1
|
Hamadeh S, Willetts G, Garvey L. Pain management interventions of the non-communicating patient in intensive care: What works for whom and why? A rapid realist review. J Clin Nurs 2024; 33:2050-2068. [PMID: 38450782 DOI: 10.1111/jocn.17065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
AIM The utility and uptake of pain management interventions across intensive care settings is inconsistent. A rapid realist review was conducted to synthesise the evidence for the purpose of theory building and refinement. DESIGN A five-step iterative process was employed to develop project scope/ research questions, collate evidence, appraise literature, synthesise evidence and interpret information from data sources. METHODS Realist synthesis method was employed to systematically review literature for developing a programme theory. DATA SOURCES Initial searches were undertaken in three electronic databases: MEDLINE, CINHAL and OVID. The review was supplemented with key articles from bibliographic search of identified articles. The first 200 hits from Google Scholar were screened. RESULTS Three action-oriented themes emerged as integral to successful implementation of pain management interventions. These included health facility actions, unit/team leader actions and individual nurses' actions. CONCLUSION Pain assessment interventions are influenced by a constellation of factors which trigger mechanisms yielding effective implementation outcomes. IMPLICATIONS The results have implications on policy makers, health organisations, nursing teams and nurses concerned with optimising the successful implementation of pain management interventions. IMPACT The review enabled formation of a programme theory concerned with explaining how to effectively implement pain management interventions in intensive care. REPORTING METHOD This review was informed by RAMESES publication standards for realist synthesis. PUBLIC CONTRIBUTION No patient or public contribution. The study protocol was registered in Open Science Framework. 10.17605/OSF.IO/J7AEZ.
Collapse
Affiliation(s)
- Samira Hamadeh
- Institute of Health and Wellbeing, Federation University, Churchill, Victoria, Australia
| | - Georgina Willetts
- Institute of Health and Wellbeing, Federation University, Churchill, Victoria, Australia
| | - Loretta Garvey
- Assessment Transformation, Federation University, Berwick, Victoria, Australia
| |
Collapse
|
2
|
Ghita M, Birs IR, Copot D, Muresan CI, Ionescu CM. Bioelectrical impedance analysis of thermal-induced cutaneous nociception. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
3
|
Dang H, Stafseth SK. Documentation for Assessing Pain in Postoperative Pain Management Pre- and Post-intervention. J Perianesth Nurs 2023; 38:88-95. [PMID: 35970659 DOI: 10.1016/j.jopan.2022.05.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Although Norwegian law requires the documentation of patients' care processes, including pain assessment, research has shown that the quality of postoperative documentation for assessing pain does not meet an acceptable standard and requires improvement. The purpose of this study was to investigate whether an educational intervention can increase nurses' documentation of postoperative pain assessments, alter patients' opioid consumption, and ensure that patients have at least one documented Numeric Rating Scale (NRS) ≤3 at rest before being discharged. A secondary aim was to investigate whether the nurses' education and experience influenced their pain assessments. DESIGN An observational study with a pre-post intervention. METHODS The study following a pre-post design involved documenting pain assessments of 304 patients undergoing cancer surgeries in a postoperative unit at the Norwegian Radium Hospital, Oslo University Hospital. In an educational intervention, two 45-minutes teaching sessions within two weeks, addressed validated pain assessment tools and the documentation of pain assessment. Descriptive frequency analysis and partial correlation with Pearson's r - value were used, with P < .05 indicating significance. FINDINGS Postintervention, pain assessments in general increased significantly from a mean of two times per patient to three times. Overall, the use of assessment tool Critical -Care Pain Observation Tool increased from 6.1% to 25.8%, opioid consumption increased in mean from 3.34 to 4.79 in milligram and the documentation at discharge increased from 81.4% to 91.4%. The documentation of nurses with more than 10 years' experience in the unit especially improved from 17.5% to 31.7%. CONCLUSIONS Educational intervention and reminders about basic systematic pain assessment and the evaluation of pain measures improved nurses' documentation of postoperative pain management and documentation at discharge. The findings underscore the importance of regularly ensuring the quality of patients' treatment by systematically documenting nurses' clinical tasks and the outcome of patients' care.
