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McLennan AIG, Castillo LIR, Hadjistavropoulos T. Pain in Dementia: An Empirical Test of a Common Assumption. THE JOURNAL OF PAIN 2024; 25:104605. [PMID: 38880391 DOI: 10.1016/j.jpain.2024.104605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/18/2024]
Abstract
Numerous, and often largely overlapping, observational pain assessment tools have been developed specifically to assess pain in older adults with dementia under the assumption that a specialized approach is necessary to evaluate pain in this population. However, this assumption has never been tested empirically. As an empirical test of this implicit assumption, our goal was to compare existing tools for people living with dementia (with respect to psychometric properties), not only against each other, but also against a tool developed for a different population with cognitive impairments. Videos of older adults with severe dementia recorded in long-term care settings were coded for pain behaviors in the laboratory. Trained coders coded pain behaviors in video segments of older adults with dementia during a quiet baseline condition as well as during a physical examination (designed to identify painful areas), using various observational pain assessment tools. An observational measure of agitation was employed to facilitate the assessment of discriminant validity. Consistent with our expectations, all pain tools (including the tool developed for younger people with cognitive impairments) successfully differentiated between painful and nonpainful states, with large effect sizes. This was the first study to compare tools specifically developed to assess pain in people living with dementia to a tool developed for a different population. Given that all tools under study showed satisfactory psychometric properties when tested on persons with dementia, this study suggests that the assumption that different tools are necessary for different populations with cognitive impairments cannot be taken for granted. PERSPECTIVE: This article challenges an implicitly held assumption that specialized tools are needed to assess pain in different populations with cognitive impairments. Given commonalities in pain expression across populations, further research is needed to determine whether population-specific tools are needed.
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Affiliation(s)
- Andrew I G McLennan
- Department of Psychology and Centre of Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Louise I R Castillo
- Department of Psychology and Centre of Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre of Aging and Health, University of Regina, Regina, Saskatchewan, Canada.
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Lee H, Lee H, Oh S, Park CG. Factors Associated With Pain Perception and Management Among Paediatric Nurses and Nursing Students Using Virtual Children: A Comparative Study. J Adv Nurs 2024. [PMID: 39258842 DOI: 10.1111/jan.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/24/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
AIM To identify and compare factors associated with pain perception and management among paediatric nurses and nursing students using virtual human technology. DESIGN This study employed a comparative, cross-sectional design. METHODS Fifty-one paediatric nurses from a tertiary hospital and 50 senior nursing students from a nursing college, both located in South Korea, participated in the study. Virtual vignettes, including scenarios with virtual children and their clinical information, were used to assess participants' pain perception and management. The virtual children, created from real face photos, varied in age (young/old), sex (boy/girl) and facial expressions (smile/grimace). Participants rated perceived pain scores and selected management choices for eight virtual vignettes, which were randomly presented. The Korean version of the Paediatric Nurses' Knowledge and Attitude Survey was completed along with demographic information. RESULTS Both paediatric nurses and nursing students rated pain scores lower than the actual pain scores reported by virtual children. Nurses rated higher pain scores and accordingly selected more medication doses compared to students. Beyond pain-related knowledge, the facial expression of the virtual child influenced pain rating and medication choices, while age and sex had no effect. CONCLUSION Nursing students were more sensitive to the facial expressions of virtual children when rating their pain compared to nurses. Future studies should explore how paediatric nurses' clinical experiences impact their assessment and management of child patient pain. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Paediatric nurses' knowledge of pain is inadequate, necessitating ongoing education in pain management. Both nurses and nursing students should self-reflect on their pain assessment practices to ensure unbiased care regardless of child patients' characteristics. IMPACT Virtual human technology can be utilised to train nurses and students to identify and address any biases in their assessment of patients' pain perception. REPORTING METHOD STROBE checklist, cross-sectional. PATIENT OR PUBLIC CONTRIBUTION Digital face photos of four healthy children were used as the fundamental material for creating virtual children, with their parents' consent.
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Affiliation(s)
- Hyejung Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Hyeryeong Lee
- College of Nursing, Yonsei University, Seoul, South Korea
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Sumi Oh
- College of Nursing, Health and Nursing Research Institute, Jeju National University, Jeju-si, South Korea
| | - Chang Gi Park
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
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Sandvik RKNM, Mujakic M, Haarklau I, Emilie G, Moi AL. Improving Pain Management in the Intensive Care Unit by Assessment. Pain Manag Nurs 2024:S1524-9042(24)00199-1. [PMID: 39244399 DOI: 10.1016/j.pmn.2024.06.013] [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: 07/03/2023] [Revised: 06/06/2024] [Accepted: 06/22/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Patients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation. DESIGN Quantitative pre-post design. METHODS The study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT). RESULTS After implementation, a 38% adherence rate was found. The frequency of nurses' pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (p = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at p < .01. CONCLUSIONS Implementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses' adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps. CLINICAL IMPLICATIONS Implementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.
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Affiliation(s)
- Reidun K N M Sandvik
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Centre for Care Research, West, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Maida Mujakic
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Haarklau
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Gosselin Emilie
- École des Sciences Infirmières, Université de Sherbrooke, Sherbrooke, Canada; Centre de Recherche Clinique CHUS, Sherbrooke, Canada
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Institute for Nursing, Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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Kodagoda Gamage MW, Pu L, Todorovic M, Moyle W. Nurses' Beliefs About Pain Assessment in Dementia: A Qualitative Study Informed by the Theory of Planned Behaviour. J Clin Nurs 2024. [PMID: 39209772 DOI: 10.1111/jocn.17417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/05/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
AIM To explore registered nurses' beliefs regarding pain assessment in people living with dementia. DESIGN A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour. METHODS Online semi-structured in-depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis. FINDINGS Registered nurses believe pain assessment improves the well-being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments. CONCLUSION Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices. IMPACT Pain is underassessed in dementia, and this could stem from registered nurses' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices. REPORTING METHOD This study adhered to the COREQ criteria. PATIENT OR PUBLIC CONTRIBUTION Registered nurses caring for people living with dementia participated as interview respondents.
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Affiliation(s)
- Madushika Wishvanie Kodagoda Gamage
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Lihui Pu
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michael Todorovic
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Wendy Moyle
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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Vesal M, Roohafza H, Feizi A, Asgari K, Shahoon H, Ani A, Adibi P. Pressure algometry in the general adult population: Age and sex differences. Medicine (Baltimore) 2024; 103:e39418. [PMID: 39183389 PMCID: PMC11346871 DOI: 10.1097/md.0000000000039418] [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: 02/02/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
Experimental pain studies have revealed inter-individual variations in pain perception that are influenced by age, sex, and country of origin. This study aimed to explore the age and sex differences in pressure pain thresholds within the Iranian general population. To assess the pressure pain thresholds, a handheld pressure algometer was applied bilaterally to the middle fingers of both hands. The participants also completed the short form of the McGill Pain Questionnaire to provide a clinical pain rating. This cross-sectional study included 1610 adult subjects (54.96% female, mean age 40.13 ± 10.18 years). The findings indicated that females generally exhibited lower pain thresholds than males when assessing pain detection and tolerance parameters (P < .001). Females also demonstrated a significant lower pressure thresholds and clinical pain ratings compared with men (P < .001). Additionally, significant differences were observed between age groups in terms of pain detection and tolerance thresholds (P = .02 and P = .03, respectively). However, the interaction between sex and age was not significant. No significant differences in pain detection thresholds were observed between the right and left hand (P = .11). This study underscores the potential utility of algometry as a valuable tool for objectifying pain in the Iranian population.
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Affiliation(s)
- Mina Vesal
- Department of Psychology, University of Isfahan, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Epidemiology and Biostatistics Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Asgari
- Department of Psychology, University of Isfahan, Isfahan, Iran
| | - Hassan Shahoon
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ani
- Department of Bioinformatics, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Ingelson B, Dahlke S, O'Rourke H, Hunter KF. Nurses' knowledge and beliefs on pain management practices with hospitalised persons living with dementia: A qualitative descriptive study. J Clin Nurs 2024; 33:3224-3235. [PMID: 38590077 DOI: 10.1111/jocn.17164] [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: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
AIM To understand nurses' knowledge, beliefs and experiences affect pain management practices in hospitalised persons living with dementia (PLWD). DESIGN Naturalistic inquiry using qualitative descriptive design. METHODS Semi-structured interviews were conducted with 12 registered nurses who worked in one acute care hospital in Southern California from October to November 2022. Data were analysed using content analysis to identify themes. RESULTS Two themes were developed: improvising pain assessment, which included how pain was documented, and administration hesitancy referring to nurse's concerns about PLWD's confusion. Nurses described the challenges of assessing pain in hospitalised PLWD particularly if they were non-verbal and/or demonstrating responsive behaviours. Nurse's years of experience, dementia stigma, and their unconscious biases affected nurses' pain management practices. CONCLUSIONS The study findings highlight the complex challenges of pain management in hospitalised PLWD that are exacerbated by nurses' knowledge deficits, negative stereotypical beliefs, dementia stigma and unconscious biases towards older people that contributes to undermanaged pain in hospitalised PLWD. IMPLICATIONS A comprehensive strategy using an implementation framework is needed to address nurse's knowledge gaps, unconscious bias, dementia stigma and techniques that enhance communication skills is suggested. Building a foundation in these areas would improve pain management in hospitalised PLWD. IMPACT Improving pain management in hospitalised PLWD would improve the quality of life, decrease hospital length of stay, prevent readmissions, and improve nurse satisfaction. REPORTING METHOD The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT CONTRIBUTIONS Improving pain management in hospitalised PLWD would prevent long term confusion, episodes of delirium and improve quality of life as they recover from their acute illness for which they required hospital care.
