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Alshehri FA, Levett-Jones T, Pich J. Nursing students' knowledge of and attitudes towards pain management: An integrative review. NURSE EDUCATION TODAY 2024; 139:106207. [PMID: 38669861 DOI: 10.1016/j.nedt.2024.106207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES The objectives of this review were to appraise the available literature regarding nursing students' knowledge of and attitudes towards pain management; and secondly, to examine the instruments currently used to measure students' knowledge of and attitudes towards pain management. DESIGN This review was conducted using Whittemore and Knafl's five-stage framework for integrative reviews. DATA SOURCES A comprehensive search to retrieve relevant studies published in English between 1978 and 2022 was conducted using the databases: CINAHL, MEDLINE, Embase and Scopus databases. An updated search of the same databases was performed to identify studies published in 2023-2024. REVIEW METHODS The initial search located 558 articles. One more relevant article was identified from an updated search test. Total of 244 duplicated records were removed. The remaining 315 studies were eligible for screening. After screening and checking for eligibility, 29 included articles were critically appraised using the Joanna Briggs Institute critical appraisal tools. RESULTS Synthesis of the findings of the 29 included studies indicated that, internationally, nursing students have limited knowledge and often hold negative attitudes towards pain. Various instruments have been used to measure students' knowledge and attitudes towards pain. Most studies used true/false or multiple-choice questions and Likert-type scales. The validity and reliability of most of the tools were reported to be acceptable. The most commonly used instrument was the Knowledge and Attitudes Survey Regarding Pain. CONCLUSION The findings from this review suggest the need for refinement of pain education programs to improve nursing students' knowledge of and attitudes towards pain management. Future research should focus on understanding the personal and environmental factors that impact students' level of knowledge and attitudes so as to inform curriculum development and ultimately the quality of the care graduates provide.
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Affiliation(s)
- Fawaz Abdullah Alshehri
- University of Technology Sydney, Faculty of Health, 235 Jones St, Ultimo, NSW 2007, Australia; University of Tabuk, School of Nursing, Tabuk City, Saudi Arabia.
| | - Tracy Levett-Jones
- University of Technology Sydney, Faculty of Health, 235 Jones St, Ultimo, NSW 2007, Australia.
| | - Jacqui Pich
- University of Technology Sydney, Faculty of Health, 235 Jones St, Ultimo, NSW 2007, Australia.
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Kodagoda Gamage MW, Pu L, Todorovic M, Moyle W. Factors related to nurses' beliefs regarding pain assessment in people living with dementia. J Clin Nurs 2024. [PMID: 38459722 DOI: 10.1111/jocn.17093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/27/2023] [Accepted: 01/07/2024] [Indexed: 03/10/2024]
Abstract
AIM To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia. DESIGN A descriptive cross-sectional survey was conducted between July 2022 and April 2023. METHODS An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia. RESULTS RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge). CONCLUSION The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes. IMPACT Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia. REPORTING METHOD This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist. PATIENT OR PUBLIC CONTRIBUTION RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.
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Affiliation(s)
- Madushika Wishvanie Kodagoda Gamage
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
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Calleja MM, O'Mahony L, O'Neill E, Timmons S. Rehabilitation Nurses' Knowledge About Pain in Older Adults in Malta. Pain Manag Nurs 2023; 24:e131-e138. [PMID: 37652829 DOI: 10.1016/j.pmn.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Rehabilitation nurses require adequate knowledge about pain to improve patient experience and quality of care. We explored nurses' knowledge and attitudes towards pain in older adults in a large rehabilitation hospital in Malta. DESIGN A cross-sectional study. METHODS In total, 130 nurses received a short survey, which gathered sociodemographic data, information regarding usual pain management, and prior education on pain. A modified version of the Knowledge and Attitudes Survey Regarding Pain (KASRP) with 18 questions was used, alongside the 24-item Pain in the Older Adults' Knowledge Survey (POAKS). Non-parametric tests identified factors associated with KASRP and POAKS scores. RESULTS Overall, 89 nurses completed the survey (response rate 68%). The median modified KASRP score was 50% (IQR 3.00), with only two nurses achieving the proposed "adequate" score of >80%. The median POAKS score was 79% (IQR 4.00). The only determinant of performance was nationality, with Maltese nurses performing better in POAKS than non-Maltese nurses (median 20.00 (3.00) vs. 16.50 (5.00); p = .003), indicating a possible language-related performance issue. Nurses scored poorly in some questions relating to analgesia administration, particularly opioids, as well as pain indicators and pain assessment. CONCLUSIONS Rehabilitation nurses have fair knowledge of pain management in older people but require further education, particularly in opioid indications for pain management, pain expression, and assessment.
