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Neuwersch-Sommeregger S, Köstenberger M, Pipam W, Demschar S, Trummer B, Breschan C, Likar R. Pain in Austrian hospitals: evaluation of 1089 in-patients. Wien Med Wochenschr 2024; 174:69-78. [PMID: 36441358 DOI: 10.1007/s10354-022-00984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the existence of internationally consistent guidelines for the management of pain, efficient regional anesthesia techniques, safe pain medications, and organizational structures, e.g., acute pain services, various studies have shown that pain is still common among both surgical and non-surgical in-patients. OBJECTIVE The primary objective of this study was to evaluate, on a multi-center basis, the point pain prevalence of surgical and non-surgical in-patients. We further analyzed pain intensities, in-hospital pain triggers, pain-related impairments, pain assessments, patient information about pain, and patient satisfaction with pain therapy. This benchmark information should lead to better implementation of pain management strategies and thus improve health care quality. METHODS We surveyed all adult in-patients in three general hospitals in Austria (general hospital Klagenfurt am Wörthersee, general hospital Villach, general hospital Wolfsberg) on the index day with two standardized questionnaires for both surgical and non-surgical patients. RESULTS Overall, a pain prevalence of 40.0%, with no statistically significant difference between surgical and non-surgical patients, was shown. Higher pain prevalence in female patients, high pain prevalence in the age group 18-30 years, and highest pain prevalence in the age group over 90 years old was found. Overall pain intensity was relatively low, but unacceptable maximum pain within the preceding 24 h was shown. Different in-hospital pain triggers like patient's care and mobilization were found. Our survey has shown that pain has an impact on personal hygiene, mobilization, mood, sleep, and appetite. However, patients were very satisfied with their pain therapy. CONCLUSION Medical staff and nurses have to be sensitized to the urgent need to improve pain management strategies.
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Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria.
- Medical University of Graz, Graz, Austria.
| | - Markus Köstenberger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Wolfgang Pipam
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Susanne Demschar
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Brigitte Trummer
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Christian Breschan
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Rudolf Likar
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Paracelsus Medical University, Salzburg, Austria
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Jin Y, Yu X, Li J, Su M, Li X. Causal effects and immune cell mediators between prescription analgesic use and risk of infectious diseases: a Mendelian randomization study. Front Immunol 2023; 14:1319127. [PMID: 38193081 PMCID: PMC10772142 DOI: 10.3389/fimmu.2023.1319127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Clinical observations have found that prolonged use of analgesics increases the incidence of infection. However, the direct causal relationship between prescription analgesic use (PAU) and risk of infection (ROI) remains unclear. Methods This study used Mendelian randomization (MR) design to estimate the causal effect of PAU on ROI, as well as their mediating factors. Genetic data on prescription analgesics use and immune cells were obtained from published GWAS. Additionally, data on ROI were extracted from the FinnGen database. Two-sample MR analysis and multivariate MR (MVMR) analysis were performed using inverse variance weighting (IVW) to ascertain the causal association between PAU and ROI. Finally, 731 immune cell phenotypes were analyzed for their mediating role between analgesics and infection. Results Using two-sample MR, IVW modeling showed that genetically predicted opioid use was associated with increased risk of pulmonary infection (PI) (OR = 1.13, 95% CI: 1.05-1.21, p< 0.001) and upper respiratory infection (URI) (OR = 1.18, 95% CI: 1.08-1.30, p< 0.001); non-steroidal anti-inflammatory drugs (NSAIDs) were related to increased risk of skin and subcutaneous tissue infection (OR = 1.21, 95% CI: 1.05-1.39, p = 0.007), and antimigraine preparations were linked to a reduced risk of virus hepatitis (OR = 0.79, 95% CI: 0.69-0.91, p< 0.001). In MVMR, the association of opioids with URI and PI remained after accounting for cancer conditions. Even with a stricter threshold (p< 0.05/30), we found a significant causal association between opioids and respiratory infections (URI/PI). Finally, mediation analyses found that analgesics influence the ROI through different phenotypes of immune cells as mediators. Conclusion This MR study provides new genetic evidence for the causal relationship between PAU and ROI, and the mediating role of immune cells was demonstrated.
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Affiliation(s)
- Yi Jin
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xinghao Yu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jun Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Mingzhu Su
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xiaomin Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
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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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Clinton-McHarg T, Paul C, Sanson-Fisher R, Turon H, Butler M, Lindeman R. Are the Physical Environments of Treatment Centres Meeting Recommendations for Patient-Centred Care? Perceptions of Haematological Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094892. [PMID: 34064433 PMCID: PMC8125011 DOI: 10.3390/ijerph18094892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
The physical environment of a treatment centre may impact the well-being of patients and their perceptions of care. Outpatients with haematological cancer may be in contact with the treatment centre over long periods and could be particularly affected. This study aimed to identify haematological cancer patients' perceptions of supportive design elements in the hospital they attended and associations with self-reported mood or well-being. Outpatients from three large metropolitan hospitals in Australia were mailed a self-report questionnaire and responded to statements about the treatment centre concerning their sense of control over the physical surroundings; access to social support; and access to positive distractions. Participants also reported whether they felt the overall environment affected their mood or wellbeing. Of the outpatients who returned the questionnaire (n = 165), almost one-quarter (24%) agreed that the physical environment of the hospital affected their mood or well-being. Patients who disagreed that the hospital was a comfortable temperature or agreed that waiting rooms were crowded had significantly higher odds of reporting that the treatment environment affected their mood or wellbeing. Implementing systems to reduce overcrowding in waiting rooms and increasing patient control over personal temperature in clinics may be the most effective strategies to improve patient wellbeing.
