Prevalencia y características clínicas del dolor en pacientes con enfermedad crónica avanzada / Prevalence and clinical characteristics of pain in patients with advanced chronic disease

Objetivos: Determinar la prevalencia y las características clínicas del dolor en pacientes con enfermedad crónica avanzada, e identificar la frecuencia del dolor irruptivo. Diseño: Estudio observacional, descriptivo y transversal. Emplazamiento: Tres equipos de atención primaria y un hospital de cuidados intermedios. Participantes: Se seleccionaron todos los pacientes con enfermedad crónica avanzada. Mediciones principales: Se realizó una entrevista semiestructurada para recoger variables demográficas, clínicas y específicas de dolor mediante escalas validadas. Se registraron la ubicación (domicilio, residencia u hospital) y la trayectoria de cronicidad avanzada (insuficiencia de órgano, enfermedad oncológica, demencia o multimorbilidad). Se valoró la presencia de dolor según la Brief Pain Inventory (BPI) y, en los casos de demencia invalidante, según la Pain Assessment in Advanced Dementia (PAINAD). Análisis estadístico descriptivo y comparativo entre variables utilizando el programa R. Resultados: Se incluyeron 223 pacientes (60,4% de los seleccionados). Prevalencia del dolor: 83,9% (n=187), sin diferencias según la ubicación ni según la trayectoria. Diferencias significativas en la intensidad del dolor según la ubicación (p=0,0046) (moderado-severo en domicilio, moderado en hospital y leve en residencia) y según la trayectoria (p<0,0001) (dolor moderado-severo en insuficiencia de órgano y multimorbilidad, moderado en cáncer y leve en demencia). Se observó impacto funcional por dolor leve-moderado, impacto emocional severo en el 41,5% de los pacientes (n=51) y dolor irruptivo en el 8,6% (n=13). Conclusiones: El dolor debe ser siempre explorado y evaluado en pacientes con cronicidad avanzada, ya que fue muy prevalente en todas las ubicaciones y trayectorias, especialmente intenso en la insuficiencia de órgano y en la multimorbilidad a domicilio. Apareció dolor irruptivo en trayectorias no oncológicas.(AU)

Objectives: Determine pain prevalence and clinical characteristics in patients with advanced chronic disease and identify breakthrough pain frequency. Design: Observational, descriptive, cross-sectional study. Location: Three primary care teams and one intermediate care hospital. Participants: All patients with advanced chronic disease. Main measurements: A semi-structured interview was performed to collect demographic, clinical, and specific variables of pain using validated scales. Patient location (home, nursing home or hospital) and advanced chronicity trajectory (organ failure, oncological disease, dementia, or multimorbidity) were recorded. Pain was assessed based on the Brief Pain Inventory (BPI) and, in cases of disabling dementia, using the Pain Assessment in Advanced Dementia (PAINAD). A statistical descriptive, comparative analysis between variables was performed using the R software. Results: Of all patients selected, 223 (60.4%) were included. Prevalence of pain: 83.9% (n=187), with no differences based on location or trajectory. Significant differences in pain intensity based on location (P=.0046) (moderate-severe in patients at home, moderate in hospital patients, and mild in nursing home patients) and on trajectory (P<.0001) (moderate-severe in patients with organ failure and multimorbidity, moderate in patients with cancer, and mild in patients with dementia). Global functional impact of pain was mild-moderate, emotional impact was severe in 41.5% of patients (n=51), and breakthrough pain was observed in 8.6% (n=13). Conclusions: Pain must always be explored and assessed in patients with advanced chronicity, since it was highly prevalent in all locations and trajectories, being particularly intense in patients at home with organ failure and multimorbidity. Breakthrough pain was found in non-oncological trajectories.(AU)

Cuidados enfermeros en el duelo perinatal. Una revisión sistemática y crítica de las actitudes y los conocimientos en la práctica clínica / Nursing care in perinatal grief. A systematic and critical review of attitudes and knowledge in clinical practice

