Pain in critically ill adults with burns should be assessed using structured pain behavioural observation measures. This study tested the clinimetric qualities and usability of the behaviour pain scale (BPS) and the critical-care pain observation tool (CPOT) in this population. This prospective observational cohort study included 132 nurses who rated pain behaviour in 75 patients. The majority of nurses indicated that BPS and CPOT reflect background and procedural pain-specific features (63–72 and 87–80%, respectively). All BPS and CPOT items loaded on one latent variable (≥0.70), except for compliance ventilator and vocalisation for CPOT (0.69 and 0.64, respectively). Internal consistency also met the criterion of ≥0.70 in ventilated and non-ventilated patients for both scales, except for non-ventilated patients observed by BPS (0.67). Intraclass correlation coefficients (ICCs) of total scores were sufficient (≥0.70), but decreased when patients had facial burns. In general, the scales were fast to administer and easy to understand. Cut-off scores for BPS and CPOT were 4 and 1, respectively. In conclusion, both scales seem valid, reliable, and useful for the measurement of acute pain in ICU patients with burns, including patients with facial burns. Cut-off scores associated with BPS and CPOT for the burn population allow professionals to connect total scores to person-centred treatment protocols.
Key summary points Aim To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Findings This guidance addresses general requirements for post-acute COVID-19 geriatric rehabilitation and critical aspects for quality assurance during the COVID-19 pandemic. Furthermore, the guidance describes relevant care processes and procedures divided in five topics: patient selection; admission; treatment; discharge; and follow-up and monitoring. Message This guidance is designed to provide support to care professionals involved in the geriatric rehabilitation treatment of post-acute COVID-19 patients.
A growing interest in person-centered care from a biopsychosocial perspective has led to increased attention to structural screening. The aim of this study was to develop an easy-to-comprehend screening instrument using single items to identify a broad range of health-related problems in adult burn survivors. This study builds on earlier work regarding content generation. Focus groups and expert meetings with healthcare providers informed content refinement, resulting in the Aftercare Problem List (APL). The instrument consists of 43 items divided into nine health domains: scars, daily life functioning, scars treatment, body perceptions, stigmatization, intimacy, mental health, relationships, financial concerns, and a positive coping domain. The APL also includes a Distress Thermometer and a question inquiring about preference to discuss the results with a healthcare provider. Subsequently, the APL was completed by 102 outpatients. To test face validity, a linear regression analysis showed that problems in three health domains, i.e., scars, mental health, and body perceptions, were significantly related to higher distress. Qualitative results revealed that a minority found the items difficult which led to further adjustment of the wording and the addition of illustrations. In summation, this study subscribes to the validity of using single items to screen for burn-related problems.
Achtergrond: In acute intensieve werksettings, waar de werkdruk al hoog was en er altijd impact is van indrukwekkende gebeurtenissen, zorgt COVID-19 voor toename van druk. Zorgprofessionals worden geconfronteerd met een nieuw en onbekend ziektebeeld, lopen risico op besmetting of om een besmettingsbron voor patiënten te zijn, communicatie met de patiënt is minder goed mogelijk, en zij krijgen te maken met een hogere werkdruk. Dit leidt tot een ongezonde werksituatie. De potentiële gevolgen hiervan zijn (post-traumatische) stress, burn-out en uitval. Er is daarom noodzaak om curatieve ondersteuning tijdens de crisis/indrukwekkende gebeurtenissen en preventieve ondersteuning ter voorbereiding op crisis/indrukwekkende gebeurtenissen en ter nazorg aan te bieden. Professionals uit het netwerk van Lectoraat Acute Intensieve Zorg werkzaam in de frontlinie vanuit ambulance, Spoedeisende Hulp (SEH), Acute Opname Afdelingen en Intensive Care geven aan moeite te hebben met het omgaan met de indrukwekkende situaties bij de COVID-19 crisis. Ze hebben gevraagd om een toolkit van werkzame interventies die kunnen worden ingezet om beter met deze situatie om te kunnen gaan om hiermee duurzame inzetbaarheid in, tijdens en na crisissituaties te vergroten. Het gaat hierbij om interventies gericht op curatieve en preventieve ondersteuning. Plan van aanpak: In dit project wordt ontwerpgericht onderzoek middels mixed methods design toegepast. In co-creatie met de praktijk ontwikkelen we een toolkit met bruikbare, zo mogelijk evidence based, interventies om zorgprofessionals te ondersteunen om om te gaan met indrukwekkende gebeurtenissen, gebaseerd op lessen uit de COVID-19 crisis. Deze toolkit dient ervoor om duurzame inzetbaarheid te ondersteunen en te vergroten. Vanuit de HAN werken de lectoraten Acute Intensieve Zorg en Human Resource Management nauw samen met beroepsverenigingen en publieke instellingen uit de acuut intensieve keten. Alle partners verspreiden ontwikkelde kennis en producten via hun netwerk.