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Affiliation(s)
- Beverly Ingelson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah O'Rourke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Yoshimi Y, Matsuura T, Miyazato K, Takahashi S, Tanaka N, Morinaga H, Hayata A, Onishi M, Nagano Y, Ohnishi H. Availability of Observational Pain Assessment Tools in Hospitalized Patients with Osteoporotic Vertebral Fractures. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1217. [PMID: 39202498 PMCID: PMC11356710 DOI: 10.3390/medicina60081217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Osteoporotic vertebral fractures in older patients cause lower back pain and abnormal posture, resulting in impaired activities of daily living (ADLs). Assessing pain using self-reported assessment tools is difficult, especially in patients with moderate-to-severe cognitive impairment. Recently, observational assessment tools have been used when self-reported ones were difficult to administer. No studies have reported the usefulness of observational assessment tools in patients with acute-phase orthopedic disorders without complication. This study aimed to examine the availability of observational tools for pain assessment in patients with lumbar vertebral fractures. Materials and Methods: Patients admitted to our hospital with acute-phase vertebral fractures were enrolled in this prospective observational study. Pain was assessed using Japanese versions of the Abbey pain scale and Doloplus-2 observational assessment tools, and the Numerical Rating Scale, a self-reported assessment tool. To compare the pain assessment tool, we examined whether each tool correlated with ADLs and ambulatory status. ADLs were assessed using the Barthel Index. Ambulatory status was assessed using the Functional Ambulation Categories and the 10-m walking test. Results: Similar to the Numerical Rating Scale scores, assessments with the Abbey pain scale and Doloplus-2 showed significant decreases in scores over time. A significant positive correlation was observed between the self-reported and observational assessment tools. Each pain assessment tool was significantly negatively correlated with ADLs and ambulatory status. Conclusions: When self-reported assessment with the Numerical Rating Scale is difficult for patients with cognitive impairment, pain can be estimated using the Abbey pain scale and Doloplus-2 observational assessment tools.
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Affiliation(s)
- Youhei Yoshimi
- Department of Orthopedics, Moji Medical Center, Moji-ku, Kitakyushu 801-8502, Japan; (Y.Y.); (K.M.)
- Department of Orthopedics, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Takanori Matsuura
- Department of Orthopedics, Moji Medical Center, Moji-ku, Kitakyushu 801-8502, Japan; (Y.Y.); (K.M.)
- Department of Orthopedics, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan
- Department of Orthopedics, Nishinomiya Watanabe Hospital, Murokawa-cho, Nishinomiya 662-0863, Japan
| | - Kazuaki Miyazato
- Department of Orthopedics, Moji Medical Center, Moji-ku, Kitakyushu 801-8502, Japan; (Y.Y.); (K.M.)
- Department of Orthopedics, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Shiho Takahashi
- Department of Nursing, Moji Medical Center, Moji-ku, Kitakyushu 801-8502, Japan
| | - Nami Tanaka
- Department of Nursing, Moji Medical Center, Moji-ku, Kitakyushu 801-8502, Japan
| | - Hanae Morinaga
- Department of Nursing, Moji Medical Center, Moji-ku, Kitakyushu 801-8502, Japan
| | - Asuka Hayata
- Department of Rehabilitation, Moji Medical Center, Moji-ku, Kitakyushu 662-0863, Japan
| | - Minami Onishi
- Department of Rehabilitation, Moji Medical Center, Moji-ku, Kitakyushu 662-0863, Japan
| | - Yousuke Nagano
- Department of Rehabilitation, Moji Medical Center, Moji-ku, Kitakyushu 662-0863, Japan
| | - Hideo Ohnishi
- Department of Orthopedics, Moji Medical Center, Moji-ku, Kitakyushu 801-8502, Japan; (Y.Y.); (K.M.)
- Department of Orthopedics, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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Lin S, Li L, Ren X, Zhong C, Wu K, Fang X, Liang S, Chen X, Chen J, Yang L, Wang X, Wang B. Effects of White Noise on Pain Scores and Salivary Cortisol Levels in Surgical Neonates: A Randomized Controlled Trial. Adv Neonatal Care 2024; 24:291-300. [PMID: 38815280 DOI: 10.1097/anc.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Neonates experience varying intensities of pain after surgery. While white noise has been used for postoperative pain relief in infants, its effects on neonates after surgery need further exploration. PURPOSE This study aimed to evaluate the effects of white noise on pain scores and salivary cortisol levels in surgical neonates. METHODS In this randomized controlled trial, 64 neonates scheduled for surgery were recruited and assigned by block randomization into 2 groups. The intervention group listened to white noise at 50 dB, while the control group listened to white noise at 0 dB, for 30 minutes 6 times for 48 hours postoperatively. Pain scores, measured by the COMFORTneo Scale, and salivary cortisol levels were compared. RESULTS Although pain scores decreased after surgery in all subjects, no statistically significant difference was observed between the 2 groups (P = .937). There was a significant difference between pre- and postintervention pain scores in the intervention group only (P = .006). Salivary cortisol levels decreased after intervention in the intervention group, but there was no significant difference between pre- and postintervention levels in the 2 groups (P = .716). IMPLICATIONS FOR PRACTICE Given the reduction in pain scores and salivary cortisol concentrations after white noise intervention, white noise shows potential as an adjunctive soothing measure for neonates after surgery. IMPLICATIONS FOR RESEARCH Future studies are needed to confirm the efficacy and utility of white noise intervention in clinical settings.
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Affiliation(s)
- Siya Lin
- Clinical Nursing Education and Research Section (Ms Lin, Dr Li, and Mss Ren and J. Chen), Department of Nursing (Ms Lin), Department of Neonatology, Pediatrics Center (Mss Zhong and Fang, and Dr B. Wang), Department of Pediatric Surgery, Pediatrics Center (Drs Wu and Yang), Department of Laboratory Medicine (Messrs Liang and X. Chen), Department of Cardiovascular Surgery (Dr X. Wang), Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Manworren RCB, Horner S, Joseph R, Dadar P, Kaduwela N. Performance Evaluation of a Supervised Machine Learning Pain Classification Model Developed by Neonatal Nurses. Adv Neonatal Care 2024; 24:301-310. [PMID: 38775675 DOI: 10.1097/anc.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Early-life pain is associated with adverse neurodevelopmental consequences; and current pain assessment practices are discontinuous, inconsistent, and highly dependent on nurses' availability. Furthermore, facial expressions in commonly used pain assessment tools are not associated with brain-based evidence of pain. PURPOSE To develop and validate a machine learning (ML) model to classify pain. METHODS In this retrospective validation study, using a human-centered design for Embedded Machine Learning Solutions approach and the Neonatal Facial Coding System (NFCS), 6 experienced neonatal intensive care unit (NICU) nurses labeled data from randomly assigned iCOPEvid (infant Classification Of Pain Expression video) sequences of 49 neonates undergoing heel lance. NFCS is the only observational pain assessment tool associated with brain-based evidence of pain. A standard 70% training and 30% testing split of the data was used to train and test several ML models. NICU nurses' interrater reliability was evaluated, and NICU nurses' area under the receiver operating characteristic curve (AUC) was compared with the ML models' AUC. RESULTS Nurses weighted mean interrater reliability was 68% (63%-79%) for NFCS tasks, 77.7% (74%-83%) for pain intensity, and 48.6% (15%-59%) for frame and 78.4% (64%-100%) for video pain classification, with AUC of 0.68. The best performing ML model had 97.7% precision, 98% accuracy, 98.5% recall, and AUC of 0.98. IMPLICATIONS FOR PRACTICE AND RESEARCH The pain classification ML model AUC far exceeded that of NICU nurses for identifying neonatal pain. These findings will inform the development of a continuous, unbiased, brain-based, nurse-in-the-loop Pain Recognition Automated Monitoring System (PRAMS) for neonates and infants.
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Affiliation(s)
- Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois (Drs Manworren and Horner); Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas (Dr Manworren); and Kavi Global, Barrington, Illinois (Messrs Joseph and Dadar and Ms Kaduwela)
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Robleda-Font G, López-López C, Latorre-Marco I, Pozas-Peña J, Alonso-Crespo D, Vallés-Fructuoso O, Castanera-Duro A. Appropriateness of behavioural scales in the monitoring of pain in the critically ill patient unable to self-report. ENFERMERIA INTENSIVA 2024; 35:e17-e22. [PMID: 38538437 DOI: 10.1016/j.enfie.2023.12.002] [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: 10/20/2023] [Accepted: 12/22/2023] [Indexed: 05/25/2024]
Abstract
Appropriateness is a dimension of quality that evaluates the effective use of technologies, resources or interventions in specific situations or populations, assessing whether our interventions do more benefit than harm. The evidence regarding pain monitoring in the critically ill patient points to the periodic assessment of pain using appropriate tools, with the aim of improving pain management and more efficient use of analgesics in the intensive care unit. The first step would be to assess the patient's ability to communicate or self-report and, based on this, to select the most appropriate pain assessment tool. In patients who are unable to self-report, behavioural pain assessment tools are recommended. When we talk about the suitability of behavioural scales for pain monitoring in critically ill patients unable to self-report, we refer to their use with a clear clinical benefit, i.e. using the right tool for pain assessment to be effective, efficient and consistent with bioethical principles. To our knowledge, there are no published data on the suitability of pain assessment tools in unable to self-report critically ill patients, so, in the framework of continuous quality improvement in pain care, new research should incorporate this approach by integrating the best scientific evidence with current clinical practice.