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Affiliation(s)
- Michela Maria Calleja
- From the Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Lauren O'Mahony
- From the Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Emer O'Neill
- From the Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- From the Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
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Graham F, Beattie E, Fielding E. Hospital nurses' management of agitation in older cognitively impaired patients: do they recognise pain-related agitation? Age Ageing 2022; 51:6632478. [PMID: 35796135 DOI: 10.1093/ageing/afac140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND cognitively impaired hospital patients often experience agitation and aggression due to pain. Agitation complicates care, increasing the risk of adverse outcomes and patient-to-nurse violence. Managing agitation is challenging for nurses. Literature suggests they may rely on antipsychotics while missing other more appropriately targeted treatments. However, nurses' management of agitation remains unclear and under-researched. OBJECTIVE the aim of this study was to investigate hospital nurses' management of agitation in older cognitively impaired patients with pain. DESIGN this was a descriptive correlational study using virtual simulation. SETTING AND PARTICIPANTS a total of 274 registered medical and surgical nurses from 10 public hospitals in Queensland, Australia participated in the study. METHODS nurses undertook a virtual simulation requiring them to manage agitation in a patient with dementia and an injury. Nurses also completed a post-simulation questionnaire. Their simulation performances were correlated with demographics such as seniority, workplace, training, experience and gerontology-specific knowledge. Constructed from an original, validated vignette, the simulation included branching pathways, video scenarios and an avatar that could converse with participants. RESULTS thirteen nurses (4.7%) recognised and treated the virtual patient's agitation as pain-related. Most nurses (89%) gave antipsychotics of which 207 (78%) gave these first-line and 102 (38%) used them twice. Independent of other variables, nurses most likely to diagnose pain were dementia-unit nurses (OR = 8.7), surgical-unit nurses (OR = 7.3) and senior nurses (OR = 5). CONCLUSIONS hospital nurses predominately managed agitation with antipsychotics, a decision that most made after undertaking inadequate patient assessments. This confirmed a common gap in practice that may lead to the missing of pain in the clinical care of agitated patients with dementia and/or delirium.
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Affiliation(s)
- Frederick Graham
- Division of Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Nursing, Queensland University of Technology, Brisbane City, QLD, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane City, QLD, Australia
| | - Elaine Fielding
- School of Nursing, Queensland University of Technology, Brisbane City, QLD, Australia
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Measuring knowledge and attitudes of pain in older adults among culturally diverse nursing students. Collegian 2021. [DOI: 10.1016/j.colegn.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ando C, Kanno Y, Uchida O, Nashiki E, Kosuge N, Ogawa A. Pain management in community-dwelling older adults with moderate-to-severe dementia. Int J Palliat Nurs 2021; 27:158-166. [PMID: 34038176 DOI: 10.12968/ijpn.2021.27.3.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. METHODS A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. FINDINGS The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. CONCLUSION Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.
