Luppana Kitrungrote

Psychometric properties of pain intensity scales comparing among postoperative adult patients, elderly patients without and with mild cognitive impairment in China

BACKGROUND Western studies have shown that patients with mild or moderate cognitive impairment (CI) can use pain intensity scales to report pain reliably and validly, however, the qualities of pain intensity scales use in various age groups including elderly with CI are varied. In China, there is a lack of studies. OBJECTIVE To compare psychometric properties of five evidence-supported pain intensity scales including the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), the Faces Pain Scale (FPS), the Numeric Box-21 Scale (BS-21), and the Colored Analogue Scale (CAS) in postoperative adults varying in ages including elderly with mild CI. DESIGN Descriptive comparative study. SETTING A university-affiliated hospital in China. PARTICIPANTS Two hundred surgical patients were recruited purposively with 50 for each group: young adults, middle-aged adults, elderly without CI, and elderly with mild CI. METHODS Participants rated the vividly remembered, current, worst, least, and average pain, and indicated scale preference and simplicity. Scale face validity, concurrent validity, convergent validity, and test-retest reliability were assessed. Fishers exact tests were used to investigate whether face validity was related to different age groups and levels of CI. One-way ANOVA and Kruskal-Wallis test were used to test the differences of concurrent validity, convergent validity, and test-retest reliability coefficients of each pain scale among the four groups. RESULTS Regarding face validity, the FPS was ranked best as nearly half of the patients selected it as both the most preferred and simplest scale and it had low errors; the VDS and the NRS were ranked following the FPS; however, the BS-21 and the CAS were ranked last. The concurrent validity, convergent validity, and test-retest reliability of all five pain scales were supported in use with the four groups. The differences in psychometric properties among the four groups were only found in face validity and test-retest reliability. CONCLUSION The findings support the psychometric properties of all five pain scales for pain assessment in Chinese adults including elderly with mild CI. However, the FPS appears to be the best, followed by the VDS and the NRS.

Predicting quality of life among family caregivers of people with spinal cord injury having chronic low back pain in Nepal: a cross-sectional pilot study

Study designDescriptive cross-sectional study.ObjectiveThis study aims to determine the factors predicting quality of life among Nepalese family caregivers of people with spinal cord injury (SCI) having low back pain.SettingEight districts of the Bagmati Zone of Nepal.MethodsSixty-five family caregivers of people with SCI having chronic low back pain were recruited from January to March 2017. The factors examined as independent variables included monthly household income, daily caregiving hours, functional independence of people with SCI, low back pain intensity, and functional disability of family caregivers. The measures were the Family Caregivers’ and Spinal Cord Injury Patients’ Demographic Form, the Modified Barthel Index, the Pain Intensity Scale, the Oswestry Disability Index, and the World Health Organization Quality of Life-BREF Nepali version. A hierarchical multiple regression analysis was used to predict quality of life.ResultsFunctional independence of people with SCI, monthly household income, and functional disability of family caregivers with chronic low back pain could significantly predict quality of life at 41% (adjusted R2 = 0.41, Fchange (3,59) = 11.02, p < 0.01). The functional dependence of persons with SCI was the most powerful factor contributing to QoL of caregivers (β = 0.36, p < 0.01) followed by monthly household income (β = 0.30, p < 0.01) and caregivers’ functional disability (β = –0.28, p < 0.01).ConclusionThe findings suggested that in order to improve the quality of life of family caregivers who have chronic low back pain while providing care for people with SCI during a long period, health professionals should strengthen the functional independence of the patients after discharge to reduce the functional disability of the caregivers. Financial support is needed for caregivers who have a low income.

Chronic pain experience and pain management in persons with spinal cord injury in Nepal

Abstract Background and aims: Chronic pain is the frequent and significantly challenging complications in persons with spinal cord injury (SCI). Socio-cultural background may lead people perceive and manage pain differently. The study aims to describe the chronic pain experience and pain management of SCI persons in Nepal. Methods: A descriptive cross sectional study was conducted among purposively selected sample of 120 SCI persons with chronic pain living in the eight districts of Bagmati Zone of Nepal. The data were collected using the International Spinal Cord Injury Pain Basic Data Set Version 2 (ISCIPBDS-2) and Open-ended Pain Management Questionnaire. The data were analyzed using descriptive statistics and content analysis method. Results: The back (n=84), lower legs/feet (n=63) and buttocks/hips (n=51) was found as the common pain locations. In common, the onset of pain was found within the first 6 month of the injury. Overall pain intensity and pain interference were found to be at the moderate level. The SCI persons used pain medications and non-pharmacological pain management. Ibuprofen was the commonly used pain medication and commonly used non-pharmacological pain management methods included physical support (e.g. massage, exercise), relaxation (e.g. distraction, substance abuse), coping (e.g. acceptance, praying), and traditional herbs. Conclusions: SCI persons had chronic pain experience which interfered with their daily living. They used pain medications and non-pharmacological pain management methods based on their beliefs, knowledge, and community resources in Nepal. Implications: This study provides some evidence to help the team of rehabilitation professional to plan and help SCI persons with chronic pain. Based on these findings, chronic pain management intervention for SCI persons should be developed and supported continuously from hospital to home based community context of Nepal.