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Affiliation(s)
- G Robleda-Font
- Campus Docent Sant Joan de Déu, Universidad de Barcelona, Sant Boi de Llobregat, Spain; Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain
| | - C López-López
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Unidad de Cuidados Intensivos de Trauma y Emergencias, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
| | - I Latorre-Marco
- Unidad de Cuidados Intensivos, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - J Pozas-Peña
- Campus Docent Sant Joan de Déu, Universidad de Barcelona, Sant Boi de Llobregat, Spain; Unidad de Cuidados Intensivos, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Patología Crítica (GREPAC), Instituto de Investigación Hospital del Mar, Barcelona, Spain
| | - D Alonso-Crespo
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Unidad de Cuidados Intensivos, Hospital Álvaro Cunqueiro, Vigo, Spain; Grupo de Investigación Traslacional en Cuidados, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - O Vallés-Fructuoso
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Unidad de Cuidados Intensivos, Hospital Vall d'Hebrón, Barcelona, Spain; Coordinadora del Grupo de Trabajo Analgesia, Sedación y Delirium de la Sociedad Catalana de Medicina Intensiva, Barcelona, Spain
| | - A Castanera-Duro
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Área del Paciente Crítico, Reanimación y Anestesia, Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain; Departamento de Enfermería Universitat de Girona (UdG), Girona, Spain
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Larson S, Laures E, Seo M, Cox M, Wagner M. Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients. Pain Manag Nurs 2024; 25:152-159. [PMID: 38246815 DOI: 10.1016/j.pmn.2023.12.005] [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: 04/06/2023] [Revised: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Central to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AIMS The purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DESIGN The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SETTINGS On a six-bed adult inpatient Palliative Care Unit (PCU). PARTICIPANTS/SUBJECTS Nonverbal palliative care patients. METHODS Evidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. RESULTS Nurses' attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. CONCLUSIONS MOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.
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Affiliation(s)
- Sara Larson
- University of Iowa Hospitals and Clinics, Iowa City, Iowa; St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| | - Elyse Laures
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Minjeong Seo
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Margo Cox
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michele Wagner
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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12
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Dannecker EA, Darchuk KM, Shigaki CL, Palmer WM, Korte PT, Turner EK. The Use and Perceptions of the Defense and Veterans Pain Rating Scale by Nursing Personnel. Pain Manag Nurs 2024; 25:113-121. [PMID: 37845129 DOI: 10.1016/j.pmn.2023.09.001] [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: 01/12/2023] [Revised: 08/27/2023] [Accepted: 09/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND In 2010, the Office of the US Army Surgeon General recommended the Veterans Administration (VA) assess pain using the Defense and Veterans Pain Rating Scale (DVPRS). One item in the DVPRS is for measuring pain intensity. This item contains a combination of five response metrics: categories, faces, colors, numbers, and functional descriptors. A few studies have supported patients' and health care providers' preferences for the DVPRS and its psychometric properties. However, they also left uncertainties about its usability and validity. AIMS To advance our understanding of the DVPRS, this study examined the use and perceptions of the DVPRS' pain intensity item by nursing personnel during multi-modal care. DESIGN A cross-sectional survey design was used. SETTING VA Community Living Center. PARTICIPANTS Nursing personnel. METHODS Nursing personnel answered closed- and open-ended survey questions during a single session. RESULTS Nursing personnel reported sufficient training before implementing the measure and that patients primarily used the numeric metric. When patients used a non-numeric metric, the nursing personnel responded in variable ways. In addition, the nursing personnel interpreted the functional descriptors differently. The nursing personnel also noted the need to supplement the pain intensity item with patients' pain duration and pain location. CONCLUSIONS Results from this study inform the nursing community about the DVPRS' pain intensity item, which combines multiple response metrics. The results support the need for nursing units to generate and standardize procedures for using the item to measure multi-site pain and for interpreting and documenting patients' non-numeric responses. The effects of such procedures on the measure's usability and psychometric properties warrants additional investigation.
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Affiliation(s)
- Erin A Dannecker
- Department of Physical Therapy, University of Missouri, Columbia, Missouri.
| | - Kathleen M Darchuk
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C
| | - Cheryl L Shigaki
- Behavioral Health Service Line (116), Harry S. Truman Memorial VA Hospital, Columbia, Missouri
| | - William M Palmer
- Behavioral Health Service Line (116), Harry S. Truman Memorial VA Hospital, Columbia, Missouri
| | - Paul T Korte
- Behavioral Health Service Line (116), Harry S. Truman Memorial VA Hospital, Columbia, Missouri
| | - Elizabeth K Turner
- Patient Services Service Line (PS), Harry S. Truman Memorial VA Hospital, Columbia, Missouri
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13
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Ingelson B, Dahlke S, O'Rourke H, Low G. A Scoping Review on Nurse's Pain Management of Older Patients with Dementia in a Hospital Environment. Pain Manag Nurs 2024; 25:104-112. [PMID: 37968142 DOI: 10.1016/j.pmn.2023.10.004] [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: 12/02/2022] [Revised: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Hospitalized persons living with dementia often experience unrelieved pain. Unmanaged pain during hospitalization has a significant negative effect on quality of life for persons living with dementia. Despite the central role of nurses in pain management, little is known about how nurses manage pain in this patient population in the hospital environment. DESIGN A scoping review explored the nurses' pain management practices when caring for persons living with dementia in a hospital setting. DATA SOURCES AND REVIEW/ANALYSIS METHODS After an extensive search for all available evidence on how nurses manage pain in hospitalized persons living with dementia, data were extracted on pain management methods that included assessment, intervention, effectiveness of pain management, and the barriers nurses encountered when managing pain. A descriptive content analysis was used to extract data from qualitative studies. RESULTS Six articles published between 2016 and 2021 met the inclusion criteria; four utilized qualitative methods, and the others used mixed-methods and quantitative study designs. A narrative description of the findings was summarized after data were categorized into pain management data elements and barriers nurses encountered when managing pain. Barriers were grouped into the subcategories of communication challenges (nurse to patient), information sharing (nurse to nurse), lack of knowledge, time constraints, and nursing stressors. CONCLUSION We identified six articles that met our inclusion criteria, highlighting a noticeable gap in the literature. Managing pain in this population is complex and lacks organizational support. Review findings indicate that pain management methods lack consistency and standardization, making it difficult to assess their effectiveness. Nurses also described knowledge deficits resulting in practice gaps that, when combined with barriers and challenges, result in underrecognized and undermanaged pain.
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Affiliation(s)
| | | | | | - Gail Low
- University of Alberta, Edmonton, Alberta, Canada.
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14
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Kim K, Choi S, Park M, Kim J, Kim K, Song E, Kim N, Park S, Song Y. Development of an Acute Pain Assessment Tool for Patients in Post-anesthesia Care Units. Pain Manag Nurs 2024; 25:e93-e98. [PMID: 38135607 DOI: 10.1016/j.pmn.2023.11.007] [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: 07/25/2023] [Revised: 10/08/2023] [Accepted: 11/12/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Post-operative pain is a common form of acute pain. Objective pain assessment in post-anesthesia care units after surgery is useful regardless of the patient's condition. AIMS This study aimed to develop and evaluate an acute pain assessment tool for patients in post-anesthesia care units. DESIGN This was a cross-sectional observational study comprising two stages: scale development and psychometric evaluation. SETTINGS . PARTICIPANTS/SUBJECTS . METHODS Scale items were developed based on a literature review and content validity by experts. The validity and interrater reliability of the pain scale were evaluated using data from 218 patients admitted to the post-anesthesia care unit at a university hospital. A receiver operating characteristic curve was used to identify the sensitivity and specificity for determining the cutoff point for acute pain. RESULTS We developed an objective acute pain scale, called the APA5, which ranges from 0-10 and comprises behavioral (facial and verbal expressions and body movement) and physiological (changes in heart rate and blood pressure) responses. The APA5 is valid and reliable for assessing acute pain in the recovery room. Sensitivity and specificity were acceptable when the cutoff was 2 out of 10 points. CONCLUSIONS The APA5 is an easy and simple tool for measuring pain in patients in post-anesthesia care units who have difficulties with self-reporting.
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Affiliation(s)
- Kyoungsook Kim
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Suna Choi
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Myouyun Park
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Junghee Kim
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kwanghee Kim
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Eunjin Song
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Nagyeong Kim
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Seyeon Park
- From the Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea; College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
| | - Youngshin Song
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
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15
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Kodagoda Gamage MW, Pu L, Todorovic M, Moyle W. Factors related to nurses' beliefs regarding pain assessment in people living with dementia. J Clin Nurs 2024. [PMID: 38459722 DOI: 10.1111/jocn.17093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/27/2023] [Accepted: 01/07/2024] [Indexed: 03/10/2024]
Abstract
AIM To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia. DESIGN A descriptive cross-sectional survey was conducted between July 2022 and April 2023. METHODS An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia. RESULTS RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge). CONCLUSION The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes. IMPACT Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia. REPORTING METHOD This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist. PATIENT OR PUBLIC CONTRIBUTION RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.
