1/26. Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/26. music therapy for assistance with pain and anxiety management in burn treatment.The management of pain is one of the primary issues in burn care. Pain is not only a physiologic experience, but a psychological one as well. With this in mind, the treatment of burned patients must incorporate a holistic view of pain management and healing. Cognitive, behavioral, and pharmacologic interventions all have a role in pain management. Studies, as well as clinical experience, have shown that musical intervention has been helpful in assisting patients with pain management in a variety of medical settings. Music is an element of normal life that can be easily adapted for the needs of individual patients and their current environment while providing a means for self expression and for normalizing the environment. This article examines the rationale for using music therapy with burned patients, describes several protocols that have been adapted to meet the specific needs of burned patients, and summarizes our preliminary findings, which demonstrate significant response to music therapy protocols employed on our patients.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
3/26. The concept of total pain: a focused patient care study.This article considers the care of a patient admitted into a hospice environment for pain management and respite care. The concept of 'total' pain is discussed together with the need for a multidimensional assessment of pain to enable effective management to be accomplished. A multiprofessional approach to care along with inclusion of both the patient and her husband in decision making achieved the best possible quality of life for them both. A palliative care approach requires healthcare professionals to focus on the achievement of quality of life for all patients whose disease is not responsive to curative treatment. This is achieved by providing relief from pain and other distressing symptoms, including psychological, spiritual and social aspects of care, together with the acknowledgement of patient and relative autonomy. Hence, the study also exemplifies contemporary palliative care in action.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/26. Understanding the patient in emergency.Psychological care should be integrated with physical care even when one works in a busy 'acute care' environment, be it an emergency department, an intensive care unit, or at the roadside as a member of the ambulance team. The quality of care is enhanced by awareness of psychological needs. Initially a conscious effort is needed to remember to have cues verified and to be open to noting subtle changes in behavior. If a continuous effort is made by each health team member, this verification process will become automatic without being time-consuming. All members of the health team must be aware that they are individuals with a multiplicity of factors affecting their thinking, feeling and behavior. They care for individuals who are also unique. A form of support proving successful with one patient may not be effective with another. Each patient must be assessed as an individual before appropriate psychological care can be effectively given. By being open to cues given by the patient and his relatives, and by having perceptions of these cues verified, an important step is taken in deciding on appropriate psychological care. With an increased awareness of the total psychological impact of the 'emergency' situation on the patient, his relatives--in fact, on the entire health team--individualized patient care will be administered in a more thorough and understanding way.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/26. Experience of cumulative trauma disorders on life roles of worker and family member: a case study of a married couple.The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/26. water-friendly virtual reality pain control during wound care.Recent research suggests that entering an immersive virtual environment can serve as a powerful nonpharmacologic analgesic for severe burn pain. The present case study describes an attempt to use water-friendly virtual reality (VR) technology with a burn patient undergoing wound care in a hydrotherapy tub. The patient was a 40-year-old male with 19% total body surface area deep flame/flash burns to his legs, neck, back, and buttocks. The virtual reality treatment decreased the patient's sensory and affective pain ratings and decreased the amount of time spent thinking about his pain during wound care. We believe that VR analgesia works by drawing attention away from the wound care, leaving less attention available to process incoming pain signals. The water-friendly VR helmet dramatically increases the number of patients with severe burns that could potentially be treated with VR (see http://www.vrpain.com).- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/26. Special sunrise & sunset solar energy stored papers and their clinical applications for intractable pain, circulatory disturbances & cancer: comparison of beneficial effects between Special solar energy Stored paper and qigong Energy Stored paper.Various phases of solar energy were evaluated for possible medical application, using the Bi-Digital O-Ring Test. A 2-4 minute interval of highly beneficial phase during sunrise and sunset which is comparable or is stronger than ( ) qigong Energy was detected. This energy was stored on 3 x 5 inch index cards. The sun energy stored on the exposed surface had a Bi-Digital O-Ring Test extremely strong positive ( ) response, and the opposite side of the index card which was not exposed to the sun showed an equally strong negative (-) response. When the Bi-Digital O-Ring Test strong positive side ( ) was applied to the patient's skin above various intractable painful areas with circulatory disturbances, including gangrenous pain, muscle pain, joint pain, & migraine headache, most of the pain disappeared or was significantly reduced within between 10 seconds and 5 minutes, with accelerated wound healing compared with qigong energy stored paper of the same exposure, which caused pain to disappear within between 1.5 minutes and 15 minutes. When this Special solar energy Stored paper was applied either directly to the skin above cancer positive areas or the midline of the upper chest above the thymus gland representation area, or the occipital area above the medulla oblongata, various cancer related parameters returned to close to normal values, with immediate clinical improvement. The beneficial effects of 10-60 seconds of application of the Special solar energy Stored paper lasted for between 7 and 40 days, depending on the individual and their environmental electromagnetic field, how the special solar energy was stored, and how it was applied to the patient.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/26. Comfort Theory and its application to pediatric nursing.Although written protocols currently are directed more to pain relief than to the comfort of each child, there is increasing interest in pediatric literature about comforting strategies for children and their families. However, pediatric nurses/researchers currently utilize measures of discomfort that designate a neutral sense of comfort as in the absence of a specific discomfort. Assessing comfort as a positive, holistic outcome is important for measuring effectiveness of comforting strategies. Comfort Theory (Kolcaba, 2003), with its inherent emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will contribute to a proactive and multifaceted approach to care. The framework of Comfort Theory for pediatric practice and research is easy to understand and implement. The application of the theory is strengthening and satisfying for pediatric patients/families and nurses, and benefits institutions where a culture of comfort is valued. Moreover, comfort is a transcultural and interdisciplinary concern.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/26. Complex pain consultations in the pediatric intensive care unit.The assessment and management of pain in children is not always easy and it is clearly more difficult in the critical care setting. pain management is further complicated in this vulnerable population by the nature of their critical condition, the complexity and multidimensionality of their illness or injuries, and the intensity of emotions in this environment. A variety of pain syndromes are encountered in the pediatric intensive care unit, and the staff there may not be familiar with or comfortable managing these cases. Pain assessment and treatment can be more appropriately managed when guided by the experts of a multidisciplinary pediatric pain service.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/26. Section 3: The nature of pain: pathophysiology.An understanding of the pathophysiology of pain involves the concepts of neuronal plasticity at the levels of the nociceptor neurons, spinal cord, and brain. Neuroplasticity allows the neurons in the brain to compensate for injury and adjust their activity in response to new situations or changes in their environment. This is an important physiologic event in the development of central sensitization. Other concepts include modulatory effects at the nociceptor, sympathetically mediated pain, the "wind-up" phenomenon, central sensitization, and descending and ascending central modulatory mechanisms for the perception of pain, as well as the related pain motivations and behaviors. Numerous modulatory mechanisms for pain have been postulated that control the degree of pain perceived and the emotional and behavioral phenomena associated with a patient's pain experience. These numerous mechanisms take place at all levels of the nervous system: peripheral nerves, spinal cord, and brain. Despite great advances in unraveling the complexities of the pathophysiology of pain, much remains to be discovered. It is hoped that further research into this critical area will lead to better therapies.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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