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Laures E, Williams J, McCarthy AM. Pain assessment & management decision-making in pediatric critical care. J Pediatr Nurs 2023; 73:e494-e502. [PMID: 37884405 DOI: 10.1016/j.pedn.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE The aim of this study was to explore how nurses in the Pediatric Intensive Care Unit (PICU) reach their pain management decisions in children who are mechanically ventilated and chemically paralyzed. DESIGN AND METHODS A qualitative descriptive design was used following a quantitative phase of a multi-method study. Eighteen PICU nurses participated in semi-structured interviews aiming at understanding how they assess pain and make management decisions. Content analysis was used to guide coding and generate themes. RESULTS Three major themes were identified: 1) Assessment or cues that nurses use to trigger a pain assessment; 2) Mental models or patterns that nurses create to interpret cues to guide decision-making; 3) External factors that inhibit or facilitate decision-making. Overall, nurses rely on physiological cues to assess pain. From there, a large amount of variation exists on how nurses interpret those cues to make their pain management decision. External factors such as unit culture, perceived barriers and facilitators, and the nurse's experiences impacted how decisions are made. CONCLUSIONS Variation exists in the mental models' nurses create to make their pain management decision in this population. Nurses reported confusion on pain and sedation scale selection and various documentation practices for pain assessment. "Assume pain present" was identified as a concept and documentation practice that may guide decisions; further research is needed. PRACTICE IMPLICATIONS Development of clinician decision support tools that not only aid their understanding of reliable pain cues but also help create clear documentation practices may help nurses make pain management decisions.
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Affiliation(s)
- Elyse Laures
- University of Iowa College of Nursing, 50 Newton Drive, Iowa City, IA 52242, United States of America; University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States of America.
| | - Janet Williams
- University of Iowa College of Nursing, 50 Newton Drive, Iowa City, IA 52242, United States of America
| | - Ann Marie McCarthy
- University of Iowa College of Nursing, 50 Newton Drive, Iowa City, IA 52242, United States of America
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Geremek A, Ruby L, Lindner C, Niederberger U, Schild U, Jung M, Soyka O, Siniatchkin M. Child and adolescent psychiatry staff's knowledge on pain management. Clin Child Psychol Psychiatry 2022:13591045221125334. [PMID: 36062462 DOI: 10.1177/13591045221125334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the level of child and adolescent psychiatric staff's knowledge regarding pain management, to determine group differences between the medically more educated (physicians, nurses) and the less educated (psychologists, educators, special therapists) and to investigate the influence of gender, age, or professional experience as well as staff's own pain experiences. METHODS A total of 193 staff members from different professional backgrounds from three independent child and adolescent psychiatry clinics in Northern Germany were tested using the German version of the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Shriner's revision (PNKAS-Sr). RESULTS In total, the staff scored correctly 66% of the inventory questions. There was no difference between medically more educated and less educated staff members regarding the knowledge of pain management. The main factors influencing PNKAS score were age, profession, and pain education training. CONCLUSIONS Although chronic pain is not one of the main aspects of continuing education in child and adolescent psychiatry, the resulting level of knowledge was comparable to results of similar surveys with paediatric staffs. Nevertheless, further education is needed to enhance knowledge and understanding of children's pain in child psychiatry staff in order to professionally treat patients with chronic somatic and mental illnesses.