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Affiliation(s)
- Madushika Wishvanie Kodagoda Gamage
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
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Hidayat AI, Purnawan I, Mulyaningrat W, Saryono S, Siwi AS, Rias YA, Efendi F. Effect of Combining Dhikr and Prayer Therapy on Pain and Vital Signs in Appendectomy Patients: A Quasi-Experimental Study. J Holist Nurs 2024; 42:6-14. [PMID: 37277995 DOI: 10.1177/08980101231180051] [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] [Indexed: 06/07/2023]
Abstract
Purpose: Dhikr and prayer reduce pain and improve a patient's vital signs. However, the interactions among these require further clarification in patients undergoing appendectomy. This study aimed to assess the effects of the combination of dhikr and prayer on pain, pulse rate, respiratory rate, and oxygen saturation. Study design: Quasi-experimental design. Method: Pain, pulse, respiratory rate, and oxygen saturation were measured via clinical examination immediately after leaving the recovery room at 1 and 2 hr after surgery in both the experimental and control groups. In total, 88 eligible participants were allocated to two groups: participants who received both dhikr and prayer (n = 44), and those who received routine care without analgesic therapy (n = 44). The chi-square test, independent t test, and general equation model were employed. Results: Respondents showed a significant interaction between group and time to decrease in pain, pulse, respiratory rate, and improved oxygen saturation, except for pain within 1 hr. The differences in all outcome scores between the groups after 1 and 2 hr were statistically significant, except for oxygen saturation after 1 hr. Conclusion: The combination of dhikr and prayer effectively decreased pain and improved vital signs. This helped nurses implement this procedure by promoting an essential culture of spiritual care for appendectomy patients.
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Affiliation(s)
| | - Iwan Purnawan
- Universitas Jenderal Soedirman, Purwokerto, Indonesia
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17
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Kaduwela NA, Horner S, Dadar P, Manworren RCB. Application of a human-centered design for embedded machine learning model to develop data labeling software with nurses: Human-to-Artificial Intelligence (H2AI). Int J Med Inform 2024; 183:105337. [PMID: 38199191 DOI: 10.1016/j.ijmedinf.2023.105337] [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: 08/14/2023] [Revised: 12/16/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Nurses are essential for assessing and managing acute pain in hospitalized patients, especially those who are unable to self-report pain. Given their role and subject matter expertise (SME), nurses are also essential for the design and development of a supervised machine learning (ML) model for pain detection and clinical decision support software (CDSS) in a pain recognition automated monitoring system (PRAMS). Our first step for developing PRAMS with nurses was to create SME-friendly data labeling software. PURPOSE To develop an intuitive and efficient data labeling software solution, Human-to-Artificial Intelligence (H2AI). METHOD The Human-centered Design for Embedded Machine Learning Solutions (HCDe-MLS) model was used to engage nurses. In this paper, HCDe-MLS will be explained using H2AI and PRAMS as illustrative cases. FINDINGS Using HCDe-MLS, H2AI was developed and facilitated labeling of 139 videos (mean = 29.83 min) with 3189 images labeled (mean = 75 s) by 6 nurses. OpenCV was used for video-to-image pre-processing; and MobileFaceNet was used for default landmark placement on images. H2AI randomly assigned videos to nurses for data labeling, tracked labelers' inter-rater reliability, and stored labeled data to train ML models. CONCLUSIONS Nurses' engagement in CDSS development was critical for ensuring the end-product addressed nurses' priorities, reflected nurses' cognitive and decision-making processes, and garnered nurses' trust for technology adoption.
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Affiliation(s)
| | - Susan Horner
- Ann & Robert H. Lurie Children's Hospital of Chicago, 255 E. Chicago Ave, Box 101, Chicago, IL, USA.
| | - Priyansh Dadar
- KaviGlobal, 1250 Grove St, Suite 300, Barrington, IL, USA.
| | - Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, 255 E. Chicago Ave, Box 101, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Pediatrics, 255 E. Chicago Ave, Chicago, IL, USA.
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18
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Beaudoin M, Belzile EL, Gélinas C, Trépanier D, Émond M, Gagnon MA, Bérubé M. Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study. Int J Orthop Trauma Nurs 2024; 52:101050. [PMID: 37848364 DOI: 10.1016/j.ijotn.2023.101050] [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: 05/29/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Pain management and early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited. AIMS To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation. METHODS A convergent mixed methods study was used. Quantitative data were collected from sixty medical records. Qualitative data was collected through a focus group with healthcare providers to explore their perspectives regarding the use of the target practices and on barriers and facilitators to their implementation. Descriptive statistics were calculated, and a thematic analysis using an inductive and deductive interpretative descriptive approach was undertaken. RESULTS A question on the presence/absence of pain was the most frequently documented pain assessment method. Pain assessment was poorly documented. Frequencies of non-opioid and opioid administrations were similar, but non-pharmacological strategies were not widely used. The first mobilization was performed quickly and was most commonly to a chair. The focus group discussion confirmed many of the data collected in the medical records. Barriers to implementing the targeted strategies were primarily related to organizational context and facilitation processes. CONCLUSIONS Areas for improvement were identified including pain assessment, the use of non-pharmacological pain management strategies and ambulation as a mobilization strategy. Our findings will serve as a starting point for optimizing and adapting practices for geriatric trauma patients and evaluating their impact.
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Affiliation(s)
- Maryline Beaudoin
- Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada.
| | - Etienne L Belzile
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Orthopaedic Surgery, CHU de Quebec- Laval University, Quebec, QC, Canada
| | - Céline Gélinas
- Quebec Pain Research Network, Sherbrooke, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal, Montreal, QC, Canada; Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - David Trépanier
- Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marcel Émond
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marc-Aurèle Gagnon
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada
| | - Mélanie Bérubé
- Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada
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Piyakhachornrot C, Youngcharoen P. Pain management education needs for nurses caring for older adults undergoing total knee replacement. Int J Orthop Trauma Nurs 2024; 52:101037. [PMID: 37438242 DOI: 10.1016/j.ijotn.2023.101037] [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: 05/06/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Effective postoperative pain management is necessary to improve the outcomes of older adults undergoing total knee replacement (TKR). Discovering what registered nurses (RNs) need to know about pain management may be beneficial to improving the quality of care. AIM The study aimed to identify the information needed to develop pain management education for RNs caring for older adults undergoing TKR. METHODS A qualitative descriptive design was used in this study. Three focus groups were conducted with 22 staff RNs with experience caring for older adults undergoing TKR at a supra-tertiary care hospital in Bangkok, Thailand; one focus group was conducted with five members of the hospital's nursing pain management committee. Data were analyzed using content analysis. RESULTS Two themes relevant to pain assessment education were pain assessment and pain management. Subthemes of pain assessment included challenges in cognitively impaired older adults, inadequate knowledge and misconceptions, and re-assessing pain. Three subthemes of pain management were created, including knowledge of pain medication, new trends in pharmacological pain management and devices, and non-pharmacological pain management using cold compression. CONCLUSIONS RNs require current information about pain management to provide effective postoperative care for older adults undergoing TKR. The findings may be used in pain management education to update RNs' knowledge of pain management.
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Affiliation(s)
- Chayada Piyakhachornrot
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phichpraorn Youngcharoen
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Vigorito M, Chang SL. Alcohol use and the pain system. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2024; 4:12005. [PMID: 38389900 PMCID: PMC10880763 DOI: 10.3389/adar.2024.12005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
The World Health Organization's epidemiological data from 2016 revealed that while 57% of the global population aged 15 years or older had abstained from drinking alcohol in the previous year, more than half of the population in the Americas, Europe, and Western Pacific consumed alcohol. The spectrum of alcohol use behavior is broad: low-risk use (sensible and in moderation), at-risk use (e.g., binge drinking), harmful use (misuse) and dependence (alcoholism; addiction; alcohol use disorder). The at-risk use and misuse of alcohol is associated with the transition to dependence, as well as many damaging health outcomes and preventable causes of premature death. Recent conceptualizations of alcohol dependence posit that the subjective experience of pain may be a significant contributing factor in the transition across the spectrum of alcohol use behavior. This narrative review summarizes the effects of alcohol at all levels of the pain system. The pain system includes nociceptors as sensory indicators of potentially dangerous stimuli and tissue damage (nociception), spinal circuits mediating defensive reflexes, and most importantly, the supraspinal circuits mediating nocifensive behaviors and the perception of pain. Although the functional importance of pain is to protect from injury and further or future damage, chronic pain may emerge despite the recovery from, and absence of, biological damage (i.e., in the absence of nociception). Like other biological perceptual systems, pain is a construction contingent on sensory information and a history of individual experiences (i.e., learning and memory). Neuroadaptations and brain plasticity underlying learning and memory and other basic physiological functions can also result in pathological conditions such as chronic pain and addiction. Moreover, the negative affective/emotional aspect of pain perception provides embodied and motivational components that may play a substantial role in the transition from alcohol use to dependence.