Collapse
Affiliation(s)
- Huong Dang
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; MEVU Department, Lovisenberg Diaconal University College, Oslo, Norway.
| | - Siv K Stafseth
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; MEVU Department, Lovisenberg Diaconal University College, Oslo, Norway
| |
Collapse
|
4
|
Kerbage SH, Garvey L, Lambert GW, Willetts G. Pain assessment of the adult sedated and ventilated patients in the intensive care setting: A scoping review. Int J Nurs Stud 2021; 122:104044. [PMID: 34399307 DOI: 10.1016/j.ijnurstu.2021.104044] [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] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is frequently encountered in the intensive care setting. Given the impact of pain assessment on patient outcomes and length of hospital stay, studies have been conducted to validate tools, establish guidelines and cast light on practices relating to pain assessment. OBJECTIVE To examine the extent, range and nature of the evidence around pain assessment practices in adult patients who cannot self-report pain in the intensive care setting and summarise the findings from a heterogenous body of evidence to aid in the planning and the conduct of future research and management of patient care. The specific patient cohort studied was the sedated/ ventilated patient within the intensive care setting. DESIGN A scoping review protocol utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping review checklist (PRISMA-ScR). METHODS The review comprised of five phases: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarizing, and reporting the results. Databases were systematically searched from January to April 2020. Databases included were Scopus, Web of Science, Medline via Ovid, CINAHL COMPLETE via EBSCO host, Health Source and PUBMED. Limits were applied on dates (2000 to current), language (English), subject (human) and age (adult). Key words used were "pain", "assessment", "measurement", "tools", "instruments", "practices", "sedated", "ventilated", "adult". A hand search technique was used to search citations within articles. Database alerts were set to apprise the availability of research articles pertaining to pain assessment practices in the intensive care setting. RESULTS The review uncovered literature categorised under five general themes: behaviour pain assessment tools, pain assessment guidelines, position statements and quality improvement projects, enablers and barriers to pain assessment, and evidence appertaining to actual practices. Behaviour pain assessment tools are the benchmark for pain assessment of sedated and ventilated patients. The reliability and validity of physiologic parameters to assess pain is yet to be determined. Issues of compliance with pain assessment guidelines and tools exist and impact on practices. In some countries like Australia, there is a dearth of information regarding the prevalence and characteristics of patients receiving analgesia, type of analgesia used, pain assessment practices and the process of recording pain management. In general, pain assessment varies across different intensive care settings and lacks consistency. CONCLUSION Research on pain assessment practices requires further investigation to explore the causative mechanisms that contribute to poor compliance with established pain management guidelines. The protocol of this review was registered with Open Science Framework (https://osf.io/25a6) Tweetable abstract: Pain assessment in intensive care settings lacks consistency. New information is needed to understand the causative mechanisms underpinning poor compliance with guidelines.
Collapse
Affiliation(s)
| | - Loretta Garvey
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Georgina Willetts
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design; Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
5
|
Harmon J, Summons P, Higgins I. Disjunction, tension and dissonance within nursing pain care provision for the older hospitalized person: A focused ethnographic insight. J Adv Nurs 2021; 77:3458-3471. [PMID: 33942354 DOI: 10.1111/jan.14878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/14/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
AIMS This study presents an ethnographic insight into the older hospitalized persons' experiences on how nurses provide pain care provision. The older persons' perceptions of culturally mediated barriers and facilitators are presented. DESIGN Focused ethnography. METHODS Multi-site across eight acute care units within two tertiary referral hospitals on the east coast of Australia collected over a one-year period from 2014 to 2015. Semi-structured interviews (n = 12) of older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) registered nurses (12 hr 38 min). Participant observation (1,041 hr) during day, night and evening shifts. RESULTS The older person experienced disjunction within pain assessment by the reliance of nurses on objective measurement gained during functional task completion. Tension emerged during pain management when the older person was not included and/or options provided were not deemed effective. For some older persons this meant they undertook a decision to exclude their nurse from involvement in pain management. A thread woven throughout was a lack of communication, continuity of care and input from the older person. CONCLUSION This study has implications for the provision of nursing care of the older hospitalized person. Dissonance within pain care provision for the older person occurs during episodes of missed pain care. Understanding and insight is gained into aspects of missed communication opportunities between nurses and the experiences of missed pain care of the older person.
Collapse
Affiliation(s)
- Joanne Harmon
- UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | | | | |
Collapse
|
6
|
Mackintosh-Franklin C. Recognising and assessing acute pain. Nurs Stand 2021; 36:61-66. [PMID: 33269844 DOI: 10.7748/ns.2020.e11501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
This article considers two areas of practice that are fundamental to the provision of high-quality nursing care for people experiencing acute pain: the initial recognition of pain, and the formal assessment of pain. The initial recognition of a patient's pain is a subject that is frequently overlooked in the literature. However, if nurses are unable to identify that a patient is experiencing pain, then a formal pain assessment may not take place, which in turn negatively affects the quality of any subsequent pain management. This article explores some of the barriers to the initial recognition of pain and examines how a formal pain assessment can support optimal patient care.
Collapse
|
7
|
Bakshi SG, Rathod A, Salunkhe S. Influence of interpretation of pain scores on patients' perception of pain: A prospective study. Indian J Anaesth 2021; 65:216-220. [PMID: 33776112 PMCID: PMC7989498 DOI: 10.4103/ija.ija_130_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Aims: Assessment of pain using pain scales is essential. In the Numeric Rating Scale (NRS), patients are asked to score their pain intensity on a scale from 0 to 10 (10- worst pain). This requires some abstract thinking by the patient, also the pain scores (PS) may not essentially communicate the patients’ need for more analgesia. We planned a study to evaluate the change in patients’ self-assessed PS after understanding clinical interpretation of the NRS. Methods: This prospective study was registered after approval from our hospital ethics board. Sample size estimated for the trial was 360 patients. All postoperative patients were recruited after informed consent. Patients having prolonged stay in Intensive Care Unit (more than 48 h), or those who underwent emergency surgeries were excluded. During Acute Pain Service (APS) rounds, patients were asked to rate their PS on the NRS. This was followed by a briefing about the clinical interpretation of the scale, and the patients were asked to re score their pain using the same scale. The change in pain severity was compared using Chi-square test. Results: Following explanation, a change in severity was seen for PS at rest [X2 (9, N- 360) = 441, P < 0.001] and at movement [X2 (9, N- 360) = 508, P < 0.001]. Overall, a change in PS severity was seen in 162 patients (45%). A decrease and an increase in the severity of pain was seen in 119 and 41 patients respectively. Conclusion: Explaining the clinical interpretation of PS on a NRS does lead to a change in patients’ self-assessed PS.
Collapse
Affiliation(s)
- Sumitra G Bakshi
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akanksha Rathod
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Salunkhe
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
8
|
Frescos N, Copnell B. Podiatrists' views of assessment and management of pain in diabetes-related foot ulcers: a focus group study. J Foot Ankle Res 2020; 13:29. [PMID: 32493455 PMCID: PMC7268326 DOI: 10.1186/s13047-020-00399-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/22/2020] [Indexed: 02/08/2023] Open
Abstract
Background Contrary to the belief that patients with diabetes-related foot ulcers (DRFU) do not experience wound related pain due to the presence of peripheral neuropathy there is increasing evidence that pain can be present. Subsequently, wound-related pain is often underestimated and undertreated. The aim of this study is to describe what influences pain assessment of DRFU. Methods A qualitative exploratory study was conducted with podiatrists who managed DRFU. Eight podiatrists were recruited through a professional organisation to participate in a focus group. A thematic analysis was conducted to identify themes that explored the barriers and enablers to pain assessment and management of DRFU. Results Three themes emerged. Observational and non-verbal cues were the preferred approaches used to assess wound pain. Assumptions and value judgments of the pain patients experienced and the relationships between podiatrists, patients and other health care practitioners were important influencers on the assessment and management of pain. Conclusion The perceived barriers to the assessment and management of wound related pain in DRFU were attitudes and beliefs about pain, lack of DRFU-specific validated assessment tools and lack of knowledge and skills to manage the pain.