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Affiliation(s)
- Adam Geremek
- 440814Psychosomatikum, Kiel, Germany.,Child and Adolescent Psychiatric Clinic, 440814Helios Klinikum Schleswig, Schleswig, Germany
| | - Lisa Ruby
- Child and Adolescent Psychiatric Clinic, 440814Helios Klinikum Schleswig, Schleswig, Germany
| | | | - Uwe Niederberger
- Institute for Medical Psychology and Sociology, University of Kiel, Kiel, Germany
| | - Ursula Schild
- Child and Adolescent Psychiatric Clinic, 440814Psychiatrische Kliniken, Lüneburg, Germany
| | | | - Oliver Soyka
- Child and Adolescent Psychiatric Clinic, 581931Vorwerker Diakonie, Lübeck, Germany
| | - Michael Siniatchkin
- 39718University Clinic for Child and Adolescent Psychiatry, Bielefeld, Germany
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Manworren RCB. Nurses' management of children's acute postoperative pain: A theory of bureaucratic caring deductive study. J Pediatr Nurs 2022; 64:42-55. [PMID: 35149258 DOI: 10.1016/j.pedn.2022.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few studies have examined the translation of nurses' knowledge of pain management into clinical practice or how nurses negotiated the bureaucracy of caring to treat patients' acute pain. PURPOSE This study describes factors that influence pediatric nurses' actions in caring for hospitalized children's acute post-surgical pain. METHOD Ray's Theory of Bureaucratic Caring provided the theoretical framework for this mixed methods study of ethnography and human factors engineering. Fourteen nurses were observed throughout their shifts (175.5 h) to elucidate humanistic and bureaucratic influences. FINDINGS Of 105 pain assessments, nurses intervened with pharmacologic (n = 45) and biobehavioral (n = 13) interventions for pediatric patients' post-surgical pain in less than 11 min; and 25 assessments revealed patients did not have pain. Pain was assessed and no intervention was provided to 4 patients who were asleep, 5 patients who refused, 2 patients who had no ordered analgesics and 10 patients who were assessed prior to peak effectiveness of their prior analgesic. Overall pain was well-controlled. Of the 28 themes identified, the interplay of 6 categorized to the social/cultural humanistic, 7 political, and 6 technologic/physiological bureaucratic dimensions most strongly influenced pain care. DISCUSSION To achieve optimal pain care outcomes, nurses' and parents' pain management knowledge was less influential for clinical practice translation than nurses' negotiation of other dimensions of bureaucratic caring.
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Affiliation(s)
- Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 100, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 100, Chicago, IL 60611, USA.
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Salim N, Joshua R, AbuBaker N, Chehab F, Jose A. Effect of a Nursing In-Service Education Program on Nurses’ Knowledge and Attitudes towards Pain Management in a Governmental Hospital in the United Arab Emirates: Experimental Random Assignment Study. DUBAI MEDICAL JOURNAL 2019. [DOI: 10.1159/000503560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Peirce D, Corkish V, Lane M, Wilson S. Nurses' Knowledge and Attitudes Regarding Pediatric Pain Management in Western Australia. Pain Manag Nurs 2019; 19:707-717. [PMID: 29773353 DOI: 10.1016/j.pmn.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 01/09/2018] [Accepted: 03/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIM Despite clinical guidelines, suboptimal pediatric pain management persists. A local audit found poor guideline compliance. Inadequate knowledge is a recognized barrier to the delivery of evidence-based care. The aim of the study was to investigate nurses' knowledge and attitudes regarding pain management at an Australian tertiary pediatric hospital. Design, Setting, Participants and Method: A cross-sectional, descriptive study using the Pediatric Pain Knowledge and Attitudes Questionnaire (Revised) was distributed to 590 nurses in an Australian pediatric hospital. RESULTS The mean knowledge score (n = 201) was 77.56 out of 100 (range 49.82-94.16, standard deviation [SD] 8.55); mean attitude score (n = 229) was 72.46 out of 100 (range 33.33-93.33, SD 11.76). Significant differences in mean knowledge scores were found between nurses' designations (p = .018), with the greatest mean difference (MD) between clinical nurses and enrolled nurses (10.5; p = .002). Nurses with experience in critical care had significantly higher mean knowledge scores (MD 3.1; p = .012). Senior registered nurses had the most positive mean attitude score (82.4, SD 6.2), which was significantly higher than clinical nurses (73.77, SD 10.0), registered nurses (71.64, SD 12.6), and enrolled nurses (68.89, SD 8.8) (p < .05). Nurses with specialist pediatric qualifications had significantly more positive attitude scores (mean 75.65, SD 11.6) than those without (mean 70.86, SD 11.7; p = .005). However, 51% of respondents believed that children tolerate pain better than adults do. CONCLUSION Although nurses' overall knowledge and attitude toward pediatric pain were among the highest reported, areas for targeted education using in-service education and workshops were identified alongside a need for exploration of the impediments to providing best care.
