Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: an observational study

Purpose: The primary objective of this study was to describe the frequency of behaviors observed during rest, a non-nociceptive procedure, and a nociceptive procedure in brain-injured intensive care unit (ICU) patients with different levels of consciousness (LOC). Second, it examined the inter-rater reliability and discriminant and concurrent validity of the behavioral checklist used. Methods: The non-nociceptive procedure involved calling the patient and shaking his/her shoulder. The nociceptive procedure involved turning the patient. The frequency of behaviors was recorded using a behavioral checklist. Results: Patients with absence of movement, or stereotyped flexion or extension responses to a nociceptive stimulus displayed more behaviors during turning (median 5.5, range 0-14) than patients with localized responses (median 4, range 0-10) or able to self-report their pain (median 4, range 0-10). Face flushing, clenched teeth, clenched fist, and tremor were more frequent in patients with absence of movement, or stereotyped responses to a nociceptive stimulus. The reliability of the checklist was supported by a high intra-class correlation coefficient (0.77-0.92), and the internal consistency was acceptable in all three groups (KR 20, 0.71-0.85). Discriminant validity was supported as significantly more behaviors were observed during nociceptive stimulation than at rest. Concurrent validity was confirmed as checklist scores were correlated to the patients' self-reports of pain (r s=0.53; 95% CI 0.21-0.75). Conclusion: Brain-injured patients reacted significantly more during a nociceptive stimulus and the number of observed behaviors was higher in patients with a stereotyped response

Perceptions of inpatients and nurses towards the importance of nurses' caring behaviours in rehabilitation ::a comparative study

Aims: this study was conducted to describe and compare nurses' and inpatients' perceptions of caring attitudes and behaviours in rehabilitation. Methods : a comparative descriptive design was used. Perceptions of caring attitudes and behaviours were compared between 34 nurses working in rehabilitation and 64 elderly patients, using the Caring Nurse Patient Inventory‐23, to explore Watson's carative factors through four dimensions. Patients' and nurses' ratings of importance for each dimension were compared. The study data were collected from 8 November 2017 to 5 May 2018. Results: patients' and nurses' responses showed high scores in terms of their perceptions of caring, with nurses having the higher scores, and significant differences were found between patients and nurses. Patients scored items linked to clinical aspects of caring as the most important, whereas nurses scored items linked to humanistic and clinical caring as equally important. Comfort care was considered important for nurses and patients. Both groups considered relational caring items as the least important. Conclusion: results show that patients and nurses value clinical aspects of care, which is the visible aspect of care. The Caring Nurse Patient Inventory‐23 is a reliable instrument to measure the nurses' and patients' perception of caring behaviours in rehabilitation

Expérience de transition vécue par les patients avec une maladie oncologique lors de la pose d’un dispositif d’accès veineux implantable ::une recherche exploratoire

Introduction : à l’annonce d’un diagnostic de cancer ou d’une récidive, les patients vivent une transition de type maladie. Contexte : la pose d’un dispositif d’accès veineux implantable (DAVI) survient souvent juste après l’annonce ; il est un facteur de perturbation supplémentaire à leur équilibre. Objectif : explorer les besoins non comblés et les attentes des patients en interrogeant leur expérience vécue de la pose du DAVI pour proposer des interventions de soins adaptées. Méthode : une méthode d’analyse de contenu déductive a été réalisée, ainsi qu’une analyse à la lumière de la théorie de la transition de Meleis. Douze entretiens ont été réalisés. Résultats : les résultats montrent la vulnérabilité des patients lors de la pose du DAVI. Des conditions entravantes et facilitantes de la transition, de nature personnelle, interpersonnelle et organisationnelle, influencent la qualité de l’expérience vécue. Différentes stratégies de coping sont utilisées par les patients pour diminuer leur détresse émotionnelle. Discussion : la préparation anticipée, le soutien au développement des capacités d’autosoins, la gestion de la douleur contribuent à diminuer l’anxiété et l’insécurité. Conclusion : les infirmières se doivent d’offrir des soins transitionnels pour favoriser une expérience positive de la pose du DAVI

Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: An observational study

Purpose: The primary objective of this study was to describe the frequency of behaviors observed during rest, a non-nociceptive procedure, and a nociceptive procedure in brain-injured intensive care unit (ICU) patients with different levels of consciousness (LOC). Second, it examined the inter-rater reliability and discriminant and concurrent validity of the behavioral checklist used. Methods: The non-nociceptive procedure involved calling the patient and shaking his/her shoulder. The nociceptive procedure involved turning the patient. The frequency of behaviors was recorded using a behavioral checklist. Results: Patients with absence of movement, or stereotyped flexion or extension responses to a nociceptive stimulus displayed more behaviors during turning (median 5.5, range 0-14) than patients with localized responses (median 4, range 0-10) or able to self-report their pain (median 4, range 0-10). Face flushing, clenched teeth, clenched fist, and tremor were more frequent in patients with absence of movement, or stereotyped responses to a nociceptive stimulus. The reliability of the checklist was supported by a high intra-class correlation coefficient (0.77-0.92), and the internal consistency was acceptable in all three groups (KR 20, 0.71-0.85). Discriminant validity was supported as significantly more behaviors were observed during nociceptive stimulation than at rest. Concurrent validity was confirmed as checklist scores were correlated to the patients' self-reports of pain (r s = 0.53; 95 % CI 0.21-0.75). Conclusion: Brain-injured patients reacted significantly more during a nociceptive stimulus and the number of observed behaviors was higher in patients with a stereotyped response