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Affiliation(s)
- Tara Clinton-McHarg
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Psychology, The University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence:
| | - Christine Paul
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Heidi Turon
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Michelle Butler
- Hunter New England Population Health, Wallsend, NSW 2287, Australia;
| | - Robert Lindeman
- Department of Haematology, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
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Jepegnanam C, Bull E, Bansal S, McCarthy D, Booth M, Purser E, Makaka T, Shapley G, Cooper J, Probert J, Malpus Z. The role of the psychologist in the inpatient pain service: development and initial outcomes. Br J Pain 2021; 15:163-174. [PMID: 34055338 PMCID: PMC8138620 DOI: 10.1177/2049463720926212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM This article describes the development and initial evaluation of introducing a psychologist role within an adult inpatient pain service (IPS) in a large North West of England National Health Service (NHS) trust. BACKGROUND The role of a psychologist in the management of outpatient chronic pain has been well documented, but their role within the IPS is less well described and rarely evaluated. We describe the development of a psychologist role within the team and initial service evaluation outcomes. METHODS Following an initial needs assessment, a band 8c psychologist joined the IPS one day per week offering brief one-to-one psychological interventions to people struggling with acute or chronic pain in hospital referred by inpatient pain team. The psychologist had an indirect role offering training, supervision and support to members of the inpatient pain team. Regarding direct patient work, following psychometric screening for pain-related disability and distress, a cognitive behavioural therapy (CBT) approach was applied including identifying unhelpful beliefs about pain, psychoeducation about acute and persistent pain, developing and sharing formulations, skills training including breathing and relaxation exercises and where appropriate, signposting onto an outpatient chronic pain services for further pain self-management advice (e.g. pain management programme. To explore the impact of this direct intervention, a prospective service evaluation with a controlled before and after design was conducted. This compared (a) number of admissions and (b) length-of-stay outcomes in the 12 months following psychometric screening for patients who received psychological input (n = 34, the treatment group) and a sample who did not receive input because of discharge before intervention or non-availability of the psychologist, for example, annual leave (n = 30, control group). Demographic information and summaries of psychometric questionnaires were also analysed. RESULTS Of the sample of 64 patients, 50 were women, ages ranged from 18-80 years, 72% reported being currently unemployed or off sick from work and on screening and 39% and 48% met criteria for severe depression and pain-related anxiety, respectively. Hospital admissions in the intervention group reduced significantly (by 60%) in the 12 months following screening but increased (by 7%) for the control group (F(1,62) = 7.21, p = .009). Days of stay in hospital reduced significantly more (by 84%) in the intervention group than in the control group (by 41%) (F(1,62) = 8.90, p = .004). Illustrated case studies of brief psychological intervention with three people struggling with pain-related distress are presented. CONCLUSIONS The psychologist became a valuable member of the multi-disciplinary IPS team, offering brief direct and indirect psychological interventions. While a relatively small sample, our prospective service evaluation data suggest brief psychological intervention may contribute to reduced length of stay and hospital admissions for people experiencing pain-related distress in hospital.
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Affiliation(s)
- Chandran Jepegnanam
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Eleanor Bull
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Sujesh Bansal
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - David McCarthy
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Maureen Booth
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Elizabeth Purser
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Tecla Makaka
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Gemma Shapley
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Jo Cooper
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Jill Probert
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoey Malpus
- Inpatient Pain Service, Manchester Royal Infirmary,
Manchester University NHS Foundation Trust, Manchester, UK
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Saunders R, Crookes K, Atee M, Bulsara C, Bulsara MK, Etherton-Beer C, Ewens B, Gallagher O, Graham RM, Gullick K, Haydon S, Nguyen KH, O'Connell B, Seaman K, Hughes J. Prevalence of frailty and pain in hospitalised adult patients in an acute hospital: a protocol for a point prevalence observational study. BMJ Open 2021; 11:e046138. [PMID: 33757956 PMCID: PMC7993156 DOI: 10.1136/bmjopen-2020-046138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. METHODS AND ANALYSIS A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. ETHICS AND DISSEMINATION Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020-02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER ACTRN12620000904976.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mustafa Atee
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- The Dementia Centre, St Leonards, New South Wales, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- WA Centre for Health & Ageing, University of Western Australia, Crawley, Western Australia, Australia
| | - Beverley Ewens
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Renee M Graham
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karen Gullick
- Clinical Services, Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Sue Haydon
- Clinical Services, Hollywood Private Hospital, Nedlands 6009, Western Australia, Australia
| | - Kim-Huong Nguyen
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Bev O'Connell
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Jeff Hughes
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- PainChek Ltd, Bentley, Western Australia, Australia
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Akbar N, Teo SP, Artini Hj-Abdul-Rahman HN, Hj-Husaini HA, Venkatasalu MR. Barriers and Solutions for Improving Pain Management Practices in Acute Hospital Settings: Perspectives of Healthcare Practitioners for a Pain-Free Hospital Initiative. Ann Geriatr Med Res 2019; 23:190-196. [PMID: 32743311 PMCID: PMC7370760 DOI: 10.4235/agmr.19.0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background Effective pain management is a fundamental human right. However, global disparities in pain management practices exist across health settings. This study explored healthcare practitioners’ views on pain management in the acute care hospital setting. Methods The focus groups included clinical specialties most likely to encounter patients with ‘difficult to manage pain’, namely those in the Geriatrics and Palliative Care Unit (2 doctors and 3 nurses), Critical Care Unit (7 doctors), and the Pain Management Team (3 doctors and 2 nurses). The transcripts were analyzed using a qualitative thematic analysis. Results The data analysis revealed four themes. Theme 1, ‘Being too safe’ described the presence of apprehensive attitudes among patients and healthcare practitioners that limits the appropriate use of diverse and tailored pain medications in acute care hospital settings. Theme 2, ‘Working as a team’ described the need for collaborative approaches to achieve hospital-wide evidence-based pain management. Theme 3, ‘Adaptation for local and cultural preferences’ explored how pain was perceived through cultural lenses and suggested strategies to tailor pain management to local and cultural preferences. Finally, Theme 4, ‘Driving acute pain management forward’ listed clinician solutions for improving pain management in acute care hospital settings toward a pain-free hospital initiative. Conclusion Despite advances in pain medicine and pain teaching strategies, effective pain management is proportionate to both clinical and cultural preferences. Future studies should investigate the standardization of global pain management tools and guidelines to fit the local culture and context.
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Affiliation(s)
- Nuraqilah Akbar
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah (PAPRSB) Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
| | - Shyh Poh Teo
- Geriatrics and Palliative Unit, Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam
| | - Hjh Noor Artini Hj-Abdul-Rahman
- Geriatrics and Palliative Unit, Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam
| | - Hjh Asmah Hj-Husaini
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah (PAPRSB) Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
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Carr ECJ, Hall M, Seneviratne C. Student Nurses’ Experiences and Reflections on Pain Management in the Clinical Setting: An Exploratory Analysis of Students’ Choice of Assignment Topic. Can J Nurs Res 2019; 51:274-284. [DOI: 10.1177/0844562119838677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundPain, particularly chronic pain, represents a global health burden. The provision of undergraduate pain education for health professionals remains suboptimal, and yet pain features as an important competency for successful licensure in Canada.PurposeTo explore what clinical events undergraduate nursing students identify as critical to their learning. If pain featured, then to describe the nature of the pain incident.MethodsA retrospective cross-sectional design with a thematic analysis of year 3 undergraduate student nurses’ assignments was used. For the assignments identified as related to pain, a more detailed inductive content analysis was used to provide a condensed but broad description of the data.ResultsA total of 215 students participated. The most reported topics were pain (14.8%), patient assessment (10.2%), patient-/family-centered care (10.2%), and effective communication (9.8%). For those who described a pain encounter in their clinical experience, advocacy, managing the gap, and a lack of knowledge were the main focus.ConclusionsThis study provided valuable insights to the ways in which student nurses wrote about their experiences and management of pain in the clinical setting. Strengthening learning in the nursing curricula around advocacy and conflict management might provide new ways to improve pain education.
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Affiliation(s)
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Pancorbo-Hidalgo PL, Bellido-Vallejo JC. Clinical Validation of the Nursing Outcome "Pain: Disruptive Effects" in People With Chronic Pain in Spain. J Nurs Meas 2019; 27:384-400. [PMID: 31871281 DOI: 10.1891/1061-3749.27.3.384] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The measurement of the effects of chronic pain on the patients is a challenge for nurses. The purpose was to translate into Spanish and to assess the psychometrics of the indicators of the nursing outcome "Pain: disruptive effects." METHODS A three-stage study: (a) translation and cultural adaptation, (b) content validation, (c) clinical validation in 10 healthcare centers. RESULTS The Spanish version of the outcome "Pain: disruptive effects" has high content validity (CVI = .90) with 17 indicators organized into three factors. The Inter-observer agreement was good (kappa = .66) and the internal consistency high (alpha = .90). CONCLUSIONS The 17 indicators of the outcome "Pain: disruptive effects" has evidence of reliability and validity for assessing the harmful effects of chronic pain.
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Jackson HJ, Reneau M. Complementary therapies for acute pain management: What does the evidence say? Nurse Pract 2019; 44:8-11. [PMID: 31764469 DOI: 10.1097/01.npr.0000605532.19434.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Heather J Jackson
- Heather J. Jackson is an NP and administrative director of advanced practice, Vanderbilt Ingram Cancer Center and associate in anesthesiology, pain division at Vanderbilt University Medical Center, Nashville, Tenn. Marcelaine Reneau is an NP at Ralph H. Johnson Veterans Administration Medical Center, Integrative Pain Clinic, Department of Anesthesia, Charleston, S.C
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Das SK, Dhar SS, Panigrahi A. Prevalence of Pain and Its Characteristics in Hospitalized Patients in an Indian Teaching Hospital. Pain Manag Nurs 2019; 21:299-303. [PMID: 31303530 DOI: 10.1016/j.pmn.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pain has a great impact on the physical and mental condition of hospitalized patients, reduces quality of life, and increases economic burden. AIMS The study aimed to determine pain prevalence, its characteristics, analgesic treatment, and associated factors for severity and chronicity of pain in hospitalized patients. METHODS A cross-sectional study was carried out including 847 eligible adult in-patients, aged ≥18 years, admitted to the All India Institute of Medical Sciences, Bhubaneswar, India, from June to August 2018. Pain severity was evaluated by visual analog scale (VAS) at the time of interview and after 1 week/completion of pain treatment. RESULTS The prevalence of pain during the 24 hours preceding the interview was 70.6%. The duration of pain was ≥4 weeks in 162 (27.1%) patients and severe (VAS ≥ 7) in 144 (24.1%) patients. The mean VAS score was 6.27 ± 1.97 at the time of interview and 3.31 ± 1.89 after 1 week/completion of pain treatment (p < .001). Use of opioid analgesics (adjusted odds ratio [aOR]: 3.18; confidence interval [CI]: 2.23-4.55) was significantly related to pain severity, whereas patients ≥60 years (aOR: 1.64; CI: 0.99-2.70), patients in a nonsurgical ward (aOR: 1.78; CI: 1.21-2.60), and patients using opioid analgesics (aOR: 2.63; CI: 1.73-3.98) had prolonged pain, defined as ≥4 weeks. CONCLUSION Pain prevalence and intensity in this Indian hospital were high and pain treatment was adequate in many cases. Timely assessment and appropriate management of pain in hospitalized patients is needed to prevent further pain and its complications in these patients.
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Affiliation(s)
- Saroj Kumar Das
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sovan Sarang Dhar
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ansuman Panigrahi
- Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India.
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Hariharan S, Chen D, Sampath C, Pundit V, Dhanai A, Blackett L, Franklyn K, Henry S, Rochester K, Siwawa G. The prevalence of pain among adult patients attending outpatient clinics in Trinidad. CARIBBEAN MEDICAL JOURNAL 2018. [DOI: 10.48107/cmj.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives
To determine the prevalence of pain among adult patients attending outpatient clinics in Trinidad and the factors associated with the higher prevalence of chronic pain.
Methods
A direct face-to face survey was conducted in adult patients of the medical and surgical outpatient clinics of the major hospitals. Data recorded included demographics, clinical information. A Numerical Pain Rating Scale (NRS) was used to quantify the intensity of pain. Patient perceptions regarding the chronic pain was captured by a 6-item questionnaire in a 5-point Likert Scale.
Results
A total of 621 adult patients were studied. Overall, acute pain was prevalent in 13% and chronic pain in 56% of the outpatients. Majority of the patients ranked their pain severity as 8 and 10 on the NRS. Pain was commonly affecting back and lower limbs. Older age, female gender, East Indian ethnicity and surgical conditions predisposed to higher prevalence of pain. Although 90% of the patients were treated with analgesics, 33% were dissatisfied with the management. More than 80% of patients felt that their chronic pain affected their quality of life and 64% felt it caused financial burden in their life.
