Trastornos/dolor músculoesquelético en estudiantes de enfermería de una universidad comunitaria del sur del Brasil / Distúrbios/dor musculoesquelética em estudantes de enfermagem de uma universidade comunitária do sul do Brasil / Musculoskeletal disorders/pain in undergraduate nursing students in a community university in southern Brazil

Objetivo: Describir el perfil académico y evaluar la prevalencia de trastornos/dolor musculoesquelético en estudiantes de graduación en Enfermería de una universidad comunitaria del sur brasileño. Método: Estudio descriptivo, cuantitativo, del tipo encuesta, con 149 estudiantes de enfermería a través del instrumento compuesto por preguntas referentes a las variables sociodemográficas, hábitos de vida y salud, así como por la versión brasileña Standardized Nordic Questionnaire. Resultados: La mayoría era del sexo femenino, con 18 y 25 años de edad, soltera, vive con la familia, no tiene hijos, no recibe beca o ayuda de la familia y trabaja en hospitales. Prevalencia de síntomas musculoesqueléticos en la región dorsal y baja de la espalda y hombros. Conclusiones: La prevalencia de estos síntomas entre los estudiantes señala la necesidad de implementar acciones preventivas y de promoción de la salud para contribuir a una mejor calidad de vida y salud, en el ámbito académico y en el futuro como profesionales (AU)

Objetivo: Descrever o perfil acadêmico e avaliar prevalência de distúrbios/dor musculoesquelética em estudantes do curso de graduação em Enfermagem de uma universidade comunitária do Sul do Brasil. Método: Estudo descritivo de natureza quantitativa do tipo survey, realizado com 149 estudantes de enfermagem, por meio da aplicação do instrumento composto por questões referentes às variáveis sociodemográficas, hábitos de vida e saúde, como pela versão brasileira Standardized Nordic Questionnaire. Resultados: A maioria dos participantes é do sexo feminino, com idade de 18 e 25 anos, sem companheiro, residem com a família, não possuem filhos, não recebem bolsa ou ajuda familiar e trabalham em hospitais. A prevalência de sintomas musculoesqueléticos foi na região dorsal e lombar e ombros. Conclusões: A prevalência desses sintomas entre os estudantes aponta necessidade de implementar ações preventivas e de promoção da saúde, a fim de contribuir para melhor qualidade de vida e saúde tanto no âmbito acadêmico quanto futuramente como profissionais (AU)

Goal: To describe the academic profile and assess the prevalence of musculoskeletal disorders/pain in undergraduate nursing students in a Community University in Southern Brazil. Method: It has been a descriptive quantitative study with a survey approach, and has been conducted with 149 nursing students, through the employment of an instrument with questions regarding sociodemographic variables, life, and health habits, as for Standardized Nordic Questionnaire. Results: Most participants were female, age ranging from 18 to 25, unmarried, living with the family, with no children, not receiving government support or family aid, and working for hospitals. The prevalence of musculoskeletal was in the dorsal and lumbar region and shoulders. Conclusions: The prevalence of such symptoms amongst the students leads to the need of implementing preventive and health promotion actions, in order to contribute for the improvement of life quality in both the academic scope and in the future as professionals (AU)

Initial testing of a behavioural pain assessment tool within trauma units.

Pain is common in trauma patients who may be older and also may have cognitive impairment leading to reduced communication about their pain. A number of observational pain assessment tools are available and have been found to have limited clinical usefulness. The Bolton Pain Assessment Tool (BPAT) was developed following a trial of three established tools and includes a section to involve family and/or close carers in the pain assessment process. The aim of this paper is to present the findings of initial testing of BPAT. BPAT was used and evaluated by clinical staff in four trauma units in the UK. Forty-six staff evaluations were completed and 98% indicated it was easy to use; it took between one and two minutes to complete by 69.5% and led to pain management interventions by 93.5% of the respondents. It was rated highly by the clinical staff, but the involvement of families and close carers in the assessment process was different at each unit, with one unit not involving the family/close carer. There remains the need for a simple and practical way of assessing pain. This initial testing of the clinical feasibility of BPAT suggests that it is easy to use and helps to identify pain, but further testing of its reliability and validity is required.

A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain.

