Examining pain-related distress in relation to pain intensity and psychological distress

Despite frequent use of the term symptom distress in the pain literature, symptom distress is often confused with symptom intensity and psychological distress, contributing to inadequate assessment of symptoms and less than ideal symptom management. In this article we address these issues and propose a hybrid model, combining Price's interaction of pain sensation, pain unpleasantness, and secondary pain affect model with an information processing model. Recommendations on methods and techniques to reduce this confusion would assist healthcare professionals and researchers to better distinguish among these terms as they manage patient symptoms and design symptom management studies. Thus, the purpose of this article is to examine the terms symptom distress, symptom intensity, and psychological distress using pain as the example symptom.     

Psychological distress: concept analysis

BACKGROUND: The term 'distress' is frequently used in nursing literature to describe patient discomfort related to signs and symptoms of acute or chronic illness, pre- or post-treatment anxiety or compromised status of fetuses or the respiratory system. 'Psychological distress' may more accurately describe the patient condition to which nurses respond than does the term 'distress'. Psychological distress is seldom defined as a distinct concept and is often embedded in the context of strain, stress and distress. This creates confusion for nurses attempting to manage the care of people experiencing psychological distress. AIMS: This paper is a concept analysis of psychological distress based on Walker and Avant's (1995) criteria that identifies the attributes, antecedents, and consequences of psychological distress based upon the findings of the literature review. In addition, empirical references are identified and constructed cases presented. METHODS: A literature search was conducted using MEDLINE, CINAHL, Ovid, PsychINFO, and Cancer Lit databases over the last 50 years. The purposes of this concept analysis were: (1) to establish the concept of psychological distress as a clear and distinct concept, separate from strain, stress and distress, and (2) to provide nurses with a base of knowledge from which to plan effective clinical interventions. FINDINGS: Content analysis of the literature revealed that, although used frequently in health care literature, the origin of the concept of psychological distress has not been clearly articulated and is ill-defined. CONCLUSIONS: Psychological distress is a serious problem faced by many of the people whom nurses encounter on a daily basis. An understanding of the concept of psychological distress will help nurses ameliorate this problem in patients. Nursing research related to the exploration of psychological distress is also needed.     

Symptom distress of Jordanian patients with cancer receiving chemotherapy

The purpose of this study was to explore the prevalence of symptom distress among Jordanian patients with cancer who are receiving chemotherapy. A total of 112 patients with cancer were evaluated using the Distress Thermometer and clinical symptom problem list, and Demographic and Clinical Characteristic Data Sheet. Patients in the sample were mostly female, and recently diagnosed with cancer during the past 6 months, with a variety of types of cancer with breast cancer being the most common. Patients reported several symptoms with nausea, fatigue, anorexia and daily activity disorder being reported most frequently. Most of the patients (71%) reported distress at a clinically significant level. Distress was correlated with clinical characteristics as treatment number and time. Problems in the areas of family relationships, emotional functioning and physical functioning were associated with higher reports of distress. Identification of the presence of distress is the first step towards referral and treatment of the symptoms that may contribute to the distress of the patient with cancer.     

Psychological distress in survivors of Hodgkin's disease

The object of this study was to reveal the psychological distress among survivors of Hodgkin's disease. Between 1985 and 1993, 55 patients were treated for Hodgkin's disease at our small oncological unit. In December 1994 all 49 survivors were mailed a questionnaire consisting of the Impact-of-Event Scale and a visual-analogue scale measuring quality of life, to which 42 patients responded (86%). Half of the patients reported moderate to high levels of psychological distress. Scores predicting significant stress response syndrome were revealed in 19% of the patients. Women reported statistically significant lower psychological distress on the intrusion (P=0.025) and avoidance scale (P=0.047) and a higher quality of life (P=0.032). In order to improve patients' care and support, cases at risk should be identified. Among patients with Hodgkin's disease, men seems to be at highest risk. This study should be helpful for developing supportive interventions for survivors of Hodgkin's disease.     

景观疗养对改善心理痛苦的作用

目的了解景观疗养对心理痛苦的缓解作用。方法使用ＳＣＬ—９０为疗效评价标准，对来院疗养的１０２例疗养员作疗养前后的对照研究，疗养期间维持原有治疗，仅加景观疗养。结果疗养员经景观疗养后心理痛苦较疗养前明显改善（Ｐ＜０．００１），高分组较低分组疗效更明显（Ｐ＜００１）。结论景观疗养能改善心理痛苦，且心理痛苦越大，疗养效果越明显。     

Predictors of psychological distress in chronic pain patients

The purpose of this study was to identify sources of psychological distress in patients attending pain clinics. Patients attending two pain clinics in the UK completed a self-report assessment questionnaire which included a 12-item, 5-point semantic differential measure of psychological well-being/distress, together with a range of single-item measures of pain and psychosocial factors measured using 5-point verbal report scales. Multiple regression analysis identified that 60% of the variance associated with psychological distress was explained by a combination of fears about the future, regrets about the past, age (younger people were more distressed), practical help (more help was associated with more distress), feeling unoccupied and personal relationship problems. These results support previous findings which have suggested that a significant proportion of the emotional disturbance in chronic pain patients is associated with psychosocial factors which are either secondary to, or concurrent with, the pain. The method described provides a simple and quick method of assessment which may be used by nurses in clinical settings to identify sources of psychological distress in patients with chronic pain and opportunities for therapeutic intervention.     