Conclusion
The prevalence of pain is high in adult Trinidadian outpatients. Pain was of severe intensity, commonly affected the back and lower limbs. Many patients were not satisfied with their current treatment. There is a need for establishing pain clinics in the public healthcare system of Trinidad & Tobago.
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Affiliation(s)
- Seetharaman Hariharan
- Anaesthesia & Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago
| | - Deryk Chen
- Anaesthesia & Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad & Tobago
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13
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Xiao H, Liu H, Liu J, Zuo Y, Liu L, Zhu H, Yin Y, Song L, Yang B, Li J, Ye L. Pain Prevalence and Pain Management in a Chinese Hospital. Med Sci Monit 2018; 24:7809-7819. [PMID: 30382075 PMCID: PMC6225731 DOI: 10.12659/msm.912273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Pain prevalence has been investigation in many developed countries, but integrated information about pain prevalence in Chinese hospitals is lacking. To achieve better pain treatment of hospitalized patients, pain management needs to be investigated. The present descriptive and cross-sectional study was performed to demonstrate the prevalence of pain by comparison with the 4 traditional vital signs, and to investigate pain management in a Chinese teaching hospital. Material/Methods Structured and systematic interviews were undertaken by independent researchers. During a patient’s hospitalization, the prevalence of pain and the 4 vital signs were recorded. Then, the catalog, severity, causes, duration of pain, and pain management were assessed. Results We found: (1) 63.36% of patients (3248 in total) suffered from pain while in hospital, which was 1.8~2.8 times higher than the prevalence of abnormality of the 4 vital signs. (2) 76% of patients had moderate pain and 21.98% had severe pain. (3) Pain intensity differed among patients with different diseases, but did not differ by demographic factors. (4) Acute and chronic pain were present in 68% and 26% of patients, respectively. In addition, 16% of the patients had neuropathic pain. (5) More than half of the patients with pain refused to receive pain-relief medication because they worried about addiction to opioids and the adverse effects of analgesics. (6) Most medical staff properly understood the 3 ladder analgesics. Conclusions The prevalence of pain is higher than the abnormality of the 4 traditional vital signs in a Chinese hospital. Although pain management has broadly improved, more patient education is necessary.
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Affiliation(s)
- Hong Xiao
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Hui Liu
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Li Liu
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Hong Zhu
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yan Yin
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Li Song
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Bangxiang Yang
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jun Li
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Ling Ye
- Department of Pain Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
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Pain in hospitalized patients in a third-level health care institution. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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The effectiveness of the Pain Resource Nurse Program to improve pain management in the hospital setting: A cluster randomized controlled trial. Int J Nurs Stud 2017; 75:83-90. [DOI: 10.1016/j.ijnurstu.2017.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023]
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Andersson V, Bergman S, Henoch I, Ene KW, Otterström-Rydberg E, Simonsson H, Ahlberg K. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain 2017; 15:22-29. [DOI: 10.1016/j.sjpain.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Abstract
Abstract
Background and aim
Studies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.
Methods
A cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.
Results
When compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.
Conclusions
This study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.
Implications
Nurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.
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Affiliation(s)
- Viveka Andersson
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Department of Medicine , Hallands Hospital Varberg , Träslövsvägen 68, 432 37 , Varberg , Sweden
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine , Institute of Medicine, The Sahlgrenska Academy , University of Gothenburg , Box 457, 405 30 , Gothenborg , Sweden
- Spenshult Research and Development Centre , Bäckagårdsvägen 47, 302 74 , Halmstad , Sweden
| | - Ingela Henoch
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Angered Local Hospital , Halmtorget 1, 424 65 , Gothenburg , Sweden
| | - Kerstin Wickström Ene
- Department of Research, Development and Education , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Eva Otterström-Rydberg
- Department of Anesthesia and Intensive Care , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Hanna Simonsson
- Department of Surgery , Hallands Hospital , Halmstad , Lasarettsvägen, 302 33 Halmstad , Sweden
| | - Karin Ahlberg
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
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Abstract
BACKGROUND In a survey of all adult inpatients at the Wilhelminen Hospital in Vienna and the Klagenfurt Clinic on Lake Wörthersee, data on pain prevalence, the most frequent sites of pain, pain intensity, pain type, effect of pain on patients, pain evaluation on the various wards, pain precipitating factors, and patient satisfaction were collected. MATERIALS AND METHODS All inpatients > 18 years were questioned using a questionnaire developed by the investigators at the Department for Anesthesia, Intensive Care, and Pain Medicine at the Wilhelminen Hospital. RESULTS A pain prevalence of 45.7% was found at the Wilhelminen Hospital and of 40.8% at the Klagenfurt Clinic. Women reported pain significantly more often than men. No significant difference was found between surgical and conservative treatment wards in terms of pain prevalence. Patients on conservative treatment wards reported significantly higher current pain intensity than those in surgical departments. The most common areas of pain were joints and bones. A score >3 in the ID pain questionnaire was reached by 8.8% (Wilhelminen Hospital) and 4.0% (Klagenfurt Clinic) of participants. Pain influenced mood, mobility, and nighttime sleep, and was intensified by the daily clinical routine. CONCLUSION Overall, it was demonstrated that the majority of patients at both hospitals were satisfied with the pain management. However, pain management in conservative treatment disciplines must not be neglected. More intense current pain, a worse quality of life, and a trend toward lower patient satisfaction indicate that analgesic treatment in nonsurgical disciplines should be optimized.