While acute musculoskeletal pain is a frequent complaint, its management is often neglected. An implementation of a nurse-initiated pain protocol based on the algorithm of a Dutch pain management guideline in the emergency department might improve this. A pre-post intervention study was performed as part of the prospective PROTACT follow-up study. During the pre- (15 months, n = 504) and post-period (6 months, n = 156) patients' self-reported pain intensity and pain treatment were registered. Analgesic provision in patients with moderate to severe pain (NRS ≥4) improved from 46.8% to 68.0%. Over 10% of the patients refused analgesics, resulting into an actual analgesic administration increase from 36.3% to 46.1%. Median time to analgesic decreased from 10 to 7 min (P < 0.05), whereas time to opioids decreased from 37 to 15 min (P < 0.01). Mean pain relief significantly increased to 1.56 NRS-points, in patients who received analgesic treatment even up to 2.02 points. The protocol appeared to lead to an increase in analgesic administration, shorter time to analgesics and a higher clinically relevant pain relief. Despite improvements, suffering moderate to severe pain at ED discharge was still common. Protocol adherence needs to be studied in order to optimize pain management.

Programa de entrenamiento en coherencia cardiaca para la reducción del estrés en personal sanitario con cervicalgia crónica: un estudio piloto / Training program in cardiac coherence for stress reduction in healthcare personnel with chronic neck pain: a pilot study

La presente nota clínica tiene por objetivo divulgar los resultados de un trabajo piloto para valorar las potencialidades de un entrenamiento en coherencia cardiaca (CC) para la reducción del estrés en personal sanitario con cervicalgia crónica. Para ello, 8 enfermeras participaron en un programa de entrenamiento en CC y se evaluadas pre/post en los siguientes factores: dolor (EVA), inteligencia emocional (TMMS-24), sintomatología ansioso-depresiva (escalas Hamilton y Goldberg) y estrés laboral (NSS). Tras el entrenamiento se observó una disminución significativa en las puntuaciones de dolor y su sintomatología asociada (contracturas, dolor por movilidad y parestesias), así como en la sintomatología depresiva. Asimismo, se observaron mayores puntuaciones en inteligencia emocional (escala de percepción) (AU)

This case report aims to disseminate the results of a pilot study exploring the potentialities of training program in cardiac coherence (CC) for reducing stress in nurses with chronic neck pain. For this purpose, 8 nurses participated in a training program in CC and were evaluated pre/post on the following factors: pain (VAS), emotional intelligence (TMMS-24), anxious depressive symptoms (Hamilton & Goldberg scales) and job related stress (NSS). After the training, a significant decrease in pain scores and associated symptoms (spasms, pain due to mobility and paresthesias) as well as depressive symptoms was observed. Also, higher scores were observed in emotional intelligence (perception scale) (AU)

Fatores associados à dor musculoesquelética em trabalhadores de enfermagem hospitalar / Factors associated with musculoskeletal pain in hospital nursing workers / Factores asociados al dolor musculoesquelético en trabajadores de enfermería

Analisar a relação entre a dor musculoesquelética, as características sociodemográficas e laborais dos trabalhadores de enfermagem de um hospital universitário do Rio Grande do Sul, Brasil. Estudo epidemiológico transversal, envolvendo 498 trabalhadores de enfermagem, em 2009. Para a coleta de dados, utilizou-se um questionário contendo dados sociodemográficos, laborais e escala analógica de avaliação da dor. A prevalência de dor musculoesquelética foi de 91,4%, sendo que 11,6% apresentaram dor de fraca intensidade, 35,7% - dor moderada, 39% - dor forte e 5,1% - dor insuportável. As mulheres, os técnicos e auxiliares de enfermagem e os com mais de 14 anos de exercício na função apresentaram significativamente maiores percentuaispara dor forte a insuportável. Os resultados indicam uma relação positiva entre dor e característica sociodemográficas e laborais dos trabalhadores e evidenciam a necessidade dos serviços de saúde oferecerem melhores condições de trabalho.

To examine the relationship between musculoskeletal pain, socio-demographic and labor characteristics among nursing workers at a university hospital in Rio Grande do Sul, Brazil. This cross-sectional epidemiological study involved 498 nursing workers, in 2009. Data were collected using a questionnaire containing socio-demographic and labor data, andan analog pain assessment scale. The prevalence of musculoskeletal pain was 91.4%, with 11.6% reporting low-intensity pain, 35.7% moderate pain, 39% strong pain and 5.1% unbearable pain. Percentages of strong and unbearable pain were significantly higher among women, nursing technicians and auxiliaries, and personnel who had been in their job more than 14 years. The results indicate a positive relationship between workers’ pain and their socio-demographic and labor characteristics,and highlight the need for health services to offer better working conditions.

Analizar la relación entre el dolor musculoesquelético, características sociodemográficas y laborales de la enfermería en un hospital universitario de Rio Grande do Sul, Brasil. Estudio epidemiológico transversal, involucrando 498 trabajadoresde enfermería, em 2009. Para recopilar los datos, se utilizó un cuestionario sobre características sociodemográficas, laborales y escala analógica de evaluación del dolor. La prevalencia del dolor musculoesquelético fue de 91,4%, y 11,6% tenían dolor de baja intensidad, 35,7% - dolor moderado, 39% - dolor severo y 5,1% - dolor insoportable. Mujeres, técnicos y auxiliares de enfermería y los con más de 14 años de trabajo en la función tuvieron porcentajes significativamente más altos para dolor fuerte a insoportable. Los resultados indican una relación positiva entre el dolor y las características sociodemográficas y laborales de los trabajadores y destacan la necesidad de los servicios de salud ofreceren mejores condiciones de trabajo.

Lesiones osteomusculares de miembros superiores y región lumbar: caracterización demográfica y ocupacional. Universidad Nacional de Colombia, Bogotá 2001- 2009 / Musculoskeletal disorders of the upper and the lumbar region: demographic and occupational characterization, Universidad Nacional de Colombia, Bogotá 2001- 2009

Objetivo: Caracterizar variables demográficas y ocupacionales de casos de lesiones osteomusculares de miembros superiores y región lumbar. Metodología: Estudio descriptivo, corte transversal. Se realizó búsqueda y revisión de literatura científica para conocer factores de riesgo laborales asociados a lesiones osteomusculares de miembros superiores, región lumbar y determinar variables relevantes. Las variables demográficas y ocupacionales en casos de lesiones osteomusculares, se obtuvieron de registros de la base de datos diseñada por la División Nacional de Salud Ocupacional de la Universidad Nacional de Colombia. Resultados: Se identificaron 99 registros de trabajadores con diagnóstico positivo de lesiones osteomusculares de miembros superiores y región lumbar. El género femenino y grupo etáreo entre 41 a 50 años reportó 60% y 43.43% de casos de lesiones osteomusculares respectivamente. El porcentaje de casos según grupo ocupacional para docentes y otros administrativos presentó distribución similar 28.28%. Se encontró que movimientos repetitivos de codo, muñeca, dedos para miembros superiores y postura prolongada para región lumbar son factores de riesgo más frecuentes. En trabajadores los segmentos corporales más comprometidos con lesiones osteomusculares fueron muñeca y zona lumbar. Escoliosis e hiperlordosis fueron las alteraciones de columna vertebral con mayor frecuencia entre la población participante. La mejoría y/o desaparición de los síntomas con descanso y reaparición o agravamiento durante el trabajo fue el criterio más representativo para considerar posible origen laboral de casos de lesiones osteomusculares para miembros superiores y región lumbar. Conclusión: El conocimiento de las variables asociadas a lesiones osteomusculares permite realizar intervenciones preventivas (AU)

The aim of this study was to characterize demographic and occupational variables of cases of upper limb and lower back musculoskeletal injuries. Methodology: In a descriptive, cross-sectional study, we searched and reviewed scientific literature to learn about occupational risk factors associated with musculoskeletal injuries of upper limbs, the lower back and to determine relevant variables. The demographic and occupational variables in musculoskeletal injury cases were obtained from records in the database designed by the National Occupational Health Division at Universidad Nacional de Colombia. Results: We identified 99 records of workers with positive diagnosis of upper limb and lower back musculoskeletal injuries. The female gender and age group between 41 to 50 years reported 60% and 43.43% of the cases of musculoskeletal injuries respectively. The percentage of cases by occupational group for teachers and administrative workers showed a similar distribution of 28.28%. We found that repetitive movements of elbow, wrist, fingers for upper limbs and an extended position for lumbar region are the most common risk factors. In workers, wrist and lower back were the most prominent musculoskeletal injuries. Scoliosis and hyperlordosis were spinal disorders more frequent among participants. The improvement and / or disappearance of symptoms with rest and recurrence or worsening during the work time was the more representative criterion for considering the possible cases of occupational origin of musculoskeletal injuries to upper limbs and lower back. Conclusion: The knowledge of these variables associated with musculoskeletal injuries allows for preventive interventions(AU)

