessment of quality of life and spiritual well-being, developed by the same organization: the EORTC QLQ-C30 and the EORTC QLQ-SWB32. The scores for each tool were analyzed separately and correlations between the two measures were explored. Results: Patients found the items of the SWB32 tool easy to understand and answer. They attested that filling the questionnaire prompted thoughts about their own spirituality. The mean score for Global Spiritual Well-Being was 60.4 (SD = 23.7) and it was associated with the mean scores in the scales “Emotional functioning” and “Cognitive functioning” of the EORTC-QOL-C30 (0.42 and 0.40 respectively, p < 0.01). The mean score for the “Relationship with God” scale (74.9, SD = 29.7) reported by the Cypriot patients is high and compatible with the homogenous spiritual orientation of the island’s population. Conclusions: All subscales of the SWB32 tool demonstrated good internal consistency in this study. Significant associations were observed between dimensions of quality of life and spiritual well-being. Additionally, the participants found the items easy to answer consistent with the tool’s suggested clinical utility which lays the ground for the application of targeted interventions to enhance spiritual well-being

The Transition from Acute to Chronic Pain: Might Intensive Care Unit Patients Be at Risk?

Pain remains a significant problem for patients hospitalized in intensive care units (ICUs). As research has shown, for some of these patients pain might even persist after discharge and become chronic. Exposure to intense pain and stress during medical and nursing procedures could be a risk factor that contributes to the transition from acute to chronic pain, which is a major disruption of the pain neurological system. New evidence suggests that physiological alterations contributing to chronic pain states take place both in the peripheral and central nervous systems. The purpose of this paper is to: 1) review cutting-edge theories regarding pain and mechanisms that underlie the transition from acute to chronic pain, such as increases in membrane excitability of peripheral and central nerve fibers, synaptic plasticity, and loss of the function of descending inhibitory pain fibers; 2) provide information on the association between the immune system and pain and its crucial contribution to development of chronic pain syndromes, and 3) discuss mechanisms at brain levels in the nervous system and their contribution to affective (i.e., emotional) states associated with chronic pain conditions. Finally, we will offer suggestions for ICU clinical interventions to attempt to prevent the transition from acute to chronic pain

Communicating with mechanically ventilated patients who are awake. A qualitative study on the experience of critical care nurses in Cyprus during the COVID-19 pandemic

Modern protocols for light sedation in combination with the increased number of COVID-19 infected patients hospitalized in Intensive Care Units (ICUs) have increased the number of patients who are mechanically ventilated and awake. Nurses require specific skills to care for this vulnerable group of patients. At the same time, nurses report feeling inadequate and frustrated when they attempt to establish communication with mechanically ventilated, conscious patients

Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs

Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided