Adolescents' acute blunt traumatic injury pain experiences.

摘要

For the over 600,000 children and adolescents admitted to the hospital each year with trauma related injuries, the majority experience unintentional blunt injuries and endure injury pain as well as pain related to subsequent care and procedures. Clinical and research data indicate adolescents experience acute unrelieved injury pain, are at risk for under-treatment of acute pain, and may continue to suffer with chronic unresolved pain.;Since little is known about adolescent blunt traumatic injury pain, a grounded theory approach incorporating interviews, case records, and pain measures (i.e., Adolescent Pediatric Pain Tool and Temporal Dot Matrix) was the research method used to develop and hypothesize about conceptual relationships between adolescents' pain perceptions and complex social interactive factors influencing that pain experience. Case records and recalled perceptions of pain at the scene, in the emergency room, and hospital settings as well as present pain perceptions were examined.;For the thirteen subjects (11–17 years) experiencing multiple sites of blunt unintentional injury, the majority recalled their worse pain at the scene and in the emergency room, with high intense pain persisting into the hospital setting. Based on constant comparative analysis grounded in interviews, case records, and pain measures, the proposed theory was that the actions of adolescents to manage their acute pain was internal control that was either promoted or threatened by their perceived intensity and experience with pain, physical losses, and actions of the staff.;Subcategories for internal control included behavioral and cognitive actions, learned passivity, and loss of control. Subcategories for pain intensity were level of pain intensity and experience of time with pain. Physical losses included both actual and potential losses of self and others. Staff actions included helpful and unhelpful subcategories of attitude, knowledge, and availability.;Similarities exist between previous research and adolescents' pain descriptions, actions recalled to manage their acute pain, and expectations of and reliance on the staff for pain relief. However, the unique contextual influences of blunt traumatic injury involving various settings, social losses of others involved in the accident, and functional consequences influenced adolescents' actions to manage their pain by altering emotions and pain experiences.