Neuroscience Nurses' Perceptions of the Barriers to Identifying and Treating Pain in Acutely Brain-Injured Adult Patients

Abstract

Pain management for the critically ill adult can be daunting. Numerous factors contribute to this challenging process including altered level of consciousness (LOC), inability to speak, life support measures, family input, level of sedation, paralyzing agents, restraints, cognitive impairment, and numerous other factors. The current practice related to pain management in the neurologically critically ill adult patient population is limited by inadequate pain scales, altered neurological status, and atypical pain-associated behaviors. Additionally, nurses are challenged by unclear practice guidelines. The critical care nurse is required to assess and manage pain, as well as implement specific interventions based on the patient's exhibiting characteristics or behaviors. The purpose of this study was to explore the neuroscience nurses' perception of the barriers to identifying and treating pain in the acutely brain-injured adult patient. Participants were registered nurses working on a Neurocritical Care Unit. The methodology included two short answer questions and 15 Likert format questions rating the frequency of specific barriers. Nurses reported declining neurological status and subjective assessment tools as the most frequently seen barriers to pain assessment and management. Development of pain assessment measures in the brain-injured acutely ill adult patient continues to be important. The need for nurse-driven research to explore alternate measures to identify pain in the neurological patient is indicated. Implications for advanced practice are discussed.

Nurse’s Practices toward Nursing Intervention of Diagnostic Procedures at Neuro Surgical Hospitals in Baghdad City

“…Table (4) presents that there are significant differences in the mean of study sample between the pre and posttest procedure, revealing a significant improvement in nurses', practices regarding CT scan. Table (5) presents that there are significant differences in the mean of study sample between the pre and posttest procedure, which reveals that there is a significant improvement in nurses', practices regarding EEG. The Mean knowledge related to all domain of the study for the study group participants has increased significantly in the post-test stage.…”

“…The staff who participated in training session were divided into those who participated in one session reached (7) and percentage (14%), while those who participated in two sessions reached (4) percentage (8%) , and the last with those who participated in three sessions reached (2) percentage (4%). Iannotti (2015) established a study in 12 neurocritical units on registered nurses and found that (54.54) percent of the study sample were within age group of (22 -33) years old, and (36.36) percent were within age group of (34-44) years old 5 . Moreover, Iannotti (2015) reported that (90.91) percent of the study sample have (0 -10) years of experience in neurocritical units 5 .…”

“…Iannotti (2015) established a study in 12 neurocritical units on registered nurses and found that (54.54) percent of the study sample were within age group of (22 -33) years old, and (36.36) percent were within age group of (34-44) years old 5 . Moreover, Iannotti (2015) reported that (90.91) percent of the study sample have (0 -10) years of experience in neurocritical units 5 . Table (2) presents that there are significant differences in the mean of study sample between the pre and posttest procedure, revealing a significant improvement in nurses', practices regarding EMG.…”

Was leisten ZOPA und BPS/BPS-NI bei kognitiv oder bewusstseinsbeeinträchtigten Patienten?

“…Die Anwendung und korrekte Interpretation der BPS/BPS-NI, bei der die motorische Funktion eine Voraussetzung für die Beurteilung der Verhaltensweise ist, kann durch veränderte Verhaltensweisen bei Personen, die eine neurochirurgische Intensivtherapie benötigen, erschwert sein 5 11 . Die im ZOPA als Item abgebildeten physiologischen Veränderungen stehen nicht immer im kausalen Zusammenhang mit einer bestehenden Schmerzsymptomatik bei Personen mit Hirnblutungen und sollten daher stets kontextuell betrachtet werden 35 36 . Die Validität von physiologischen Parametern als objektiver Faktor zur Schmerzidentifikation ist zudem nicht abschließend geklärt und daher umstritten 21 .…”