Caseload management in community children's nursing

AIM: Little is known about the working practices of community children's nurses and how they manage the complexities of working with children and young people with life-limiting, life-threatening and chronic ill-health conditions and their families. This action research project aimed to find ways of managing community children's nursing caseloads that would improve the efficiency, effectiveness and equity of services and inform negotiations with service commissioners. METHODS: A data collection template comprising six input categories was adapted from the Cornwall Community Trust's health visitor weighting framework to reflect the complexity of need and the family focus of the service provided. Data were collected for one year by nurses in one integrated community children's nursing and clinical psychology service in the Southwest of England. Qualitative interviews were held with the nurses to further explore patterns identified in the input data. RESULTS: From the documentary analysis and the interviews it was possible to identify a typical ratio of client numbers in each category which allowed the nurses to be proactive in meeting children's and families' assessed needs. The numbers of clients on caseloads fluctuated over time and varied between geographical caseload areas. The type of work carried out by individual nurses varied depending on the type of contract for their locale. However, by weighting the clients in each category it was possible to arrive at a means of meaningful comparison in terms of family centred nursing. CONCLUSION: The nursing input framework supports monthly caseload monitoring by community children's nurses and informs reports to the service commissioners as part of activity monitoring data. The mechanism will be tested in comparable services in the UK to gauge its transferability.     

A review of children's pain assessment and management

Pain is a subjective experience, thus, whenever the children stated they are in pain, the pain is existed. In the case of children under 3 years old, however, or those who have difficulty expressing themselves or controlling their behavior, nurses are required to make a judgment about whether they are just moody or are truly experiencing pain; an accurate assessment must be made before pain relief is administered. To relieve pain is one of the obligations of nurses. The purposes of this paper are not only to describe current trends in children's pain assessment and management in the clinical setting, but also to discuss issues related to pain assessment tools. Pain assessment should include a history of pain experience, self-reported measures, behavioral observation measures and physiological measures. Pain management includes pharmacological and non-pharmacological methods. A multi-method approach for managing children's pain is needed.     

疼痛的评估与管理

综述了疼痛的评估,疼痛的程度与性质关系,疼痛的程度对情感的影响,疼痛与性别的关系,并阐述了疼痛的管理。     

疼痛的评估与管理

综述了疼痛的评估，疼痛的程度与性质关系，疼痛的程度对情感的影响，疼痛与，巨别的关系，并阐述了疼痛的管理。     

Assessment and management of chronic pain in the older person living in the community.

AIM: This paper reviews the nursing research literature on chronic pain in the older person living in the community and suggests areas for future research. BACKGROUND: Chronic pain is a pervasive and complex problem that is difficult to treat appropriately. Nurses managing chronic pain in older people in domiciliary/home/community nursing settings face many challenges. To provide care, the many parameters of chronic pain which include the physical as well as the psycho-social impact and the effect of pain on patients and their families, must be carefully assessed. Beliefs of the older person about pain and pain management are also important. METHOD: Relevant nursing studies were searched using CINAHL, Cochrane Database of Systematic Reviews, EMBASE and PUBMED databases using key words about pain and the older person that were appropriate to each database. RESULTS: Tools to assess pain intensity in the older person have been studied but there has been less research on the other parameters of pain assessment or how the older person manages pain. An effective nurse-patient relationship is an important component of this process and one that needs more study. Few research studies have focused on how nurses can be assisted, or on the challenges, nurses' face, when managing this vulnerable population. CONCLUSION: A broad approach at the organisational level will assist nurses to manage this health care issue.     

Assessment of neuropathic pain in the community

The purpose of this paper is to provide the reader with evidence basedclinical guidance regarding assessing neuropathic pain. Persistent pain is a huge burden on health-care provision and the prevalence of persistent neuropathic pain is likely to increase owing to the ageing population. The provision of appropriate relieving interventions depends on accurate assessment. This paper sets out to provide the reader with simple neuropathic assessment tools that can be applied to community care. This will allow the community nurse to identify patients who have neuropathic pain and will therefore enable appropriate management.     

Temperament: a variable in children's pain management

Young children undergoing similar surgical procedures vary greatly in their need for analgesics. The influence of temperament on pain management differences in hospitalized 3- to 7-year-old children was examined. Variation in the number of analgesic medications administered was attributed to the impact of the child's individual behavioral style. A child's temperament should be considered when pain management is planned.     