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Affiliation(s)
- Michael Vigorito
- Institute of NeuroImmune Pharmacology, Seton Hall University, South Orange, NJ, United States
| | - Sulie L Chang
- Institute of NeuroImmune Pharmacology, Seton Hall University, South Orange, NJ, United States
- Department of Biological Sciences, Seton Hall University, South Orange, NJ, United States
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Nguyen V, Richard-Lalonde M, Gélinas C. Interrater Agreement between Bedside and Video Raters Using the CPOT-Neuro for Pain Assessment in Critically Ill Patients with a Brain Injury. NURSING REPORTS 2024; 14:212-219. [PMID: 38391062 PMCID: PMC10885079 DOI: 10.3390/nursrep14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/15/2023] [Accepted: 01/08/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to examine the interrater agreement of Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro) scores as a newly developed tool for pain assessment in patients with critical illness and brain injury between raters using two methods of rating (bedside versus video) during standard care procedures (i.e., non-invasive blood pressure and turning). The bedside raters were research staff, and the two video raters had different backgrounds (health and non-health disciplines). Raters received standardized 45 min training by the principal investigator. Video recordings of 56 patient participants with a brain injury at different levels of consciousness were included. Interrater agreement was supported with an Intraclass Correlation Coefficient (ICC) > 0.65 for all pairs of raters and for each procedure. Interrater agreement was highest during turning in the conscious group, with ICCs ranging from 0.79 to 0.90. The use of video recordings was challenging for the observation of some behaviors (i.e., tearing, face flushing), which were influenced by factors such as lighting and the angle of the camera. Ventilator alarms were also challenging to distinguish from other sources for the video rater from a non-health discipline. Following standardized training, video technology was useful in achieving an acceptable interrater agreement of CPOT-Neuro scores between bedside and video raters for research purposes.
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Affiliation(s)
- Vivienne Nguyen
- Undergraduate Neuroscience Program, McGill University, Montreal, QC H3A 1R1, Canada
| | - Melissa Richard-Lalonde
- Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital-CIUSSS West-Central-Montreal, Montreal, QC H3T 1E2, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital-CIUSSS West-Central-Montreal, Montreal, QC H3T 1E2, Canada
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Sabater-Gárriz Á, Gaya-Morey FX, Buades-Rubio JM, Manresa-Yee C, Montoya P, Riquelme I. Automated facial recognition system using deep learning for pain assessment in adults with cerebral palsy. Digit Health 2024; 10:20552076241259664. [PMID: 38846372 PMCID: PMC11155325 DOI: 10.1177/20552076241259664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Objective Assessing pain in individuals with neurological conditions like cerebral palsy is challenging due to limited self-reporting and expression abilities. Current methods lack sensitivity and specificity, underlining the need for a reliable evaluation protocol. An automated facial recognition system could revolutionize pain assessment for such patients.The research focuses on two primary goals: developing a dataset of facial pain expressions for individuals with cerebral palsy and creating a deep learning-based automated system for pain assessment tailored to this group. Methods The study trained ten neural networks using three pain image databases and a newly curated CP-PAIN Dataset of 109 images from cerebral palsy patients, classified by experts using the Facial Action Coding System. Results The InceptionV3 model demonstrated promising results, achieving 62.67% accuracy and a 61.12% F1 score on the CP-PAIN dataset. Explainable AI techniques confirmed the consistency of crucial features for pain identification across models. Conclusion The study underscores the potential of deep learning in developing reliable pain detection systems using facial recognition for individuals with communication impairments due to neurological conditions. A more extensive and diverse dataset could further enhance the models' sensitivity to subtle pain expressions in cerebral palsy patients and possibly extend to other complex neurological disorders. This research marks a significant step toward more empathetic and accurate pain management for vulnerable populations.
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Affiliation(s)
- Álvaro Sabater-Gárriz
- Department of Research and Training, Balearic ASPACE Foundation, Marratxí, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - F Xavier Gaya-Morey
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - José María Buades-Rubio
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Cristina Manresa-Yee
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pedro Montoya
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
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Asriyanto LF, Chayati N. Cross-cultural adaptation and validation of the Indonesian version of the Critical-care Pain Observation Tool. Int J Nurs Sci 2024; 11:113-119. [PMID: 38352280 PMCID: PMC10859591 DOI: 10.1016/j.ijnss.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Objective The Critical-care Pain Observation Tool (CPOT) is one of the most accurate methods for assessing pain in ICU patients with critical illness and/or a decreased level of consciousness (LOC). This study aimed to determine the validity and reliability of the Indonesian version of the CPOT. Methods The English version of CPOT was translated into the Indonesian version following five steps: initial translation, synthesis of instrument translation results, back translation, validation of the instrument by an expert committee, and testing of the Indonesian instrument. Between September and December 2022, a total of 52 ICU patients from four hospitals in Indonesia were evaluated for pain at rest, during body-turning procedure, and 15 minutes after the procedure using the CPOT. The researcher used the verbal Faces Pain Thermometer (FPT) instrument as a gold standard to assess the CPOT's criteria validity. Validity assessments included content and criterion validity. Reliability was evaluated using Cronbach's α coefficient and interrater reliability. Results Higher CPOT scores were found during the body-turning procedure than at rest and after the procedure. The instrument's item-content validity index (I-CVI) ranged from 0.75 to 1.00, and the overall instrument's average scale-level content validity index (S-CVI/Ave) was 0.93. The statistical analysis revealed a positive correlation (r) between the CPOT and the patient's FPT scores (0.877-0.983, P < 0.01). The significant agreement amongst raters (κ) revealed the inter-rater reliability of the CPOT (0.739-0.834, P < 0.01). Conclusion The Indonesian version of the CPOT has been proven valid and reliable in assessing pain in patients with critical illness and/or decreased LOC.
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Affiliation(s)
- Luthfi Fauzy Asriyanto
- Master of Nursing Program, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Indonesia
| | - Nur Chayati
- School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Indonesia
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Baird C, Miller H, Hoti K, Hughes J. Clinical impact of a multifaceted intervention aimed at decreasing distress in people living with dementia: evaluating the Reconnect program. Front Psychiatry 2023; 14:1191105. [PMID: 38144480 PMCID: PMC10748381 DOI: 10.3389/fpsyt.2023.1191105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023] Open
Abstract
Background To better meet the needs of people living with advanced dementia, Orchard Care Homes, United Kingdom have established an enhanced person focused program, namely the Reconnect program, which provides an enriched psycho-social care to enhance peoples' quality of life and well-being. Here we aimed to review the impact of this program on people living with dementia. Methods In this study the implementation of the Reconnect program was evaluated for two six-month periods (April-September 2020 and April-September 2021). The focus of this evaluation was on three key interventions: increasing meaningful occupation and engagement; improving pain identification and management, and reducing constipation. The Reconnect program was conducted in a single for-profit care home. It involved residents with complex dementia needs who previously not responded to support in alternative settings or found previous care ineffective in relieving their distress and reducing risks they pose to themselves or others. Results A total of 24 people participated in the program during this evaluation. We observed a substantial increase in engagement in meaningful activity per person, including an increase of outdoor access to fresh air. Pain management improved as evidenced by more standardized pain assessments using the PainChek system and coverage of people with either regular and/or "when required" pain management. Constipation relief also improved. For the two comparison periods, distress responses per resident reduced from 14.5 to 10.6 events and use of regular pain relief increased from 21.7 to 48.1%. Use of "when required" benzodiazepine halved from 6 months average of 46 to 23.2 doses given. Benzodiazepine dose reductions increased from 13.3 to 31.8%, while cessations increased from 20 to 50%. We also observed a reduction from 76.3 to 56.3% in antipsychotic use. Their dose reductions increased from 8.3 to 40% and drug cessation was made in 30% of people using antipsychotics (compared to the first period in which no medication cessation was observed). A 91.7% reduction (i.e., from 36 to 3 events) in safeguarding events related to behaviors was also observed. Conclusion Introduction of the Reconnect program, through its interventions focused on meaningful activity engagement, pain management and constipation relief resulted in substantial improvements related to people's distress, safeguarding and psychotropic use.
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Affiliation(s)
| | | | - Kreshnik Hoti
- Faculty of Medicine, University of Prishtina, Pristina, Albania
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Jeffery Hughes
- Faculty of Medicine, University of Prishtina, Pristina, Albania
- PainChek Ltd., Sydney, NSW, Australia
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25
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Johnson E, van Zijl K, Kuyler A. Pain communication in children with autism spectrum disorder: A scoping review. PAEDIATRIC & NEONATAL PAIN 2023; 5:127-141. [PMID: 38149220 PMCID: PMC10749405 DOI: 10.1002/pne2.12115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 12/28/2023]
Abstract
Children with autism spectrum disorder (ASD) experience social interaction and communication challenges and often display repetitive, restricted patterns of behavior, activities, and interests. The concept of pain is regarded as one of the most complex human stressors due to its subjective and personal nature and the influences of multiple internal and external factors. Due to the complexity of this disorder, it remains concerning how children with ASD communicate their pain and how observers (i.e., parents, carers, and health care practitioners) respond to these children's pain communication. This scoping review aimed to identify how children with ASD communicate or express their pain. Ten studies met the inclusion criteria for further data extraction. Through reflexive thematic analysis, two main themes were identified: verbal and nonverbal responses used by children with ASD to communicate their pain that could influence pain assessment and management strategies. This review highlighted that children with ASD utilized various verbal and nonverbal methods to communicate their pain experiences and that these methods differed compared to children without disabilities. Furthermore, this review emphasizes the importance of holistic pain assessment strategies as well as additional pictorial support for children with ASD. This review recommends that future research should focus on understanding how the inclusion of different stakeholders in pain assessment for children with ASD, can contribute to holistic pain assessment.
