| 1. |
- Boström, Barbro, et al.
(författare)
-
A comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain
- 2003
-
Ingår i: Journal of Clinical Nursing. - Chichester : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 12:5, s. 726-735
-
Tidskriftsartikel (refereegranskat)abstract
- A study was performed to describe and compare pain and Health-Related Quality of Life (HRQOL) in two groups of cancer patients in palliative care as well as to describe the correlation between pain and HRQOL. ○ Forty-seven patients with mild average pain [Visual Analogue Scale (VAS) < 3] and 28 patients with moderate to severe average pain (VAS > 3) were included. Medical Outcomes Study Short Form (SF-36) was used to evaluate HRQOL, pain intensity levels were measured with the VAS on Pain-O-Meter. ○ Compared to patients with mild pain, patients with moderate to severe pain had statistically significant, higher pain intensity for the items 'pain at time of interview', 'worst pain in the past 24 hours' and 'pain interrupting sleep.' They also had the lowest scores of the SF-36 dimensions: physical functioning, role-physical, and bodily pain. Patients with moderate to severe pain had statistically significant, fewer months of survival. There were statistically significant positive correlations between pain items and negative correlation between pain and SF-36 dimensions. ○ The conclusion is that pain has a negative impact on HRQOL, especially on physical health and that pain increases towards the final stages of life. Even if patients have to endure symptoms such as fatigue and anxiety during their short survival time, dealing with pain is an unnecessary burden, which can be prevented.
|
|
| 2. |
- Boström, Barbro, et al.
(författare)
-
Cancer patients' experiences of care related to pain management before and after palliative care referral
- 2004
-
Ingår i: European Journal of Cancer Care. - : Wiley-Blackwell. - 0961-5423 .- 1365-2354. ; 13:3, s. 238-245
-
Tidskriftsartikel (refereegranskat)abstract
- Pain is the main problem for patients with cancer referred to palliative care (PC). Pain management in PC requires a multidimensional approach. A questionnaire was used to determine cancer patients' experiences of care related to pain management, before and after being referred to PC, and to also discover possible correlations between pain control and other aspects of care. Seventy-five consecutive patients from two PC teams were included in the study. The patients had experienced a statistically significant (P < 0.01) improvement in care after being referred to PC, despite the fact that pain control had not been optimized. Patients' description of 'pain control' after being referred to PC had a statistically significant correlation with their 'feeling of security' and 'continuity of care' throughout the same period. The conclusion is that care provided in PC is vital to successful pain management. Pain control depends not only on analgesics but also on many other aspects of care provided by the nurse. Continuity of care and the opportunity to talk increases the patients' feeling of security, which is also of utmost importance to successful pain management.
|
|
| 3. |
- Boström, Barbro, et al.
(författare)
-
Cancer-related pain in palliative care : patients' perceptions of pain management
- 2004
-
Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 45:4, s. 410-419
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. Aim: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. Method: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. Findings: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. Conclusion: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.
|
|
| 4. |
- Boström, Barbro, et al.
(författare)
-
Pain and health-related quality of life among cancer patients in final stage of life : a comparison between two palliative care teams
- 2003
-
Ingår i: Journal of Nursing Management. - Chichester, West Sussex : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 11:3, s. 189-196
-
Tidskriftsartikel (refereegranskat)abstract
- A two-centred descriptive study was performed in order to describe and compare pain and health-related quality of life (HRQOL) among cancer patients, in their final stage of life. The patients were cared for by either a nurse-led palliative care team I (PCT I) or a physician-led palliative care team II (PCT II). Forty-six consecutive, stratified patients (PCT I, n = 21 and PCT II, n = 25) participated. The medical outcomes study short form 36 (SF-36) was used for evaluating HRQOL and the Pain-O-Meter for assessing pain. Patients' pain intensity, pain quality and HRQOL showed no significant difference between the two groups PCT I and PCT II. The patients from PCT I had significantly longer survival time (P = 0.017) than those from PCT II. The different composition of the teams being led by nurses or physicians is worth further research; both from the patient's and staff's viewpoint, there may also be cost-benefits worth examining.
|
|
| 5. |
- Samuelson, Karin, et al.
(författare)
-
Intensive care sedation of mechanically ventilated patients: a national Swedish survey
- 2003
-
Ingår i: Intensive and Critical Care Nursing. - 1532-4036 .- 0964-3397. ; 19:6, s. 350-362
-
Tidskriftsartikel (refereegranskat)abstract
- Sedation in critically ill patients is a complex issue and at the same time an important concept for ensuring patient comfort. The aim of this study was to review the current practice of sedation for patients on mechanical ventilation in Swedish intensive care units (ICUs). Questionnaires were sent by post to head nurses in 89 ICUs with mechanically ventilated patients. By August 2000, 87 (98%) questionnaires had been returned. The results show that mechanically ventilated patients were routinely sedated in 91% of ICUs. Midazolam or propofol in combination with an opioid were the drugs preferred by 76%. Heavy sedation was most usual in 63% of ICUs but, when asked about the sedation level preferred by nurses, 78% chose light sedation (P=0.001). Only 16% used sedation scales. This study indicates that local habits and personal attitudes seem to have a great impact on sedation routines. It therefore appears worthwhile for ICUs to review their practice and, if necessary, to consider implementing sedation scales and sedation guidelines. Research pertaining to potential complications and patient comfort in relation to different sedation levels as well as further validation of the efficacy of sedation scales is needed.
|
|
| 6. |
- Samuelson, Karin, et al.