Collapse
Affiliation(s)
- Nicoletta Frescos
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, 3086, Australia.
| | - Bev Copnell
- Northern Clinical School, School of Nursing and Midwifery, Northern Centre for Health Education and Research, College of Science, Health and Engineering, La Trobe University, Melbourne, 3086, Australia
| |
Collapse
|
9
|
Wikström L, Nilsson M, Eriksson K. The association of patients' daily summarized self-rated "real-time" pain scores with physical recovery after major surgery - A repeated measurement design. Nurs Open 2020; 7:307-318. [PMID: 31871715 PMCID: PMC6917937 DOI: 10.1002/nop2.392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/26/2019] [Accepted: 09/08/2019] [Indexed: 11/29/2022] Open
Abstract
Aim To determine the associations of patients' documented self-rated pain with self-rated early postoperative physical recovery. Design Observational with repeated measures. Methods General and orthopaedic inpatients (N = 479) were during the period 2012-2015 screened for pain. Individual daily median pain scores at rest and during activity were based on 4-9 self-ratings on postoperative days 1 and 2, using the Numeric Rating Scale. Nine items reflecting physical recovery from the "Postoperative Recovery Profile" were used in a questionnaire. Results Associations between median pain scores on postoperative day 1 and physical recovery (fatigue, sleeping difficulties, bladder function, mobilization, muscle weakness and personal hygiene) the same day were found. Additionally, associations were found between median pain scores on day 1 and physical recovery (fatigue, sleeping difficulties, mobilization and muscle weakness) on day 2.
Collapse
Affiliation(s)
- Lotta Wikström
- School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Anaesthesia and Intensive CareRyhov County HospitalJönköpingSweden
| | | | - Kerstin Eriksson
- School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Anaesthesia and Intensive CareRyhov County HospitalJönköpingSweden
| |
Collapse
|
10
|
Nurses' culturally mediated practices influencing pain care provision for older people in acute care: Ethnographic study. Appl Nurs Res 2019; 48:22-29. [DOI: 10.1016/j.apnr.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/07/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022]
|
11
|
Wehner L. Pain assessments in emergency departments lack consistency and validity, and this impacts effective pain management. Evid Based Nurs 2019; 23:85. [PMID: 31302600 DOI: 10.1136/ebnurs-2019-103139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 11/04/2022]
|
12
|
Wikström L, Nilsson M, Broström A, Eriksson K. Patients’ self‐reported nausea: Validation of the Numerical Rating Scale and of a daily summary of repeated Numerical Rating Scale scores. J Clin Nurs 2018; 28:959-968. [DOI: 10.1111/jocn.14705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/14/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lotta Wikström
- School of Health and WelfareJönköping University Jönköping Sweden
- Department of Anesthesia and Intensive CareRyhov County Hospital Jönköping Sweden
| | - Mats Nilsson
- FuturumAcademy for Health and Care Region Jönköping County Sweden
| | - Anders Broström
- School of Health and WelfareJönköping University Jönköping Sweden
- Sweden Department of Clinical NeurophysiologyUniversity Hospital Linköping Sweden
| | - Kerstin Eriksson
- School of Health and WelfareJönköping University Jönköping Sweden
- Department of Anesthesia and Intensive CareRyhov County Hospital Jönköping Sweden
| |
Collapse
|
13
|
Carlsson T. Management of physical pain during induced second-trimester medical abortions: a cross-sectional study of methodological quality and recommendations in local clinical practice guidelines at Swedish hospitals. Scand J Caring Sci 2018; 33:111-118. [PMID: 30113714 DOI: 10.1111/scs.12608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/04/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim was to assess the methodological quality and describe recommendations for pain management in local clinical practice guidelines about induced second-trimester medical abortions at Swedish university and county hospitals. METHODS In 2017, Swedish university and county hospitals that provided abortion care in the second trimester of pregnancy were contacted (n = 29), and guidelines from 25 were received (university: n = 6, county: n = 19). Guideline quality was assessed according to two systematic instruments. Recommendations were systematically assessed regarding frequency and tools for pain measurement, prophylactic pharmacologic treatment, as needed pharmacologic treatment and nonpharmacologic treatment. RESULTS Overall methodological quality was poor across both instruments, as the majority of the guidelines did not fulfil the investigated quality criteria. For pain measurements, no guideline recommended measurement frequency and four recommended specific measurement tools. Prophylactic pharmacologic treatment, described in 23 (92%) guidelines, included paracetamol (n = 23, 92%), anti-inflammatory drugs (n = 23, 92%) and opioids (n = 18, 72%). As needed pharmacologic treatment, described in 23 (92%) guidelines, included anaesthetics (n = 21, 84%), opioids (n = 21, 84%) and paracetamol (n = 1, 4%). Recommendations for as needed anaesthetics included paracervical block (n = 21, 84%), epidural analgesia (n = 16, 64%) and inhalation of nitrous oxide (n = 5, 20%). Nonpharmacologic treatments were recommended in nine (36%) guidelines. CONCLUSIONS The findings indicate that local clinical practice guidelines about induced second-trimester medical abortions are of inadequate methodological quality and that a large majority lack recommendations concerning systematic pain measurements. Although most recommend prophylactic and as needed pharmacologic management, national inconsistencies exist in Sweden with regard to recommendations of epidural analgesia, nitrous oxide and nonpharmacologic methods. In Sweden, there is room for improvement in the development of these guidelines.