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Affiliation(s)
- Ensa Johnson
- Department of Inclusive Education, College of EducationUniversity of South AfricaPretoriaSouth Africa
| | - Karen van Zijl
- School of the Arts: Visual ArtsUniversity of South AfricaPretoriaSouth Africa
| | - Ariné Kuyler
- Department of Inclusive Education, College of EducationUniversity of South AfricaPretoriaSouth Africa
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Treiman-Kiveste A, Kangasniemi M, Kalda R, Pölkki T. Parental Participation in Their Infants' Procedural Pain Alleviation with Nonpharmacologic Methods in Estonia. Pain Manag Nurs 2023; 24:641-649. [PMID: 37002054 DOI: 10.1016/j.pmn.2023.02.008] [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: 06/21/2022] [Revised: 02/11/2023] [Accepted: 02/19/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Aim: To describe parent's participation in their infants' procedural pain alleviation using nonpharmacologic methods in neonatal and neonatal intensive care units. METHOD A descriptive cross-sectional survey study was carried out in four Estonian hospitals between 2019 and 2020. Data were collected by using a validated questionnaire comprised of three sections: (1) background information of parents and infants; (2) nonpharmacologic methods used by parents; and (3) parental guidance by nurses on the methods. Altogether 280 questionnaires were distributed to parents and 232 of them were received back. Finally, 189 of them were included in the study (response rate 67.5%). The data were analyzed using descriptive and analytical statistics. Analysis of open-ended questions followed principles of inductive content analysis. RESULTS Most participants reported using nonpharmacologic methods, such as holding and placing the infant in a more comfortable position, nearly always/always (61%, 62%, respectively). However, rarely used methods included skin-to-skin contact (7%), breastfeeding the infant (7%), and listening to recorded music (3%). While studying a correlation between the parents' use of nonpharmacologic methods and their guidance, we found a correlation among all nonpharmacologic methods. However, almost half (48%) of the parents reported that the nurses advised them "sometimes" or "nearly always/ always" to go elsewhere during painful procedures rather than participating in alleviation of the infant´s pain. CONCLUSIONS The parents reported using mostly the nonpharmacologic methods that were easy to implement and did not require thorough instructions in preparation. In addition, it seemed that parents wanted to be more involved in their infant's pain alleviation, but they were advised not to take part in painful procedures and pain alleviation for various reasons. Therefore, more attention should be paid to the principles of family-centered care. As health care providers, we should welcome all families as team members to involve in their infants' pain alleviation in the neonatal and neonatal intensive care units.
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Affiliation(s)
- Airin Treiman-Kiveste
- From the Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia; Nursing and Midwifery Department, Tartu Health Care College, Tartu, Estonia.
| | - Mari Kangasniemi
- From the Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia; University Researcher, University of Turku, Turku, Finland
| | - Ruth Kalda
- From the Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tarja Pölkki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu University Hospital, Finland
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Muench U, Kim KM, Zimmer Z, Monroe TB. The association between cognitive ability and opioid prescribing in vulnerable older adults with chronic pain in ambulatory care: a secondary data analysis using the Medical Expenditure Panel Survey. BMC Med 2023; 21:446. [PMID: 37974164 PMCID: PMC10655447 DOI: 10.1186/s12916-023-03133-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Vulnerable older adults living with Alzheimer's disease or Alzheimer's disease and related dementia (AD/ADRD) and chronic pain generally receive fewer pain medications than individuals without AD/ADRD, especially in nursing homes. Little is known about pain management in older adults with AD/ADRD in the community. The aim of the study was to examine opioid prescribing patterns in individuals with chronic pain by levels of cognitive ability in ambulatory care. METHODS We used the Medical Expenditure Panel Survey (MEPS), years 2002-2017, and identified three levels of cognitive impairment: no cognitive impairment (NCI), individuals reporting cognitive impairment (CI) without an AD/ADRD diagnosis, and individuals with a diagnosis of AD/ADRD. We examined any receipt of an opioid prescription and the number of opioid prescriptions using a logistic and negative binomial regression adjusting for sociodemographic and health characteristics and stratifying by three types of chronic pain (any chronic pain, severe chronic pain, and chronic pain identified through ICD 9/10 chronic pain diagnoses). RESULTS Among people with any chronic pain, adjusted odds of receiving an opioid for people with CI (OR 1.41, 95% confidence interval 1.31-1.52) and AD/ADRD (OR 1.23, 95% confidence interval 1.04-1.45) were higher compared to NCI. Among people with chronic pain ICD 9/10 conditions, the odds of receiving an opioid were also higher for those with CI (OR 1.43, 95% confidence interval 1.34-1.56) and AD/ADRD (OR 1.48, 95% confidence interval 1.23-1.78) compared to NCI. Among those with severe chronic pain, people with CI were more likely to receive an opioid (OR 1.17, 95% confidence interval 1.07-1.27) relative to NCI (OR 0.89, 95% confidence interval 0.75-1.06). People with AD/ADRD experiencing severe chronic pain were not more likely to receive an opioid compared to the NCI group. Adjusted predicted counts of opioid prescriptions showed more opioids in CI and AD/ADRD in all chronic pain cohorts, with the largest numbers of opioid prescriptions in the severe chronic pain and ICD 9/10 diagnoses groups. CONCLUSIONS The results suggest increased opioid use in people living with CI and AD/ADRD in the ambulatory care setting and potentially indicate that these individuals either require more analgesics or that opioids may be overprescribed. Further research is needed to examine pain management in this vulnerable population.
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Affiliation(s)
- Ulrike Muench
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 490 Illinois St., Floor 12, Box 0612, San FranciscoSan Francisco, CA, 94143, USA.
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA.
- Healthforce Center, University of California, San Francisco, San Francisco, USA.
| | - Kyung Mi Kim
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 490 Illinois St., Floor 12, Box 0612, San FranciscoSan Francisco, CA, 94143, USA
- Office of Research Patient Care Services, Stanford Health Care, Stanford, USA
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, USA
| | - Zachary Zimmer
- Global Aging and Community Initiative and Department of Family Studies & Gerontology, Mount Saint Vincent University, Halifax, Canada
| | - Todd B Monroe
- Center for Healthy Aging Self-Management, and Complex Care, College of Nursing, The Ohio State University, Columbus, USA
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Macharia JM, Raposa BL, Sipos D, Melczer C, Toth Z, Káposztás Z. The Impact of Palliative Care on Mitigating Pain and Its Associated Effects in Determining Quality of Life among Colon Cancer Outpatients. Healthcare (Basel) 2023; 11:2954. [PMID: 37998446 PMCID: PMC10671794 DOI: 10.3390/healthcare11222954] [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: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Pain continues to be a significant problem for cancer patients, and the impact of a population-based strategy on their experiences is not completely understood. Our study aimed to determine the impact of palliative care on mitigating pain and its associated effects in determining the quality of life (QoL) among colon cancer outpatients. Six collection databases were used to perform a structured systematic review of the available literature, considering all papers published between the year 2000 and February 2023. PRISMA guidelines were adopted in our study, and a total of 9792 papers were evaluated. However, only 126 articles met the inclusion criteria. A precise diagnosis of disruptive colorectal cancer (CRC) pain disorders among patients under palliative care is necessary to mitigate it and its associated effects, enhance health, promote life expectancy, increase therapeutic responsiveness, and decrease comorbidity complications. Physical activities, the use of validated pain assessment tools, remote outpatient education and monitoring, chemotherapeutic pain reduction strategies, music and massage therapies, and bridging social isolation gaps are essential in enhancing QoL. We recommend and place a strong emphasis on the adoption of online training/or coaching programs and the integration of formal and informal palliative care systems for maximum QoL benefits among CRC outpatients.
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Affiliation(s)
- John M. Macharia
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Bence L. Raposa
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Str 14/B, 7400 Kaposvár, Hungary
| | - Csaba Melczer
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary;
| | - Zoltan Toth
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Zsolt Káposztás
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
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Neshat H, Ghorbani F. Differences in the child, mother, and nurses' pain score measurements during pediatric venipuncture. J Pediatr Nurs 2023; 73:102-105. [PMID: 37659337 DOI: 10.1016/j.pedn.2023.08.025] [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: 11/10/2022] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Self-reporting is the gold standard for measuring pain in adult pain management; however, this issue is unique and different in children. Accurate pain assessment for the appropriate management of children's pain is important. PURPOSE This study was conducted to assess the pain level by the child, mother, and nurse during intravenous line insertion in preschool children, candidates for surgery in Tabriz Children's Hospital. DESIGN AND METHODS This is descriptive observational study. A total of 140 eligible children were included in the study using convenience and sequential methods. The intravenous line was inserted by an experienced nurse and pain assessment was performed by the child, mother, and nurse immediately after procedure, using the Wong-Baker face scale (WBFS). The data were analyzed through descriptive statistics and repeated measures ANOVA test using SPSS version 13 software. RESULTS The difference between child-mother and nurse-mother mean scores was not statistically significant; however, there was a statistically significant difference between the score measured by the child and the nurse (P = 0.017). CONCLUSION The children's pain assessment score during venipuncture was higher than that of mothers and nurses. The mothers' score was more closely related to the children's score. As a result, a mother's assessment can be considered a reliable estimation of proper pain management in young children and mothers can act as a moderator and actualize the nurses' score. Consequently, establishing a three-way communication between mother, child, and nurses is necessary to precisely estimate the child's actual pain and take appropriate measures to reduce it.