Objetivo: Revisar y sintetizar la evidencia disponible sobre las actitudes y conocimientos de las enfermeras ante el duelo perinatal de los progenitores. Método: Se realizó una revisión sistemática de artículos originales publicados desde enero del 2016 hasta febrero del 2023, sin límite de idioma, en las bases de datos Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect y Web Of Science. Se utilizó el marco metodológico de la Declaración Preferred Reporting Items for Systematic reviews and Meta-Analyse (PRISMA) para revisiones sistemáticas y metaanálisis. Todo el proceso se efectuó por pares, siendo solventadas las discrepancias por un tercer revisor. Se evaluó la calidad de los artículos siguiendo los criterios Critical Appraisal Skills Programme Español (CASPe). Resultados: Se obtuvieron 12 artículos en esta revisión tras aplicar los criterios de inclusión, de los cuales, salvo un estudio cuantitativo transversal (8,33%), los demás eran análisis cualitativos realizados mediante entrevistas (75%) o grupos de discusión (16,66%). Se destaca que existen diferentes problemas biopsicosociales relacionados con las necesidades de cuidado que demanda la familia y que, por escasa formación o cultura del profesional sanitario, no se abordan de una manera adecuada. Los estudios encontrados muestran diversos recursos para atender adecuadamente el duelo perinatal, existiendo discrepancias en relación con permitir o no que se muestre y/o coja el cuerpo del bebé fallecido; existen también desacuerdos respecto a si el equipo asistencial debe fundamentar su práctica en protocolos o teorías como la del duelo de Kübler-Ross. La mayoría de los estudios (75%) consideran necesarias más formación y sensibilización contemplando la naturaleza biopsicosocial del usuario.(AU)

Aim: To review and synthesize the available evidence on the attitudes and knowledge of nurses regarding the perinatal grief of the parents. Methods: A systematic review of original articles published from January 2016 to February 2023 without language limit in the Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect and Web Of Science databases was carried out. The PRISMA Statement methodological framework was used for systematic reviews and meta-analyses. The entire process was carried out in pairs, with discrepancies being resolved by a third reviewer. The quality of the articles was evaluated following the Critical Appraisal Skills Program Spanish (CASPe criteria). Results: Twelve articles were obtained in this review after applying the inclusion criteria, of which. Except for one cross-sectional quantitative study (8.33%), the rest were qualitative studies carried out through interviews (75%) or discussion groups (16.66%). It is highlighted that there are different biopsychosocial problems related to the care needs demanded by the family and that, due to poor training or culture of the health professional, are not adequately addressed. The studies found show various resources to adequately attend to perinatal grief, there being discrepancies in relation to allowing or not allowing the body of the deceased baby to be shown and/or taken; There are also disagreements regarding whether the healthcare team should base its practice on protocols or theories such as the Kübler-Ross theory of grief. Most of the studies (75%) consider that more training and awareness is necessary, contemplating the biopsychosocial nature of the user.(AU)

The usability of an AAC pain description system for patients with acquired expressive communication disorders.

Augmentative and alternative communication (AAC) has been used by patients with acquired expressive communication disorders as an alternative to natural speech. The use of symbols to express pain, which is intangible, is challenging because designing a series of comprehensible symbols to represent personal experiences such as pain is not straightforward. This study describes (a) the development of symbols to express pain that were derived from Chinese pain-related similes and metaphors for an AAC mobile application developed specifically for this study known as PainDiary and (b) an assessment of the appropriateness of the app compared to conventional methods of collecting pain information. The symbols depicted headache pain and discomfort, which is prevalent among neurosurgical patients. The participants were 31 patients diagnosed with acquired expressive communication disorders who were receiving treatment in a neurosurgery general ward of Chang Gung Memorial Hospital in Taiwan and 14 nurses who worked on the ward. Pain information was collected by nurses using conventional methods and the PainDiary app. Assessment data, including the accuracy and efficiency of and user satisfaction with PainDiary, are compared. The results show that use of the app was effective in reporting pain and that patients required less time to report a pain event. The results further indicate that the PainDiary app was better received by younger individuals than by their older counterparts.

Intervenções não farmacológicas implementadas por enfermeiros no controlo da dor em cuidados paliativos: protocolo scoping review / Non-pharmacological pain-relief interventions implemented by nurses in palliative care: scoping review protocol

Objetivo: Identificar e mapear a evidência científica existente no âmbito das intervenções não farmacológicas implementadas por enfermeiros, com o objetivo de proporcionar controlo da dor, da pessoa em situação paliativa. Metodologia: Protocolo de Scoping review com base na metodologia proposta pelo Joanna Briggs Institute. Na pesquisa e identificação dos estudos, serão usadas as bases de dados eletrónicas MEDLINE (via Pubmed), CINAHL Complete (via EBSCOhost), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scielo, JBI Library of Systematic Reviews, Scopus. Adicionalmente, a pesquisa de estudos não publicados incluirá o Repositório Científico de Acesso Aberto de Portugal (RCAAP) e o OpenGrey. A estratégia de pesquisa abrangerá todos os artigos publicados em português, espanhol e inglês, nos últimos 5 anos. Resultados: Os resultados serão apresentados em formato narrativo, recorrendo a tabelas, de acordo com o objetivo, foco e questão de revisão. O mapeamento das intervenções não farmacológicas implementadas por enfermeiros, no âmbito do controlo da dor, irá contribuir para a disseminação da evidência disponível. Conclusão: Espera-se que a presente scoping review contribua para a análise crítica das intervenções não farmacológicas implementadas pelos enfermeiros neste âmbito, dado o potencial impacte destas no controlo da dor e na qualidade dos cuidados prestados.

Objetivo: Identificar y mapear la evidencia científica existente en el ámbito de las intervenciones no farmacológicas implementadas por enfermeras, con el objetivo de proporcionar el control del dolor a la persona en situación paliativa. Método: Protocolo de scoping review, según la metodología de Instituto Joanna Briggs. En la estrategia de investigación e identificación de estudios, se utilizarán las bases de datos electrónicas CINAHL Complete (vía EBSCOhost), MEDLINE (vía Pubmed), Registro Cochrane Central de Ensayos Controlados, Base de Datos Cochrane de Revisiones Sistemáticas, Scielo, JBI Library of Systematic Reviews. Scopus. A su vez, la búsqueda de estudios inéditos incluirá el Repositorio Científico de Acceso Abierto de Portugal (RCAAP) y OpenGrey. La estrategia de búsqueda incluirá todos los artículos publicados en portugués, español e inglés en los últimos 5 años. Resultados: Los resultados se presentarán en formato narrativo, mediante tablas, de acuerdo con el objetivo, enfoque y pregunta de revisión. El mapeo de las intervenciones no farmacológicas, en el ámbito del control del dolor, contribuirá para la difusión de la evidencia disponible. Conclusión: Se espera que la presente revisión contribuya para el análisis crítico de las intervenciones no farmacológicas en esta área, dado el potencial impacto de estas en el control del dolor y en la cualidad de los cuidados prestados.

Aim: To identify and map the existing scientific evidence within the scope of non-pharmacological interventions implemented by nurses with the objective of providing pain relief to the people in a palliative situation. Method: This study followed the scoping review protocol based on the Joanna Briggs Institute methodology. In regard to the research strategy and identification of studies, the following electronic databases were consulted: MEDLINE (via Pubmed), CINAHL Complete (via EBSCOhost), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scielo, JBI Library of Systematic Reviews, and Scopus. In addition, the search for unpublished studies included the Scientific Repository for Open Access of Portugal (RCAAP) and OpenGrey. The research strategy included all the articles published in Portuguese, Spanish and English in the last 5 years. Results: Following the main objective, focus and research question, the results will be presented in a narrative format, using tables. The mapping of the non-pharmacological interventions implemented by nurses focused on pain relief will contribute to the dissemination of the available evidence. Conclusion: It is expected that the present scoping review will contribute to the critical analysis of non-pharmacological interventions implemented by nurses in this area given the potential impact of these on pain relief and the quality of care provided.

Determination of prevalence, characteristics, management and related factors for pain in the older adults: pain among nursing home residents

This study aimed to determine pain assessment approaches and pain management strategies in elderly people in a nursing home.The cross-sectional-descriptive study sample consisted of 147 older adults living in a nursing home in Turkey in 2019. They all agreed to participate in the study (n = 147); however, as our research was about older adultswith pain problems, the study was completed with a total of 108 older adultsexperiencing pain problems. The participants' average age was 73.60 ± 6.97 years. Geriatric pain scale scores were higher for women aged 75 years and over, those who had a chronic disease and those who received analgesics, and there was a statistically significant difference between the mean scores (p < 0.05). Nurses must pay attention to pain assessment and management in nursing homes because of the adverse effects of pain on older adults' health status, vital functions, and well-being.

Music to reduce stress in hospitalized patients.

PURPOSE: To determine the impact of music on the physiologic and psychological stress experienced by hospital inpatients. METHODS: This pilot study monitored vital signs; utilized pain, anxiety, and agitation rating scales; and gathered verbal feedback from 50 participating inpatients at the authors' healthcare facility as they listened to music via an audiovisual interactive patient engagement technology system. RESULTS: After listening to music for 30 minutes, patients reported significantly lower pain and anxiety. CONCLUSION: Music offered a helpful tool to reduce pain and anxiety for patients in the ICU and telemetry units at the authors' healthcare facility. Future research may be geared toward incremental expansion and monitoring of this music intervention in other units.

Understanding the issues experienced by older people undergoing emergency surgery.

The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration.

Con E de enfermera Anestesia, reanimación y terapia del dolor / With E for nurse Anesthesia, resuscitation and pain therapy

Antonia Ballesteros es secretaria de la Asociación Española de Enfermeras de Anestesia, Reanimación y Terapia del Dolor (ASEEDAR-TD), representante española de The International Federation of Nurse Anesthetists (IFNA) y miembro del Grupo de investigación en cuidados, cronicidad y evidencias en salud Cures (idisBa). Nos atiende para hablar sobre las necesidades de los pacientes en terapia del dolor, de los diferentes tratamientos y del papel de las enfermeras en este ámbito.(AU)

Bearing witness to the challenges of breathlessness.

The community respiratory nurse specialist (CRNS) supports patients at different stages of lung disease, witnessing the challenge of living with chronic obstructive pulmonary disease (COPD), a progressive illness for which there is no cure. Breathlessness is the most prominent and debilitating symptom experienced; it is frightening, distressing and very difficult to manage. Little is known about the experience of CRNSs in witnessing the distress of patients, specifically those experiencing breathlessness. The nurse may have cared for such patients over many months or years. In witnessing this distress, CRNSs engage in emotional labour, which is associated with burnout and poor-quality care. This paper seeks to identify bearing witness to suffering and vulnerability as components of emotional labour in the context of the CRNS role. It highlights the need for research to explore the experience of CRNSs and insights into supporting people with long-term breathlessness. It is more likely that well-supported staff can provide sustained, supportive care to patients living with breathlessness.

Acerca del conocimiento sobre dolor en enfermeras de cuidados intensivos / About knowledge of intensive care unit nurses regarding pain

No disponible

A soft silicone foam dressing that aids healing and comfort in oncology care.

Maintaining skin integrity plays a key role in the ongoing care and comfort of patients at the end of life. Unfortunately, patients receiving cancer treatments are at higher risk of altered skin integrity. Cancer treatments involve multiple modalities, all of which impair wound healing. Excess exudate can be distressing to patients, resulting in catastrophic damage to the wound bed and surrounding skin, reducing quality of life and increasing the need for specialist services. This article describes the use of the Kliniderm foam silicone range of dressings, in combination with best practice, in the treatment of wounds in the oncology setting. The case study evidence presented indicates that this range of dressings is useful in the management of radiotherapy and oncology wounds. It had a positive effect on the exudate level, wound-association pain and the peri-wound skin in these patients, aiding the management of the wound bed.

An audience survey of practice relating to pain in the management of chronic venous leg ulcers.

Venous leg ulcers (VLU) respond well to compression, yet many ulcers remain unhealed after 1 year. Practitioners could be reluctant to apply compression to patients with significant ulcer pain. This study aimed to capture the views of practitioners on compression therapy for patients with painful VLU. A survey was conducted at a UK meeting in 2019 using handheld voting pads to capture the anonymous responses to four questions to which a mean of 90 practitioners responded. Nearly 40% of practitioners treat six or more patients a day with painful lower-limb ulcers. Some 80% felt confident in managing patients with painful ulcers; yet, most practitioners suggested they would refer onward for pain management. Some 40% would omit or reduce compression therapy as a pain management strategy. This survey supports the need for technological solutions that reduce VLU pain so that patients receive effective compression therapy.

Supportive care needs and quality of care of patients with lung cancer in Mexico: A cross-sectional study.

PURPOSE: To assess the supportive care needs (SC-needs), quality of patient-centered care (PCC), and factors associated with increased SC-needs of patients with lung cancer (LC) in Mexico. METHODS: We conducted a cross-sectional survey in the main oncology hospital of the Mexican Institute of Social Security in Mexico City. The study included LC ambulatory patients aged ≥18 years with at least one hospitalization before the survey, ≤five years since diagnosis, and without memory loss. Participants answered SC-needs and quality of PCC questionnaires. We performed a multiple negative binomial regression analysis to evaluate the factors associated with an increased number of SC-needs. RESULTS: One hundred twenty-eight LC patients participated. Most participants had adenocarcinoma (61.7%) and were at an advanced disease stage (92.1%). In the month preceding the survey, 3.9% had undergone surgery and 78.9% had been receiving chemotherapy and/or radiotherapy; 28.9% had symptoms of depression and 21.9% had anxiety. All patients reported one or more SC-needs-predominantly physical, daily living, information, and psychological needs. The significant gaps in PCC-quality were in the domains of care that addressed biopsychosocial needs and information for treatment decision-making. Factors that decreased the probability of SC-needs were respectful and coordinated care, high-school education, and older age. The factors increasing the likelihood of SCneeds were the type of LC (adenocarcinoma, mesenchymal tumors), chemotherapy and/or radiotherapy, and anxiety. CONCLUSION: PCC improvement initiatives to address SC-needs of LC patients should be prioritized and focus on: (1) information on physical suffering relief and treatment; (2) psychological support; and (3) SC-needs monitoring.

[Knowledge and attitudes of intensive care unit nurses regarding pain in patients].

BACKGROUND: Intensive Care Units (ICU) usually treat patients with pain. Being close to patients makes nurses key professionals for guaranteeing an optimal assessment and treatment of pain, which are crucial to ensure quality care. Therefore this study aims to describe the knowledge and attitudes of ICU nurses about pain management in their clinical practice, and its relationship with socio-demographic data. METHODS: Cross-sectional study carried out in a third level university teaching hospital ICU. The Knowledge and Attitudes Survey Regarding Pain (KARSP) translated into Spanish was used to obtain information about the knowledge and attitudes towards pain of nurses. RESULTS: All nurses (n?=?37) working at the ICU answered the questionnaire. The mean score of the questionnaire was 5.87 over 10 (SD: 0.98, range: 7.89-3.68). There was not a statistically significant relationship among the questionnaire score and age, professional experience, time worked at the ICU, specialized training or pain training. However, nurses with a master's degree obtained significantly higher mean scores in the questionnaire (6.97; DE: 0.75 vs. 5.73; DE: 0.92; p?=?0.018). CONCLUSIONS: ICU nurses show insufficient knowledge and attitudes towards pain. Having a master's degree improves the results obtained in the questionnaire about knowledge and attitudes towards pain.

Prevalencia, manejo y registro del dolor en unidades de Medicina Interna / Prevalence, pain management and registration in Internal Medicine units

OBJETIVO: Analizar la prevalencia y el manejo de los episodios de dolor, su evaluación y registro en unidades de hospitalización de Medicina Interna en un hospital público de tercer nivel del Servicio Regional de Salud de Castilla y León. MÉTODO: Estudio descriptivo transversal sobre los pacientes ingresados en unidades de Medicina Interna. La prevalencia del dolor se detectó mediante el cuestionario Brief Pain Inventory. La gestión de los episodios se analizó mediante su registro en la historia clínica. RESULTADOS: Se incluyeron 83 pacientes, el 73,5% manifestaron dolor y el 67,2% desconocían su pauta analgésica. Se identificaron más episodios de dolor en el caso de las mujeres (p = 0,006) con respecto a los hombres. La administración farmacológica se registró en todos los casos, el episodio de dolor dentro del evolutivo de la enfermera se registró en el 29,5% y en ningún caso se registró intensidad o grado de alivio con la Escala Visual Analógica, en la gráfica de constantes. CONCLUSIONES: Se ha evidenciado una alta prevalencia de dolor en los pacientes hospitalizados y una deficiencia en la gestión de los episodios de dolor por parte de las enfermeras, tanto en la evaluación como en el registro. Ello implica la necesidad de protocolizar el control del dolor implementando buenas prácticas basadas en la evidencia y dotar a las enfermeras de los medios y el apoyo necesario para poder realizar un manejo adecuado del dolor

OBJECTIVE: To analyze the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalization units in a third level public hospital of the regional health service of Castilla y León. METHOD: A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analyzed as recorded in the clinical records. RESULTS: 83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale. CONCLUSIONS: There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management

Implementation of a hospice pain-education programme.

BACKGROUND: No studies have explored the pain resource nurse curriculum in the hospice setting. This curriculum offers a structured method to teach pain management to nurses. AIMS: The purpose of this study was to examine the effect of implementing a modified pain resource nurse curriculum on nursing knowledge in a community hospice agency. METHODS: A modified and condensed version of the pain resources nurse curriculum was presented to community hospice nurses during two educational sessions. A pre-test-post-test assessment was conducted using a modified version of the Nursing Knowledge and Attitudes Survey Regarding Pain tool to assess knowledge growth from the educational sessions. FINDINGS: For educational session 1, average correct responses rose slightly from the pre-test to the post-test. However, this increase was not found to be statistically significant. For educational session 2, average correct responses rose an average of 2.6 points. This increase was found to be statistically significant. CONCLUSIONS: Based on this pre-experimental study, there is evidence that the pain resources nurse curriculum can provide an instructional framework for teaching hospice nurses. However, further study is needed, including a more rigorous design.

Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC) en España / Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO)

OBJETIVO: Analizar la evolución de la implantación de las recomendaciones de proceso de la guía RNAO Valoración y manejo del dolor y de los resultados en salud. MÉTODO: Estudio observacional, longitudinal, retrospectivo, realizado en 3hospitales de tercer nivel de España. Se incluyó a todos los pacientes dados de alta los últimos 5 días de cada mes de las unidades seleccionadas en el proceso de implantación. Se evaluaron datos estructurales, estancia media, estrategia de implantación y grado de implantación de recomendaciones de proceso según la guía RNAO durante los 3primeros años de implantación y resultados. Se realizó un análisis descriptivo mediante el cálculo de medias y frecuencias absolutas y relativas por periodos: basal (T0) y anual durante los 3primeros años de implantación (T1, T2 y T3, respectivamente) e inferencial. RESULTADOS: Se ha incluido a 8.128 pacientes. Se ha realizado contraste de hipótesis entre los diferentes periodos. La valoración inicial del dolor en las primeras 24h de ingreso o poscirugía se incrementó tras el periodo basal en todos los hospitales, especialmente en aquellos en los que no se cumplían los requisitos de la guía al inicio, y continuó creciendo de forma progresiva hasta a los 3 años de implantación (alcanzando un 94,6% en el hospital 2). En cambio, la implantación del plan de cuidados no ha llegado a superar el 37,5 o el 38,5% de los hospitales 1 y 3, respectivamente. Respecto a los indicadores de resultado, la prevalencia de dolor a las 24 h e intenso disminuyó en los 3hospitales de forma general desde T0 o T1 a T3; sin embargo, no se obtuvieron diferencias estadísticamente significativas concluyentes. CONCLUSIONES: La evolución de la implantación de las recomendaciones de proceso ha mejorado desde el inicio, al igual que los resultados sobre los pacientes, consiguiendo una disminución de la prevalencia y la intensidad del dolor, aunque no se obtuvieron datos concluyentes; todo esto conlleva una mejor práctica enfermera con mayores registros, continuidad asistencial y mejora de la gestión del dolor en los pacientes

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients

Defining compassion in a hospital setting: consensus on the characteristics that comprise compassion from researchers in the field.

Aims: To seek consensus on the key characteristics that comprise compassion in a health care setting from pre-defined experts currently researching in the field. Background: Compassion is a vital component in healthcare. There is currently little consensus on how compassion is defined or operationalized in healthcare or research. Design: Modified Delphi Study. Methods: A four phase Delphi process was conducted: (1) Literature review of contemporary research (2) open ended questionnaire (n = 9); (3) content analysis results and synthesis with literature; (4) two round Delphi approach (Round 1 n = 8; Round 2 n = 6). Results: A total of 31 out of 36 statements reached consensus. Conclusions: Experts came to a consensus that compassion was a virtuous response involving awareness of and participation in the suffering of another conveyed through action intended to reduce the suffering observed. Experts placed less emphasis on compassion as sympathetic concern or pity. Compassion does not involve witnessing of the plight of another nor suffering with the patient.

Procesos dolorosos, evaluación y tratamiento en unidades de cuidados intensivos neonatales: revisión de la literatura científica / Painful procedures, assesment and treatment in neonatal intensive care units: a scientific literature review

INTRODUCCIÓN: Los recién nacidos ingresados en las Unidades de Cuidados Intensivos Neonatales (UCIN) están expuestos a numerosos procedimientos diagnósticos y terapéuticos. Estos procesos causan dolor y estrés, que a su vez pueden provocar consecuencias futuras para el neonato. Las escalas de valoración del dolor se crearon para poder evaluarlo y tratarlo adecuadamente. Actualmente la inexistencia de consenso y protocolos de ámbito internacional provoca una evaluación y consecuentemente un tratamiento irregular. El objetivo de este trabajo es dar a conocer los procedimientos invasivos más frecuentes, las escalas que se utilizan en las UCIN para valorar el dolor producido durante estos procedimientos y las estrategias que se utilizan para disminuir el dolor y estrés de los neonatos. METODOLOGÍA: Estudio documental mediante revisión por publicaciones en bases de datos de ciencias de la salud (PubMed/Medline), siguiendo las recomendaciones PRISMA. Se utilizaron los descriptores MeSH: pain assessment tools. El intervalo de publicación revisado fue de 1999 a 2017. Un total de 72 artículos cumplieron los criterios de inclusión. RESULTADOS: El procedimiento invasivo más frecuente en las UCIN es la punción con lanceta (32,8%). La escala de valoración más utilizada es la PIPP (51,8%). El tratamiento no farmacológico más común para la disminución del dolor y estrés fue la administración de soluciones glucosadas orales (59%). CONCLUSIONES: Existen más de 16 herramientas de evaluación del dolor en los neonatos. Cada UCIN utiliza las escalas de valoración del dolor en torno a la naturaleza propia de la unidad. La falta de homogeneidad y consenso provoca que no se obtenga una valoración regular y uniforme

INTRODUCTION: New-borns that are hospitalized in Neonatal Intensive Care Units (NICU) are subjected to numerous diagnostics and therapeutic procedures. These procedures cause pain and distress that they can produce futures consequences. Pain assessment tools were created to assess and to treat appropriately. Currently there are not an international consensus and protocols to assess the pain in new-borns, for this reason there is an irregular value and treatment. The aim of this review is to let know the invasive procedures most frequently applicate in NICU, the pain assessment tools most utilized and the different strategies to reduce pain and distress of new-borns. METHODS: Documental study through published reviews in Health Sciences databases (PubMed/Medline). PRISMA recommendations were followed. Mesh terms «pain assessment tools» were utilised. The interval of years reviewed was from 1999 to 2017.72 articles were met the inclusion criteria. RESULTS: The most invasive procedure in NICU was the heel lancet (32.8%). The pain assessment tool most utilised was PIPP (51.8%). The pharmacological treatment most applicate to reduce pain and distress of new-born was the oral glucose solutions (59%). CONCLUSIONS: There are more than 16 pain assessment tools to assess newborns' pain. Each NICU use the most tool concerned by the specific nature of the unit. There are not consensus and homogeneity to assess pain in new-borns. In fact, this makes an irregular a uniformity value