title: [A reflective case report applied to pain management in a complex care situation].
abstract: OBJECTIVE
  This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed.
  
  
  METHODS
  The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management?
  
  
  RESULTS
  Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future.
  
  
  CONCLUSIONS
  The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.
authors.affiliation: 1 Institut für Pflegewissenschaft, Fakultät für Sozialwissenschaften, Universität Wien.
authors.forename: Laura
authors.initials: L
authors.lastname: Kinsperger
authors.affiliation: 1 Institut für Pflegewissenschaft, Fakultät für Sozialwissenschaften, Universität Wien.
authors.forename: Stefanie Maria
authors.initials: SM
authors.lastname: Mayrhofer
authors.affiliation: 1 Institut für Pflegewissenschaft, Fakultät für Sozialwissenschaften, Universität Wien.
authors.forename: Birgit
authors.initials: B
authors.lastname: Pichler
authors.affiliation: 1 Institut für Pflegewissenschaft, Fakultät für Sozialwissenschaften, Universität Wien.
authors.forename: Hong
authors.initials: H
authors.lastname: Qin
authors.affiliation: 1 Institut für Pflegewissenschaft, Fakultät für Sozialwissenschaften, Universität Wien.
authors.forename: Iris
authors.initials: I
authors.lastname: Rheinfrank
authors.affiliation: 1 Institut für Pflegewissenschaft, Fakultät für Sozialwissenschaften, Universität Wien.
authors.forename: Berta
authors.initials: B
authors.lastname: Schrems
mesh_terms: D000328:Adult; D000698:Analgesia / Q000451:nursing; D016887:Cardiopulmonary Resuscitation / Q000451:nursing; D064646:Cardiovascular Nursing / Q000379:methods; D003299:Cooperative Behavior; D006323:Heart Arrest / Q000451:nursing*; D006801:Humans; D002534:Hypoxia, Brain / Q000451:nursing*; D033183:Interdisciplinary Communication; D008297:Male; D016294:Models, Nursing; D009633:Nonverbal Communication; D009737:Nursing Records; D059408:Pain Management / Q000451:nursing*; D010147:Pain Measurement / Q000451:nursing*
keywords: Bewusstseinsveränderung; Fallbericht; Intermediate Care Unit; Pflege; Schmerzmanagement; altered level of consciousness; case report; intermediate care facilities; nursing care; pain management