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Affiliation(s)
- Hanieh Neshat
- Pediatric Health Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ghorbani
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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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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MacDonald I, Alvarado S, Marston MT, Gomez Tovar L, Chanez V, Favre E, Gu Y, Trombert A, Perez MH, Ramelet AS. A systematic review of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal syndrome in pediatric intensive care. Front Pediatr 2023; 11:1264717. [PMID: 37868267 PMCID: PMC10587441 DOI: 10.3389/fped.2023.1264717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction This systematic review aimed to evaluate the quality of clinical practice guidelines (CPGs) and recommendations for managing pain, sedation, delirium, and iatrogenic withdrawal syndrome in pediatric intensive care (PICU). The objectives included evaluating the quality of recommendations, synthesizing recommendations, harmonizing the strength of the recommendation (SoR) and the certainty of evidence (CoE), and assessing the relevance of supporting evidence. Methods A comprehensive search in four electronic databases (Medline, Embase.com, CINAHL and JBI EBP Database), 9 guideline repositories, and 13 professional societies was conducted to identify CPGs published from January 2010 to the end of May 2023 in any language. The quality of CPGs and recommendations was assessed using the AGREE II and AGREE-REX instruments. Thematic analysis was used to synthesize recommendations, and the GRADE SoR and CoE harmonization method was used to interpret the credibility of summary recommendations. Results A total of 18 CPGs and 170 recommendations were identified. Most CPGs were of medium-quality, and three were classified as high. A total of 30 summary recommendations were synthesized across each condition, focused on common management approaches. There was inconsistency in the SoRs and CoE for summary recommendations, those for assessment showed the highest consistency, the remaining were conditional, inconsistent, inconclusive, and lacked support from evidence. Conclusion This systematic review provides an overview of the quality of CPGs for these four conditions in the PICU. While three CPGs achieved high-quality ratings, the overall findings reveal gaps in the evidence base of recommendations, patient and family involvement, and resources for implementation. The findings highlight the need for more rigorous and evidence-based approaches in the development and reporting of CPGs to enhance their trustworthiness. Further research is necessary to enhance the quality of recommendations for this setting. The results of this review can provide a valuable foundation for future CPG development. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274364, PROSPERO (CRD42021274364).
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Affiliation(s)
- Ibo MacDonald
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Silvia Alvarado
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Mark T. Marston
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Luz Gomez Tovar
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Faculty of Health, Universidad Surcolombiana, Neiva, Colombia
| | - Vivianne Chanez
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Eva Favre
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department Adult Intensive Care, Lausanne University Hospital, Lausanne, Switzerland
| | - Ying Gu
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Alexia Trombert
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maria-Helena Perez
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Carter M, Manworren RC, Stinson JN. Commentary: Pediatric Pain Measurement, Assessment, and Evaluation. Semin Pediatr Neurol 2023; 47:101074. [PMID: 37919028 DOI: 10.1016/j.spen.2023.101074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 11/04/2023]
Abstract
PEDIATRIC PAIN MEASUREMENT, ASSESSMENT, AND EVALUATION Renee C.B. Manworren, Jennifer Stinson Seminars in Pediatric Neurology Volume 23, Issue 3, August 2016, Pages 189-200 Assessment provides the foundation for diagnosis, selection of treatments, and evaluation of treatment effectiveness for pediatric patients with acute, recurrent, and chronic pain. Extensive research has resulted in the availability of a number of valid, reliable, and recommended tools for assessing children's pain. Yet, evidence suggests children's pain is still not optimally measured or treated. In this article, we provide an overview of pain evaluation for premature neonates to adolescents. The difference between pain assessment and measurement is highlighted; and the key steps to follow are identified. Information about self report and behavioral pain assessment tools appropriate for children are provided; and fac tors to be considered when choosing a specific 1 are outlined. Finally, we preview future approaches to personalized pain medicine in pediatrics that include harnessing the use of potential digital health technologies and genomics.
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Affiliation(s)
- Michela Carter
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Renee Cb Manworren
- Nursing Research & Professional Practice, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX.
| | - Jennifer N Stinson
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Shahid A, Sept BG, Owen VS, Johnstone C, Paramalingam R, Moss SJ, Brundin-Mather R, Krewulak KD, Soo A, Parsons-Leigh J, Gélinas C, Fiest KM, Stelfox HT. Preliminary clinical testing to inform development of the Critical Care Pain Observation Tool for Families (CPOT-Fam). Can J Pain 2023; 7:2235399. [PMID: 37719471 PMCID: PMC10503446 DOI: 10.1080/24740527.2023.2235399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
Introduction Many patients in the intensive care unit (ICU) cannot communicate. For these patients, family caregivers (family members/close friends) could assist in pain assessment. We previously adapted the Critical Care Pain Observation Tool (CPOT) for family caregiver use (CPOT-Fam). In this study, we conducted preliminary clinical evaluation of the CPOT-Fam to inform further tool development. Methods For preliminary testing, we collected (1) pain assessments of patients in the ICU from family caregivers (CPOT-Fam) and nurses (CPOT) and determined the degree of agreement (kappa coefficient, κ) and (2) collected openended feedback on the CPOT-Fam from family caregivers. For refinement, we used preliminary testing data to refine the CPOT-Fam with a multidisciplinary working group. Results We assessed agreement between family caregiver and nurse pain scores for 29 patients. Binary agreement (κ) between CPOT-Fam and CPOT item scores (scores ≥2 considered indicative of significant pain) was fair, κ = 0.43 (95% confidence interval [CI] 0.18-0.69). Agreement was highest for the CPOT-Fam items ventilator compliance/vocalization (weighted κ = 0.48, 95% CI 0.15-0.80) and lowest for muscle tension (weighted κ = 0.10, 95% [CI] -0.17 to 0.20). Most participants (n = 19; 69.0%) reported a very positive experience using the CPOT-Fam, describing it as "good" and "easy-to-use/clear/straightforward." We iteratively refined the CPOT-Fam over five cycles using the data collected until no further revisions were suggested. Conclusion Our preliminary clinical testing suggests that family involvement in pain assessment in the ICU is well perceived. The CPOT-Fam has been further refined and is now ready for clinical pilot testing to determine its feasibility and acceptability.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie G. Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Victoria S. Owen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Corson Johnstone
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Rameiya Paramalingam
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Stephana J. Moss
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Karla D. Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Jeanna Parsons-Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, and Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital–CIUSSS West-Central Montreal, Montreal, Quebec, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Boon JT, Herr K, Schirle L, Dietrich MS, Maxwell CA. Caregiving self-efficacy and pain assessment by family caregivers of people living with dementia. Geriatr Nurs 2023; 53:146-152. [PMID: 37540909 PMCID: PMC10530151 DOI: 10.1016/j.gerinurse.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/06/2023]
Abstract
Like other older adults, people living with dementia (PLWD) experience pain, and the task of pain assessment often falls to family caregivers. In this study, we surveyed family caregivers of PLWD to determine the frequency with which they use different elements of pain assessment. We also determined correlations of family caregivers' characteristics (caregiving self-efficacy, relationship duration and type, mood, education level, and health literacy) with their use of the elements of pain assessment. Participants reported frequent use of many pain assessment elements. Statistically significant correlations were found between caregiving self-efficacy for obtaining respite and asking others about noticed behavior change (rho=.0.41, p=.007); and for responding to disruptive patient behaviors for multiple pain assessment elements including observing pain behaviors (rho=0.49, p<.001), asking others about noticed behavior change (rho=0.54, p<.001) and rechecking (rho=0.56, p<.001). Continued efforts are needed to describe pain assessments by family caregivers of PLWD.
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Affiliation(s)
- Jeffrey T Boon
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA; Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Keela Herr
- University of Iowa College of Nursing, 50 Newton Road, Iowa City, IA 52242-1121, USA
| | - Lori Schirle
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA; Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37240, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA; Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN 37240, USA
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
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Goodall M, Irving K, Nevin M. The recognition, assessment and perceptions of total pain in people with profound intellectual disabilities: A mixed methods systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:940-950. [PMID: 37365750 DOI: 10.1111/jar.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND People with profound intellectual disabilities are a population with complex comorbidities. Total pain recognises the interconnectedness of aspects of pain; social, psychological, physical, emotional, spiritual. Pain is under-recognised due to communication challenges and carers perceptions. This review's purpose is to synthesise current literature and provide guidance for future research and care. METHODS Five databases were searched in this mixed methods systematic review (Cinahl, Medline, Psycinfo, Web of Science, Scopus). Articles retrieved were reported via a PRISMA flow diagram. Quality appraisal utilised the mixed methods appraisal tool (MMAT). A convergent qualitative design was the method of data synthesis. RESULTS Data from 16 included articles generated four themes; Absent voices, reductionist assessment, pain intensity, valuing expertise. Data included physical pain only. CONCLUSION Multifaceted pain needs inclusion in research. Assessment must consider the unique expressions of pain by individuals with profound intellectual disabilities. A sharing of expertise may improve pain care.