Collapse
Affiliation(s)
- Tommy Carlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| |
Collapse
|
14
|
Wikström L, Eriksson K, Fridlund B, Nilsson M, Årestedt K, Broström A. The clinical applicability of a daily summary of patients’ self-reported postoperative pain-A repeated measure analysis. J Clin Nurs 2017; 26:4675-4684. [DOI: 10.1111/jocn.13818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lotta Wikström
- School of Health and Welfare; Jönköping University; Jönköping Sweden
- Department of Anaesthesia and Intensive Care; Ryhov County Hospital; Jönköping Sweden
| | - Kerstin Eriksson
- School of Health and Welfare; Jönköping University; Jönköping Sweden
- Department of Anaesthesia and Intensive Care; Ryhov County Hospital; Jönköping Sweden
| | - Bengt Fridlund
- School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Mats Nilsson
- Futurum-Academy for Health and Care; Jönköping Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences; Linnaeus University; Kalmar Sweden
- Division of Nursing Science; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Anders Broström
- School of Health and Welfare; Jönköping University; Jönköping Sweden
- Sweden Department of Clinical Neurophysiology; University Hospital; Linköping Sweden
| |
Collapse
|
15
|
van Boekel RLM, Vissers KCP, van der Sande R, Bronkhorst E, Lerou JGC, Steegers MAH. Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery. PLoS One 2017; 12:e0177345. [PMID: 28489926 PMCID: PMC5425226 DOI: 10.1371/journal.pone.0177345] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/26/2017] [Indexed: 12/01/2022] Open
Abstract
Background Clinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships. Methods A cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient’s opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses’ observation of patient’s performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients’ performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO. Results 15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0–4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power. Conclusions Our results suggest pain management should be guided by the many dimensions of the patient’s pain experience, not solely by NRS cut-off points. Future research should evaluate the impact of such multidimensional pain assessment on patients’ functional outcome.
Collapse
Affiliation(s)
- Regina L. M. van Boekel
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Kris C. P. Vissers
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob van der Sande
- Faculty of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department of Medical Statistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos G. C. Lerou
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique A. H. Steegers
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
16
|
Treating without Seeing: Pain Management Practice in a Thai Context. Pain Res Manag 2016; 2016:9580626. [PMID: 28044071 PMCID: PMC5156806 DOI: 10.1155/2016/9580626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 01/07/2023]
Abstract
Pain management is a core nursing function, and it plays a key role in postoperative care. It is important to understand the cultural context of nursing practices and how this affects effective pain management. The aim of this study was to describe the professional and cultural framework within which pain management is practiced on a Thai surgical ward. Spradley's ethnographic methodology was used. Data were collected through 98.5 hours of field observations and interviews at a surgical ward in Thailand. Three themes were constructed that describe the way Thai nurses practiced pain management: (i) complex communications system to address pain and to respond to it, (ii) the essence of Thai-ness, and (iii) a passive approach to pain management. The results indicate that, in the response to discomfort and pain, better pain management will result if there is a shift from functional to patient-centered care. The nursing culture needs to be further researched and discussed, in order to set priorities in line with the goals of national and international organizations for improving postoperative care and promoting patient comfort.