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Affiliation(s)
- Deborah Peirce
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia.
| | - Victoria Corkish
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia
| | - Margie Lane
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia
| | - Sally Wilson
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia
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Nurses’ Knowledge, Attitudes and Clinical Practice in Pediatric Postoperative Pain Management. Pain Manag Nurs 2018; 19:585-598. [DOI: 10.1016/j.pmn.2018.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 02/11/2018] [Accepted: 04/01/2018] [Indexed: 11/18/2022]
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Treadgold R, Boon D, Squires P, Courtman S, Endacott R. Implementation of paediatric pain care-bundle across South-West England clinical network of Emergency Departments and Minor Injury Units: A before and after study. Int Emerg Nurs 2018; 43:56-60. [PMID: 30381143 DOI: 10.1016/j.ienj.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/15/2018] [Accepted: 10/07/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pain management in children is often poorly executed in Emergency Departments and Minor Injury Units. The aim of this study was to assess the impact of a care bundle comprising targeted education on pain score documentation and provision of appropriately dosed analgesia for the paediatric population attending Emergency Departments (EDs) and Minor Injury Units (MIUs). METHODS A total of 29 centres - 5 EDs and 24 MIUs - participated in an intervention study initiated by Emergency Nurse Practitioners to improve paediatric pain management. In Phase 1, up to 50 consecutive records of children under 18 presenting at each MIU and ED were examined (n = 1201 records); Pain Score (PS), age, whether the child was weighed, and provision of analgesia was recorded. A care bundle consisting of an education programme, paediatric dosage chart and flyers, was then introduced across the 29 centres. Nine months following introduction of the care bundle, the same data set was collected from units (Phase 2, n = 1090 records). RESULTS The likelihood of children having a pain score documented increased significantly in Phase 2 (OR 6.90, 95% CI 5.72-8.32), The likelihood of children receiving analgesia also increased (OR1.82, 95% CI 1.51-2.19), although there was no increase in the proportion of children with moderate or severe pain receiving analgesia. More children were weighed following the care bundle (OR 2.58 95% CI 1.86-3.57). Infants and children who were not weighed were more likely to receive an incorrect analgesia dose (p < 0.01). CONCLUSIONS Rates of PS documentation improved and there was greater provision of analgesia overall following introduction of the care bundle. Although weighing of children did improve, the levels remain disappointingly low. EDs generally performed better than MIUs. The results show there were some improvements with this care bundle, but future work is needed to determine why pain management continues to fall below expected standards and how to further improve and sustain the impact of the care bundle.
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Affiliation(s)
- Ruth Treadgold
- Anaesthetic Department, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK.
| | - Daranee Boon
- Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK.
| | - Phillipa Squires
- Anaesthetic Department, Torbay and South Devon NHS Foundation Trust, Torquay TQ2 7AA, UK.
| | - Simon Courtman
- Anaesthetic Department, Derriford Hospital, Plymouth PL6 8DH, UK.
| | - Ruth Endacott
- Plymouth University/Royal Devon and Exeter Hospital Clinical School, Faculty of Health and Human Sciences, Plymouth University, Plymouth PL4 8AA, UK; School of Nursing and Midwifery, Monash University, Melbourne, VIC 3199, Australia.
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Alotaibi K, Higgins I, Day J, Chan S. Paediatric pain management: knowledge, attitudes, barriers and facilitators among nurses - integrative review. Int Nurs Rev 2018; 65:524-533. [PMID: 29956310 DOI: 10.1111/inr.12465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS To identify and synthesize evidence regarding the knowledge and attitudes of nurses, and barriers and facilitators to effective pain assessment and management in infants and children. BACKGROUND Pain among children is a common experience. Relief from pain is a fundamental human right, yet hospitalized children continue to experience unrelieved pain. Provision of effective pain management is an integral part of the nurse's role. METHODS Guided by Whittemore & Knafl's five-stage framework, primary peer-reviewed studies published in English between 2000 and 2018 were searched using CINAHL, PubMed, ProQuest, PsycINFO and Scopus. The initial search yielded 292 papers. Twenty-seven papers were included in this review: quantitative (n = 18), qualitative (n = 5) and mixed-methods (n = 4). RESULTS Findings showed that nurses internationally have poor knowledge and attitudes of basic pain assessment and management principles. Barriers to effective pain management include the absence of pain education and assessment tools, parents' reluctance to report pain and insufficient prescription of analgesia by physicians. Facilitators for the effective management of pain include parental participation in care, trusting and respectful relationships between nurses and children, and adequate nurse-patient ratios. CONCLUSION The review findings suggest a need to improve education for nurses, doctors and the patients' family in relation to paediatric pain management, communication and interprofessional collaborations. There is a need to maximize facilitators and overcome barriers, such as those identified in this review, to ensure the quality of paediatric pain management. IMPLICATIONS FOR NURSING AND HEALTH POLICY Nursing and health policy should mandate the prioritization of paediatric pain management and the clinical roles and responsibilities of the interdisciplinary team members. Undergraduate, postgraduate and in-service education for nurses and other health professionals should also address paediatric pain management. In-service education on paediatric pain management should be compulsory for all health professionals caring for children.