Comfort in Patients Receiving Mechanical Ventilation: A Literature Review

Background: Comfort in patients receiving mechanical ventilation can be disturbed for many reasons. This condition may lead to negative impacts due to unmet comfort needs in patients with mechanical ventilation. Kolcaba’s comfort theory described that patients’ comfort may be enhanced, if the needs of comfort can be met in four contexts of comfort, including physical, psychospiritual, environmental, and sociocultural comfort. Therefore, there is a need to identify causative factors that may disturb comfort during mechanical ventilation and intervention to promote comfort while receiving mechanical ventilation. Objective: This study aimed at reviewing the literature concerning comfort in patients receiving mechanical ventilation. Methods: A literature review was conducted by analyzing 42 scholarly papers from year 2002 to 2016. The data were searched through Scopus, ProQuest, Elsevier/Science Direct, CINAHL, and PubMed based on PICO questions with keywords; ‘comfort’, ‘discomfort’, ‘comfort need’ ‘patient’, ‘mechanical ventilation’, and ‘ventilator’. Relevant articles were appraised following the recommendation of the Joanna briggs institute for evidence-based nursing. Results: Overall, 116 articles were retrieved and 42 articles met the inclusion criteria. The results presented comfort needs of mechanically ventilated patients in physical, psychospiritual, environmental, and sociocultural contexts, and interventions to promote comfort during mechanical ventilation were divided to the following three categories, pharmacological interventions, nursing care interventions, and complementary and alternative interventions. Conclusion and Recommendation: The knowledge from this literature review can be useful for nurses and other healthcare providers to develop quality comfort care for patients dependent on mechanical ventilation.

Development of a Trauma-based Continuing Care Model for Enhancing Care Outcomes in Social Unrest Area: A Case Study

Background: Improving care outcomes in trauma patients is regarded as important and linked to an appropriate model of care particularly in social unrest area where there are limited resources and accessibility after discharge. To facilitate prompt management to improve patient recovery or quality of life and decrease some complications, a specific model of continuing care for those trauma survivors is required. Objective: This participatory action research (PAR) aimed to develop the trauma-based continuing care model (TCCM) for enhancing care outcomes in trauma patients affected from Social Unrest area. Method: A three-phase of PAR design was implemented with stakeholders in both hospital and community services related to care for trauma survivors and their families. In the first phase, 11 trauma survivors were interviewed and 3 focus group discussions with nurses and related health care staff were conducted to identify existing systems and problems encountered. The second phase consisted of two workshops, involving 20 key informants and allied health staff for the purpose of developing the model. The final phase evaluated the initial effects of the model after implementing with 20 patients by measuring the care process and outcomes such as nurses’satisfaction, patients’quality of life, patients’self care ability, caregivers’ ability to care. Data were analyzed using descriptive statistics for care outcomes and content analysis for the care process. Result: The model consisted of a) trauma-care process through a trauma nurse-initiated discharge planning program b) patient-family follow up. With the PAR process, the following steps included 1) preparing the multidisciplinary health care team including patient and family caregivers, 2) organizing the system, identifying individual role and function for continuing care, and 3) collaborating with community support network for patient and family management. The main strategies to drive all process were teamwork involvement, care coordination, and staff education. The model could enhance both health care staff and family caregivers in providing better care. In this study, most patients were able to manage themselves. Twenty patients and 10 family caregivers were satisfied with the care process and obtained better outcomes regarding health status and quality of life. In addition, the developed trauma nurse-initiated discharge planning program was also discussed for further implication. Conclusion: The key success was derived from trauma nurse-initiated discharge planning process and collaborating with community support network. To enhance the sustainability of the model, care managed by enhancing networking of community nurse, patient and family after discharge needs to be further explored.

Holistic self-care for rehabilitation experienced by thai buddhist trauma patients in areas of political and social unrest.

This study describes the meaning and practice of holistic self-care for rehabilitation among Thai Buddhist trauma patients living in areas of political unrest where acts of terrorism occur. Eleven Thai Buddhist trauma patients were selected as specified. The data were collected by in-depth interviews between November 2011 and April 2012, and analyzed using the Van Manen method.Those interviewed described “holistic self-care for rehabilitation” as learning (1) to acquire a new life and (2) to bear the increased demands of care as a chronic disease. Health care responses fell into 3 categories: (1) improving physical self-sufficiency and rehabilitation by increasing muscle strength, pain management, and pressure sores; (2) improving psychological well-being by applying positive thinking, making an effort to live independently, and following a set of religious practices; and (3) finding harmony in life through caution and a willingness to adjust ones lifestyle. Although the participants seemed to adapt well to their new lifestyles, extensive support from health care professionals was necessary. This study promotes better understanding of the holistic health care experiences the survivors of trauma have as a result of an unstable political situation that includes aspects of social unrest and terrorism.