Pacientes quirúrgicos e intervenciones enfermeras estandarizadas. Estudio descriptivo sobre resultados / Descriptive study of the results of nursing interventions applied to surgical patients

Objetivos: conocer la evolución de los resultados de salud de los pacientes quirúrgicos durante su estancia hospitalaria, evaluando criterios de resultado NOC al ingreso y alta. Método: estudio prospectivo observacional realizado en las plantas de hospitalización quirúrgica del Hospital General de Vic, con pacientes que precisaron una intervención quirúrgica de cualquier especialidad, a partir de 18 añ;os, con niveles de riesgo anestésico I, II o III. Las variables principales de resultado fueron indicadores asociados a cada NOC de un plan de cuidados estandarizado, basado en el concepto «paciente tipo». Resultados: participaron 460 pacientes, de ellos 69(15%) fueron intervenidos de operaciones del sistema musculoesquelético y 391(85%) de operaciones del aparato digestivo, urinario y órganos genitales masculinos y femeninos, de operaciones de la piel, tegumentos y/o sistema endocrino. Las puntuaciones NOC al alta de todos los pacientes se mantuvieron o mejoraron, nunca empeoraron y en todos los pacientes el número de caídas y de infecciones recurrentes fue una constante. Prácticamente ningún enfermo se cayó, ni se infectó. Conclusiones: la mayoría de los pacientes quirúrgicos en el momento de recibir el alta hospitalaria mejoran o mantienen sus condiciones de ingreso y los que empeoran nunca lo hacen sustancialmente(AU)

Objectives: Knowing the evolution of health outcomes of surgical patients during their hospital stay, evaluating NOC outcome criteria at admission and discharge. Material and methods: Prospective observational study conducted in the surgical hospital wards of the Hospital General de Vic, with patients who required surgical intervention of any specialty, of 18 or more years old and anesthetic risk levels I, II or III. The main outcome variables were indicators associates with each NOC of a standard of care based on the "patient type" concept. Results: Four hundred and six patients participated. Of these, 69 (15%) were operated of the musculoskeletal system and 391 (85%) were operated on the digestive or urinary systems, male/female genitalia, skin, integuments, and endocrine system. NOC scores high of all patients were maintained or improved, never worse and in all patients the number of falls and recurrent infections was constant, virtually no patient fell or became infected. Conclusions: The majority of surgical patients at the time of hospital discharge improves or maintain their conditions of admission and patients who never worse substantially(AU)

An expanded view of self-management: patients' perceptions of education and support in an intervention for chronic musculoskeletal pain.

OBJECTIVES: Chronic pain is prevalent, costly, and is associated with profound psychological effects. Although pain is prevalent in returning veterans of the recent military conflicts in Afghanistan and Iraq (Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn [OEF/OIF/OND] Veterans), little is known about chronic pain in these patients. This study's objective was to ascertain perceptions of a multicomponent intervention tested in a randomized controlled trial for OEF/OIF/OND veterans with chronic musculoskeletal pain (Evaluation of Stepped Care for Chronic Pain [ESCAPE]). DESIGN: Qualitative interviews were conducted with 26 patients in the intervention arm of ESCAPE (21% of total intervention patients) to determine patients' experiences with and perceptions of the intervention. Patients were purposefully sampled to include treatment responders (defined as ≥30% reduction in pain-related disability or pain severity), nonresponders, and noncompleters (completed <50% of trial). Qualitative analysis was guided by grounded theory. RESULTS: Both responders and nonresponders discussed the importance of the self-management education they received. Of particular significance, patients identified the nurse care manager who administered the intervention as being integral to patients' ability to self-manage their chronic pain. Patients described important ways in which the nurse facilitated their self-management, reported under three themes: 1) helping patients find what works for their pain; 2) holding patients accountable for their pain management; 3) motivating and providing emotional support to patients. CONCLUSIONS: Results corroborate previous work and suggest that current conceptualizations of self-management are incomplete. A model is proposed that not only depicts self-management as involving more than activities and strategies, but also acknowledges the central role of relationships and support in pain self-management.

