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Takahashi T, Oyama Y, Sakuramoto H, Tamoto M, Sato T, Nanjo Y, Hosoi S, Unoki T. Nurses' Attitudes, Practices, and Barriers to Assessing Symptoms of Discomfort in Mechanically Ventilated Patients: A Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241245209. [PMID: 38596509 PMCID: PMC11003335 DOI: 10.1177/23779608241245209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 02/17/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Critically ill patients experience various stressful symptoms of discomfort, including dyspnea, pain, and sleep disruption. Notably, ventilated patients have difficulty self-reporting discomfort symptoms. Nurses need to assess discomfort symptoms to alleviate them, but limited research exists on discomfort symptom assessment and management in critically ill patients. Objective To identify the practices, attitudes, and barriers among nurses related to the assessment of discomfort symptoms in mechanically ventilated patients. Methods Using a cross-sectional, descriptive study design, a web-based survey was conducted between May and June 2022 with critical care nurses sampled through Japanese academic societies and social networking services. The survey contained questions relative to the above-stated objective. Descriptive statistical analysis was performed without sample size calculation because of the descriptive and exploratory nature of this study. Results There were 267 respondents to the questionnaire. The discomfort symptoms that nurses perceived as important to assess were pain (median 100 [interquartile range, IQR 90-100]), insomnia (99 [80-100]), and dyspnea (96.5 [75-100]). Most participants (89.8%) routinely assessed pain in mechanically ventilated patients using a scale; however, other discomfort symptoms were assessed by less than 40% (dyspnea [28.4%], fatigue [8.1%], thirst [13.1%], insomnia [37.3%], and anxiety [13.6%]). Two major barriers to assessing discomfort symptoms were lack of assessment culture within the intensive care unit and lack of knowledge of the relevant evaluation scales. Conclusions Nurses were aware of the importance of using scales to assess the discomfort symptoms experienced by mechanically ventilated patients. However, except for pain, most nurses did not routinely use scales to assess discomfort symptoms. Barriers to routine discomfort symptom assessment included the lack of an assessment culture and the lack of knowledge of the assessment scales. Clinicians should be educated regarding the existence of validated rating scales and develop additional rating scales utilizable for minor discomforts in mechanically ventilated patients.
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Affiliation(s)
- Tomohiko Takahashi
- Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yusuke Oyama
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Mitsuhiro Tamoto
- Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Tomoo Sato
- Acute Care Nursing Division, Kobe City College of Nursing, Kobe, Hyogo, Japan
| | - Yuko Nanjo
- Department of Fundamental Nursing, Faculty of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
| | - Sayaka Hosoi
- Department of Coronary Care Unit, Hitachi General Hospital, Ibaraki, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
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Saleh AM. Nurses' assessment and management practices of pain among intensive care patients in King Khalid Hospital, Kharj, Riyadh. Heliyon 2023; 9:e19986. [PMID: 37809981 PMCID: PMC10559661 DOI: 10.1016/j.heliyon.2023.e19986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background Pain is a disagreeable combination of sensory and emotional sensations. Employing behavioral pain assessment tools is strongly associated with improved identification of pain. Purpose The main purpose of the study is to investigate Nurses' Assessment and Management Practices of Pain among Intensive Care Patients in King Khalid Hospital, Kharj, Riyadh. Materials and methods A self-administered questionnaire was employed in a descriptive cross-sectional study. The study focused on nurses employed in the intensive care unit at King Khalid Hospital in Al-Kharj Province. The researchers utilized convenience sampling to recruit participants. Out of the total 48 nurses approached 45 of them provided responses, leading to a response rate of 94%. The Critically Ill questionnaire was utilized to gather information regarding the treatment and evaluation of pain in patients who were in critical condition. Descriptive statistics and inferential statistics were employed to analyze the collected data. Principal results it was found that 88% of them utilized instruments to evaluate pain in patients who could express themselves. Among these instruments, the numeric rating scale was the most commonly employed. Furthermore, 77% of the nurses (35 in total) used a pain assessment tool for patients who were unable to communicate, with the Adult Nonverbal Pain Scale being the most frequently used tool in this case. The nurses' perception of the significance of pain assessment was positively associated with the regular utilization of pain assessment tools. Additionally, the nurses considered the use of pain assessment tools with patients who could communicate as more important compared to using such tools with patients who could not communicate. Conclusions Most ICU nurses utilized nurses' pain assessment instruments to assess the discomfort levels of both patients who could communicate and those who couldn't express themselves effectively. By employing such tools, nurses can improve patient outcomes, ensure effective pain management, and demonstrate a high standard of professional care.
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Affiliation(s)
- Ahmad Mahmoud Saleh
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
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Abdalrahim MS, Hamdan KM, Shaheen AM. Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses. Br J Pain 2023; 17:400-407. [PMID: 37538941 PMCID: PMC10395392 DOI: 10.1177/20494637231172496] [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] [Indexed: 08/05/2023] Open
Abstract
Background The importance and efficacy of Preemptive analgesia in reducing pain for patients undergoing painful procedures still debatable and seldom investigated. The aim of this study was to describe intensive care nurses' perception of the importance of pain assessment and Preemptive analgesia prior painful procedures in critical care settings in Jordan. Method A cross-sectional descriptive design was used. The sample consisted of 300 registered nurses recruited from 22 intensive care units in Jordan. The data was gathered using a self-administered questionnaire. Results The results showed that nurses considered pain assessment moderately and extremely important for surgical (n = 263, 87.7%), burn (n = 261, 87%), and trauma patients (n = 256, 85.3%). The majority of nurses rated pain assessment as moderately to extremely important for invasive line placement 80.3%, wound care 78.3%, and drain removal 69%. Nurses assessed the need for Preemptive analgesia more frequently before wound care 70.7%, and before invasive line placement 69.7%. Nurses perceived pain assessment for Preemptive analgesia as less priority for unconscious patients. Conclusion Effective assessment and management of pain for critically ill patients is mandatory. Thus, it is important to improve nurses' knowledge regarding the Preemptive analgesia and its effects in relieving post-procedural pain in critically ill patient. It is recommended to ensure proper clinical training on how to assess critically ill patients and auditing system.
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Affiliation(s)
- Maysoon S Abdalrahim
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Khaldoun M Hamdan
- Acute and Chronic Care Nursing Department, Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | - Abeer M Shaheen
- Community Health Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Rababa M, Al-Sabbah S, Hayajneh AA, Al-Rawashdeh S. Critical care nurses' perceived barriers and enablers of pain assessment and management. Pain Manag 2023; 13:105-114. [PMID: 36515086 DOI: 10.2217/pmt-2022-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To examine critical care nurses' perceived barriers and enablers of pain assessment and management. Materials/methods: This descriptive correlational study recruited a convenience sample of 200 Jordanian nurses. Pain Assessment and Management for the Critically Ill questionnaire was used to measure the study variables. Results: The most common barriers to pain assessment and management were patient inability to communicate (57.5%), patient instability (56.5%), and the lack of protocols/guidelines for pain assessment (55.0%). Whereas the most common enablers for effective pain management practices were the ongoing education on pain for nurses (60.5%) and physicians who prescribe adequate doses of analgesia (60.0%). Conclusion: Addressing nurses' perceived barriers and the enablers of pain assessment and management is crucial for optimal pain practice.
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Affiliation(s)
- Mohammad Rababa
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Shatha Al-Sabbah
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Audai A Hayajneh
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Sami Al-Rawashdeh
- Department of Community & Mental Health- Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
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Zuazua-Rico D, Mosteiro-Diaz MP, Collado-Boira E, Del Carmen Casal-Angulo M, Cobo-Cuenca AI, Fernandez-Garrido J, Lavado-Garcia JM, Maestro-Gonzalez A. Knowledge about Pain in Spanish Nursing Students. Pain Manag Nurs 2022; 23:871-877. [PMID: 35491350 DOI: 10.1016/j.pmn.2022.03.006] [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: 02/27/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND All nurses should receive training and education regarding pain as part of their pre-graduate stage, as its assessment and appropriate management when treating patients largely depends on them. With the right knowledge it is possible to reduce its high prevalence, as well as the serious consequences it can lead to. AIM To determine the level of knowledge and attitudes towards pain of final-year nursing students in Spain. METHODS Descriptive cross-sectional study using a convenience sample of five Spanish universities during the academic year 2020-2021. The Spanish version of the Knowledge and Attitudes Survey Regarding Pain (KASRP) was used. In addition, socio-demographic variables such as age, sex, relationship status, employment status, and the number of dependants were collected. The specific palliative or oncology subjects of each university was also assessed. RESULTS A total of 224 questionnaires were collected. One of the nursing universities obtained the best score in the KASRP (59.75%) which was significant (p = .001). This university was the only one that offers specific subjects in palliative or oncologic care. A training deficit in aspects related to pain assessment and pharmacologic concepts was detected. We found no relationship between the KASRP and the different sociodemographic variables. CONCLUSIONS Specific training in palliative care improves the students' knowledge regarding pain, although the results did not reach an acceptable minimum. The universities' training programs for Spanish students need to be adapted in order to achieve better results.
