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

Transformations of self: A phenomenological investigation into the lived experience of survivors of critical illness

Based on the hermeneutical, phenomenological perspective, this study explored the lived experience of individuals with a past hospitalization in an intensive care unit, with focus on their dreams. The purpose was to explore how it is to have been critically ill • Dreams are the language of the unconscious and can symbolically convey meanings • Eight participants recounted their experiences with critical illness through semi-structured phenomenological interviews and dream-telling. An interplay between the ‘factual–external’ world and the ‘internal’ world appeared to be the basis of their perception of the situation. Participants’ narratives were immensely rich in symbols of transformation, transcendence and rebirth. Transformations in perception, in lived-body, and in lived time and space were some of the themes emerging as part of both conscious and dreaming experiences. Attitudes towards death were altered, and elements of heightened spirituality were evident in the aftermath of critical illness • Critical illness was conceptualized as a ‘cocooning phase’ leading to transformation of self, spiritual arousal and personal growth. Nurses may be able to alleviate suffering by supporting this process while in the ICU, as well as after discharge. © 2003, John Wiley and Sons Inc. All rights reserved

Genomic variations and susceptibility to sepsis

The considerable variability in septic patients' outcomes, which exceeds our understanding of the pathophysiology of sepsis and defies our current prognostic tools, has prompted investigation in the genetic variations that may predispose individuals for increased susceptibility to sepsis and adverse outcomes. This article aims to critically review current evidence from genetic association studies regarding the role of genetic polymorphisms in sepsis. Findings regarding polymorphisms in intercellular messenger mediators (cytokines), membrane-bound inflammatory receptors, intracellular signaling cascades, heat shock proteins, coagulation/fibrinolysis pathways, apoptotic mechanisms, and neuroendocrine axes are presented and discussed. Study results are often discrepant, whereas many methodological limitations, in terms of both study design and genotyping methods, may render the results difficult to generalize. Nonetheless, a role for genomic variations in sepsis outcomes has emerged. A theoretical framework for incorporation of genetic variations into individualized care planning based on complexity theory is proposed, and future prospects of microarray technology and systems modelling are discussed briefly. © 2006 Lippincott Williams & Wilkins, Inc

Multiple organ dysfunction syndrome pathogenesis and care: A complex systems’ theory perspective

Aims and objectives: To discuss multiple organ dysfunction syndrome (MODS) from a complex systems’ theory perspective and to delineate a conceptual framework for the development and care of MODS. Background: MODS is an intricate and devastating manifestation of critical illness characterized by widespread aberrant molecular, cellular and systemic responses. Design and methods: Narrative literature review (MEDLINE, CINAHL databases) and knowledge synthesis with the theoretical assertions of chaos and complex systems’ theory. Cellular and systemic response paradoxes in MODS (including cellular hypoxia, cell death and signalling) are reviewed. Results: The diseased person is depicted as a complex adaptive system. The relevancy of some of the principles of complex chaotic systems’ theory to the proposed model is illustrated, including sensitive dependence on initial conditions, emergence, attractors, self-organization, self-organized criticality and emerging order. The transition from life-supporting to death-related organismic responses is illustrated as a critical event in MODS and care implications are drawn. Conclusions: Patient responses in MODS appear to conform to the principles of chaotic systems. Death is illustrated not as a consequence of homeostatic failure but as a ‘deliberate’ self-organized phenomenon entailing multiple dynamically evolving mechanisms. Relevance to clinical practice: Some of the principles of chaotic complex systems may need to be taken into account to advance care in MODS. An alternative theoretical perspective may support nurses to conceptualize both MODS and their role in a way that will help them to cope better with this devastating syndrome and develop practice. © 2008 The Authors. Journal Compilation and 2008 British Association of Critical Care Nurses, Nursing in Critical Care 2008

Evaluation of patient satisfaction with nursing care: Quantitative or qualitative approach?

The purpose of this study was to assess the results, along with the feasibility, applicability and relative merits of paradigm triangulation in the field of nursing care quality by conducting, concurrently, a quantitative and a qualitative study of patient satisfaction. The sample consisted of 200 randomly selected in-patients from two large Greek metropolitan hospitals. Highest ratings were assigned to the technical aspects of care, whilst information delivery items were associated with the lowest ratings. Qualitative analysis revealed a perception of nurses as weak against organisational limitations as the core theme underlying all categories of patients' complaints with nursing care. Seven more common themes were identified. The interpersonal aspect of care was central to patients' experience. The combination of qualitative and quantitative methodology appeared to contribute to the completeness of description and understanding of the phenomenon. © 2003 Elsevier Ltd. All rights reserved

Pilot exploration of the association between self-esteem and professional satisfaction in Hellenic Hospital nurses

Aim: To explore potential associations between nurses' self-esteem and professional satisfaction. Background: Professional burnout and moderate job satisfaction have been reported consistently among nurses. However, potential associations of the above elements with personality characteristics have not been adequately addressed. Methods: A random sample of 154 adult healthcare nurses completed the Maslach Burnout Inventory, the Berger's Scale and the Index of Work Satisfaction. Associations and comparisons across different settings and background variables were explored. Results: Moderate to positive levels of self-acceptance (mean Likert rating: 3.95 ± 0.51) and acceptance-of-others (mean Likert rating: 3.7 ± 0.43) and low to moderate levels of professional satisfaction (mean Likert rating: 3.69 ± 0.63) were observed. Positive correlations were detected between professional satisfaction and self-esteem indices (r = 0.249-0.313, P ≤ 0.008). A mediating effect of burnout was implied. Conclusions: A potential interaction between personality and professional attitudes of Hellenic Hospital nurses was observed. The present study is limited within the correlational frame. Further study is needed to investigate a potential causal relationship between self-esteem indices and professional satisfaction, in order to inform nursing retention and support policies. © 2007 Blackwell Publishing Ltd

Burnout syndrome indices in Greek intensive care nursing personnel

Burnout symptoms in Greek intensive care unit (ICU) nurses have not been explored adequately. The aim of this descriptive, correlational study was to investigate the prevalence and intensity of burnout symptoms in Greek ICU nursing personnel and any potential associations with professional satisfaction, as well as with demographic, educational, and vocational characteristics. Findings showed that the overall burnout level reported by Greek ICU nursing personnel was at a moderate to high degree. The most pronounced symptom of burnout was depersonalization, whereas emotional exhaustion was found to be a strong predictor of job satisfaction. This is a factor connected with the nurses' intention to quit the job. It appears that work factors have a more powerful influence over the development of burnout in comparison to personality traits. Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited