INTENSIVE AND CRITICAL CAFtE NURSING 301

as underfeeding. Thus, careful consideration of all Despite the prevalence of literature related to pain factors affecting energy expenditure, protein and its management, deficits still exist in the manage- requirements and protein to non-protein calorie ment of pain. The essence of caring promotes the ratio is essential. desire to relieve pain promptly. This action is essential

3. Information collation re factors governing alter- not only for humanitarian reasons but also since persis- ations in nutritional needs. The effects of critical tent unrelieved pain can initiate deleterious pathophys- illness, activity, body temperature, drugs etc on the iological effects which may inhibit optimal recovery. In patient’s nutritional needs will be discussed. order to treat pain adequately it is necessary to make a

4. Calculating the patient’s individual requirements. systematic assessment of the patient’s pain. The contin- Methods of assessment including anthropometric, uing reasons for the inadequacies which exist in pain biochemical and indirect calorimetry will be dis- assessment will be considered. The behaviour during cussed with particular reference to their relevance nurse-patient interactions when patients are in pain in the critically ill patient. will be explored as nursing staff can strongly influence

Different methods of nutritional support and access pain assessment and subsequent management.

and their benefits and disadvantages will be briefly out- Having attempted to increase the visibility of pain,

lined the implications for education related to pain manage- ment will be addressed and the variety of therapeutic

References

Adam S K, Webb A R 1990 Attitudes to the delivery of enteral nutritional support to patients in British intensive care units. Clinical Intensive Care 1: 150-156.

Eesentiahs of wound management Noel LocbyeAtevens Tissue Viability Clinical

interventions which are available to improve pain man- agement in critical care will be considered. Having emphasised the existing deficiencies and considered various pain management strategies, we must encour- age critical evaluation of current practice. By such actions we can strive to improve the quality of pain man- agement and reduce the needless suffering which still occurs in many clinical areas.

Specialist, Royal Boumemouth and Christchurch Hospitals NHS Trust, UK The essentials of psychosocial care _ .

This lecture will cover the types of wound a nurse may Julie Pearce Senior Nurse, Research and Practice

face in the critical care situation. It will then discuss the Development and Senior Research Fellow,

relevant factors to the inhibition of wound healing in Southampton General Hospital/University of

the same environment. The need for accurate wound Southampton, Southampton, UK

assessment and use of a reliable tool that facilitates com- Nurses are the key providers of intimate physical care munication to other staff about a wound’s condition and psychosocial support. This paper sets out to: will be discussed. What objectives for treatment should be set and agreed by staff before commencing a dress ing regime and what products may facilitate healing will conclude the lecture.

1. Outline the impact of critical illness and the envi- ronment on the psychosocial, social and emotional wellbeing of the patient and family members.

2. Identify strategies which may be employed which will facilitate assessment of need and planning of

The essentials of pain assessment and management Karen Smith Senior Charge Nurse, Coronary Care Unit and part time Research Fellow, Ninewells Hospital, Dundee, UK

care designed to provide psychological and emo- tional support.

3. Discuss the role of the advanced nurse practitioner and the quality of psychosocial and emotional sup port achieved.

The experience of pain is universal in nature, yet unique to the individual. It is one of the commonest reasons for people to seek medical assistance. It is only in tbe last two decades that interest in this fundamental aspect of care has increased, stimulating both research and clinical practice to focus on improving pain relief.

4. Reflect on the nature of caring and the therapeutic potential of the nursing role with regards to met- ing the psychosocial and emotional needs of the patient and family members.

It is vital to recognise pain control as a priority and to The dynamics of decision maldq~ in clinical practice

give this the same emphasis as we do the life-saving Sarah J Sanford Chief Executive Officer of the

treatments and interventions which are common place American Association of Critical Care Nurses

in critical care areas. The provision of adequate pain (MCN)

management may have particular implications for the Global economic recession, ageing populations and critically ill patient thus offering a challenge to nursing seemingly intractable social and public health dilem- and medical staff. mas have combined to create service demands often