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Affiliation(s)
- David Zuazua-Rico
- Medicine department, Nursing Area. University of Oviedo, Spain; Hospital Universitario Central de Asturias. Oviedo, Spain
| | | | | | | | - Ana Isabel Cobo-Cuenca
- Faculty of Physiotherapy and Nursing. Group IMCU. University of Castilla-La Mancha. Toledo, Spain.
| | - Julio Fernandez-Garrido
- Faculty of Nursing and Podiatry. University of Valencia, Spain; Conselleria de Sanitat Universal i Salut Pública. Generalitat Valenciana, Spain
| | | | - Alba Maestro-Gonzalez
- Medicine department, Nursing Area. University of Oviedo, Spain; Hospital Universitario Central de Asturias. Oviedo, Spain
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6
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Level of attitude, knowledge and practice of nurses toward postoperative pain management, cross-sectional study. Ann Med Surg (Lond) 2022; 84:104902. [DOI: 10.1016/j.amsu.2022.104902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/02/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022] Open
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Rababa M, Al-Sabbah S. Nurses’ Pain Assessment Practices for Cognitively Intact and Impaired Older Adults in Intensive Care Units. Dement Geriatr Cogn Dis Extra 2022; 12:115-121. [PMID: 35950149 PMCID: PMC9294931 DOI: 10.1159/000525477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Pain is still under-recognized and undertreated among intensive care unit (ICU) patients, such as those being intubated or with dementia, cognitive impairments, or communication deficits due to inability to self-report. This study aimed to describe nurses' pain assessment practices for cognitively intact and impaired older adult ICU patients. Methods A descriptive correlational study of a convenience sample of 200 registered nurses was conducted in private, public, and university-affiliated hospitals in Irbid, Jordan. Descriptive statistics, such as mean, standard deviation, and frequency, were used to analyze the study data. Results Statistically significant differences were found in the proportion of nurses who assessed and documented pain every 1–4 h in cognitively intact patients than those with cognitive impairment (n = 67, 63.21% vs. n = 39, 36.79%), p = 0.002, compared to the proportion of nurses who never assessed and document pain in cognitively impaired patients than those without cognitive impairment (n = 38, 76.0% vs. n = 12, 24%), p < 0.001. Discussion/Conclusion Our study results showed that the majority of participant nurses felt that the use of pain assessment tools for cognitively intact and impaired older adult ICU patients to self-report is somewhat not at all important. This study also reported that nurses perceived themselves as the individuals who accurately rate the pain in cognitively intact patients, followed by the patients themselves.
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Melile Mengesha B, Moga Lencha F, Ena Digesa L. Pain assessment practice and associated factors among nurses working at adult care units in public hospitals in Wolaita Zone, Southern Ethiopia, 2021. BMC Nurs 2022; 21:115. [PMID: 35562827 PMCID: PMC9102635 DOI: 10.1186/s12912-022-00892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Using standard pain assessment techniques is a cornerstone for effective pain management. Pain is not assessed in a standardized manner in numerous practice settings. The problem of applying pain assessment principles was found to be higher in low-income countries. Very limited evidence indicates the standard of pain assessment practice among nurses in Ethiopia. Therefore, the purpose of this study was to identify pain assessment practice and associated factors among nurses working at adult care units in public hospitals in the Wolaita Zone, Southern Ethiopia. METHODS A cross-sectional study was conducted among 290 nurses working at adult care units in public hospitals in Wolaita zone. Data were collected from February to March 2021. A structured self-administered questionnaire was used for data collection. Epi Data 4.6 was used to enter the data, and SPSS version 26 was used to analyze the data. A logistic regression model was used, and statistical significance was declared at P ≤ 0.05. An adjusted odds ratio with 95%CI was used to measure the degree of association. RESULTS A total of 267 nurses participated in the study, giving a response rate of 97.8%. Almost three-fourths (73.8%) of the study nurses reported that they assessed pain for their patients. Only 23.6% of the study nurses discussed pain assessment scores during a nurse-to-nurse report. Below, half (47.2%) of the study participants documented pain assessment scores. The proportion of nurses with good pain assessment practice was found to be 38.2%. The odds of having good pain assessment practice among nurses who received training on pain management was two times higher than its counterpart. The nurses who perceived organizational support were twice more likely to have good pain assessment practice than their counterparts. CONCLUSION Nurses' pain assessment practice was found to be low. Moreover, a substantial proportion of the study nurses did not discuss pain assessment scores during a nurse-to-nurse report with low documentation practice. Continuous professional development through in-service training and education is crucial to the improvement of nurses' pain assessment practice. Furthermore, ameliorating organizational support by means of a supportive working environment is suggested to the betterment of nurses' assessment practice.
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Affiliation(s)
| | - Fikre Moga Lencha
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Lankamo Ena Digesa
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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9
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Rababa M, Al-Sabbah S, Hayajneh AA. Nurses' Perceived Barriers to and Facilitators of Pain Assessment and Management in Critical Care Patients: A Systematic Review. J Pain Res 2021; 14:3475-3491. [PMID: 34764688 PMCID: PMC8577531 DOI: 10.2147/jpr.s332423] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/27/2021] [Indexed: 12/18/2022] Open
Abstract
Aim This review aims to examine nurses’ perceived barriers to and facilitators of pain assessment and management in adult critical care patients. Background Pain is one of the worst memories among critically ill patients. However, pain among those patients is still undertreated due to several barriers that impede effective management. Therefore, addressing the perceived barriers and facilitators to pain assessment management among critical care nurses is crucial. Methods A systematic search of pain assessment and management in critical care patient-relevant literature from four databases was done, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results The barriers and facilitators were categorized into four groups: nurse-related, patient-related, physician-related, and system-related. The most frequently reported barriers in this study included nurses’ lack of knowledge regarding the use of pain assessment tools, patients’ inability to communicate, physicians’ prescription of analgesics being independent of pain scores evaluation, and absence of standardized guidelines and protocols for pain evaluation and control. For the facilitators, the most reported ones include ongoing education and professional training related to pain assessment and management, patients’ ability to self-report pain, effective collaboration between physicians and nurses, and productive discussion of patients’ pain scores during nurse-to-nurse handovers. Conclusion Various barriers and facilitators to pain assessment and management were identified and examined in this review. However, future research is still needed to further investigate these barriers and facilitators and examine any other potential associated factors among critical care nurses. Relevance to Clinical Practice The findings of our study could help hospital managers in developing continuous education and staff development training programs on assessing and managing pain for critical care patients. Also, our findings could be used to develop an evidence-based standard pain management protocol tailored to effectively assess and promptly treat pain in critical care patients.
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Affiliation(s)
- Mohammad Rababa
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Shatha Al-Sabbah
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Audai A Hayajneh
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan
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Alnajar MK, Shudifat R, Mosleh SM, Ismaile S, N'erat M, Amro K. Pain Assessment and Management in Intensive Care Unit: Nurses' Practices, Perceived Influencing Factors, and Educational Needs. Open Nurs J 2021. [DOI: 10.2174/1874434602115010170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Critically ill patients and those mechanically ventilated or unable to communicate may not be able to report any pain they experience. Consequently, pain assessment and management (PAM) is challenging and underestimated in intensive care units (ICUs), where patients suffer alteration of consciousness, sedation, invasive procedures and mechanical ventilation.
Aim:
This study aimed to investigate ICU nurses’ PAM practices, their perceptions of influencing factors, and their related educational needs.
Methods:
A descriptive cross-sectional design was employed, using a valid self-reported questionnaire.
Results:
Among the sample of 171 nurses, 55% were male and 83% held a bachelor’s degree. 60% reported performing pain assessment for patients able to report pain and 50% for those unable to do so. Almost 40% of participants reported that pain management plans and scores were not discussed in medical rounds. Workload and lack of guidelines were reported as the most common barriers to PAM, while the most common enablers were perceived to be prescribing analgesia and considering pain a priority. Nurses recognized the need for education regarding pain, especially the physiological (50%) and psychological (47%) consequences of untreated pain.
Conclusion:
Nurses’ reported performance of pain assessment for ICU patients remains suboptimal. Therefore, healthcare professionals, organizations, nursing schools, and policymakers should work together to improve nurses’ PAM knowledge and practices.
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Istanboulian L, Rose L, Yunusova Y, Dale CM. Protocol for a mixed method acceptability evaluation of a codesigned bundled COmmunication intervention for use in the adult ICU during the COVID-19 PandEmic: the COPE study. BMJ Open 2021; 11:e050347. [PMID: 34518267 PMCID: PMC8438574 DOI: 10.1136/bmjopen-2021-050347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Patients requiring invasive mechanical ventilation via an artificial airway experience sudden voicelessness placing them at risk for adverse outcomes and increasing provider workload. Infection control precautions during the COVID-19 pandemic, including the use of personal protective equipment (eg, gloves, masks, etc), patient isolation, and visitor restrictions may exacerbate communication difficulty. The objective of this study is to evaluate the acceptability of a codesigned communication intervention for use in the adult intensive care unit when infection control precautions such as those used during COVID-19 are required. METHODS AND ANALYSIS This three-phased, prospective study will take place in a medical surgical ICU in a community teaching hospital in Toronto. Participants will include ICU healthcare providers, adult patients and their family members. Qualitative interviews (target n: 20-25) will explore participant perceptions of the barriers to and facilitators for supporting patient communication in the adult ICU in the context of COVID-19 and infection control precautions (phase 1). Using principles of codesign, a stakeholder advisory council of 8-10 participants will iteratively produce an intervention (phase 2). The codesigned intervention will then be implemented and undergo a mixed method acceptability evaluation in the study setting (phase 3). Acceptability, feasibility and appropriateness will be evaluated using validated measures (target n: 60-65). Follow-up semistructured interviews will be analysed using the theoretical framework of acceptability (TFA). The primary outcomes of this study will be acceptability ratings and descriptions of a codesigned COmmunication intervention for use during and beyond the COVID-19 PandEmic. ETHICS AND DISSEMINATION The study protocol has been reviewed, and ethics approval was obtained from the Michael Garron Hospital. Results will be made available to healthcare providers in the study setting throughout the study and through publications and conference presentations.
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Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Provincial Centre for Excellence in Weaning, Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Critical Care and Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Nurses Knowledge, Attitude, and Practices Toward Pain Assessment and Management of Patients Unable to Communicate Verbally. Crit Care Nurs Q 2021; 44:413-423. [PMID: 34437320 DOI: 10.1097/cnq.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Critically ill patients usually experience a significant level of pain during rest or during routine care such as turning, wound care, and endotracheal suctioning. Pain assessment is the cornerstone of pain management. Adequate pain assessment and management are major responsibilities of critical care nurses. The purpose of this study was to evaluate the nurses' knowledge, attitudes, and practices toward pain assessment and management of the intensive care unit (ICU) patients who are unable to communicate verbally. A descriptive cross-sectional design was used in this study. The study was conducted at ICUs in 5 hospitals from the north, middle, and south areas of Jordan. A self-administered questionnaire developed by Rose was used in this study. The most important finding in this study was that a large number of ICU nurses do not use assessment tools to evaluate the level of pain in patients who are unable to communicate verbally. Moreover, the nurses have inadequate knowledge about pain assessment and management. As perceived by the nurses, "restlessness" was the highest rated routine indicator of pain (25.1%), followed by "not following commands" (24%). Half of the participants (50%) answered that nurses were the persons who provide the most accurate rating of pain intensity. However, the participants showed positive attitude toward pain assessment and management.
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Hamdan KM, Shaheen AM, Abdalrahim MS. Barriers and enablers of intensive care unit nurses' assessment and management of patients' pain. Nurs Crit Care 2021; 27:567-575. [PMID: 33797160 DOI: 10.1111/nicc.12624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/18/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inadequate pain assessment and management is a problem in hospitalized patients that impairs their well-being. Intensive care unit nurses' pain practices are affected by several barriers and enablers. AIMS AND OBJECTIVES To explore intensive care unit nurses' pain education, perceived barriers, and enablers of pain assessment and management practices among critically ill patients. DESIGN A cross-sectional descriptive design was used in the study. METHODS Convenience sampling technique was used, including 300 nurses recruited from 22 intensive care units in Jordan. The Pain Assessment and Management for Critically Ill Adults Survey was used to collect data. Descriptive statistics, spearman correlation, and chi-square tests were used to analyse the data. RESULTS Only 127 (42.3%) of the nurses reported moderate to extreme satisfaction about receiving professional development education related to pain among critically ill patients. Nurse workload (65.3%), patient instability (54.4%), patient inability to communicate (53.3%), and sedation interfering with pain assessment (50%) were reported by nurses as the most frequent barriers impacting pain assessment and management. Enablers of pain assessment and management reported most frequently were "pain assessment and management is a unit priority" (63.7%), "enthusiastic and motivated staff" (61.3%), "protocols and guidelines are in use" (57.4%), and "standardized assessment tools are in use" (57%). Some barriers and enablers to pain assessment and management and pain education differed significantly according to nurses' experience and hospital type. CONCLUSION This study identified a range of enablers and barriers to pain assessment and management practices perceived by intensive care unit nurses. Nurse workload was an important barrier while making pain assessments, and management a unit priority was an important enabler for pain assessment and management. Frequent assessment of barriers and enablers of pain assessment and management is needed in critical care units to improve nurses' practices. Pain education should be included in the hospitals' continuous educational program.
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Affiliation(s)
- Khaldoun M Hamdan
- Acute and Chronic Care Nursing Department, Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | - Abeer M Shaheen
- Community Health Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Maysoon S Abdalrahim
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Kia Z, Allahbakhshian M, Ilkhani M, Nasiri M, Allahbakhshian A. Nurses' use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study. Complement Ther Med 2021; 58:102705. [PMID: 33677019 DOI: 10.1016/j.ctim.2021.102705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Pain is a common and unpleasant feeling among patients in intensive care units. Therefore, the use of proper pain management methods, such as non-pharmacological interventions, is a priority in intensive care units. OBJECTIVE This study aimed to ascertain the extent of the use of non-pharmacological pain management methods by intensive care unit nurses in Iran and to identify the obstacles that hindered the use of these methods. MATERIAL AND METHODS This study used a descriptive cross-sectional design which involved a convenience sample of 224 nurses who worked in 16 intensive care units across northern Iran. Data were collected using the non-pharmacological pain management questionnaire and a researcher-developed checklist of the obstacles that hindered the use of non-pharmacological pain management methods. RESULTS A moderate number of ICU nurses used non-pharmacological pain management methods (55.8 %). The most common method used by nurses was repositioning (M = 2.72), while methods such as acupuncture and reflexology were used less frequently. Furthermore, the most common obstacles to the use of non-pharmacological pain management methods were nurses' fatigue (M = 2.92) and multiple responsibilities (M = 2.91). Demographic variables such as age, gender, educational level, and work experience were not significantly associated with the use of non-pharmacological pain management methods. CONCLUSIONS Due to factors such as fatigue, multiple responsibilities, a heavy workload, and an insufficient number of nurses per shift, the rate of utilization of non-pharmacological pain management methods among intensive care unit nurses in Iran was low. Furthermore, most of the participants in this study had not attended courses on non-pharmacological pain management.
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Affiliation(s)
- Zeinab Kia
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Allahbakhshian
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahnaz Ilkhani
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Malihe Nasiri
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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15
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Maartmann-Moe CC, Solberg MT, Larsen MH, Steindal SA. Patients' memories from intensive care unit: A qualitative systematic review. Nurs Open 2021; 8:2221-2234. [PMID: 33611859 PMCID: PMC8363378 DOI: 10.1002/nop2.804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 11/05/2022] Open
Abstract
AIM To identify and synthesize the evidence regarding adult patients' memories from their stay in the intensive care unit. DESIGN A qualitative systematic review and meta-synthesis. PROSPERO # CRD42020164928. The review employed the guideline of Bettany-Saltikov and McSherry and the Enhancing transparency in reporting the synthesis of qualitative research guidelines. METHODS Systematic search for qualitative studies published between January 2000 and December 2019 in Cumulative Index to Nursing and Allied Health, Medical Literature Analysis and Retrieval System Online, PsycINFO, and Excerpta Medica Database. Pairs of authors independently assessed eligibility, appraised methodological quality using Joanna Briggs's quality appraisal tool and extracted data. The analysis followed the principles of interpretative synthesis. RESULTS Sixteen papers from 15 studies were included in the review. Three themes emerged: (a) memories of surreal dreams and delusions, (b) care memories from sanctuary to alienation and (c) memories of being vulnerable and close to death.
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Affiliation(s)
- Charlotte C Maartmann-Moe
- Lovisenberg Diaconal University College, Oslo, Norway.,Emergency Department, Oslo University Hospital, Oslo, Norway
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16
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Helmer LM, Weijenberg RA, de Vries R, Achterberg WP, Lautenbacher S, Sampson EL, Lobbezoo F. Crying out in pain-A systematic review into the validity of vocalization as an indicator for pain. Eur J Pain 2020; 24:1703-1715. [PMID: 32573041 PMCID: PMC7587015 DOI: 10.1002/ejp.1623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 06/14/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Vocalization is often used to assess pain, sometimes combined with other behaviours such as facial expressions. Contrary to facial expressions, however, for vocalization, there is little evidence available on the association with pain. The aim of this systematic review was to critically analyse the association between vocalization and pain, to explore if vocalizations can be used as a "stand-alone" indicator for pain. METHODS The search was performed according to the Prisma Guidelines for systematic reviews and meta-analysis. The following terms were used: "Pain Measurement," "Vocalization" and "Verbalization." The study population included verbal and non-verbal individuals, including older people and children. The search was performed in three different databases: PubMed, Embase and CINAHL. A total of 35 studies were selected for detailed investigation. Quality assessments were made using two grading systems: Grading of Recommendations Assessment Development and Evaluation system and the Newcastle-Ottawa scale. RESULTS An association between vocalization and pain was found in most studies, particularly when different types of vocalizations were included in the investigation. Different types of vocalization, but also different types of pain, shape this association. The association is observed within all groups of individuals, although age, amongst others, may have an influence on preferred type of vocalization. CONCLUSIONS There is an association between vocalization and pain. However, vocalization as a "stand-alone" indicator for pain indicates only a limited aspect of this multifactorial phenomenon. Using vocalization as an indicator for pain may be more reliable if other pain indicators are also taken into account. SIGNIFICANCE Vocalizations are frequently used in pain scales, although not yet thoroughly investigated as a "single indicator" for pain, like, e.g. facial expression. This review confirms the role of vocalizations in pain scales, and stresses that vocalizations might be more reliable if used in combination with other pain indicators.
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Affiliation(s)
- Loreine M.L. Helmer
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Roxane A.F. Weijenberg
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ralph de Vries
- Medical LibraryVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Wilco P. Achterberg
- Department of Public Health and Primary careLeiden University Medical CentreLeidenThe Netherlands
| | | | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUniversity College LondonLondonUK
| | - Frank Lobbezoo
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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17
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Hylén M, Akerman E, Idvall E, Alm-Roijer C. Patients´ experiences of pain in the intensive care - The delicate balance of control. J Adv Nurs 2020; 76:2660-2669. [PMID: 32808692 DOI: 10.1111/jan.14503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/12/2020] [Accepted: 07/14/2020] [Indexed: 01/10/2023]
Abstract
AIM To explore the patients´ experiences of pain when being cared for in the intensive care. DESIGN An exploratory, qualitative design was chosen. METHOD Interviews were performed with patients (October 2015-March 2017) within a week of post-intensive care (N = 16). Thematic analysis was used as method for analysis. RESULTS The findings generated two themes - a lack of control and to struggle for control. Pain was described as overwhelming, both in body and mind and generating the experience of a lack of control, with feelings of incapacitation, isolation, and having their needs unmet. Feeling in control of the pain and thus in control of the situation was experienced as a constant struggle. Well-planned care, finding ways to handle the pain and good communication were all helpful in this struggle. CONCLUSION The participants recalled their experience of pain in the ICU and control seems to be crucial for how pain is experienced. They experienced a lack of control due to not only the pain but also the treatment, which can be avoided by the nurse continuously evaluating and individualising the care. Balanced care, meeting the patients' needs and good communication helps the patient feel more in control when experiencing pain. IMPACT The experience of pain is dependent on control for the intensive care patient. The nurse may help them gain control and thereby handle the experience of pain through including the patient, striving for better communication and implementing individualised care that continuously assesses and treats pain.
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Affiliation(s)
- Mia Hylén
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden.,Department of Intensive and Perioperative Care, Skane University Hospital, Malmo, Sweden
| | - Eva Akerman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,General Intensive Care Unit, Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Idvall
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
| | - Carin Alm-Roijer
- Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden
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18
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Olsen BF, Rustøen T, Valeberg BT. Nurse's Evaluation of a Pain Management Algorithm in Intensive Care Units. Pain Manag Nurs 2020; 21:543-548. [PMID: 32651048 DOI: 10.1016/j.pmn.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/05/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many patients have memories of pain during intensive care unit stay. To improve pain management, practice guidelines recommend that pain management should be guided by routine pain assessment and suggest an assessment-driven, protocol-based, stepwise approach. This recommendation prompted the development of a pain-management algorithm. AIM Evaluate the feasibility and clinical utility of this algorithm. DESIGN A descriptive survey. SETTINGS One medical/surgical intensive care unit, one surgical intensive care unit, and one postanesthesia care unit at two hospitals in Norway. PARTICIPANTS/SUBJECTS Nurses working at the three units. METHODS A pain-management algorithm, including three pain assessment tools and a guide to pain assessment and pain management, was developed and implemented in three intensive care units. Nurses working at the three units (n = 129) responded to a questionnaire regarding the feasibility and clinical utility of the algorithm used. RESULTS Our results suggested that nurses considered the new pain-management algorithm to have relatively high feasibility, but somewhat lower clinical utility. Less than half of respondents thought that pain treatment in clinical practice had become more targeted using the tree pain-assessment tools (45%) and the algorithm for pain assessment and pain management (24%). CONCLUSIONS Pain-management algorithms may be appropriate and useful in clinical practice. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on pain-treatment actions and reassessment of patients' pain is needed. Further focus in clinical practice on how to implement an algorithm and more focus on pain-treatment action and reassessment of patients' pain is needed.
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Affiliation(s)
- Brita F Olsen
- Intensive and Postoperative Unit, Østfold Hospital Trust, Grålum, Norway; Faculty of Health and Welfare, Østfold University College, Halden, Norway.
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Berit T Valeberg
- Department of Nursing, Oslo Metropolitan University, Oslo, Norway; University of South-Eastern Norway, Kongsberg, Norway
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19
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ADA M, YILMAZ E. Mekanik Ventilatör Desteğindeki Hastaların İntravasküler Girişimler Sırasındaki Ağrı Davranışları. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.617091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Zuazua-Rico D, Mosteiro-Diaz MP, Maestro-Gonzalez A, Fernandez-Garrido J. Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records. Pain Manag Nurs 2020; 21:510-515. [PMID: 32362473 DOI: 10.1016/j.pmn.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the relationship between frequency of pain assessment and nursing workload, and also to analyze the frequency of pain assessment and its relation to knowledge and attitudes toward pain on nursing professionals in intensive care unit. METHODS An ambispective study was conducted in a Spanish tertiary-level intensive care unit between October 2017 and April 2018. For measurement of workload, the Nursing Activities Score scale was used, and for measurement of pain knowledge, the Knowledge and Attitudes Survey Regarding Pain was used. RESULTS There were 1,207 measurements among 41 nurses and 1,838 among 317 patients. The average nursing workload was high (70.97 points). We found statistically significant positive association between nursing workload and the frequency of assessment (p < .001), as well as frequency of assessment and patients with communicative capacity (p = .008). CONCLUSIONS Nursing workload affects the registration and assessment of patients' pain, resulting in a greater number of records as the workload performed by nurses increases. It is necessary to study in greater depth how the severity of pain, gender of the patients, and workload of nurses influence pain registration and assessment.