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Affiliation(s)
- K Alotaibi
- School of Nursing and Midwifery, the University of Newcastle, Callaghan NSW 2308, Australia
| | - I Higgins
- School of Nursing and Midwifery, the University of Newcastle, Callaghan NSW 2308, Australia
| | - J Day
- School of Nursing and Midwifery, the University of Newcastle, Callaghan NSW 2308, Australia
| | - S Chan
- Priority Research Centre of Brain and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan Australia
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Azize PM, Cattani A, Endacott R. Perceived language proficiency and pain assessment by registered and student nurses in native English-speaking and EAL children aged 4-7 years. J Clin Nurs 2018; 27:1081-1093. [PMID: 29076588 DOI: 10.1111/jocn.14134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To identify the factors that influence decisions made by health professionals when assessing the pain of native English speaking and children whose English is an additional language. BACKGROUND Pain assessment in children is often poorly executed following acute injury. Whilst a range of pain assessment tools have been developed, little guidance is provided for assessing pain in children with English as an additional language. DESIGN Factorial survey design. METHODS Twenty minor injuries unit nurses and 20 children's nursing students participated in an electronic survey to make judgements on 12 scenarios describing a child attending a minor injuries unit following an incident, accompanied by a parent. Respondents had to decide the most important form of pain assessment, and whether they would ask a parent or an interpreter to assess the pain of the child. An open-ended question asked about the difficulties found in making a judgement. RESULTS Observation of the child's behaviour was the most common pain assessment reported. The visual analogue scale was significantly associated with children with proficient English. Respondents were significantly more likely to involve parents in the assessment if they could speak English well compared to parents with poor English skills. Moreover, nursing students were significantly more likely than registered nurses to call for support from an interpreter. Thematic analysis identified three themes related to difficulties with pain assessment: contrasting approaches, differing perceptions of pain and overcoming challenges. CONCLUSIONS The reduced ability to communicate between child, parent and healthcare professional highlights the need to identify forms of assessment based on individual cases. RELEVANCE TO CLINICAL PRACTICE The number of children with English as an additional language has seen a marked rise over the last decade. In situations where communication ability is reduced, assessment of pain should be tailored to meet the needs of the child. This may require timely access to interpreter services.
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Affiliation(s)
- Pary M Azize
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.,Department of Nursing, Sulaimani Polytechnic University, Sulaimani, Iraq
| | | | - Ruth Endacott
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.,Royal Devon and Exeter Clinical School, Royal Devon and Exeter Hospital, Exeter, UK.,School of Nursing and Midwifery, Monash University, Melbourne, Vic., Australia
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Affiliation(s)
- Roberta Heale
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
| | - Alison Twycross
- School of Health and Social Care, London South Bank University, London, UK
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AlReshidi N, Long T, Darvill A. A Systematic Review of the Impact of Educational Programs on Factors That Affect Nurses’ Post-Operative Pain Management for Children. Compr Child Adolesc Nurs 2017; 41:9-24. [DOI: 10.1080/24694193.2017.1319432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nahar AlReshidi
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, UK
| | - Tony Long
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, UK
| | - Angela Darvill
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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12
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Mackintosh-Franklin C. Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom. NURSE EDUCATION TODAY 2017; 48:84-89. [PMID: 27723538 DOI: 10.1016/j.nedt.2016.08.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/15/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Pain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering. Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management. DESIGN A three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool. RESULTS The word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes. CONCLUSION In spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary patient suffering will continue. Undergraduate nurse education in the UK needs to review its current approach to content and ensure that pain is appropriately and prominently featured within pre-registration nurse education.
