[Psychoeducational Group Intervention for Parents of Adolescents with an Eating Disorders: Feasibility and Satisfaction]. / Intervention psychoéducative de groupe pour les parents d'adolescents avec un trouble des conduites alimentaires : faisabilité et satisfaction.

Parental involvement is recommended and essential in the treatment of eating disorders in adolescence. This role is certainly difficult to accomplish and requires guidance.Objective This article aims to describe the implementation of a psychoeducational group intervention for parents of teenagers consulting for eating disorders in a regional hospital in the province of Quebec, and the results of a satisfaction survey.Method The intervention is mainly based on the principles of the Maudsley approach. Additional information on physical activity and the disorder maintenance cycle was added. It consisted of 2 meetings of 2 hours, and was offered to 36 parents divided in 5 cohorts. Their level of satisfaction was then assessed.Results The intervention was feasible and parents have expressed overall high satisfaction with the services they received.Conclusion This type of intervention has proven to be feasible, acceptable and valued.

Validation of the critical-care pain observation tool in adult patients.

BACKGROUND: Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. OBJECTIVE: To validate the Critical-Care Pain Observation Tool. METHODS: A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation. RESULTS: The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest. CONCLUSIONS: The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.

Educational needs of palliative care nurses in Quebec.

Education appears to be a useful strategy for improving quality of care and work-related stress management. The present study assesses the educational needs of palliative care nurses working in acute care hospitals (n=88) and CLSCs (Centre Local de Services Communautaires, home-based, n=109) of the larger Quebec City area. It also describes relationships between educational needs, psychological distress, and self-efficacy. Nurses were surveyed and compared on training needs, preferred learning format, as well as barriers and factors facilitating attendance to workshops. Similar educational needs were observed in both work settings. Crisis, stress, and emotion management were rated as the most useful topics, followed by nonpharmacological ways to manage pain. Preferred educational formats were lectures and group discussions. Attending free training sessions during work hours was described as the best way to promote participation. Educational needs were positively related to psychological distress, and negatively related to perceived self-efficacy in providing good palliative care.

[Pain indicators in critical care]. / Les indicateurs de la douleur en soins critiques.

In this descriptive/qualitative study, focus groups and individual interviews were completed with 48 critical care nurses and 12 critical care physicians. Results showed that many indicators are used by those clinicians for pain assessment in intubated patients, whatever their level of consciousness. Nurses and physicians mentioned giving weight to the patient's self-assessmen tof pain even when intubated, communication then being by means of signs. Behavioural and physiological indicators also provide clinicians with valuable information for pain assessment. However, for the most part these indicators are not specific to pain, limiting their usefulness in this context. The study aslo suggests recommendations for nursing practice and ideas for nursing resarch.

[Better understanding of cancer-related fatigue]. / Mieux comprendre la fatigue liée au cancer.

Cancer-related fatigue (CRF) is a major reality during treatment as well as once treatment is completed. For many people, CRF persists for long periods in the post-therapeutic phase and has a considerable negative impact on the quality of life. Fatigue is defined as a subjective and multidimensional phenomenon. CRF is associated with many factors, hence its complexity. The goal of this article is to summarize major findings from a review of literature in order to better understand the phenomenon of CRF itself, its progressive course, the main associated factors and some of the most promising interventions.

Pain assessment and management in critically ill intubated patients: a retrospective study.

BACKGROUND: Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally. OBJECTIVES: To describe (1) pain indicators used by nurses and physicians for pain assessment, (2) pain management (pharmacological and nonpharmacological interventions) undertaken by nurses to relieve pain, and (3) pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are intubated. METHODS: Medical files from 2 specialized healthcare centers in Quebec City, Quebec, were reviewed. A data collection instrument based on Melzack's theory was developed from existing tools. Pain-related indicators were clustered into nonobservable/subjective (patients' self-reports of pain) and observable/objective (physiological and behavioral) categories. RESULTS: A total of 183 pain episodes in 52 patients who received mechanical ventilation were analyzed. Observable indicators were recorded 97% of the time. Patients' self-reports of pain were recorded only 29% of the time, a practice contradictory to recommendations for pain assessment. Pharmacological interventions were used more often (89% of the time) than nonpharmacological interventions (<25%) for managing pain. Almost 40% of the time, pain was not reassessed after an intervention. For reassessments, observable indicators were recorded 66% of the time; patients self-reports were recorded only 8% of the time. CONCLUSIONS: Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.

Implementing a hospital-based animal therapy program for children with cancer: a descriptive study.

Children living with cancer must cope with the disease, frequent hospitalizations, aggressive treatments and numerous treatment side effects. Combined, these stressors can lead to adverse biopsychosocial effects. An animal therapy program called "A Magical Dream" was instituted for children hospitalized in pediatric oncology to promote their well-being during hospitalization and facilitate their adaptation to the therapeutic process. The main goal of this preliminary study was to complete a descriptive assessment of the program implementation using Donabedian's quality model. This study aims more specifically at documenting the observed connection between participating in the program, quality of care and satisfaction of participating parents and nurses. A total of 16 parents of children and 12 nurses took part in the implementation study and composed the sample. Data were collected through two self-administered questionnaires intended for parents and one questionnaire for nurses. Evaluating the quality of the animal therapy program includes issues related to user profiles, animal therapy intervention process, organizational structure and client outcomes. It appears that dog-assisted therapy may contribute to alleviate psychological distress in children and parents, facilitate their adaptation to the therapeutic process, and promote their well-being while hospitalized. The goal of a second phase to the project will be to verify the effectiveness of the animal therapy intervention by targeting more specifically children hospitalized with solid tumours. Stemming from a nursing initiative started in 1999, this project aims to promote the well-being of children living with cancer during their hospitalization, reduce their emotional distress and facilitate their adaptation to the therapeutic (psychological, physical and social) process by promoting the emergence of special bonds between children and animals. The animal therapy program at CHUQ allows children accompanied by a parent to spend a whole day with a dog while being hospitalized in a room that is safe, warm and family friendly (Landry et al., 2000). In addition to facilitating the child's adaptation, this initiative may contribute to improving the quality of care, especially by offering a service for which client outcomes have already been noted (refreshing rest, better nourishment, physical exercise, socialization, participation in recreational activities, verbalization of fears and concerns, feeling less anxious, happier, etc.). Animal therapy is defined as a clinical method aiming to promote the natural and healing bonds that exist between humans and animals, both for preventive and therapeutic reasons (Daoust, 1987). The rationale behind this practice is that animals naturally stimulate an attraction and involvement response in humans (Brodie & Biley, 1999), which is then reflected in the person's well-being. As well-being is inconsistent with the state of emotional distress, animal-assisted therapy may be a beneficial intervention to alleviate distress in the child, his family and caregivers.