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Affiliation(s)
- David Zuazua-Rico
- Medicine Department, Nursing Area, University Of Oviedo, Oviedo, Spain
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21
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Kahsay DT, Pitkäjärvi M. Emergency nurses´ knowledge, attitude and perceived barriers regarding pain Management in Resource-Limited Settings: cross-sectional study. BMC Nurs 2019; 18:56. [PMID: 31832015 PMCID: PMC6873521 DOI: 10.1186/s12912-019-0380-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background Pain is a common phenomenon among emergency patients which may lead to chronic pain conditions and alteration of physiological function. However, it is widely reported that proper pain assessment and management, which is often accomplished by adequately trained nurses reduce the suffering of patients. Therefore, the aim of this study was to assess the emergency nurses´ knowledge, attitude and perceived barriers regarding pain management. Methods A cross-sectional quantitative study design was applied to determine the nurses´ knowledge level, attitude and the perceived barriers related to pain management. Hundred twenty-six nurses from the emergency departments of seven referral hospitals of Eritrea participated in the study. Data were collected in August and September 2017. Both descriptive and inferential statistics were used to summarize and elaborate on the results. Result In general, the knowledge level and attitude of the emergency nurses was poor. The participants’ correct mean score was 49.5%. Nurses with Bachelor’s Degree had significantly higher knowledge and attitude level compared to the nurses at the Diploma and Certificate level of professional preparation (95% CI = 7.1–16.7 and 9.4–19.1; p < 0.001) respectively. Similarly, nurses who had previous training regarding pain scored significantly higher knowledge level compared to those without training (95% CI =1.82–8.99; p = 0.003). The highest perceived barriers to adequate pain management in emergency departments were measured to be overcrowding of the emergency department (2.57 ± 1.25), lack of protocols for pain assessment (2.45 ± 1.52), nursing workload (2.44 ± 1.29) and lack of pain assessment tools (2.43 ± 1.43). There was no significant difference in perceived barriers among nurses with different demographic characteristics. Conclusion The emergency nurses’ knowledge and attitude regarding pain management were poor. Nurses with higher educational level and nurses with previous training scored significantly higher knowledge level. This indicates the need for nursing schools and the ministry of health to work together to educate nurses to a higher level of preparation for pain assessment and management.
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Affiliation(s)
- Desale Tewelde Kahsay
- Department of Anaesthesia and Critical Care, Asmara College of Health Sciences, Mai Bela Ave, Asmara, Eritrea
| | - Marianne Pitkäjärvi
- Metropolia University of Applied Sciences, Myllypurontie 1, PO BOX 4000, 00079 Helsinki, Metropolia Finland
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22
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Kutlutürkan S, Urvaylıoğlu AE. Evaluation of Pain as A Fifth Vital Sign: Nurses' Opinions and Beliefs. Asia Pac J Oncol Nurs 2019; 7:88-94. [PMID: 31879689 PMCID: PMC6927158 DOI: 10.4103/apjon.apjon_39_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: After the American Pain Society recognized pain as a fifth vital sign, many countries adopted similar pain screening approaches. The routine evaluation of pain has recently come to the agenda in Turkey, along with the important role played by nurses in pain evaluation, and hence, this study focuses on the opinions of nurses on the evaluation of pain as a fifth vital sign, their pain beliefs, and how their pain beliefs influence their opinions. Methods: This descriptive study was conducted in a City Hospital with the involvement of 223 nurses. A questionnaire and a Pain Beliefs Questionnaire were used for the collection of data, and the data were analyzed using descriptive statistics, and Mann–Whitney U-test, analysis of variance, and Kruskal–Wallis tests. Results: Of the respondent nurses, 31.8% of the nurses were working in medical inpatient clinics, and 56.5% stated that pain should not be evaluated as a fifth vital sign, giving the following reasons: if patients are in pain, they already report it (40.5%), and overwork and the lack of sufficient nurses (34.9%). There was no difference in the pain beliefs scores of the nurses who stated that pain should not be evaluated as a fifth vital sign (56.5%) and the scores of those who stated the opposite (43.5%) (P > 0.05). Conclusions: Most of the nurses do not think that pain should be evaluated as a fifth vital sign. Furthermore, the pain beliefs of nurses do not influence their opinions regarding the assessment of pain as a fifth vital sign.
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Affiliation(s)
- Sevinç Kutlutürkan
- Department of Medical Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Aydan Eda Urvaylıoğlu
- Department of Medical Nursing, Faculty of Health Sciences, Yozgat Bozok University, Yozgat, Turkey
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23
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Hamdan KM. Nurses' Assessment Practices of Pain Among Critically Ill Patients. Pain Manag Nurs 2019; 20:489-496. [PMID: 31133409 DOI: 10.1016/j.pmn.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/24/2019] [Accepted: 04/10/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Systematic pain assessment is necessary to ensure effective pain management. Despite the availability of recommendations, guidelines, and valid tools for pain assessment, the actual implementation in clinical practice is inconsistent. AIMS The purpose of this study was to investigate intensive care nurses' pain assessment practices among critically ill patients in Jordanian hospitals. DESIGN A descriptive cross sectional design was used in this study. SETTINGS This study was conducted in 22 intensive care unites located in eight hospitals in Jordan. PARTICIPANTS/SUBJECTS Convenience sampling was used to recruit a sample of 300 nurses working in intensive care units. METHODS The Pain Assessment and Management for the Critically Ill survey was used to collect data. Descriptive statistics, χ2, and correlational analysis were used to analyze data. RESULTS A total of 89.7% of nurses (N = 300) used pain assessment tools with patients able to communicate, and the numeric rating scale was the most commonly used tool. A total of 81.7% of the nurses used a pain assessment tool with patients unable to communicate, and the Adult Nonverbal Pain Scale was the most commonly used tool. Nurses' perceived importance of pain assessment was positively associated with frequent use of pain assessment tools. Nurses perceived the use of pain assessment tools for patients able to communicate as being more important than the use of pain assessment tools for patients unable to communicate. CONCLUSIONS The majority of intensive care unit nurses used pain assessment tools for patients both able and unable to communicate; however, the most valid and reliable tools were not used often. Nurses were not aware of the pain behaviors most indicative of pain among critically ill patients.
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24
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Chen J, Hu F, Yang J, Wu XY, Feng Y, Zhan YC, An YZ, Lu Q, Zhang HY. Validation of a Chinese version critical-care pain observation tool in nonintubated and intubated critically ill patients: Two cross-sectional studies. J Clin Nurs 2019; 28:2824-2832. [PMID: 30938890 DOI: 10.1111/jocn.14862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/05/2019] [Accepted: 03/23/2019] [Indexed: 01/05/2023]
Abstract
AIMS AND OBJECTIVES To validate the Chinese version of the Critical-Care Pain Observation Tool (CPOT) in nonintubated and intubated ICU patients. BACKGROUND While CPOT was found to have the best psychometric properties among objective pain assessment scales, there is no Chinese version CPOT for nonintubated patients. DESIGN Cross-sectional design was used in these two observational studies. METHODS Seventy-six nonintubated patients and 53 intubated patients were assessed to examine internal consistency, criterion-related and discriminative validity of CPOT in the first study. Pain assessment during low pain condition as well as increased pain condition was performed by Numeric Rating Scale (NRS) and the Chinese version COPT. Forty nonintubated patients and 43 intubated patients were assessed to examine inter-rater reliability in the second study. A bedside nurse and a researcher independently executed paired pain assessments with CPOT in the same conditions. The STROBE Statement was followed to guide these studies. RESULTS The Cronbach's α in nonintubated patients and intubated patients was 0.903-0.930 and 0.868-0.870. The intraclass correlation coefficients (ICCs) in nonintubated patients ranged from 0.959-0.982, and the ICC in intubated patients ranged from 0.947-0.959, confirming the inter-rater reliability. The moderately positive Pearson's correlations between CPOT and NRS scores (r = 0.757-0.838 in nonintubated patients, r = 0.574-0.705 in intubated patients) indicated the criterion-related validity. A significant increase in CPOT scores in the increased pain condition compared with those acquired in the low pain condition verified the discriminative validity. CONCLUSIONS The Chinese version of CPOT was presented to be valid and reliable for both nonintubated and intubated critically ill adults, which could be applicable for pain assessment in patients in ICU. RELEVANCE TO CLINICAL PRACTICE This study provides an applicable pain assessment tool for both nonintubated patients and intubated patients in ICU.
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Affiliation(s)
- Jie Chen
- University of Connecticut School of Nursing, Storrs, Connecticut.,Nursing Department, Peking University People's Hospital, Beijing, China.,School of Nursing, Peking University, Beijing, China
| | - Fen Hu
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian Yang
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-Ying Wu
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology and Pain Management, People's Hospital Peking University, Beijing, China
| | - Yan-Chun Zhan
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - You-Zhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China
| | - Hai-Yan Zhang
- Nursing Department, Peking University People's Hospital, Beijing, China.,Nursing Center, National Institute of Hospital Administration, Beijing, China
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25
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Melia R, Morrell-Scott N, Maine N. A review of compliance with pain assessments within a UK ICU. ACTA ACUST UNITED AC 2019; 28:382-386. [PMID: 30925247 DOI: 10.12968/bjon.2019.28.6.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: clinical audits highlight areas where care may not be of the desired quality; they are essential to ensure care is safe and effective. Effective assessment and management of pain have been shown to improve patient wellbeing and clinical outcomes. AIM: this audit aimed to identify compliance with pain assessment tools and documentation within intensive care and make recommendations to improve practice. DISCUSSION: compliance with documenting pain assessments was poor, a finding that is consistent with the literature. Although a wealth of evidence has shown pain assessments are not being completed effectively, this continues to be a problem. Intensive care has significant areas for improvement in this area, which would improve patients' experiences and outcomes. Nurses should be educated in the use of pain assessment tools and compliance. CONCLUSION: providing patients in intensive care with appropriate analgesia benefits their physical and psychological health. Areas for improvement identified in this audit include that pain assessments need to be carried out and documented regularly. The audit has implications for practice in that it shows a need for reinforced education for staff, better communication and updates to promote pain assessment and the implementation of guidelines.
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Affiliation(s)
- Rachel Melia
- Staff Nurse, Intensive Care, Royal Liverpool Hospital NHS Trust
| | | | - Norman Maine
- Intensive Care Consultant, Royal Liverpool Hospital NHS Trust
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26
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Dale CM, Prendergast V, Gélinas C, Rose L. Validation of The Critical-care Pain Observation Tool (CPOT) for the detection of oral-pharyngeal pain in critically ill adults. J Crit Care 2018; 48:334-338. [PMID: 30286403 DOI: 10.1016/j.jcrc.2018.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/28/2018] [Accepted: 09/21/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Mechanically ventilated patients experience pain at rest and during daily care procedures. Our objective was to test the reliability and validity of the Critical-Care Pain Observation Tool (CPOT) to detect oral-pharyngeal pain in intubated and tracheostomised adults during routine oral care procedures. MATERIALS AND METHODS Two trained research team members independently observed patients during two non-painful (rest and gentle touch) and three potentially painful (oral suctioning, tooth brushing, and swabbing with a sponge toothette) procedures. Conscious patients were asked if they experienced pain during each procedure (yes/no) and to rate their pain intensity on a 0 to 10 numeric rating scale. RESULTS A total of 98 patients, primarily intubated (92.9%) and male (63.3%) participated. Criterion validation was supported by patient self-report of pain during tooth brushing (AUC=.80; P<0.5) and oral suction (AUC=.72; P<0.3) but not for oral swabbing (AUC=.68; P=0.16). Discriminative validation was demonstrated for all oral care procedures compared to rest (P<.001). Intra-class correlation coefficients between raters ranged from .78 to .91 (P<.001) for total CPOT scores, indicating excellent inter-rater reliability. CONCLUSIONS The CPOT is reliable and valid for the detection of oral-pharyngeal pain during oral care procedures indicated as painful by critically ill adults.
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Affiliation(s)
- Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
| | | | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, CIUSSS Centre-Ouest-Ile-Montréal, Montréal, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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27
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Khalil NS. Critical care nurses' use of non-pharmacological pain management methods in Egypt. Appl Nurs Res 2018; 44:33-38. [PMID: 30389057 DOI: 10.1016/j.apnr.2018.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 07/01/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022]
Abstract
AIM To examine Critical Care Nurses' Practices of Non-pharmacological Pain Management Interventions in Egypt. METHODS Descriptive exploratory design was utilized in the current study with a convenience sample of 60 critical care nurses working in three intensive care units at Al Manial university Hospital, Egypt. The questionnaires included; nurses' demographic data, non-pharmacological pain management checklist utilizing likert scale, and perceived barriers to the practice of non-pharmacological pain management interventions. Comparisons were made between the nurses' responses about practices of non-pharmacological pain management and selected demographic variables. RESULTS The non-pharmacological methods used by few nurses were putting the patient in comfortable position, communication with the patients and their families and using comfort devices. Moreover, nurses' education, work experience and the work area showed no statistically significant association with the few of non-pharmacological pain relief interventions they used. Finally, the barriers that hindered non-pharmacological pain practices from being used by nurses were lack of nurses' knowledge, lack of time, nurses' workload and patients' instability. CONCLUSION Most of the critical care nurses didn't apply non-pharmacological pain interventions practices with their patients in pain. The approaches used by a few nurses were changing position and the use of some comfort devices. Moreover, no significant correlations were found between nurse' application of non-pharmacological pain measures and either educational level and work area. RECOMMENDATIONS Barriers need to be explored and continuing education is needed to eliminate some of these perceived barriers. Moreover, theoretical and practical non-pharmacological pain management interventions should be incorporated in nursing curricula.
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Affiliation(s)
- Nahla Shaaban Khalil
- Critical Care and Emergency Nursing, Faculty of Nursing, Cairo University, Egypt.
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An Association Between Pain and American Association of Respiratory Care 2010 Guidelines During Tracheal Suctioning. Dimens Crit Care Nurs 2018; 35:283-90. [PMID: 27487754 DOI: 10.1097/dcc.0000000000000200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Tracheal suctioning is recalled by mechanically ventilated patients as the most painful procedure during their stay in the intensive care unit. AIM The aim of this study was to evaluate whether the implementation of American Association of Respiratory Care suction guidelines positively affects the levels of patients' pain. MATERIALS AND METHODS This is a prospective observational study on adult patients admitted to 2 general intensive care units. Pain levels in sedated mechanically ventilated patients were recorded before, during, and after tracheal suctioning, using the Critical Care Pain Observation Tool (CPOT). RESULTS Forty-seven patients were enrolled, with a mean age of 61.72 (±18.46) years. Median CPOT value was 0 (quartile 1 [Q1] [25%], 0; quartile 3 [Q3] [75%], 0; min, 0; max, 2) during the procedure. The Critical Care Pain Observation Tool reached a median value of 3, while 5 minutes after suctioning. Postprocedural CPOT median score was 0 (Q1 [25%], 0; Q3 [75%], 0; min, 0; max, 2). The median number of passes during suctioning was 1 (Q1, 1; Q3, 2). The sizes of suction catheters used in the recorded procedures were as follows: 12F in 27 cases (57%), 14F in 18 cases (38%), and 10F in 2 cases (5%). The median size of the endotracheal tube was 7.5 mm (Q1, 7.5; Q3, 8). The correct ratio between endotracheal tube diameter and suction catheter was used in 24 procedures (51%). CONCLUSIONS Despite the low number of patients, this study showed that the implementation of the American Association of Respiratory Care 2010 endotracheal suctioning guidelines into practice helps to reduce procedural-induced pain. Therefore, training and continuing education are important for clinical staff performing tracheal suctioning.
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Deldar K, Froutan R, Ebadi A. Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study. BMC Nurs 2018; 17:11. [PMID: 29568232 PMCID: PMC5857143 DOI: 10.1186/s12912-018-0281-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background One helpful strategy adopted for pain management in non-verbal, intubated patients is the use of a proper pain assessment scale. The purpose of the present study is to achieve a better and deeper understanding of the existing nurses' challenges in using pain assessment scales among patients unable to communicate. Methods This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until data saturation. The participants included 20 nurses working in intensive care units. Data was collected using semi-structured interviews and analysis was done using an inductive approach. Results Four categories and ten sub-categories were extracted from the experiences of the nurses working in the intensive care units in terms of nursing challenges in using non-verbal pain assessment scales. The four categories included "forgotten priority", "organizational barriers", "attitudinal barriers", and "barriers to knowledge". Conclusions The findings of the present study have shown that various factors might influence on the use of non-verbal pain assessment scales in patients unable to communicate. Identifying these challenges for nurses can help take effective steps such as empowering nurses in the use of non-verbal pain assessment scales, relieving pain, and improving the quality of care services.
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Affiliation(s)
- Kolsoum Deldar
- 1Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Froutan
- 2Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- 3Behavioral Sciences Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Moradi M, Zeighami R, Tuzandeh jani H, Alipur M. Investigating the Effect of Pressure on the Hugo Point on the Severity of a Headache after Head Injury. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2017. [DOI: 10.29252/jgbfnm.14.2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Björn A, Pudas-Tähkä SM, Salanterä S, Axelin A. Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study. Intensive Crit Care Nurs 2017; 42:68-74. [PMID: 28431797 DOI: 10.1016/j.iccn.2017.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the impact of video education on critical care nurses' knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses' experiences with video education. METHODS Forty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients' pain assessment between nurses and the researcher was determined to examine nurses' skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis. RESULTS The knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction. CONCLUSIONS Video education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.