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18
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Carr EC, Watt-Watson J, McGillion M, Huizinga A. The quest of pain education leaders in Canada and the United States: a qualitative study. J Adv Nurs 2016; 72:2728-2737. [DOI: 10.1111/jan.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Judy Watt-Watson
- Faculty of Nursing (Lawrence S. Bloomberg); University of Toronto; Ontario Canada
| | - Michael McGillion
- Heart and Stroke Foundation/Michael G. DeGroote Chair in Cardiovascular Nursing; School of Nursing; McMaster University; Hamilton Ontario Canada
| | - Anne Huizinga
- Faculty of Nursing; University of Calgary; Alberta Canada
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19
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Ludvigsen ES, Flaeten ØØ, Gay CL, TarAngen M, Granheim TI, Lerdal A. Pain and concomitant symptoms in medical and elective surgical inpatients: a point prevalence survey. J Clin Nurs 2016; 25:3229-3240. [DOI: 10.1111/jocn.13346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Caryl L Gay
- Department of Family Health Care Nursing; School of Nursing; University of California; San Francisco CA USA
- Department
of Patient Safety and Research; Lovisenberg Diakonale Hospital; Oslo Norway
| | - Magnus TarAngen
- Surgical Department; Lovisenberg Diakonale Hospital; Oslo Norway
| | | | - Anners Lerdal
- Department
of Patient Safety and Research; Lovisenberg Diakonale Hospital; Oslo Norway
- Department of Nursing Science; Faculty of Medicine; Institute of Health and Society; University of Oslo; Oslo Norway
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20
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Gregory J, McGowan L. An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review. J Clin Nurs 2016; 25:583-98. [DOI: 10.1111/jocn.13094] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Julie Gregory
- School of Nursing, Midwifery and Social Work; University of Manchester; Manchester UK
| | - Linda McGowan
- Faculty of Medicine & Health; School of Healthcare; University of Leeds; Leeds UK
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21
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Zoëga S, Gunnarsdottir S, Wilson ME, Gordon DB. Quality Pain Management in Adult Hospitalized Patients: A Concept Evaluation. Nurs Forum 2016; 51:3-12. [PMID: 24428273 DOI: 10.1111/nuf.12085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To explore the concept of quality pain management (QPM) in adult hospitalized patients. BACKGROUND Pain is common in hospitalized patients, and pain management remains suboptimal in some settings. DESIGN A concept evaluation based on Morse et al.'s method. DATA SOURCE Of more than 5,000 articles found, data were restricted to 37 selected key articles published in peer-reviewed journals. REVIEW METHODS Data were extracted from the selected articles and then synthesized according to the following: definition, characteristics, boundaries, preconditions, and outcomes. RESULTS QPM relates to the Structure: organizationally supported evidence-based policies, competent staff, interprofessional and specialized care, and staff accountability; PROCESS screening, assessment/reassessment and communication of pain and its treatment, patient/family education, individualized evidence-based treatment, embedded in safe, effective, patient-centered, timely, efficient, and equitable services; and OUTCOMES reduced pain severity and functional interference, decreased prevalence/severity of adverse consequences from pain or pain treatment, and increase in patient satisfaction. CONCLUSIONS QPM is a multifaceted concept that remains poorly defined in the literature. Studies should aim to develop valid, reliable, and operational measures of the pillars of QPM and to look at the relationship among these factors. Authors need to state how they define and what aspects of QPM they are measuring.
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Affiliation(s)
- Sigridur Zoëga
- Faculty of Nursing, University of Iceland, Reykjavik, Iceland
- Landspítali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigridur Gunnarsdottir
- Faculty of Nursing, University of Iceland, Reykjavik, Iceland
- Landspítali-The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Debra B Gordon
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
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22
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Favre C, Dériaz O, Hanon R, Luthi F. Care related pain in rehabilitation after orthopedic trauma: An exploratory study with qualitative data. Ann Phys Rehabil Med 2014; 58:132-8. [PMID: 25818069 DOI: 10.1016/j.rehab.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Care related pain (CRP) is generally under-estimated and rarely studied in rehabilitation as well as in general medecine. Beliefs about pain influence psychological distress, adjustment to pain and physical disability. In this sense, perceptions of CRP could limit recovery. This exploratory study aims to understand patients' and caregivers' subjective perceptions and beliefs about CRP. PATIENTS AND METHODS Questionnaires about CRP were submitted to members of the interdisciplinary team of a rehabilitation hospital and to patients with musculoskeletal complaints (cross-sectional design). Twenty patients were also individually interviewed (qualitative data). Four topics were addressed: frequency of CRP, situations and procedures causing CRP, beliefs about CRP and means used to deal with CRP. RESULTS Seventy-five caregivers and 50 patients replied to the questionnaire. CRP is a very common experience in rehabilitation and it is recognized by both groups. Generally, the situations causing CRP reflect the specificity of rehabilitation (mobilization…) and are similarly perceived by patients and caregivers, with patients considering them as more painful. Beliefs about CRP are clearly different from those usually associated with pain. Both groups point out the utilitarian and the inevitable character of CRP. They differ on that, that patients had a more positive view about CRP. They associate it more often with progress and see it as acceptable at least until a certain limit. They are also able to perceive the richness of means used by physiotherapists to help them coping with CRP. CONCLUSION Our data may suggest new keys to motivate patient to be active in rehabilitation for example in choosing carefully arguments or words which may fit theirs' beliefs about CRP, or in using various means to manage CRP. Promoting the use of relational competences with chronic pain patients and of a patient-centred approach may also be a concern in training caregivers.
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Affiliation(s)
- C Favre
- Service de psychosomatique, clinique romande de réadaptation Suvacare, avenue Grand-Champsec 90, 1950 Sion, Switzerland.
| | - O Dériaz
- Institut de recherche en réadaptation-réinsertion, avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - R Hanon
- Service de physiothérapie, clinique romande de réadaptation Suvacare, avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - F Luthi
- Service de réadaptation de l'appareil locomoteur, clinique romande de réadaptation Suvacare, avenue Grand-Champsec 90, 1950 Sion, Switzerland; Département de l'appareil locomoteur, service de rhumatologie, centre hospitalier universitaire Vaudois (CHUV), avenue Pierre-Decker 4, 1005 Lausanne, Switzerland
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Jabusch KM, Lewthwaite BJ, Mandzuk LL, Schnell-Hoehn KN, Wheeler BJ. The pain experience of inpatients in a teaching hospital: revisiting a strategic priority. Pain Manag Nurs 2014; 16:69-76. [PMID: 25439113 DOI: 10.1016/j.pmn.2014.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/21/2014] [Accepted: 05/27/2014] [Indexed: 11/28/2022]
Abstract
For hospital executives and clinicians to improve pain management, organizations must examine the current pain experience of in-patients beyond simply measuring patient satisfaction. The aim of this study was to quantify the prevalence of pain among adult in-patients and the degree of interference pain had on daily activities. A descriptive, cross-sectional study was undertaken in a 530 bed tertiary care, teaching hospital in central Canada. A convenience sample (N = 88) of adult medical-surgical patients completed the Short Form-Brief Pain Inventory survey. Pain prevalence was 70.4%. The mean pain severity score was 3.76 (standard deviation, SD = 2.88) and mean pain interference score on daily activities was 4.56 (SD = 3.93). The most frequently identified site of pain was the lower extremities (n = 15, 28%). Women had higher mean scores on pain "right now" compared to men (p < 0.05). The sample majority (n = 81) indicated hospital staff asked about the presence of pain. Seventy-nine percent (n = 57) reported hospital staff "always" did everything they could to help manage pain. Eighty-four percent (n = 61) selected "always" or "usually" to describe their ability to be involved in deciding pain treatments. The mean pain relief score from treatments was 61% (SD = 34.79). Significant positive correlations were found between pain intensity ratings and pain interference on all daily activities (p < 0.001). Pain prevalence remains high with a significant relationship between pain and activities of daily living. The study provides baseline data to direct future initiatives at improving pain management.
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Affiliation(s)
| | | | - Lynda L Mandzuk
- Rehabilitation and Geriatrics Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | | | - Barbara J Wheeler
- Woman & Child Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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Bjørnnes AK, Rustøen T, Lie I, Watt-Watson J, Leegaard M. Pain characteristics and analgesic intake before and following cardiac surgery. Eur J Cardiovasc Nurs 2014; 15:47-54. [PMID: 25192967 DOI: 10.1177/1474515114550441] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiac surgery is a common intervention that involves several pain-sensitive structures, and intense postoperative pain is a predictor of persistent pain. AIMS To describe pain characteristics (i.e. intensity, location, interference, relief) and analgesic intake preoperatively and across postoperative days 1 to 4 after cardiac surgery, and to explore associations between postoperative pain and demographic and clinical characteristics. METHODS Four hundred and sixteen patients (24% women) undergoing elective coronary artery bypass grafting and/or valve surgery were enrolled in a randomized controlled trial. Data were collected using standardized measures including the Brief Pain Inventory-short form. A linear mixed model analysis estimated the impact of sex, age, body mass index, analgesic intake and preoperative pain on postoperative worst pain ratings in the previous 24 hours from postoperative days 1 to 4 prior to discharge RESULTS Thirty-eight per cent of the cardiac surgery patients reported preoperative pain. Postoperative worst pain remained in the moderate to severe range for the majority of patients across day 1 (85%) to day 4 (57%), mainly around the chest incision area for the majority (70%). Mean oral morphine intake was 17 mg/24 h (day 1: 27mg; day 4: 10mg). Lower age, female sex, preoperative pain and analgesic intake had a statistically significant association with higher postoperative worst pain ratings. CONCLUSION Study findings demonstrated a high prevalence of moderate to severe pain after cardiac surgery and insufficient analgesic administration. Results indicated that patients were discharged from hospital with unrelieved pain and a potential risk for further postoperative complications.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Norway Institute of Health and Society, University of Oslo, Norway
| | - Irene Lie
- Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Norway
| | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, Senior Fellow, Massey College University of Toronto, Canada
| | - Marit Leegaard
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Institute of Nursing, Norway
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Shoqirat N. “Sleepless Nights and Sore Operation Site”: Patients' Experiences of Nursing Pain Management After Surgery in Jordan. Pain Manag Nurs 2014; 15:609-18. [DOI: 10.1016/j.pmn.2013.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/24/2022]
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Botti M, Kent B, Bucknall T, Duke M, Johnstone MJ, Considine J, Redley B, Hunter S, de Steiger R, Holcombe M, Cohen E. Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design. Implement Sci 2014; 9:110. [PMID: 25164125 PMCID: PMC4164760 DOI: 10.1186/s13012-014-0110-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/11/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described. METHODS In partnership with clinicians, and based on best available evidence, the aim of the Management Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of patients where the MAPP guidelines were or were not followed. DISCUSSION The outcomes of this study have relevance for nursing and medical professionals as well as informing health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a standardised approach to post-operative pain management, the findings have implications for clinicians and patients within multiple surgical contexts.
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Affiliation(s)
- Mari Botti
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Bridie Kent
- />Plymouth University, Drake Circus, Plymouth England
| | - Tracey Bucknall
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Maxine Duke
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Megan-Jane Johnstone
- />School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Julie Considine
- />Eastern Health/Deakin University Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Bernice Redley
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Susan Hunter
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
| | - Richard de Steiger
- />Epworth Victor Smorgon Chair of Surgery, Epworth HealthCare, 185-187 Hoddle Street, Richmond, 3121 VIC Australia
| | - Marlene Holcombe
- />Epworth HealthCare, 62 Erin Street, Richmond, 3121 VIC Australia
| | - Emma Cohen
- />Epworth/Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125 VIC Australia
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Slatyer S, Williams AM, Michael R. Seeking empowerment to comfort patients in severe pain: a grounded theory study of the nurse's perspective. Int J Nurs Stud 2014; 52:229-39. [PMID: 25035166 DOI: 10.1016/j.ijnurstu.2014.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital patients experience significant pain, which can delay healing and increase the risk of developing chronic pain. Nurses are affected by patients' ongoing pain and may cope with consequent anxiety and helplessness by distancing themselves from such patients. Understanding nurses' responses to patients in severe pain will inform strategies to support their coping, their patients and, ultimately, their retention in the nursing workforce. OBJECTIVES The aim of the study was to develop a substantive theory explaining the hospital nurse's perspective of caring for patients in severe pain. DESIGN The study used grounded theory method. SETTINGS Data were collected on four acute care wards in a 610 bed Australian hospital. PARTICIPANTS The sample included 33 nurse participants and 11 patient participants. Selection criteria for nurse participants were those who worked in the four study wards, cared for patients who experienced severe pain, and consented to be included. Selection criteria for patient participants were those who self-reported pain at intensity of seven or more on a scale of 0-10, were aged 18 years or older, could speak and read English, and consented to be included. METHODS Theoretical sampling directed the collection of data using semi-structured interviews with nurses and participant observation, including structured observations of nurses who cared for patients in pain. Data were analysed using constant comparison method. RESULTS Nurse participants encountered a basic psychosocial problem of feelings of disempowerment when their patients experienced persisting severe pain. In response, they used a basic psychosocial process of seeking empowerment to provide comfort in order to resolve distress and exhaustion associated with disempowerment. This coping process comprised three stages: building connections; finding alternative ways to comfort; and quelling emotional turmoil. CONCLUSIONS The substantive theory proposed a link between the stress of nurses' disempowerment and a coping response that provides direction to support nurses' practice. Strategies indicated include enhanced communication protocols, access to advanced practice nurses, use of nonpharmacological comfort measures, utilization of ward-based pain resource nurses, and unit-specific pain management education. Further research to verify and extend the substantive theory to other settings and nursing populations is warranted.
