Valutazione e terapia del dolore nel disabile grave

CHILD DEVELOPMENT & DISABILITIES - SAGGI ◽

10.3280/cdd2010-003008 ◽

2012 ◽

pp. 49-54

Author(s):

Marcello Marri

Keyword(s):

Negli ultimi anni la ricerca di laboratorio e quella clinica hanno aperto nuovi scenari nella fisiopatologia del dolore, permettendo un'approfondita comprensione di numerosi eventi presenti nella persona sofferente. La trasformazione del dolore da "sintomo-segnale d'allarme" caratteristico dell'evento acuto in una vera e propria sindrome "dolore-malattia" caratteristica del quadro cronico č in funzione della "persistenza nel tempo" o della "alta intensitŕ non controllata". All'evoluzione temporale del dolore č associato l'impatto negativo sulla persona. Differenze di ordine neurofisiologico, neuropsicologico e comportamentale giustificano la distinzione dolore acuto-sintomo/dolore cronico-sindrome [4]. Queste scoperte, insieme ad una nuova sensibilitŕ culturale che si č fatta strada nella societŕ civile, hanno permesso a molti operatori sanitari di porre il dolore al centro dell'attenzione della loro attivitŕ assistenziale. Pertanto si sono predisposti e vengono seguiti in molti Centri di cura protocolli e/o procedure che prevedono l'utilizzazione di scale per la valutazione dell'intensitŕ percepita del dolore o della inabilitazione che ne consegue e per la misurazione della componente affettiva, in diversi tipi di soggetti e/o in diversi quadri patologici, utilizzando, come nel caso dei neonati/lattanti o di condizioni cliniche estreme (coma farmacologico), il rilievo del cambiamento di alcuni parametri vitali o fisiologici. Queste scale possono essere distinte, semplificando e dal punto di vista della modalitŕ di "somministrazione", in due gruppi: quelle di Autovalutazione e quelle di Eterovalutazione. Numerose équipe hanno lavorato per trovare i segni comportamentali e fisici idonei a reperire e misurare il dolore nel bambino con disabilitŕ complessa e che non puň esprimersi verbalmente [3]. In Francia l'équipe dell'Ospedale "San Salvadour" (Hyčres) ha messo a punto una scala di 10 item, la DESS (Douleur Enfant San Salvadour), sul modello della DEGR (Douleur Enfant Gustave Roussy). I 10 punti si riferiscono alle modificazioni, in presenza di dolore, di segni neurologici abituali [2]. Un gruppo canadese ha messo a punto e validato una lista di 30 item molto semplici (pianto, grido, gemito, smorfia ecc.) che non necessita di conoscenza preliminare del bambino con disabilitŕ: č la NCCPC (Non-Communicating Children's Pain Checklist) [1]. Per trattare il dolore abbiamo a disposizione due approcci: cercare di interferire con il Sistema Eccitatorio filtrando o inibendo la trasmissione del messaggio "dolore" o rinforzare il Sistema Inibitorio. I mezzi a disposizione per ridurre il dolore sono numerosi e complementari. Per ottenere buoni risultati č sovente necessario associarne molti.

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Mitigating Children’s Pain and Anxiety during Blood Draw Using Social Robots

Electronics ◽

10.3390/electronics10101211 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1211

Author(s):

Matthijs H. J. Smakman ◽

Koen Smit ◽

Lotte Buser ◽

Tom Monshouwer ◽

Nigel van Putten ◽

...

Keyword(s):

Healthcare Professionals ◽

Young Patients ◽

Hospital Setting ◽

Social Robots ◽

Social Robot ◽

Blood Collection ◽

Medical Procedure ◽

Blood Draw ◽

The Social ◽

Children's Pain

Young pediatric patients who undergo venipuncture or capillary blood sampling often experience high levels of pain and anxiety. This often results in distressed young patients and their parents, increased treatment times, and a higher workload for healthcare professionals. Social robots are a new and promising tool to mitigate children’s pain and anxiety. This study aims to purposefully design and test a social robot for mitigating stress and anxiety during blood draw of children. We first programmed a social robot based on the requirements expressed by experienced healthcare professionals during focus group sessions. Next, we designed a randomized controlled experiment in which the social robot was applied as a distraction method to measure its capacity to mitigate pain and anxiety in children during blood draw in a children’s hospital setting. Children who interacted with the robot showed significantly lower levels of anxiety before actual blood collection, compared to children who received regular medical treatment. Children in the middle classes of primary school (aged 6–9) seemed especially sensitive to the robot’s ability to mitigate pain and anxiety before blood draw. Children’s parents overall expressed strong positive attitudes toward the use and effectiveness of the social robot for mitigating pain and anxiety. The results of this study demonstrate that social robots can be considered a new and effective tool for lowering children’s anxiety prior to the distressing medical procedure of blood collection.

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Effect of Active Distraction on Children’s Pain and Behavioral Response during Intravenous Catheter Insertion

Child Care in Practice ◽

10.1080/13575279.2021.1898340 ◽

2021 ◽

pp. 1-13

Author(s):

Shimmaa Moustafa

Keyword(s):

Behavioral Response ◽

Catheter Insertion ◽

Intravenous Catheter ◽

Children's Pain ◽

Active Distraction

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Nursing-Related Barriers to Children’s Pain Management at Selected Hospitals in Ghana: A Descriptive Qualitative Study

Pain Research and Management ◽

10.1155/2020/7125060 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Abigail Kusi Amponsah ◽

Evans Frimpong Kyei ◽

John Bright Agyemang ◽

Hanson Boakye ◽

Joana Kyei-Dompim ◽

...

Keyword(s):

Pain Management ◽

Qualitative Study ◽

Developed Countries ◽

Assessment Tools ◽

Pediatric Care ◽

Material Resources ◽

Management Interventions ◽

Communication Difficulties ◽

Children's Pain ◽

Descriptive Qualitative

Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children’s pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children’s pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children’s pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females (n = 24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses’ inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children’s pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children’s pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management.

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