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Twycross A, Forgeron P, Williams A. Paediatric nurses’ postoperative pain management practices in hospital based non-critical care settings: A narrative review. Int J Nurs Stud 2015; 52:836-63. [DOI: 10.1016/j.ijnurstu.2015.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
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Yin HH, Tse MMY, Wong FKY. Systematic review of the predisposing, enabling, and reinforcing factors which influence nursing administration of opioids in the postoperative period. Jpn J Nurs Sci 2015; 12:259-75. [PMID: 25781037 DOI: 10.1111/jjns.12075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 12/17/2014] [Indexed: 11/28/2022]
Abstract
AIM To provide an overview of the administration of opioid analgesics by nurses when prescription is on an "as-needed" basis for postoperative pain, and to identify the important factors that determine the decisions of nurses, by using the framework of predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation. METHODS Multiple databases were searched for the period from 2000-2012. Out of a total of 1755 citations and 148 abstracts retrieved, 39 studies met the criteria for inclusion. Studies were considered eligible for review if they focused on situations or factors influencing a nurse's performance in pain assessment and the administration of opioid analgesics in postoperative pain management. RESULTS The topics of the descriptive and qualitative studies presented four themes: (i) nurses' knowledge and attitudes about pain management; (ii) the situation of nurses' work practices in administrating range orders for opioid analgesics; (iii) factors that influenced nurses' work practices; and (iv) perceived barriers to effective pain management from the nurse's perspective. The experimental studies investigated the effects of different approaches in nurses' pain management practices in postoperative settings and their outcomes for patients. CONCLUSION A knowledge deficit was observed to be the reason in most cases for a nurse's failure to administrate adequate analgesics for postoperative pain relief. Pain-related education for nurses is the cornerstone to improve pain management. The integration of enabling and reinforcing factors will help nurses to develop the ability to make the decision to engage in a comprehensive intervention to improve pain management and patient outcomes.
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Affiliation(s)
- Hai-Hui Yin
- Department of Nursing Administration, Anhui Provincial Hospital, Hefei
| | - Mimi M Y Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Frances K Y Wong
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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He HG, Klainin-Yobas P, Ang ENK, Sinnappan R, Pölkki T, Wang W. Nurses' provision of parental guidance regarding school-aged children's postoperative pain management: a descriptive correlational study. Pain Manag Nurs 2014; 16:40-50. [PMID: 24957816 DOI: 10.1016/j.pmn.2014.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/28/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022]
Abstract
Involving parents in children's pain management is essential to achieve optimal outcomes. Parents need to be equipped with sufficient knowledge and information. Only a limited number of studies have explored nurses' provision of parental guidance regarding the use of nonpharmacologic methods in children's pain management. This study aimed to examine nurses' perceptions of providing preparatory information and nonpharmacologic methods to parents, and how their demographics and perceived knowledge adequacy of these methods influence this guidance. A descriptive correlational study using questionnaire surveys was conducted to collect data from a convenience sample of 134 registered nurses working in seven pediatric wards of two public hospitals in Singapore. Descriptive statistics, independent-samples t test, and multiple linear regression were used to analyze the data. Most nurses provided various types of cognitive information to parents related to their children's surgery, whereas information about children's feelings was less often provided. Most nurses provided guidance to parents on positioning, breathing technique, comforting/reassurance, helping with activities of daily living, relaxation, and creating a comfortable environment. Nurses' provision of parental guidance on preparatory information and nonpharmacologic methods was significantly different between subgroups of age, education, parent or not, and perceived knowledge adequacy of nonpharmacologic methods. Nurses' perceived knowledge adequacy was the main factor influencing their provision of parental guidance. More attention should be paid to nurses who are younger, have less working experience, and are not parents. There is a need to educate nurses about nonpharmacologic pain relief methods to optimize their provision of parental guidance.
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Affiliation(s)
- Hong-Gu He
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emily Neo Kim Ang
- Clinical and Oncology Nursing, National University Hospital, Singapore
| | | | - Tarja Pölkki
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies Department, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Olmstead DL, Scott SD, Mayan M, Koop PM, Reid K. Influences shaping nurses' use of distraction for children's procedural pain. J SPEC PEDIATR NURS 2014; 19:162-71. [PMID: 24589186 DOI: 10.1111/jspn.12067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE This study explored pediatric nurses' choices to use distraction for managing painful procedures. DESIGN AND METHODS Using interpretive description approaches, interviews with pediatric nurses provided descriptions of choices to manage procedural pain. RESULTS Nurses' distress influenced distraction use to mitigate the suffering of children and themselves. Newer nurses described task mastery as influencing distraction choices. Nurses' accounts of performing painful procedures on children mirrored children's descriptions of pain from the literature. PRACTICE IMPLICATIONS Nurses' distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain.
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Twycross A, Finley GA. Nurses' aims when managing pediatric postoperative pain: is what they say the same as what they do? J SPEC PEDIATR NURS 2014; 19:17-27. [PMID: 24393225 DOI: 10.1111/jspn.12029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/15/2013] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to explore nurses' aims when managing postoperative pain and whether reported aims reflect actual practices. DESIGN AND METHODS Participant observation was used to collect data regarding nurses' (n = 17) pain management practices. Nurses (n = 19) were asked: When managing postoperative pain, what is your overall aim? RESULTS Around half the participants (n = 10) aimed for patients to be comfortable while others aimed for a pain score of 2-3 (n = 7), or below 5 (n = 2). Observed practices matched aims for just more than half the participants (n = 9). PRACTICE IMPLICATIONS There is evidence of individual variation in practices. This may impact on the care provided.
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Affiliation(s)
- Alison Twycross
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, London, UK
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Review of Pain Content in Three-Year Preregistration Pediatric Nursing Courses in the United Kingdom. Pain Manag Nurs 2013; 14:247-258. [DOI: 10.1016/j.pmn.2011.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 11/19/2022]
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Twycross A, Williams A. Establishing the Validity and Reliability of a Pediatric Pain Knowledge and Attitudes Questionnaire. Pain Manag Nurs 2013; 14:e47-53. [DOI: 10.1016/j.pmn.2011.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/23/2011] [Accepted: 03/02/2011] [Indexed: 11/28/2022]
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Copanitsanou P, Valkeapää K. Effects of education of paediatric patients undergoing elective surgical procedures on their anxiety - a systematic review. J Clin Nurs 2013; 23:940-54. [DOI: 10.1111/jocn.12187] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kirsi Valkeapää
- Department of Nursing Science; University of Turku; Turku Finland
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Twycross A. Nurses' views about the barriers and facilitators to effective management of pediatric pain. Pain Manag Nurs 2011; 14:e164-e172. [PMID: 24315269 DOI: 10.1016/j.pmn.2011.10.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 09/28/2011] [Accepted: 10/17/2011] [Indexed: 10/14/2022]
Abstract
Children continue to experience moderate to severe pain during hospitalization. This paper presents data from two modified focus groups undertaken as part of a larger study exploring pediatric pain management practices in one hospital in the south of England. Thirty nurses took part in the focus groups and were asked questions about their views about the barriers and facilitators to effective pain management in the hospital. Participants identified a number of barriers which related to the staff, children and parents and the organization. Nurses indicated that they and the medical staff lacked knowledge about pain management. They also felt that staff shortages and a heavy workload detracted from the quality of the care they could provide. Several participants indicated that insufficient analgesic drugs were sometimes prescribed. Many of the barriers identified related to parents and children. It appears that nurses may not take as active a role as they could do in managing pediatric pain rather seeing it as the parents and child's responsibility to let them know when they are experiencing pain. Nurses also felt that parents exaggerate their child's pain and ask for analgesic drugs before their child needs them. There is a need to explore the interactions between nurses, children and parents in this context in more detail.
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Affiliation(s)
- Alison Twycross
- Faculty of Health and Social Care Sciences, Kingston University-St. George's University of London, London, United Kingdom; Epsom and St. Helier NHS Trust, Carshalton, Surrey.
