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Patients´ experiences of pain in the intensive care - The delicate balance of control.
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0002-9300-6422
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0001-9065-6377
2020 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 76, no 10, p. 2660-2669Article in journal (Refereed) Published
Abstract [en]

AIM: To explore the patients´ experiences of pain when being cared for in the intensive care.

DESIGN: An exploratory, qualitative design was chosen.

METHOD: Interviews were performed with patients (October 2015-March 2017) within a week of post-intensive care (N = 16). Thematic analysis was used as method for analysis.

RESULTS: The findings generated two themes - a lack of control and to struggle for control. Pain was described as overwhelming, both in body and mind and generating the experience of a lack of control, with feelings of incapacitation, isolation, and having their needs unmet. Feeling in control of the pain and thus in control of the situation was experienced as a constant struggle. Well-planned care, finding ways to handle the pain and good communication were all helpful in this struggle.

CONCLUSION: The participants recalled their experience of pain in the ICU and control seems to be crucial for how pain is experienced. They experienced a lack of control due to not only the pain but also the treatment, which can be avoided by the nurse continuously evaluating and individualising the care. Balanced care, meeting the patients' needs and good communication helps the patient feel more in control when experiencing pain.

IMPACT: The experience of pain is dependent on control for the intensive care patient. The nurse may help them gain control and thereby handle the experience of pain through including the patient, striving for better communication and implementing individualised care that continuously assesses and treats pain.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020. Vol. 76, no 10, p. 2660-2669
Keywords [en]
critical care nursing, intensive care nursing, nursing, pain, pain experience, pain management, patient experience
National Category
Nursing
Identifiers
URN: urn:nbn:se:mau:diva-18363DOI: 10.1111/jan.14503ISI: 000567067200001PubMedID: 32808692Scopus ID: 2-s2.0-85089531459OAI: oai:DiVA.org:mau-18363DiVA, id: diva2:1469995
Available from: 2020-09-23 Created: 2020-09-23 Last updated: 2024-03-28Bibliographically approved
In thesis
1. Pain in intensive care: assessments and patients’ experience
Open this publication in new window or tab >>Pain in intensive care: assessments and patients’ experience
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the thesis was to translate, psychometrically test, and further develop the Behavioral Pain Scale for pain assessment in intensive care and to analyze if any other variables (besides the behavioral domains) could affect the pain assessments. Furthermore, the aim was to explore the patients’ experience of pain within the intensive care.

The Behavioral Pain Scale (BPS), consisting of the domains “facial expression,” “upper limbs,” and “compliance with ventilator/vocalization,” was translated andculturally adapted into Swedish and psychometrically tested in a sample of 20 patients(study I). The instrument was then further developed within one of the domains and tested for inter-rater reliability, discriminant validity, and criterion validity (study II). The method for analysis in both study I and II was a method specifically developed for paired, ordered, and categorical data. To describe and analyze the process of pain assessment, a General Linear Mixed Model was used to investigate what variables, besides the behaviors, could be associated with the observers’ own assessment of the patients’ pain (study III). Further, the patients’ experiences of pain when being cared for in intensive care were explored (study IV) through interviews with 16 participants post intensive care. Qualitative thematic analysis with an inductive approach was used for the analysis.

The first psychometric tests of the BPS (study I) showed inter-rater reliability with agreement of 85%. For the discriminant validity, all domains, except “compliance with ventilator,” indicated discriminant validity.

Therefore, in study II, a developed domain of “breathing pattern” was tested alongside the original version. The BPS showed discriminant validity for both the original and the developed version and an inter-rater reliability with agreement of 76-80%. Wheninspecting the respective domains there was a difference in discriminant validity between the original domain of “compliance with ventilation” and the developed domain of “breathing pattern,” showing higher values on the scale for the developed domain during turning. For criterion validity, the BPS showed a higher sensitivity than the observers, who on the contrary had a higher specificity.The General Linear Mix Model (study III) showed that heart rate could be associated with the observers’ assessments of pain. For the behavioral signs, the result indicated that breathing pattern was most associated with the observers’ pain assessment, whilst facial expression did not show any impact on the observers’ assessments.

The patients’ experiences of pain (study IV) in intensive care were described as generating a need for control; they experienced a lack of control when pain was present and continuously struggled to regain control. The experience of pain was not only related to the physical sensation but also to psychological and social aspects, along with the balance in the care given, which was important to the participants.

In conclusion, the translated and developed version of the Swedish BPS showed promising psychometric results in assessing pain in the adult intensive care patients. Still, other signs, besides behavioral, is possibly used when pain assessing and therefore information about and training in pain assessment are needed to enhance the assessments that are made. Also, the patients’ own experiences highlight the importance of individualizing and adapting pain assessment and treatment to the needs of each patient. Making them a part of the team could enhance their feeling of control, thereby supporting them in facing the experience of pain.

Place, publisher, year, edition, pages
Malmö: Malmö universitet, 2021. p. 108
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 2021:1
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-40867 (URN)10.24834/isbn.9789178771424 (DOI)978-91-7877-141-7 (ISBN)978-91-7877-142-4 (ISBN)
Public defence
2021-03-19, 09:00
Opponent
Note

Due to copyright reasons, the articles are not included in the fulltext online

Available from: 2021-02-25 Created: 2021-02-25 Last updated: 2024-03-07Bibliographically approved

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Hylén, MiaIdvall, EwaAlm-Roijer, Carin

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