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Pain and distress in adults and children undergoing peripheral blood stem cell or bone marrow transplant
1School of Nursing, University of Minnesota, Minneapolis, USA.
Purpose/Objectives:
To examine the pattern of self-report of pain, opioids received, and nurses' assessments of pain, somatic distress, mood/behavior, cooperation/compliance, and activity in adults and children undergoing stem cell or bone marrow transplant.
Design:
Descriptive, longitudinal design; quantitative approach.
Setting:
A 32-bed bone marrow transplant unit in an urban tertiary-care center.
Sample:
20 adults (10 males and 10 females) 21-54 years of age and 20 children (10 males and 10 females) 5-17 years of age.
Methods:
Once daily over a period of 22 days, study participants used the Patient Self-Report of Pain Log to record their pain level and nurses used a Nurse Observations tool to record patient assessments. Researchers used a Patient Record Data form to record demographic data and daily totals of opioids given.
Main Research Variables:
Pain, somatic distress, mood/behavior, cooperation/compliance, activity, and daily totals of opioids received.
Findings:
Means of adults' and children's daily self-reported pain levels were low to moderate. Means of morphine equivalents/kg that children received daily were between 3 and 5.6 times more than means of morphine equivalents/kg that adults received. Nurses' assessments of somatic distress, mood/behavior, and cooperation/compliance were similar in adults and children. Cooperation/compliance was not related consistently to pain or somatic distress.
Conclusions:
Continuous infusion of an opioid with titration or bolus doses as needed allows patients to experience low to moderate pain levels. Although children received far more opioids/kg than adults received, children's and adults' self-reported pain levels were similar. Thus, children may need greater relative amounts of opioids than do adults to maintain a comparable level of comfort.
Implications For Nursing Practice:
Administering opioid therapy by continuous infusion with titration or bolus doses as needed was effective in managing pain in transplant recipients. Nurses should be prepared to give children more opioids/kg than adults receive to maintain a comparable level of comfort. Self-reported pain level should not be expected to correlate with level of patient cooperation/compliance with care.