Collapse
|
17
|
Setälä P, Kalliomäki ML, Järvelä K, Huhtala H, Sisto T, Puolakka P. Postoperative hyperalgesia does not predict persistent post-sternotomy pain; observational study based on clinical examination. Acta Anaesthesiol Scand 2016; 60:520-8. [PMID: 26659097 DOI: 10.1111/aas.12659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/15/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Persistent post-sternotomy pain is a common problem, but the risk of developing it varies among patients. We sought to find out whether the risk of persistent post-sternotomy pain could be predicted by measuring the area of acute sensory dysfunction around the sternotomy wound. The secondary aim was to determine risk factors for persistent post-sternotomy pain. PATIENTS AND METHODS Hundred patients who were scheduled to undergo elective coronary artery bypass surgery were recruited to the study. Patients were excluded if they had undergone previous cardiac surgery or if they lacked co-operation. Preoperative pain scores were determined and the patients filled in questionnaires about depression, anxiety, and pain. The area of sensory dysfunction around the sternotomy wound was assessed by pin prick on postoperative day 4. The presence of persistent post-sternotomy pain was determined at a follow-up evaluation at 4-6 months after surgery. RESULTS The sizes of the area of hyperalgesia or overall sensory dysfunction were not associated with persistent post-sternotomy pain. Independent risk factors for persistent post-sternotomy pain were found to be smoking and high pain score on postoperative day 1. The prevalence of persistent post-sternotomy pain in our study population was 38% analyzed by only the questionnaire and 15% according to the clinical examination. CONCLUSION Measuring the area of hyperalgesia in the acute phase does not give any additional information on the risk of developing a persistent post-sternotomy pain. We do thus not recommend measuring the area in this particular group of patients. Evaluation of pain by only a questionnaire risks to overestimate the presence of persistent post-sternotomy pain as compared to clinical examination.
Collapse
Affiliation(s)
- P. Setälä
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - M.-L. Kalliomäki
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - K. Järvelä
- Heart Center; Tampere University Hospital; Tampere Finland
| | - H. Huhtala
- School of Health Sciences; University of Tampere; Tampere Finland
| | - T. Sisto
- Heart Center; Tampere University Hospital; Tampere Finland
| | - P. Puolakka
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| |
Collapse
|
18
|
Stomberg MW, Saxborn E, Gambreus S, Brattwall M, Jakobsson JG. Tools for the assessment of the recovery process following discharge from day surgery: a literature review. J Perioper Pract 2016; 25:219-24. [PMID: 26721127 DOI: 10.1177/175045891502501102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This literature review provides an overview of ten studies which assessed the patient's general recovery after discharge from hospital following elective surgery and anaesthesia. Ten multi-dimensional tools were identified and these included six common domain assessments: pain, physiological function, activities of daily living (ADL), emotions, nausea/vomiting and nutrition/elimination. Most of the tools assessed the recovery process by using patient-subjective reported outcomes on visual analogue (VAS) or pre-graded scales.
Collapse
|
19
|
Eriksson K, Wikström L, Fridlund B, Årestedt K, Broström A. Patients' experiences and actions when describing pain after surgery--a critical incident technique analysis. Int J Nurs Stud 2015; 56:27-36. [PMID: 26772655 DOI: 10.1016/j.ijnurstu.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients' experiences and actions could help healthcare professionals to improve pain management and could increase patients' participation in pain assessments. OBJECTIVE The aim of this study was, through an examination of critical incidents, to describe patients' experiences and actions when needing to describe pain after surgery. METHODS An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. FINDINGS Pain experiences were described according to two main areas: "Patients' resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients' ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals' large work load.
Collapse
Affiliation(s)
- Kerstin Eriksson
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, 551 85 Jönköping Sweden.
| | - Lotta Wikström
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Anaesthesia and Intensive Care, Ryhov County Hospital, 551 85 Jönköping Sweden
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden.
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, 581 83 Linköping, Sweden; Department of Clinical Neurophysiology, University Hospital, 581 85 Linköping, Sweden.
| | - Anders Broström
- School of Health Sciences, Jönköping University, PO Box 1026, 551 11 Jönköping, Sweden; Department of Clinical Neurophysiology, University Hospital, 581 85 Linköping, Sweden.
| |
Collapse
|
20
|
Wikström L, Eriksson K, Fridlund B, Årestedt K, Broström A. Healthcare professionals' descriptions of care experiences and actions when assessing postoperative pain - a critical incident technique analysis. Scand J Caring Sci 2015; 30:802-812. [PMID: 26709955 DOI: 10.1111/scs.12308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments. OBJECTIVES The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain. METHODS An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience. FINDINGS In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain. CONCLUSIONS Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain.
Collapse
Affiliation(s)
- Lotta Wikström
- School of Health Sciences, Jönköping University, Jönköping, Sweden.,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Kerstin Eriksson
- School of Health Sciences, Jönköping University, Jönköping, Sweden.,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden
| | - Anders Broström
- School of Health Sciences, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden
| |
Collapse
|