The impact of a nurse-led chronic musculoskeletal pain clinic on healthcare utilization.

AIMS AND OBJECTIVES: To determine whether a nurse-led chronic musculoskeletal pain clinic for fibromyalgia patients can reduce utilization of healthcare services. BACKGROUND: People with fibromyalgia often consult multiple specialities due to the vast nature of their symptoms but receive little or no help in managing their symptoms. DESIGN: A retrospective evaluation of a nurse consultant-led chronic pain management clinic. METHODS: The frequency of hospital attendances in the five years before and three years after pain clinic attendance was evaluated. General practitioner (GP) attendances in the 12-month period before and after pain clinic attendance were compared with attendances for two groups of patients from an established GP cohort: (i) patients referred to rheumatology new patient clinics and (ii) all patients with fibromyalgia referred to any hospital new patient clinic. RESULTS: In the three years following attendance at the pain clinic, the mean number of hospital appointments fell significantly from 2.8 to 1.4 per annum (p < 0.001). The mean reduction seen in hospital clinic attendances in the first year (0.8/annum) improved in the second (1.2/annum) and third (2.1/annum) years. Seventy-eight per cent of pain clinic patients reduced their visits to their GP in the 12 months following treatment in the pain service, compared with 53% of patients referred to rheumatology clinics and 46% of patients with fibromyalgia. CONCLUSION: A nurse-led chronic pain clinic for fibromyalgia patients can have a positive impact on primary and secondary healthcare utilization. RELEVANCE TO CLINICAL PRACTICE: Having a designated nurse-led pain clinic can enable patients to access the appropriate service at an earlier stage in their condition and receive the support needed to manage the impact of their pain.

Experiences of a web-based nursing intervention--interviews with women with chronic musculoskeletal pain.

Patients with fibromyalgia must simultaneously cope with chronic pain, emotional distress, activity avoidance and disability. The majority of fibromyalgia patients are women. New interventions using information and communications technologies such as Internet applications and smart phones can be used for text-based communications between providers and patients with chronic pain. The aim of this qualitative study was to explore female patients' experiences of participating in a 4-week web-based home intervention after in-house multidimensional rehabilitation. The framework of the intervention was inspired by mindfulness-based cognitive behavioral therapy using daily diaries and situational feedback as tools. Interviews were made with seven women about their general experiences of participation, specific relationship with the therapist, communication, activity, emotions, and coping. The interviews were transcribed and analyzed using systematic text condensation. A main result was that informants experienced this follow-up program as consciousness expanding as well as both motivating and supportive. Another main result was their reported ambivalence in relation to: (1) using web-based technology; (2) experiencing feedback as challenging but positive; and (3) experiencing relationships of trust and detachment with the therapist. Web-based nursing stimulates a "zone for reflection" that may assist in the counseling and support of patients with chronic pain. However, this is a new area of research that needs to be further explored.

Nurse practitioner management of chronic musculoskeletal pain: a chart review.

This study explored NPs' management of chronic musculoskeletal pain via a record review of 50 uninsured patients. The findings include a summary of the utilization of services and treatments along with demographic data. Recommendations for education, practice, and further research are discussed.

[Contribution of nurse-led clinics in the management of the patient with rheumatoid arthritis]. / Aportación de la consulta de enfermería en el manejo del paciente con artritis reumatoide.

The goal of a nurse-led clinic in the management of rheumatoid arthritis patients is to promote patient independence. Patient education and empowerment are efficacious tools for achieving this. The main nursing care roles are vigilance of physical symptoms, drug toxicity and co-morbidities; management of physical and psychological symptoms; to provide continuity of care. There is evidence supporting the effectiveness of nurse-led clinics and the economic benefits related to it.