[Nursing pain experts in German hospitals : A compilation of activity profiles and tasks]

Perioperative pain management models in four European countries: A narrative review of differences, similarities and future directions

There is general agreement that acute pain management is an important component of perioperative medicine. However, there is no consensus on the best model of care for perioperative pain management, mainly because evidence is missing in many aspects. Comparing the similarities and differences between countries might reveal some insights into different organisational models and how they work. Here, we performed a narrative review to describe and compare the structures, processes and outcomes of perioperative pain management in the healthcare systems of four European countries using Donabedian's framework as a guide. Our comparison revealed many similarities, differences and gaps. Different structures of acute pain services in the four countries with no common definition and standards of care were found. Protocols have been implemented in all countries and guidelines in some. If outcome is assessed, it is mainly pain intensity, and many patients experiencing more intense pain than others have common risk factors (e.g. preoperative pain, preoperative opioid intake, female sex and young age). Outcome assessment beyond pain intensity (such as pain-related physical function, which is important for early rehabilitation and recovery) is currently not well implemented. Developing common quality indicators, a European guideline for perioperative pain management (e.g. for patients at high risk for experiencing severe pain and other outcome parameters) and common criteria for acute pain services might pave the way forward for improving acute pain management in Europe. Finally, the education of general and specialist staff should be aligned in Europe, for example, by using the curricula of the European Pain Federation (EFIC).

Nursing care and outcome in surgical patients - why do we have to care?

Nurses have an important role in patient care. They continuously work in very close contact with patients and foster the realization of activities of daily living as well as ensure quality medical treatment. For both, a high educational level is needed. A large proportion of patients with complex health situations involving chronic illnesses and multimorbidities are treated in hospitals with shortened hospital lengths of stay, changing the caring needs and the demands on nursing. Nurses must handle complex nursing tasks for which a higher educational level is indispensable, including the ability to implement evidence-based practice. In addition, studies show a correlation between the educational level of nursing staff and the health outcomes of patients. If there are too few highly educated nurses, there is an increase in patient mortality as well as the risk of patient complications, such as falls. Also, a low number of nursing staff and a high proportion of admissions decrease the quality of nursing and result in unfavorable patient outcomes. Both developments call for the necessity of a changing nursing practice and the possibilities to transform interprofessional work.