Thunder Project ® |
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AACN's Thunder Project® was conceptualized and developed to provide critical care nurses with a research protocol ready for institutional review and implementation. Project goals included providing a research package (protocol, educational, and data collection materials), as well as a topic of clinical significance to critical care nurses. Site Coordinators and Research Associates were identified at participating institutions to coordinate and implement all study activities.
Thunder Project ® I
Purpose: At the conclusion of the project, an evaluation study was undertaken to determine the perceptions of the Site Coordinators and Site Research Associates in relation to the process and content goals of the Thunder Project®. Specifically, the evaluation's purpose was to determine the extent process and content goals of the project were met, as well as provide an opportunity for Site Coordinators and Site Research Associates to comment on the study process. Methods: When all completed data collection forms were received from a project site, the Site Coordinators were sent evaluation tools. Site Coordinators and Site Research Associates completed the appropriate form and returned the completed evaluation tools to the AACN National Office for processing. Separate evaluation tools for Site Coordinators and Site Research Associates were developed by the Thunder Project® Task Force. Statements were developed to describe the project's ability to meet the stated process and content goals. A 4-point Likert-type scale was used to measure the respondent's level of agreement with each statement. Optically scannable forms were used, and written comments were requested at the end of each evaluation tool. The responses to each item were scanned using an OpScan5 scanner, and these data were downloaded into the CRUNCH4 statistical software for analysis. Descriptive statistics were generated. Comments were read and categorized according to themes. Results, Demographics: Project evaluation forms were received from 165 (83%) of the 198 Site Coordinators submitting data from their sites by the end of the data collection period. A total of 1118 Site Research Associates submitted completed evaluation forms. Eighty-nine percent of the Site Coordinators were either Doctoral or Masters prepared. The remaining 11% were either working on a degree or had a support person with either Masters or Doctoral preparation. Thunder Project® was the first nursing research coordinator experience for 97 (60.6%) of the Site Coordinators. Another 36 (22.5%) indicated it was their second experience, and 27 (16.9%) had coordinated three or more research projects. Content Goal: The Thunder Project® explored the effects of heparinized and non-heparinized flush solutions on the patency of arterial pressure monitoring lines. Site Coordinators and Research Associates were asked to rate the importance of the Thunder Project®'s research topic to clinical practice. All of the Site Coordinators and 95% of the Research Associates felt that the research topic addressed by the project was important to clinical practice. Comments illustrate their thoughts: "Heparin is a drug, and if we can eliminate one drug from the patient's regimen in critical care, we are doing something good." "Hopefully it will lead to the elimination of the use of heparin to maintain line patency which would be much safer for patients, less costly, and less time consuming for the nursing staff."
Thunder Project ® II
Background: Diagnostic and treatment-related procedures are performed each day on millions of acutely and critically ill patients. Practice guidelines for the management of acute procedural pain are limited due to the lack of scientifically-based knowledge of the perceptions and responses of acutely and critically ill patients undergoing procedural pain. Objectives: (1) to describe patients' pain perceptions and responses to turning, wound drain removal, tracheal suctioning, femoral line removal, central line insertion, and non-burn wound dressing change; (2) to compare patients' pain perceptions and responses across procedures. Methods: a comparative, descriptive design was used. Descriptions and extent of pain intensity, pain quality, and procedural distress were obtained from 6201 patients from 4 to 94 years of age in 169 hospitals. Data were collected by hospital site nurses who used pretested valid and reliable data collection instruments and standardized procedure outlines and scripts. Chart reviews elicited demographic and procedure-specific information as well as information about analgesics administered before and during procedures. Results: data were obtained from 91 children ages 4 to12, 151 adolescents ages 13 to17, and 5959 adults over 18 years of age. Children 4-12 years of age only underwent tracheal suctioning and turning. Mean pain intensity scores on a 0-5 scale for children 4-7 were 2.3 and 2.7 for the two procedures, respectively. Mean pain scores on a 0-100 scale for children 8-12 were 52.0 and 28.1, respectively. Patients 13 years of age and older used 0-10 numeric rating scales to rate pain intensity across the six procedures. Mean pain intensity scores ranged from 3 to 7, and mean procedural distress scores ranged from 2 to 6 across the six procedures. The most painful and distressing procedure for adults was turning, while adolescents found wound care to be the most painful and distressing. Procedural pain was most often described by those 18 years of age and older as sharp, stinging, stabbing, shooting, and bad, words that suggest an incisive quality to the pain and a negative experience for the patient. Patients undergoing turning, tracheal suctioning, wound care, and wound drain removal received less analgesics than patients undergoing femoral sheath removal or central line insertion, the two least painful procedures. The majority of patients in this descriptive study did not receive any form of analgesic, anesthetic, or sedative therapy prior to their procedure, including patients who had reported pain prior to the procedure. Conclusions: Procedural pain intensity and its associated distress vary considerably, depending on the specific procedure performed. The variation in pain intensity and distress can depend on how patients are prepared for the procedure as well as the different stimuli that may occur with various procedures. Anticipatory preparation that includes analgesic administration and information about expected sensations may prepare patients better for the experience. Given the frequency with which procedures are performed on acutely and critically ill patients, more directed, individualized attention to proparation for and control of procedural pain is warranted.
Thunder Project ® II continues to generate information in the form of articles, manuscripts, abstracts and poster presentations.
Publications
Puntillo, K.A., White, C., Morris A., Perdue S., Stanik-Hutt J., Thompson C., Wild L. (2001). Patients’ perceptions and responses to procedural pain: Results from Thunder II Project. American Journal of Critical Care, 10(4), 238-251.
Thompson C.L., White C., Wild L.R., Morris A.B., Perdue S.T., Stanik-Hutt J., Puntillo K.A. Translating research into practice: Implications of Thunder Project II. Critical Care Clinics of North America, 2001 Dec;13(4):541-6.
Puntillo K.A., Wild L.R., Morris A.B., Stanik-Hutt J., Thompson C., White C. Practices and predictors of analgesic interventions for adults undergoing painful procedures. (In review, AJCC).
Abstracts
K. Puntillo, L. Wild, A. Morris, J. Stanik-Hutt, C. Thompson, C. White. “Practices and Predictors of Analgesic Interventions for Adults Undergoing Painful Procedures”. (Accepted, Society of Critical Care Medicine Annual Meeting, San Diego, January 2002).
Kathleen Puntillo RN, DNSc, FAAN. Nursing Specialty Award recipient for Thunder Project II poster abstract, titled "Practices and Predictors of Analgesic Interventions for Adults Undergoing Painful Procedures." SCCM Meeting Jan-Feb 2002. San Diego CA
Carol Thompson, Univ. TN; Cheri White, Sutter Roseville Med.Ctr.; Lori Wild, Univ. Washington; Ann Morris, Children’s Recovery Center of N. Cal.; Julie Stanik-Hutt, Johns Hopkins Univ.; Kathleen Puntillo, UCSF. "Pain and distress with adult tracheal suctioning. (Accepted: American Thoracic Society Annual Meeting, Atlanta GA, May 2002).
Kathleen A. Puntillo, Ann B. Morris, Carol L. Thompson, Julie Stanik-Hutt, Lorie R. Wild, Cheri White. Validity and Predictability of Pain Behaviors Observed During Six Common Procedures: Results From Thunder Project II. (Accepted: American Pain Society Annual Meeting, Baltimore, MD, March 2002).
Treating Pain in the Difficult Patient-AACN Thunder Project, Society for Critical Care Medicine, Annual MeetingSan Francisco, CA, February, 2001
Pain During Procedures: Lessons Learned from the AACN Thunder Project II, Washoe Medical Center, Trauma the Challenge, Reno, NV, August, 2001
Bernice Budz did a presentation about Thunder from a site coordinator's perspective at the Canadian Critical Care Nursing Annual Meeting 2001.
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