Pain as a fifth vital sign in a standardized pain flow sheet: impact on patient-reported pain experience after cardiovascular surgery

Random pain assessments and the subsequent administration of analgesics may provide inadequate pain management, which is a major health care problem. To improve the quality of pain management, pain should be assessed as the fifth vital signs in a standardized pain flow sheet, because pain assessment is rarely complete, and because health care professionals are poor predictors of patient's pain. Thus the present study was conducted to examine the impact of nurses' use of a standardized pain flowsheet to document pain assessment and pharmacologic management on patient reported pain intensity after cardiac surgery. A pre and post implementation design was used to compare 51 patients from Cardiac Surgical Units in Shark El Madina Hospital /Ministry of Health/ Alexandria and Mansoura University Hospital. For the first [28 patients] in the pre-implementation group, traditional charting of presence or absence of pain was documented in the narrative notes and the pharmacologic management was documented in the medication profile. In the post-implementation group [23 patients], the intensity of pain and pharmacological management were documented on a pain flowsheet. Within 24 hour patients were interviewed regarding pain intensity experienced in the surgical heart unit and at the time of questioning. The distribution of these pain intensity scores was compared. Results revealed that the use of a standardized pain flowsheet to assess pain intensity and document pharmacological intervention improved pain management in post operative cardiovascular patients. Use of this scale helps patients quantify pain intensity and relief and requires the health care member to be accountable for providing effective management of pain

Thirst distress scale for hemodialysis patients

Thirst is the most frequently occurring symptom in hemodialysis patients. An increase in thirst is usually associated with an increase in both fluid intake and an increase in weight gain. Intervention to reduce the symptom of thirst may provide a meaningful way to decrease intra-dialytic weight gain [IWG] and prevent associated complications. The purpose of the present study was to develop and test the psychometric properties of an instrument to measure thirst in hemodialysis patients. Hemodialysis Unit of the Main University Hospital / Alexandria University and Hemodialysis Unit of El Mouassat Hospital. Instrument development study. Two hundred and four adult patients receiving thrice-weekly outpatient hemodialysis therapy. Four dimensions of thirst were conceptualized in the instrument development in this study as follows: thirst intensity, distress, duration, and frequency. During a midweek scheduled hemodialysis session, participants were asked to verbally respond to the items based on experiences with thirst since their last dialysis treatment. The items were scored on 5-point rating scale from 1 [strongly disagree] to 5 [strongly agree]. Data were analyzed using the Statistical Package for Social Sciences [SPSS 10.0] and LISREL [LISREL 8.3]. Reliability was assessed using item analysis, and coefficient alpha. Validity was tested using confirmatory factor analysis, exploratory factor analysis, and relationship testing of constructs identified in the theoretical model. The sample age ranged from 18 to 74 years with a mean of 5 3 +/- 14.8 years. The individual's mean daily interdialytic weight gain [IWG] since the last hemodialysis treatment was 1.2 +/- 0.7 Kg. The mean thirst intensity was 54.23 +/- 27.31. The final thirst distress scale had 6 items whose correlations ranged from 0.43 to 0.68 and the Cronbach's alpha for the thirst distress scale was satisfactory [0.78]. The mean thirst distress score was 17.1 +/- 4.2. There was a positive relationship between thirst distress and IWG [r=0.17, P < 0.01], and also between thirst distress and thirst intensity [r=0.31, P<0.001]. The present study provided evidence for the reliability and validity of the thirst distress scale proposed herein. Although this scale was initially developed for use in a research study, it appears to have potential for use in a clinical setting, particularly in conjunction with measures that may be related to weight gain. The scale could also be tested on patients without end stage renal disease, such as persons with congestive heart failure