光量子血氧疗法治疗急性呼吸窘迫综合征的临床疗效观察

目的：研究用光量子血氧疗法治疗急性呼吸窘迫综合征（ＡＲＤＳ）的临床疗效。方法：早期ＡＲＤＳ患者６０例,随机分为对照组（３０例）、治疗组（３０例）,对照组采用常规综合治疗,治疗组在综合治疗的基础上加用光量子血氧疗法。观察２组血液流变性、肺动脉压（ＰＡＰ）、氧合指数（ＰａＯ２／ＦｉＯ２）和红细胞Ｃ３ｂ受体花环率（ＲＣ３ｂＲＲ）及其免疫复合物花环率（ＲＩＣＲ）的变化和治愈率。结果：治疗组较对照组血液流变     

癌症患者症状困扰的研究进展

文章指出了症状困扰对癌症患者生活质量及疾病康复的不良影响,并从概念、内涵、测量工具、特点、影响因素、对心理健康及生活质量的影响等方面对国内外癌症患者症状困扰的研究现状进行了系统的阐述。在此基础上,对国内症状困扰的研究进行了展望,并提出开发有效测评工具及扩大病种研究范畴等建议。     

Analysis and evaluation of the moral distress theory

Moral distress is a pervasive problem in nursing resulting in a detriment to patient care, providers, and organizations. Over a decade ago, the moral distress theory (MDT) was proposed and utilized in multiple research studies. This middle range theory explains and predicts the distress that occurs in a nurse because of moral conflict. The research findings born from this theory have been substantial. Since inception of this theory, moral distress has been extensively examined which has further elaborated its understanding. This paper provides an analysis and evaluation of the MDT according to applicable guidelines. Current understanding of the phenomenon indicates that a new theory may be warranted to better predict, treat, and manage moral distress.     

Miliary tuberculosis presenting as adult respiratory distress syndrome

We report the history of a 27-year-old Caucasian girl who died of adult respiratory distress syndrome secondary to miliary tuberculosis (MTB), after treatment with antibiotics to which the organism was sensitive, and a long period of ventilation. This case emphasises the importance of considering MTB as the cause of respiratory failure when another aetiology is not apparent.     

急诊科护士道德困境的现状调查

目的探讨急诊科护士道德困境水平,为管理者改善护士道德困境提供参考。方法采用中文版护士道德困境量表,对湖州市3所三级医院182名急诊科护士进行问卷调查。结果急诊科护士道德困境总均分为(2.03±1.15)分,不同急诊护龄、急诊岗位、学历与用工性质的急诊科护士道德困境水平差异均具有统计学意义(P0.01或P0.05)。结论护理管理者应重视急诊科护士道德困境问题,通过提高急诊科护士的自我预防与应对能力,以降低其道德困境的发生。     

The assessment of psychological distress.

This paper describes the assessment of psychological distress symptoms in the hospitalized physically ill elderly using a screening instrument known as the Comprehensive Psychopathological Rating Scale (CPRS) (Asberg et al. 1978). The methodological properties of this scale and a subscale known as the Montgomery Asberg Depression Scale (MADRS) (Montgomery-Asberg 1979) are discussed. It is suggested that the introduction of these scales into routine nursing practice would facilitate the identification and collection of psychological distress symptoms in this population and serve as a basis for nursing intervention and evaluation.     

2型糖尿病患者糖尿病痛苦现状及影响因素分析

目的调查2型糖尿病患者糖尿病痛苦状况,并分析影响因素。方法采用问卷调查方式收集患者人口社会学资料及疾病治疗相关资料。采用反刍思维量表(RRS)、心理弹性量表(CD-RISC)和糖尿病痛苦量表(DDS)分别评定患者反刍思维、心理弹性和糖尿病痛苦状况。结果223例患者中,217例(97.3%)患者糖尿病痛苦轻度,5例(2.2%)中度,1例(0.4%)重度。DDS量表4个维度方差分析结果显示,患者生活规律相关痛苦最高,其次是情感负担相关痛苦,最后是人际关系相关痛苦和医生相关痛苦(P<0.05)。单因素分析显示,年龄>70岁、吸烟、3个及以上合并症、低血糖、空腹血糖≥10.0 mmol/L、反刍思维高、心理弹性低者DDS评分更高(P<0.05)。多因素Logistic回归分析显示,吸烟(P=0.048)、反刍思维高(P=0.029)是糖尿病痛苦中重度的独立影响因素。结论2型糖尿病患者糖尿病痛苦比率较高,患者生活规律相关痛苦最高,其次是情感负担相关痛苦。患者糖尿病痛苦受多种因素影响,吸烟和反刍思维是主要影响因素。     