Assessment and management of pain in infancy

Infant pain assessment and management are complex processes. Although infants are able to communicate distress, interpretation of their signals is difficult. We now understand infant pain perception and the resulting adverse sequelae of uncontrolled pain. We know infants do feel pain and suffer adverse long-term outcomes resulting from early exposure to repetitive, unrelieved pain. Infants perceive pain more intensely than adults. The developing brain is extremely vulnerable to environmental influences; repeated painful situations and stress can alter its development. Infant pain interventions are more important than ever realized. Interventions include pharmacologic and nonpharmacologic methods. Pharmacologic interventions include opioids, weak opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs. Nonpharmacologic interventions in conjuction with pharmacologic strategies are preferred pain treatments. To determine the best pain intervention, evaluation of infant pain requires both physiologic and behavioral criteria. Pain assessment tools for the older infants are presented. Copyright © 2001 by W.B. Saunders Company     

综合医院癌症疼痛护理策略团队的管理与成效

针对综合医院肿瘤患者分散在各相关科室的情况,组建了医院癌痛护理策略团队.通过对团队的建设,癌痛知识的培训,以及团队成员在各科室的临床实践等活动,提高了科室护理人员对癌痛的认知水平,从而使更多的癌痛患者得到专业护理.     

Parents' management of children's pain at home after surgery

Purpose. We tested home pain management for children for effects on pain intensity, analgesics administered, satisfaction, and use of healthcare services over 3 post‐discharge days. Design and Methods. In this quasi‐experimental study with 108 children and their parents, we used the numeric rating scale or the Faces Pain Scale‐Revised, calculated percentages of analgesics administered, and asked questions about expectations, satisfaction, and services. Between‐group differences were tested with t‐tests and analysis of variance. Results: After home pain management for children, children reported moderate pain, and parents administered more analgesics on study days. Parents and children were satisfied; parents used few services. Written instructions and a brief interactive session were not sufficient to change parents' analgesic administration practices to relieve their children's pain. Practice Implications. Further research is needed to develop and test effective education interventions to facilitate relief of children's postoperative pain.     

Assessment and management of pain in the paediatric patient

A combination of pharmacological and non-pharmacological interventions can ensure the highest standard of care in the management of pain in children. Nurses are in a prime position to care for children and educate them and their parents on effective pain management strategies.     

Assessment and management of chronic pain in elderly people

The ageing process can bring with it an increased incidence of conditions which give rise to chronic pain. Persistent musculoskeletal and/or neuropathic pain due to conditions such as back pain, arthritis, osteoporosis and diabetes in elderly people can lead to a marked deterioration in their quality of life. Pain assessment can be complicated by concomitant disorientation, confusion and communication deficits, leading to the undertreatment of pain in this client group. Pain management can be difficult due to the existence of multiple medical problems and the increased incidence of side-effects related to the treatment. This article aims to update nurses on the assessment and management of pain in the older adult, and will provide a broad overview of pain management strategies suitable for elderly patients.     

Assessment and management of pain in the terminally ill

Regular assessment for the presence of pain and response to pain management strategies should be high priority in terminally ill patients. Pain management interventions are most effective when treatments are individualized based on the various physical and nonphysical components of pain at the end of life, and patients and family are educated and involved in the decision making. Opioids remain the cornerstone of pain management, and adjuvant analgesics and nonpharmacologic options are usually considered after relative stabilization of pain. This article describes the various issues that are pertinent to the assessment and treatment of pain in terminally ill patients.     

Assessment and management of the trauma patient in pain

Optimum management of the critically ill trauma patient with pain combines a level of ongoing assessment that considers the intensity of the pain being experienced and the meaning of that pain to the individual. The physiologic responses of the critically ill patient to pain should be considered when assessing pain and when prescribing a particular medication and method of administration to relieve pain. Ongoing systematic assessment is critical so that patients are getting the maximal effects to keep them above their particular pain thresholds but below their sedation thresholds. Other modalities that are independent nursing functions, such as heat, distraction and positioning, should be an adjunct to medication prescribed for the overall care of the patient.     

Assessment and management of acute low back pain

Acute low back pain is commonly treated by family physicians. In most cases, only conservative therapy is needed. However, the history and physical examination may elicit warning signals that indicate the need for further work-up and treatment. These "red flags" include a history of trauma, fever, incontinence, unexplained weight loss, a cancer history, long-term steroid use, parenteral drug abuse, and intense localized pain and an inability to get into a comfortable position. Treatment usually consists of nonsteroidal anti-inflammatory agents or acetaminophen and a gradual return to usual activities. Surgery is reserved for use in patients with severe neurologic deficits and, possibly, those with severe symptoms that persist despite adequate conservative treatment.     

Assessment and management of patients with post-operative pain

Effective pain management is essential in the post-operative period to ensure that patients do not experience unnecessary distress or suffering and to minimise potential complications. Post-operative pain management strategies should focus on combining pharmacological management and comfort measures to ensure maximum pain relief for each patient.