PAINAD -mittarin hyödynnettävyys dementiapotilaiden kivun arvioinnissa

Dementiapotilaiden kivunarviointi voi olla haasteellista, koska potilaan omaa arviota hänen kivustaan pidetään kaikkein luotettavimpana keinona kivunarvioinnissa ja dementianpotilaat eivät välttämättä pysty kommunikoimaan. Siksi dementiapotilaiden kipu on usein alidiagnosoitua ja -hoidettua. Tutkimuksen tarkoituksena on testata PAINAD -mittarin hyödynnettävyyttä hoitotyössä kivun arvioinnissa dementiaa sairastavilla potilailla. Tutkimus on osa Turun ammattikorkeakoulun Kivun hoidon potilasohjaus -hanketta. Hanke toteutetaan Turun ammattikorkeakoulun terveysala-tulosalueen ja Turun sosiaali- ja terveystoimen yhteistyönä. Opinnäytetyö on kvalitatiivinen tutkimus. PAINAD- mittari esiteltiin kolmen geriatrisen sairaalahoidon osaston ja neljän ympärivuorokautisenhoidon osaston hoitohenkilökunnalle. He käyttivät PAINAD -mittaria neljän viikon ajan dementiapotilaiden kivun arvioinnissa. Neljän viikon jälkeen hoitohenkilökuntaa haastateltiin heidän kokemuksistaan PAINAD -mittarin käytöstä. Tutkimusta ohjasi kolme tutkimuskysymystä, jotka olivat; Miten hoitohenkilökunta voisi hyödyntää PAINAD -mittaria dementiapotilaan kivun arvioinnissa? Miten hoitajien mielipiteet PAINAD -mittarista eroavat toisistaan eri osastoilla? Mitä kritiikkiä ilmeni PAINAD -mittarin käytössä? Tulokset osoittivat hoitohenkilökunnan kokevan PAINAD- mittarin helpottavan todentamaan kipua. Kipulääkkeen käyttö koettiin perustellummaksi ja mittarista koettiin olevan apua myös kivun ja ahdistuksen erottamisessa. Mielipide eroja oli myös lähihoitajien ja sairaanhoitajien mielipiteissä. Kritiikkiä ilmeni PAINAD- mittarin raja-arvojen epäselvyydestä ja arviointi koettiin vaikeaksi niiden potilaiden kohdalla, jotka olivat jatkuvasti levottomia tai jäykkiä. PAINAD- mittarista näytti kuitenkin ollevan hyötyä dementiapotilaiden kivun arvioinnissa. Tutkimuksen tuloksia voidaan käyttää, kun etsitään hyvää kivunarviointia ja -hoitoa dementiapotilaille. PAINAD- mittari osoittautui hyväksi apuvälineeksi kivunarviointiin dementiapotilailla vaikka kritiikkiä ja eroavaisuuksia hoitohenkilökunnan mielipiteissä ilmeni. PAINAD- mittarin hyödynnettävyyttä, luotettavuutta ja soveltuvuutta dementiapotilaiden kivunarviointiin tulee kuitenkin vielä tutkia.Normally, persons’ self-report is kept as the most reliable measurement of pain. Pain assessment in people with dementia can be challenging because demented patients are often unable to communicate, and therefore their pain can often go under-recognized and/or under-treated. The purpose of the study was to test the usefulness of the observational tool PAINAD in pain assessment in patients with dementia. This Bachelor’s thesis is part of the Patient education in pain management project. This project was ran by the Turku University of Applied sciences the Faculty of Health Care and the Department of Health Care and Social Services of the city of Turku. This thesis is a qualitative research. The PAINAD was presented to nursing staff in three geriatric hospital wards and four long term care wards. These wards used the PAINAD- scale for four weeks in assessment of the pain in demented patients. After four weeks, a group interview was held and the nurses' opinions of the PAINAD and its use were clarified. Three questions were used as to help in the research, and they were: How could the nursing staff utilize the PAINAD- scale in evaluating the pain of dementia patient? How do the nurses' opinions of the PAINAD- scale differ from each other in different wards? What criticism did become apparent in the use of the PAINAD- scale? The results of this study showed that nursing staff felt that the PAINAD-scale helped them in their work as it made it easier to register the pain which in turn helped to justify when to use medication for that pain. It also helped them to separate pain from anxiety which isn’t always easy with demented patents. The opinions of the PAINAD varied in different wards quite a lot. The opinions between the nurses and practical nurses were also distinctly different. Criticism was shown in the unclarity of the values of the PAINAD. The assessment of pain was also regarded to be difficult if the patient was constantly restless or stiff. PAINAD- scale, however, seemed to be beneficial in pain assessment in patients with dementia. The results of this study can be utilized when seeking a good pain assessment and care of pain in demented patients. PAINAD proved to be a good tool for the assessment of demented patients' pain even though criticism and differences in opinions appeared. The benefit, reliability and suitability of the PAINAD should still be further examined in demented patients

Temperament, physical activity and sedentary time in preschoolers : the DAGIS study

Abstract Background Identifying individual characteristics linked with physical activity (PA) and sedentary time (SED) can assist in designing health-enhancing interventions for children. We examined cross-sectional associations of temperament characteristics with 1) PA and SED and 2) meeting the PA recommendation in Finnish children. Methods Altogether, 697 children (age: 4.7 ± 0.9 years, 51.6% boys) within the Increased Health and Wellbeing in Preschools (DAGIS) study were included. Parents responded to the Very Short Form of the Children’s Behavior Questionnaire consisting of three temperament dimensions: surgency, negative affectivity, and effortful control. PA and SED were assessed for 7 days (24 h per day) using a hip-worn ActiGraph accelerometer, and the daily minutes spent in light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and SED were calculated. The PA recommendation was defined as having PA at least 180 min/day, of which at least 60 min/day was in moderate-to-vigorous PA. Adjusted linear and logistic regression analyses were applied. Results Surgency was associated with LPA (B = 3.80, p = 0.004), MPA (B = 4.87, p < 0.001), VPA (B = 2.91, p < 0.001), SED (B = − 11.45, p < 0.001), and higher odds of meeting the PA recommendation (OR = 1.56, p < 0.001). Effortful control was associated with MPA (B = − 3.63, p < 0.001), VPA (B = − 2.50, p < 0.001), SED (B = 8.66, p < 0.001), and lower odds of meeting the PA recommendation (OR = 0.61, p = 0.004). Negative affectivity was not associated with PA, SED, or meeting the PA recommendation. Conclusion Children’s temperament should be considered when promoting PA in preschoolers. Special attention should be paid to children scoring high in the temperament dimension effortful control