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Efe E, Dikmen Ş, Altaş N, Boneval C. Turkish pediatric surgical nurses' knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns' pain relief. Pain Manag Nurs 2011; 14:343-350. [PMID: 24315257 DOI: 10.1016/j.pmn.2011.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 08/12/2011] [Indexed: 10/15/2022]
Abstract
Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to describe Turkish pediatric surgical nurses' knowledge and use of pain assessment and nonpharmacologic and environmental methods in relieving newborn's pain in hospital. The sample consisted of 111 pediatric surgical nurses employed in pediatric surgical unit in 15 university hospitals located in Turkey. A questionnaire was used to measure the nurses' knowledge and use of pain assessment, nonpharmacologic, and environmental methods. Data were analyzed with the use of descriptive statistics. Of the nurses that participated in the study, 83.8% were between the ages of 20 and 35 years, 54.1% had a bachelor degree, and 75.7% had a nursing experience ≤10 years. 50.5% stated that physiologic and behavioral indicators used in the assessment of pain in infants. The most commonly used nonpharmacologic methods were giving nonnutritive sucking, skin-to-skin contact, and holding. The most commonly used environmental methods were avoiding talking loudly close to the baby, minimal holding, care when opening and closing of the incubator, avoiding making noise when using wardrobe, drawers, trash, or nearby devices, such as radio and television, avoiding sharp fragrances, such as alcohol, perfume, near the baby, and reducing light sources. Although Turkish pediatric surgical nurses used some of the nonpharmacological and environmental methods in infant's pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.
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Affiliation(s)
- Emine Efe
- Child Health Nursing Department, School of Health, Akdeniz University, Antalya, Turkey.
| | - Şevkiye Dikmen
- Pediatric Surgical Unit, Akdeniz University Hospital, Antalya, Turkey
| | - Nuray Altaş
- Pediatric Surgical Department, Akdeniz University Hospital, Antalya, Turkey
| | - Cem Boneval
- Pediatric Surgical Department, Akdeniz University Hospital, Antalya, Turkey
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Cancer pain management in ambulatory care: can we link assessment and action to outcomes? Support Care Cancer 2010; 19:1865-71. [PMID: 21052733 DOI: 10.1007/s00520-010-1030-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 10/11/2010] [Indexed: 11/12/2022]
Abstract
PURPOSE Good cancer pain control requires appropriate assessment and treatment. The purpose of this study was to examine the relationships among physician, nurse practitioner, and nurse knowledge, documentation of assessment, treatment, and pain reduction in cancer patients seen in ambulatory settings. METHOD The study method included an assessment of pain knowledge of providers (physicians, nurse practitioners, and nurses) who worked in cancer clinics and a retrospective review of patients' records treated for cancer-related pain in their clinics. Fifty-eight providers from eight cancer clinics completed the knowledge questionnaire; 56 patient records were reviewed for assessment, treatment, and outcome data. Pain relief, the outcome, was obtained from documentation at the next clinic visit. RESULTS Of the 54 patient records that documented pain relief at the next clinic visit, 61.9% reported no relief. Chi square analysis revealed clinics with a higher level of pain knowledge documented a greater number of elements of an ideal pain assessment (p = 0.03) but was unrelated to treatment and pain relief reported. Assessment and treatment were unrelated to reported pain relief at the next clinic visit. CONCLUSION These data suggest that providers' pain knowledge is related to pain assessment but not treatment or outcome. In addition, these data showed no relationship between assessment, treatment prescribed, and pain relief in these ambulatory settings.
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He HG, Jahja R, Lee TL, Ang ENK, Sinnappan R, Vehviläinen-Julkunen K, Chan MF. Nurses’ use of non-pharmacological methods in children’s postoperative pain management: educational intervention study. J Adv Nurs 2010; 66:2398-409. [DOI: 10.1111/j.1365-2648.2010.05402.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Twycross A. Does the perceived importance of a pain management task affect the quality of children’s nurses’ post-operative pain management practices? J Clin Nurs 2008; 17:3205-16. [DOI: 10.1111/j.1365-2702.2008.02631.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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