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Affiliation(s)
- Susan Slatyer
- Curtin University, Sir Charles Gairdner Hospital, Edith Cowan University, Australia.
| | - Anne M Williams
- Edith Cowan University, Sir Charles Gairdner Hospital and Murdoch University, Australia
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Echevarria Moreno M, Ortega Garcia JL, Herrera Silva J, Galvez Mateo R, Torres Morera LM, de la Torre Liebanas R. [Prevalence of pain in Andalusian public hospitals]. ACTA ACUST UNITED AC 2014; 61:549-56. [PMID: 24742791 DOI: 10.1016/j.redar.2014.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the prevalence of pain in medical and surgical patients admitted to reference hospitals in Andalusia, as well as their features and the most population groups most affected. MATERIAL AND METHODS A cross-sectional, multicenter epidemiological study was conducted simultaneously on the population admitted to 5 hospitals. Using a structured questionnaire the demographics, hospital area, presence of pain at the time of the interview, and pre- and post-variables related to the intensity of pain and its treatment at 24h were investigated. All patients over 18 years old were included, except those patients with difficulty in understanding the questionnaire, and psychiatric and obstetric patients. Pain intensity was assessed by simple verbal scale. RESULTS Of the 1,236 patients included, 54.2% were male, with 51.1% of patients aged 65 years, and 69.17% were admitted to medical areas. Pain was observed in 52.9% of patients admitted to the surgical area compared to 29.4% in the medical area. Of the 19.4% who reported having had pain in the last 24h prior to the questionnaire, 57.7% of them were surgical patients and 32% were medical, P<.005), and of the 42.2% who had pain at the time of study, 52.7% were female. The incidence of pain on movement was higher than that observed at rest. The mean resting pain was 1.8 and 1.4 for the surgical and medical patients, respectively (P<.01). The mean pain on movement was 2.2 and 1.6 for the surgical and medical patients, respectively (P<.01). More than one quarter (25.8%) of surgical patients and 16.5% of medical patients had difficulty sleeping (P<.005). Some 12.8% of all patients had no analgesic regimen, and 66.2% and 85.6% of surgical and medical patients, respectively, did not request analgesics (P<.005). The main drugs were prescribed paracetamol analgesic and metamizole, and in 54.4% of patients. CONCLUSIONS We believe that the presence of pain in patients admitted to our study population is high and it is essential to encourage an improvement in the pain management of both acute and chronic pain processes.
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Affiliation(s)
- M Echevarria Moreno
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España.
| | - J L Ortega Garcia
- Servicio de Anestesiología y Reanimación, Hospital Puerto Real, Cádiz, España
| | - J Herrera Silva
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España
| | - R Galvez Mateo
- Servicio de Anestesiología y Reanimación, Hospital Virgen de la Nieves, Granada, España
| | - L M Torres Morera
- Servicio de Anestesiología y Reanimación, Hospital Puerta del Mar, Cádiz, España
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Zoëga S, Sveinsdottir H, Sigurdsson GH, Aspelund T, Ward SE, Gunnarsdottir S. Quality pain management in the hospital setting from the patient's perspective. Pain Pract 2014; 15:236-46. [PMID: 24433333 DOI: 10.1111/papr.12166] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/02/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pain management is a crucial issue for patients, and patients' perception of care is an important quality outcome criterion for health care institutions. Pain remains a common problem in hospitals, with subsequent deleterious effects on well-being. OBJECTIVES To assess the epidemiology of pain (frequency, severity, and interference), patient participation in pain treatment decisions, and patient satisfaction with care in a hospital setting. METHODS A point-prevalence study was conducted. Data were collected with the American Pain Society Patient Outcome Questionnaire (Icelandic version). Participants (n = 308) were ≥ 18 years old, alert, and hospitalized for ≥ 24 hours. RESULTS The response rate was 73%. The mean age of participants was 67.5 (SD = 17.4; range 18 to 100) years, and 49% were men. Pain prevalence in the past 24 hours was 83%, mean worst pain severity was 4.6 (SD = 3.1), and 35% experienced severe pain (≥ 7 on 0 to 10 scale). Moderate to severe interference with activities and sleep was experienced by 36% and 29% of patients respectively. Patient participation in decision making was weakly associated with spending less time in severe pain and better pain relief. Patient satisfaction was related to spending less time in severe pain, better pain relief, and lower pain severity (P < 0.05). CONCLUSIONS Pain was both prevalent and severe in the hospital, but patient participation in decision making was related to better outcomes. Optimal pain management, with emphasis on patient participation in decision making, should be encouraged in an effort to improve the quality of care in hospitals.