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Affiliation(s)
- Chiaki Ando
- Associate Professor, Nayoro City University, Hokkaido, Japan
| | - Yusuke Kanno
- Assistant Professor, Yokohama City University, Yokohama, Japan
| | - Osamu Uchida
- Associate Professor, University of Information Sciences, Chiba, Japan
| | - Emiko Nashiki
- Certified Nurse Specialist In Gerontological Nursing; Assistant Professor, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Noriko Kosuge
- Deputy Director of Nursing, Kenwakai Medical Corporation, Tokyo, Japan
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The Barcelona Orthorexia Scale (BOS): development process using the Delphi method. Eat Weight Disord 2019; 24:247-255. [PMID: 30076528 DOI: 10.1007/s40519-018-0556-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Orthorexia nervosa is a currently investigated eating disorder proposed by US physician Steve Bratman, defined as pathological fixation on eating healthy food. This study aimed to develop, by consensus of experts, the basic items for a new questionnaire to evaluate some defining psychological features of orthorexia nervosa in English and Spanish language, the so-called Barcelona Orthorexia Scale (BOS). METHODS The initial item pool was composed of 105 items divided into six different content areas. To analyse the content of the items, a three-round Delphi study was developed, in which participants had to evaluate the representativeness and clarity of each item. Participants were chosen because of their knowledge on orthorexia and/or eating disorders. RESULTS 58 experts, from 17 different countries, participated in the initial round and 30 in the last round. Items were added, rephrased, changed into another content area, modified or eliminated according to the participants' suggestions, partly due to the group's response, analysed statistically, and partly due to participants' recommendations. CONCLUSIONS 64 items were obtained, with two versions in Spanish and English. The future BOS aims to provide a possible solution to the shortage of valid instruments to evaluate psychological features of orthorexia and to promote research on this field. Further analysis regarding validity and reliability is necessary to prove the BOS' value on this matter.
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Muñoz-Alvaredo L, López Vallecillo M, Jiménez Pérez JM, Martín-Gil B, Muñoz Moreno MF, Fernández-Castro M. Prevalence, pain management and registration in Internal Medicine units. ENFERMERIA CLINICA 2019; 30:275-281. [PMID: 30598350 DOI: 10.1016/j.enfcli.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/18/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalization units in a third level public hospital of the regional health service of Castilla y León. METHOD A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analyzed as recorded in the clinical records. RESULTS 83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale. CONCLUSIONS There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management.
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Affiliation(s)
- Laura Muñoz-Alvaredo
- Unidad de Medicina Interna y Enfermedades Infecciosas, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - María López Vallecillo
- Unidad de Gestión de Cuidados Gacela, Hospital Clínico Universitario de Valladolid, Valladolid, España; Facultad de Enfermería, Universidad de Valladolid, Valladolid, España
| | | | - Belén Martín-Gil
- Unidad de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Fe Muñoz Moreno
- Estadística, Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Mercedes Fernández-Castro
- Sección de Enfermería, Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España.
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Brunkert T, Ruppen W, Simon M, Zúñiga F. A theory-based hybrid II implementation intervention to improve pain management in Swiss nursing homes: A mixed-methods study protocol. J Adv Nurs 2018; 75:432-442. [PMID: 30109728 DOI: 10.1111/jan.13817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/11/2018] [Accepted: 06/26/2018] [Indexed: 12/01/2022]
Abstract
AIM To present a protocol for evaluating an implementation intervention to improve pain management in nursing homes by addressing behaviour change of the care workers. BACKGROUND Pain management in nursing homes often is inadequate despite the availability of evidence-based pain management guidelines. Barriers to pain management in nursing homes occur on several levels including lack of knowledge and negative beliefs towards pain of care workers. A comprehensive approach incorporating contextual and behavioural factors is needed to sustainably improve pain management practice. DESIGN A hybrid type II effectiveness-implementation design comprising an incomplete non-randomized stepped-wedge design and concurrent focus groups is proposed. METHODS A convenience sample of six nursing homes will be included. Implementation of a facility pain management policy will be facilitated by introduction of a facility pain champion and training of all care workers in pain assessment and management. Quantitative outcomes assessed at baseline, after 3 and 6 months include self-efficacy in pain management and attitudes to pain of care workers and functional interference from pain and pain intensity in residents. Feasibility and acceptability of the intervention and implementation strategies and potential barriers to implementation will be explored in focus groups and interviews. (Protocol approved in October 2017). CONCLUSION The proposed intervention implementation has been developed in a participatory approach involving relevant stakeholders. To further improve the contextual fit, development of implementation strategies was guided by the consolidated framework of implementation research. Findings of this research are expected to inform adaptions to the implementation of the intervention. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT03471390.
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Affiliation(s)
- Thekla Brunkert
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Wilhelm Ruppen
- Department of Anesthesiology, Perioperative, Preclinical Emergency and Pain Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Nursing Research Unit, Bern, Switzerland
| | - Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
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