Experiences of pain and distress in hip fracture patients

The aims were to investigate: (1) experiences of physical pain in elderly patients with hip fracture; (2) if background variables, confusion, experiences of pain and distress and interventions aimed at reducing pain and distress, functional ability, pain in the ambulance, and type of fracture varied between patients with more intense physical pain and patients with less intense physical pain. The sample included 49 patients, 70 years or older, with hip fracture. Structured instruments were used to interview and observe the patients on four occasions during the hospital stay. The patients’ experiences of physical pain decreased during the hospital stay. Physical pain at rest was lower than pain with movement. Patients who scored physical pain as more intense (group B) during the visit to the hospital had significantly more unfavourable experiences in the sensory, emotional, and existential dimensions the day before discharge from the hospital compared with the patients who scored pain as less intense (group A). The patients in group B perceived the interventions as less favourable than group A. Furthermore, group B had more intense physical pain in the ambulance than the patients in the other group. More patients in group B than in group A had additional health problems.     

Nonsteroidal anti-inflammatory drug-induced acute respiratory distress syndrome

Drug induced acute respiratory distress syndrome (ARDS) is a common clinical condition. Patients typically present with noncardiogenic pulmonary edema. Large number of ARDS cases reported induced by antineoplastic drugs and other drug intoxications. The pathophysiologic mechanisms of drug induced ARDS remains unknown. One of the postulated mechanisms of drug induced ARDS is anaphylaxis. We present a case of acute respiratory distress syndrome complicated by anaphylactic shock after use of two different nonsteroidal antiinflammatory drugs (NSAID). To the best of our knowledge, ARDS following normal doses of NSAID ingestion has not been reported previously. The case showed that ARDS may occur after ingestion of therapeutic doses of NSAID. NSAID ingestion should be considered in the differential diagnosis of patients with non-cardiogenic pulmonary edema.     

新生儿急性呼吸窘迫综合征的CT诊断

目的：探讨新生儿急性呼吸窘迫综合征（ARDs）的CT特征,提供影像学的诊断依据。方法：回顾性分析20例临床诊断明确的ARDS患儿的双肺CT表现,对其分级,并分析CT分级与疾病严重程度的相关性。结果：Ⅰ级4例,均为轻度;Ⅱ级7例,其中轻度4例,中度3例;Ⅲ级6例,其中中度4例,重度2例;Ⅳ级3例,均为重度。研究显示CT分级与ARDS严重程度分度具有相关性,分级增加,分度亦增加（P〈0．01）。结论：肺部CT能及时地反映新生儿ARDS的危重程度,有助于疾病的早期诊断以及鉴别诊断,病情允许时可以选择。     

肺超声评分评估新生儿呼吸窘迫综合征

目的 观察肺超声评分(LUS)用于评估新生儿呼吸窘迫综合征(NRDS)的价值。方法 回顾性分析148例NRDS患儿(NRDS组)及60名非肺病新生儿(对照组)的肺超声声像图,比较组间肺部各分区及总LUS的差异,观察总LUS与NRDS患儿临床资料及相关参数的关系,评价总LUS判断临床分度的效能及总LUS、X线分级判断NRDS患儿是否需要接受有创辅助通气的效能并比较其差异。结果 NRDS组患儿肺部A线消失,B线呈散在或融合分布;对照组新生儿胸膜线规则、光滑,双肺均见A线,仅见极少量B线。NRDS组各分区及总LUS均高于对照组(P均＜0.05)。NRDS组患儿总LUS与临床分度、X线分级、辅助通气模式分级及使用呼吸机天数均呈正相关(r=0.67、0.56、0.60、0.63,P均＜0.05),与呼吸机参数呼气末正压、吸气峰压及吸入氧浓度均呈正相关(r=0.41、0.65、0.47,P均＜0.05)。总LUS评估轻、中及重度NRDS的曲线下面积(AUC)分别为0.845、0.862、0.905;以总LUS 22.5分及X线分级2级判断NRDS患儿需要接受有创辅助通气的AUC分别为0.862及0.796,总LUS评估效能优于X线分级(P＜0.001)。结论 LUS可用于评估NRDS患儿病情严重程度并判断其预后。     

护士道德困境与同情心疲乏的相关性研究

目的调查护士道德困境与同情心疲乏的现状,并分析二者的关系,为护理管理者有效应对护士道德困境和同情心疲乏提供依据。方法采用护士道德困境量表和专业生活质量量表对湖州市某三级乙等综合医院240名护士进行问卷调查。结果临床护士道德困境评分为(1.61±0.46)分;护士继发性创伤应激(20.76±5.02)分,工作倦怠(24.83±5.73)分,同情心满足(29.68±5.96)分。护士道德困境与同情心疲乏中工作倦怠、继发性创伤应激呈正相关(P0.01或P0.05)。结论护士的道德困境处于轻度水平,有发生同情心疲乏的危险,且护士道德困境与同情心疲乏呈正相关;提示护理管理者应采取针对性教育,克服道德困境,降低护士同情心疲乏的发生,以促进医护人员的身心健康,保证临床护理质量。