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Affiliation(s)
- Annika Björn
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland; Helsinki University Hospital, HUCH Perioperative, Intensive Care and Pain Medicine, Helsinki, Finland.
| | | | - Sanna Salanterä
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland; Turku University Hospital, Hospital District of South-West Finland, Finland
| | - Anna Axelin
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland
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Krotsetis S, Richards KC, Behncke A, Köpke S. The reliability of the German version of the Richards Campbell Sleep Questionnaire. Nurs Crit Care 2017; 22:247-252. [PMID: 28168810 DOI: 10.1111/nicc.12275] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 08/30/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The assessment of sleep quality in critically ill patients is a relevant factor of high-quality care. Despite the fact that sleep disturbances and insufficient sleep management contain an increased risk of severe morbidity for these patients, a translated and applicable instrument to evaluate sleep is not available for German-speaking intensive care settings. AIM This study aimed to translate the Richards Campbell Sleep Questionnaire (RCSQ), a simple and validated instrument eligible for measuring sleep quality in critically ill patients, and subsequently to evaluate the internal consistency of the German version of the RCSQ. Furthermore, it also aimed to inquire into the perception of sleep in a sample of critically ill patients. METHODS The RCSQ was translated following established methodological standards. Data were collected cross-sectionally in a sample of 51 patients at 3 intensive care units at a university hospital in Germany. RESULTS The German version of the RCSQ showed an overall internal consistency (Cronbach's alpha) of 0·88. The mean of the RSCQ in the sample was 47·00 (SD ± 27·57). Depth of sleep was rated the lowest and falling asleep again the highest of the RCSQ sleep items. CONCLUSION The study demonstrated very good internal consistency of the German version of the RCSQ, allowing for its application in practice and research in German-speaking countries. Quality of sleep perception was generally low in this sample, emphasizing the need for enhanced care concepts regarding the sleep management of critically ill patients. Relevance to clinical practice Assessment of self-perception of sleep is crucial in order to plan an individually tailored care process.
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Affiliation(s)
- Susanne Krotsetis
- Nursing Directorate, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Kathy C Richards
- Doctoral Programs and Research School of Nursing, George Mason University, Fairfax, VA, USA
| | - Anja Behncke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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Results of implementing a pain management algorithm in intensive care unit patients: The impact on pain assessment, length of stay, and duration of ventilation. J Crit Care 2016; 36:207-211. [PMID: 27546773 DOI: 10.1016/j.jcrc.2016.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/27/2016] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to measure the impact of implementing a pain management algorithm in adult intensive care unit (ICU) patients able to express pain. No controlled study has previously evaluated the impact of a pain management algorithm both at rest and during procedures, including both patients able to self-report and express pain behavior, intubated and nonintubated patients, throughout their ICU stay. MATERIALS AND METHODS The algorithm instructed nurses to assess pain, guided them in pain treatment, and was implemented in 3 units. A time period after implementing the algorithm (intervention group) was compared with a time period the previous year (control group) on the outcome variables: pain assessments, duration of ventilation, length of ICU stay, length of hospital stay, use of analgesic and sedative medications, and the incidence of agitation events. RESULTS Totally, 650 patients were included. The number of pain assessments was higher in the intervention group compared with the control group. In addition, duration of ventilation and length of ICU stay decreased significantly in the intervention group compared with the control group. This difference remained significant after adjusting for patient characteristics. CONCLUSION Several outcome variables were significantly improved after implementation of the algorithm compared with the control group.
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Hylén M, Akerman E, Alm-Roijer C, Idvall E. Behavioral Pain Scale - translation, reliability, and validity in a Swedish context. Acta Anaesthesiol Scand 2016; 60:821-8. [PMID: 27251598 DOI: 10.1111/aas.12688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Assessing pain in the intensive care unit (ICU) is challenging. Due to intubation and sedation, communication can be limited. International guidelines recommend assessing pain with instruments based on behavioral parameters when critically ill patients are unable to self-report their pain level. One of the recommended instruments, the Behavioral Pain Scale (BPS), has shown good validity and reliability in international studies. The aim of this study was to translate and adapt the BPS for critically ill intubated and non-intubated patients in a Swedish ICU context and to assess inter-rater reliability and discriminant validity. METHODS The BPS (both for intubated and non-intubated patients) was translated and adapted into Swedish using a translation method consisting of ten steps. The Swedish version was then tested for inter-rater reliability and discriminant validity on 20 critically ill patients (10 intubated and 10 non-intubated) before and directly after a potentially painful procedure (repositioning). RESULTS The Swedish version of the BPS showed inter-rater reliability with a percentage agreement of 85% when tested on a sample of critically ill patients. The instrument also showed discriminant validity between assessments at rest and after repositioning. CONCLUSION Results of the Swedish version of the BPS support its use in critically ill patients who cannot self-report their pain level. Still, additional studies are needed to further explore its reliability and validity in the Swedish ICU context.
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Affiliation(s)
- M. Hylén
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
- Department of Intensive and Perioperative Care; Skane University Hospital; Malmo Sweden
| | - E. Akerman
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
- Department of Intensive and Perioperative Care; Skane University Hospital; Malmo Sweden
| | - C. Alm-Roijer
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
| | - E. Idvall
- Faculty of Health and Society; Department of Care Science; Malmo University; Malmo Sweden
- Department of Intensive and Perioperative Care; Skane University Hospital; Malmo Sweden
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Kiavar M, Azarfarin R, Totonchi Z, Tavakoli F, Alizadehasl A, Teymouri M. Comparison of Two Pain Assessment Tools, "Facial Expression" and "Critical Care Pain Observation Tool" in Intubated Patients After Cardiac Surgery. Anesth Pain Med 2016; 6:e33434. [PMID: 27110536 PMCID: PMC4834529 DOI: 10.5812/aapm.33434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 10/09/2015] [Accepted: 10/17/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation. OBJECTIVES This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to communicate verbally. The studied tools were "critical-care pain observation tool (CPOT)" and "facial expression (FE)". PATIENTS AND METHODS This was a prospective study based on diagnostic test evaluation. A sample of 91 intubated patients was selected from cardiac post-anesthesia care unit. Collected data were demographic characteristics, vital signs, FE and CPOT tools' scale. Pain was assessed with CPOT and FE scores five times. The first assessment was performed in at least 3 hours after admission of patients to ICU. Then, the pain intensity was reassessed every 30 minutes. In addition, blood pressure, heart rate, respiratory rate and oxygen saturation were measured simultaneously. RESULTS At the first period, the frequency of "severe" pain intensity using the CPOT was 58.2% and with the FE tool was 67% (P = 0.001). Both tools demonstrated reduction in severity of pain on second and third assessment times. Significantly increasing level of pain and blood pressure due to nursing painful procedures (endo-tracheal suctioning, changing patient's position, etc.), were obtained by CPOT in fourth assessment. FE was not able to detect such important findings (κ = 0.249). In the fifth step, pain intensity was reduced. The most agreement between the two tools was observed when the reported pain was "severe" (κ = 0.787, P < 0.001) and "mild" (κ = 0.851, P < 0.001). CONCLUSIONS The sensitivity of CPOT was higher for detection and evaluation of pain in intubated postoperative patients compared with "Facial Expression". Best agreement between these tools was observed in two extremes of pain intensity.
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Affiliation(s)
- Majid Kiavar
- Cardiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ziae Totonchi
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Tavakoli
- Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Cardiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Teymouri
- Cardiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Kizza IB, Muliira JK, Kohi TW, Nabirye RC. Nurses’ knowledge of the principles of acute pain assessment in critically ill adult patients who are able to self-report. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2016. [DOI: 10.1016/j.ijans.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Kizza IB, Muliira JK. Nurses' pain assessment practices with critically ill adult patients. Int Nurs Rev 2015; 62:573-82. [PMID: 26602531 DOI: 10.1111/inr.12218] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to describe the perceived barriers, enablers and acute pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting. BACKGROUND Acute pain is a common problem among critically ill adult patients, and nurses' play a central role in its control. Very few studies have examined nurses' acute pain assessment practices in resource-limited settings. METHODS A descriptive and cross-sectional design was used. A total of 170 nurses working in a Ugandan hospital were enrolled. Data were collected using a questionnaire measuring various aspects of pain assessment for critically ill adult patients. RESULTS The majority of nurses had poor pain assessment practices. The most commonly performed pain assessment practices were documenting assessment findings, discussing pain assessment and management during nurse-to-nurse reports, and assessing for analgesics need before wound care. The main barriers to pain assessment were workload; lack of education and familiarity with assessment tools; poor documentation and communication of pain assessment priorities. The only reported enabler was physician's prescriptions for analgesia. Pain assessment practices were significantly associated with perceived workload and priority given to pain assessment. CONCLUSION Pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting are affected by several barriers. IMPLICATION FOR NURSING AND HEALTH POLICY Interventions to reduce barriers and enhance enablers of acute pain assessment are needed to improve pain management in critically ill adult patients. To be effective, the interventions have to be holistic and implemented by professional bodies and employers of nurses.