(författare)
-
Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients.
- 2006
-
Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 32, s. 660-7
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the relationship between memory and intensive care sedation. Design and setting: Prospective cohort study over 18 months in two general intensive care units (ICUs) in district university hospitals. Patients: 313 intubated mechanically ventilated adults admitted for more than 24 h, 250 of whom completed the study. Measurements: Patients (n = 250) were interviewed in the ward 5 days after discharge from the ICU using the ICU Memory Tool. Patient characteristics, doses of sedative and analgesic agents, and sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview. Results: Patients with no recall (18%) were significantly older, had higher baseline severity of illness, and experienced fewer periods of wakefulness (median proportion of MAAS score 3; 0.37 vs. 0.70) than those who had memories of the ICU (82%). Multivariate analyses showed that increasing proportion of MAAS 0-2 and older age were significantly associated with having no recall. Patients with delusional memories (34%) had significantly longer ICU stay (median 6.6 vs. 2.2 days), higher baseline severity of illness, higher proportions of MAAS scores 4-6, and more administration of midazolam than those with recall of the ICU without delusional memories. Conclusions: Heavy sedation increases the risk of having no recall, and longer ICU stay increases the risk of delusional memories. The depth of sedation during total ICU stay as recorded with the MAAS may predict the probability of having memories of the ICU.
|
|
| 7. |
- Samuelson, Karin, et al.
(författare)
-
Memory in relation to intensive care sedation
- 2005
-
Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 1432-1238 .- 0342-4642. ; 31:Suppl. 1, s. 12-12
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)
|
|
| 8. |
- Samuelson, Karin, et al.
(författare)
-
Stressful experiences in relation to depth of sedation in mechanically ventilated patients.
- 2007
-
Ingår i: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 12:2, s. 93-104
-
Tidskriftsartikel (refereegranskat)abstract
- n mechanically ventilated patients, sedatives and analgesics are commonly used to ensure comfort, but there is no documented knowledge about the impact of depth of sedation on patients' perception of discomfort. The aim of this study was, therefore, to investigate the relationship between stressful experiences and intensive care sedation, including the depth of sedation. During 18 months, 313 intubated mechanically ventilated adults admitted to two general intensive care units (ICU) for more than 24 h were included. Patients (n= 250) were interviewed on the general ward 5 days after ICU discharge using the ICU Stressful Experiences Questionnaire. Patient data including sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview. Of the 206 patients with memories of the intensive care, 82% remembered at least one experience as quite a bit or extremely bothersome. Multivariate analyses showed that higher proportion of MAAS score 3 (indicating more periods of wakefulness), longer ICU stay and being admitted emergent were factors associated with remembering stressful experiences of the ICU as more bothersome. The findings indicate that the depth of sedation has an impact on patients' perception of stressful experiences and that light sedation compared with heavy seems to increase the risk of perceiving experiences in the ICU as more bothersome. In reducing discomfort, depth of sedation and patient comfort should be assessed regularly, non-pharmacological interventions taken into account and the use of sedatives and analgesics adapted to the individual requirements of the patient
|
|
| 9. |
- Samuelson, Karin, et al.
(författare)
-
Stressful memories and psychological distress in adult mechanically ventilated intensive care patients - a 2-month follow-up study
- 2007
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 51:6, s. 671-678
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate patients' psychological distress in relation to memory and stressful experiences in the intensive care unit (ICU), and to identify early predictors for the development of high levels of acute post-traumatic stress disorder (PTSD)-related symptoms. Methods: A prospective cohort study was performed over 18 months in two general ICUs, including 313 intubated mechanically ventilated adults admitted for more than 24 h, 226 of whom completed the study. Patients were interviewed 5 days and 2 months post-ICU concerning their memories and psychological distress. The instruments used were the ICU Memory Tool, ICU Stressful Experience Questionnaire, Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised (IES-R). Results: High symptom levels of anxiety, depression and acute PTSD 2 months post-ICU were present in 4.9%, 7.5% and 8.4% of the 226 patients, respectively. Psychological distress 2 months post-ICU was associated with experiences of the ICU rated as extremely stressful and with high levels of anxiety and depression 5 days post-ICU, but not with amnesia or delusional memories without factual recall of the ICU. Female sex, signs of agitation (increasing proportion of Motor Activity Assessment Scale scores of 4-6) and feelings of extreme fear during the ICU stay were significantly and independently associated with IES-R scores of 30 or more. Conclusions: Extremely stressful experiences of the ICU are associated with subsequent psychological distress. Female sex, agitation and extreme fear during the ICU stay seem to increase the risk of developing high levels of acute PTSD-related symptoms.
|
|