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Affiliation(s)
- Sigridur Zoëga
- Surgical Services, Landspítali - The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Nursing, University of Iceland, Reykjavik, Iceland
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Carr ECJ, Meredith P, Chumbley G, Killen R, Prytherch DR, Smith GB. Pain: a quality of care issue during patients' admission to hospital. J Adv Nurs 2013; 70:1391-403. [PMID: 24224703 DOI: 10.1111/jan.12301] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 12/22/2022]
Abstract
AIM To determine the extent of clinically significant pain suffered by hospitalized patients during their stay and at discharge. BACKGROUND The management of pain in hospitals continues to be problematic, despite long-standing awareness of the problem and improvements, e.g. acute pain teams and patient-controlled analgesia, epidural analgesia. Poorly managed pain, especially acute pain, often leads to adverse physical and psychological outcomes including persistent pain and disability. A systems approach may improve the management of pain in hospitals. DESIGN A descriptive cross-sectional exploratory design. METHOD A large electronic pain score database of vital signs and pain scores was interrogated between 1st January 2010 and 31st December 2010 to establish the proportion of hospital inpatient stays with clinically significant pain during the hospital stay and at discharge. FINDINGS A total of 810,774 pain scores were analysed, representing 38,451 patient stays. Clinically significant pain was present in 38·4% of patient stays. Across surgical categories, 54·0% of emergency admissions experienced clinically significant pain, compared with 48·0% of elective admissions. Medical areas had a summary figure of 26·5%. For 30% patients, clinically significant pain was followed by a consecutive clinically significant pain score. Only 0·2% of pain assessments were made independently of vital signs. CONCLUSION Reducing the risk of long-term persistent pain should be seen as integral to improving patient safety and can be achieved by harnessing organizational pain management processes with quality improvement initiatives. The assessment of pain alongside vital signs should be reviewed. Setting quality targets for pain are essential for improving the patient's experience.
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Affiliation(s)
- Eloise C J Carr
- Faculty of Graduate Studies, University of Calgary, Alberta, Canada
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Bernhofer EI, Higgins PA, Daly BJ, Burant CJ, Hornick TR. Hospital lighting and its association with sleep, mood and pain in medical inpatients. J Adv Nurs 2013; 70:1164-73. [PMID: 24164506 DOI: 10.1111/jan.12282] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2013] [Indexed: 11/29/2022]
Abstract
AIMS To describe light exposure, sleep-wake patterns, mood, pain and their relationships in adult medical inpatients. BACKGROUND The hospital environment may contribute to patient discomfort by providing a lighting structure that interferes with circadian rhythmicity, sleep, mood and pain. DESIGN A descriptive correlational design was used in this preliminary study. METHODS Between May 2011-April 2012, data were collected from a convenience sample of 23 women and 17 men admitted to a large academically affiliated hospital in the United States. Over 72 hours, light exposure and sleep-wake patterns were continuously measured with wrist actigraph/light meters for each participant. Mood was measured daily using the Profile Of Mood States Brief™ Form. Subjective pain scores were abstracted from medical records. RESULTS Light exposure levels were low: mean daytime light intensity was 104·80 lux. Sleep time was fragmented and low: mean 236·35 minutes of sleep/night. Intra-daily stability scores indicated little sleep-wake synchronization with light. Fatigue and total mood disturbance scores were high and inversely associated with light. Pain levels were also high and positively associated with fatigue, but not directly with light exposure. Low light exposure significantly predicted fatigue and total mood disturbance. CONCLUSION Medical inpatients were exposed to light levels insufficient for circadian entrainment. Nevertheless, higher light exposure was associated with less fatigue and lower total mood disturbance in participants with pain, suggesting the need for further investigation to determine if manipulating light exposure for medical inpatients would be beneficial in affecting sleep-wake disturbances, mood and pain.
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Affiliation(s)
- Esther I Bernhofer
- Office of Research and Innovation, Nursing Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Moore RA, Straube S, Aldington D. Pain measures and cut-offs - ‘no worse than mild pain’ as a simple, universal outcome. Anaesthesia 2013; 68:400-12. [DOI: 10.1111/anae.12148] [Citation(s) in RCA: 280] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 11/28/2022]
Affiliation(s)
- R. A. Moore
- Pain Research and Nuffield Division of Anaesthetics; University of Oxford; The Churchill; Oxford UK
| | - S. Straube
- Department of Occupational; Social and Environmental Medicine; University Medical Center Göttingen; Göttingen Germany
| | - D. Aldington
- Royal Hampshire County Hospital; Winchester Hants UK
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Peña A, Estrada CA, Soniat D, Taylor B, Burton M. Nominal group technique: a brainstorming tool for identifying areas to improve pain management in hospitalized patients. J Hosp Med 2012; 7:416-20. [PMID: 22190453 DOI: 10.1002/jhm.1900] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/19/2011] [Accepted: 11/15/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. OBJECTIVE To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. DESIGN Qualitative and quantitative group consensus using a brainstorming technique for quality improvement-the nominal group technique (NGT). SETTING One medical, 1 medical-surgical, and 1 surgical hospital unit at a large academic medical center. PARTICIPANTS Nurses, resident physicians, patient care technicians, and unit clerks. MEASUREMENTS Responses and ranking to the NGT question: "What causes uncontrolled pain in your unit?" RESULTS Twenty-seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. CONCLUSIONS Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context-specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers.
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Affiliation(s)
- Adolfo Peña
- Saint Joseph Hospital, Section of Hospital Medicine, London, Kentucky, USA
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Wadensten B, Fröjd C, Swenne CL, Gordh T, Gunningberg L. Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden. J Clin Nurs 2011; 20:624-34. [PMID: 21320191 DOI: 10.1111/j.1365-2702.2010.03482.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to investigate the prevalence of pain and pain assessment among inpatients in a university hospital. BACKGROUND Pain management could be considered an indicator of quality of care. Few studies report on prevalence measures including all inpatients. DESIGN Quantitative and explorative. METHOD Survey. RESULTS Of the inpatients at the hospital who answered the survey, 494 (65%) reported having experienced pain during the preceding 24 hours. Of the patients who reported having experienced pain during the preceding 24 hours, 81% rated their pain >3 and 42.1% rated their pain >7. Of the patients who reported having experienced pain during the preceding 24 hours, 38.7% had been asked to self-assess their pain using a Numeric Rating Scale (NRS); 29.6% of the patients were completely satisfied, and 11.5% were not at all satisfied with their participation in pain management. CONCLUSIONS The result showed that too many patients are still suffering from pain and that the NRS is not used to the extent it should be. Efforts to overcome under-implementation of pain assessment are required, particularly on wards where pain is not obvious, e.g., wards that do not deal with surgery patients. Work to improve pain management must be carried out through collaboration across professional groups. RELEVANCE TO CLINICAL PRACTICE Using a pain assessment tool such as the NRS could help patients express their pain and improve communication between nurses and patients in relation to pain as well as allow patients to participate in their own care. Carrying out prevalence pain measures similar to those used here could be helpful in performing quality improvement work in the area of pain management.
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Affiliation(s)
- Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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