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Affiliation(s)
- I B Kizza
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - J K Muliira
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
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Implementation of a pain management algorithm in intensive care units and evaluation of nurses' level of adherence with the algorithm. Heart Lung 2015; 44:528-33. [PMID: 26391017 DOI: 10.1016/j.hrtlng.2015.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/02/2015] [Accepted: 08/07/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To implement a pain management algorithm in intensive care units (ICU) and to evaluate nurses' level of adherence with the algorithm. BACKGROUND Many ICU patients experience pain. Therefore, an evidence-based algorithm for pain management was developed. METHODS A pain management algorithm was implemented in three units over three weeks. Nurses' level of adherence with the algorithm and associations between level of adherence and patient and unit characteristics over 22 weeks were evaluated using multivariate regression analysis. RESULTS Nurses' level of adherence was 74.6%. Adherence rates were lower on the evening and night shifts compared to the day shift. Males were assessed significantly less frequently than females. Patients with "injury, poisoning, or certain other consequences of external causes" were assessed significantly less frequently than patients with "diseases of the respiratory system." CONCLUSIONS ICU nurses can use a pain management algorithm consistently. Findings from this study suggest that a pain management algorithm is a useful tool to increase ICU nurses' adherence with pain assessment.
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Bae KH, Jeong IS. [Pain perception of nurses and pain expression of patients in critical care units]. J Korean Acad Nurs 2015; 44:437-45. [PMID: 25231809 DOI: 10.4040/jkan.2014.44.4.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to identify pain perception (P-PER) by nurses and pain expression (P-EXP) by patients in critical care units (ICUs) and degree of agreement between nurses' P-PER and patients' P-EXP. METHODS Nurses' P-PER was measured with a self-administered questionnaire completed by 99 nurses working in ICUs during May, 2013. Patients' P-EXP was measured with the Critical Care Non-Verbal Pain Scale through observations of 31 ICU patients during nine nursing procedures (NPs) performed between May and July, 2013. RESULTS Nurses' P-PER was from 4.49 points for nasogastric tube (NGT) insertion to 0.83 for blood pressure (BP) measurement based on a 9-point scale, Patients' P-EXP was 4.48 points for NGT to 0.18 for BP measurement based on a 10-point scale. Eight NPs except oral care showed higher scores for nurses' P-PER than for patients' P-EXP. Position change (p=.019), subcutaneous injection (p<.001), blood sugar test (p<.001), and BP measurement (p<.001) showed significant differences between nurses' P-PER and patients' P-EXP. CONCLUSION Nasogastric tube (NGT) insertion was scored highest by both nurses and patients. Eight NPs except 'oral care' showed nurses' P-PER was higher or similar to patients' P-EXP, which indicates that nurses may overestimate procedural pain experienced by patients.
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Affiliation(s)
- Kyung Hee Bae
- Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Korea.
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Roulin MJ, Ramelet AS. Generating and selecting pain indicators for brain-injured critical care patients. Pain Manag Nurs 2014; 16:221-32. [PMID: 25439115 DOI: 10.1016/j.pmn.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 06/15/2014] [Accepted: 06/18/2014] [Indexed: 10/24/2022]
Abstract
Current pain assessment tools for nonverbal critical care patients may not be appropriate for those with brain injury, as these patients demonstrate specific responses to pain. The aim of this study was to generate and select items that could be used to assess pain in brain-injured patients. A sequential mixed-method design was chosen with three consecutive steps: 1. Generate items with a literature review, the results of a pilot study, and interviews with 18 clinicians using the nominal group technique. 2. Evaluate content validity with 10 clinicians and four scientists, using a web-based questionnaire. 3. Describe and reduce items with the observation of 116 brain-injured patients in the intensive care unit during common painful procedures. This study took place between May 2010 and October 2011 in two tertiary hospitals in Western Switzerland. Forty-seven items were generated and reduced to 33 during the content validity process. The behaviors most frequently observed during turning were closing the eyes (58.6%), eye movements (57.8%), ventilator asynchrony (55.2%), and frowning/brow lowering (50%). Five items were observed in less than 5% of the patients during nociceptive procedure. Constant motor activity was observed more frequently at rest than during nociceptive stimulation. All physiologic items showed little variability and their reliability was low. Based on these results, the number of items was reduced to 23. This study identified items that could be specific to brain-injured patients and found that the variability of physiologic items was poorly assessed by clinicians.
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Affiliation(s)
- Marie-José Roulin
- Institute of Higher Education and Nursing Research, Lausanne University-CHUV, Lausanne, Switzerland; University Hospitals of Geneva, Geneva, Switzerland.
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Nursing Research, Lausanne University-CHUV, Lausanne, Switzerland; University of Applied Sciences and Arts of Western Switzerland, Delémont, Switzerland
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Echegaray-Benites C, Kapoustina O, Gélinas C. Validation of the use of the Critical-Care Pain Observation Tool (CPOT) with brain surgery patients in the neurosurgical intensive care unit. Intensive Crit Care Nurs 2014; 30:257-65. [DOI: 10.1016/j.iccn.2014.04.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 04/04/2014] [Accepted: 04/05/2014] [Indexed: 11/29/2022]
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Chen HJ, Chen YM. Pain assessment: validation of the physiologic indicators in the ventilated adult patient. Pain Manag Nurs 2014; 16:105-11. [PMID: 25155717 DOI: 10.1016/j.pmn.2014.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 10/24/2022]
Abstract
Pain is one of the major stressors for critically ill patients. The first step for effective pain management is pain assessment. Due to the availability of physiologic monitoring devices in intensive care units, observing changes in vital signs provides a fast, simple, and objective method. However, the validity of physiologic indicators in pain assessment is still debatable. The aim of this study was to validate the discriminant and criterion validity of physiologic indicators for pain assessment in nonverbal patients. The study included 120 patients from the intensive care unit of a medical center of Taiwan. Patients were observed under two nursing procedures to examine the discriminant validity of physiologic indicators: 1) a nociceptive procedure: suctioning; 2) a non-nociceptive procedure: taking noninvasive blood pressure. Forty-four consciously ventilated patients were also asked to provide self-reported pain intensity. Discriminant validity was supported with higher heart rate and blood pressure during suctioning than the values before and after suctioning. Moreover, the heart rate and blood pressure during suctioning were significantly higher than the values during noninvasive blood pressure measurement. In terms of criterion-related validity, there was no significant correlation between patient's self-report of pain intensity and heart rate and blood pressure. As recommended by other scholars and researchers, heart rate and blood pressure can only be used as a cue for pain assessment. If pain is suspected, further appropriate assessment is necessary to provide accurate judgment.
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Affiliation(s)
- Huei-Jiun Chen
- Department of Nursing, Taichung Veterans General Hospital, Taiwan, ROC
| | - Yuh-Min Chen
- School of Nursing, China Medical University, Taiwan, ROC.
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Luk EK, Rose L. Conducting a large survey of critical care nurses in Canada: lessons learnt. Intensive Crit Care Nurs 2011; 27:173-9. [PMID: 21664135 DOI: 10.1016/j.iccn.2011.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/13/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Survey research provides information regarding clinician opinion, adherence to evidence-based recommendations and practice variation. Yet, the conduct of large surveys can present numerous challenges. Practical challenges such as establishing a sampling strategy consistent with a population's distribution may be anticipated. Additional unanticipated challenges may emerge during survey implementation that require troubleshooting and result in additional costs. OBJECTIVE Our objective is to inform nurse clinicians and researchers of our experiences in the conduct of a large, Canadian survey of critical care nurses. Specifically, we describe administrative, financial and logistical considerations and challenges. RESULTS Administrative challenges included negotiation with each provincial/territorial nursing association to facilitate survey distribution. Financial considerations included anticipated and unanticipated costs such as postage, nursing association fees, translation, printing, shipping and research assistant time. Logistical challenges included systematizing survey mail outs and tracking, and translating survey materials and responses for bilingual provinces. CONCLUSION Conduct of this large national survey required considerable financial resources, time, energy and coordination. We anticipate greater understanding of the work and cost associated with planning and implementing such surveys may inform researchers as well as critical care nurses considering responding to future survey invitations.
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Affiliation(s)
- Elena K Luk
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, Canada M5T 1P8
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