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Affiliation(s)
- Maeve Goodall
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Ireland
| | - Kate Irving
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Ireland
| | - Mary Nevin
- School of Nursing, Psychotherapy & Community Health, Dublin City University, Dublin, Ireland
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Özsaban A, Üzen Cura Ş, Yılmaz Coşkun E, Kibar D. Investigation of pain associated with endotracheal aspiration and affecting factors in an intensive care setting: A prospective observational study. Aust Crit Care 2023; 36:687-694. [PMID: 36604267 DOI: 10.1016/j.aucc.2022.11.010] [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: 07/24/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Endotracheal aspiration is a painful nociceptive procedure. There is still a gap in the literature on studies to determine the pain level and nursing interventions for aspiration. OBJECTIVES This study evaluated pain during endotracheal aspiration and examined the factors affecting pain. METHODS This prospective observational study was conducted with 105 inpatients meeting the inclusion criteria in the internal intensive care unit of a public hospital. Two hundred ten aspiration procedures were monitored for pain and other variables. ASPMN 2019 Position Statement recommendations were followed in designing the study and determining the procedure. The pain score range obtained from The Critical Care Pain Observation Tool was 0-8. A score of 2 or more is considered to indicate the presence of pain. The primary outcome measures were pain associated with endotracheal aspiration and affecting factors in this study. The generalised linear mixed model established for aspiration procedure-associated pain and affecting factors was analysed. RESULTS Patients' mean pain score was 1.24 ± 2.05 before, 3.07 ± 2.17 during, and 2.35 ± 1.94 after aspiration and 0.89 ± 1.40 at 15 min after aspiration. The pain rate was 26.1% before, 71% during, and 60.9% after the aspiration procedure and 18.8% after 15 min. There was a statistically significant difference between all pain scores evaluated. The difference in aspiration-related pain scores by age, respiratory diseases, sedation status, aspiration pressure, and tube diameter was statistically significant. CONCLUSIONS The pain score due to aspiration procedure increased significantly in intensive care unit inpatients and is an important risk factor for patient safety. More focus is needed on the causes and measures of aspiration-related pain.
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Affiliation(s)
- Aysel Özsaban
- Karadeniz Technical University, Faculty of Health Sciences, Department of Fundamentals of Nursing, Üniversite Neighbourhood, Farabi Street, Number 88, 61080 Ortahisar/Trabzon, Turkey.
| | - Şengül Üzen Cura
- Canakkale Onsekiz Mart University, Faculty of Health Sciences, Department of Fundamentals of Nursing, Terzioğlu Campus, Çanakkale, Turkey.
| | - Ela Yılmaz Coşkun
- Tekirdag Namik Kemal University, School of Health Sciences, Department of Nursing, Campus Street, Number 1, 59030 Tekirdag, Turkey.
| | - Dilanur Kibar
- Akçaabat Haçkalı Baba Public Hospital, Yaylacık Neigbourhood, Şifa Street, Number 14, 61300 Akçaabat/Trabzon, Turkey.
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Fang J, Wu W, Liu J, Zhang S. Deep learning-guided postoperative pain assessment in children. Pain 2023; 164:2029-2035. [PMID: 37146182 PMCID: PMC10436358 DOI: 10.1097/j.pain.0000000000002900] [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: 04/16/2022] [Revised: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 05/07/2023]
Abstract
ABSTRACT Current automated pain assessment methods only focus on infants or youth. They are less practical because the children who suffer from postoperative pain in clinical scenarios are in a wider range of ages. In this article, we present a large-scale Clinical Pain Expression of Children (CPEC) dataset for postoperative pain assessment in children. It contains 4104 preoperative videos and 4865 postoperative videos of 4104 children (from 0 to 14 years of age), which are collected from January 2020 to December 2020 in Anhui Provincial Children's Hospital. Moreover, inspired by the dramatic successful applications of deep learning in medical image analysis and emotion recognition, we develop a novel deep learning-based framework to automatically assess postoperative pain according to the facial expression of children, namely Children Pain Assessment Neural Network (CPANN). We train and evaluate the CPANN with the CPEC dataset. The performance of the framework is measured by accuracy and macro-F1 score metrics. The CPANN achieves 82.1% accuracy and 73.9% macro-F1 score on the testing set of CPEC. The CPANN is faster, more convenient, and more objective compared with using pain scales according to the specific type of pain or children's condition. This study demonstrates the effectiveness of deep learning-based method for automated pain assessment in children.
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Affiliation(s)
- Jihong Fang
- Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Wei Wu
- Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Jiawei Liu
- University of Science and Technology of China, Hefei, Anhui, China
| | - Sicheng Zhang
- University of Science and Technology of China, Hefei, Anhui, China
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Laures EL, LaFond CM, Marie BS, McCarthy AM. Pain Assessment and Management for a Chemically Paralyzed Child Receiving Mechanical Ventilation. Am J Crit Care 2023; 32:346-354. [PMID: 37652886 DOI: 10.4037/ajcc2023403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pain assessment in the pediatric intensive care unit (PICU) is complex, specifically for children receiving mechanical ventilation who require neuromuscular blockade (NMB). No valid pain assessment method exists for this population. Guidelines are limited to using physiologic variables; it remains unknown how nurses are assessing and managing pain for this population in practice. OBJECTIVES To describe how PICU nurses are assessing and managing pain for children who require NMB. METHODS A cross-sectional quantitative design was used with an electronic survey. Nurses were asked to respond to 4 written vignettes depicting a child who required NMB and had a painful procedure, physiologic cues, both, or neither. RESULTS A total of 107 PICU nurses answered the survey. Nurses primarily used behavioral assessment scales (61.0%) to assess the child's pain. All nurses reported that physiologic variables are either moderately or extremely important, and 27.3% of nurses used the phrase "assume pain present" formally at their organization. When physiologic cues were present, the odds of a nurse intervening with a pain intervention were 23.3 times (95% CI, 11.39-53.92; P < .001) higher than when such cues were absent. CONCLUSIONS These results demonstrate variation in how nurses assess pain for a child who requires NMB. The focus remains on behavioral assessment scales, which are not valid for this population. When intervening with a pain intervention, nurses relied on physiologic variables. Decision support tools to aid nurses in conducting an effective pain assessment and subsequent management need to be created.
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Affiliation(s)
- Elyse L Laures
- Elyse L. Laures is a nurse scientist, University of Iowa Hospitals and Clinics, and instructional track faculty, University of Iowa College of Nursing, Iowa City
| | - Cynthia M LaFond
- Cynthia M. LaFond is a senior nurse scientist, University of Iowa College of Nursing, Iowa City, and Ascension Illinois, Chicago
| | - Barbara St Marie
- Barbara St. Marie is an associate professor, University of Iowa College of Nursing, Iowa City
| | - Ann Marie McCarthy
- Ann Marie McCarthy is a professor, University of Iowa College of Nursing, Iowa City
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Cole CS, Blackburn J, Carpenter JS, Chen CX, Hickman SE. Pain and Associated Factors in Nursing Home Residents. Pain Manag Nurs 2023; 24:384-392. [PMID: 37003932 PMCID: PMC10440293 DOI: 10.1016/j.pmn.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Understanding factors associated with risk of pain allows residents and clinicians to plan care and set priorities, however, factors associated with pain in nursing home residents has not been conclusively studied. AIM To evaluate the association between pain and nursing home (NH) resident demographic and clinical characteristics. DESIGN Retrospective analysis of Minimum Data Set 3.0 records of nursing home residents residing in 44 Indiana NHs between September 27, 2011 and December 27, 2019 (N = 9,060). RESULTS Pain prevalence in this sample of NH residents was 23.7%. Of those with pain, 28.0% experienced moderate to severe/frequent pain and 54.6% experienced persistent pain. Risk factors for moderate to severe/frequent pain include female sex; living in a rural setting; intact, mildly, or moderately impaired cognition; arthritis; contracture; anxiety; and depression. In contrast, stroke and Alzheimer's disease and Alzheimer's-disease related dementias (AD/ADRD) were associated with decreased risk of reporting moderate to severe/frequent pain, likely representing both the under-assessment and under-reporting of pain among cognitively impaired NH residents. Risk factors for persistent pain included age <70, Black race, living in a rural location, intact cognition, contracture, and depression. CONCLUSIONS Pain remains a pressing problem for NH residents. In this study, we identified demographic and clinical factors associated with moderate to severe frequent pain and persistent pain. Residents with a diagnosis of AD/ADRD were less likely to report pain, likely representing the difficulty of evaluating pain in these residents. It is important to note that those with cognitive impairment may not experience any less pain, but assessment and reporting difficulties may make them appear to have less pain. Knowledge of factors associated with pain for NH residents has the potential for improving the ability to predict, prevent, and provide better pain care in NH residents.
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Affiliation(s)
- Connie S Cole
- School of Nursing, Indiana University, Indianapolis, Indiana; School of Medicine, University of Colorado, Aurora, Colorado; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana.
| | - Justin Blackburn
- Richard Fairbanks School of Public Health, Indiana University Purdue University, Indianapolis, Indiana
| | | | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, Indiana
| | - Susan E Hickman
- School of Nursing, Indiana University, Indianapolis, Indiana; RESPECT (Research in Palliative and End-of-Life Communication and Training) Signature Center, Indiana University Purdue University, Indianapolis, Indiana; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana
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Abdalrahim MS, Hamdan KM, Shaheen AM. Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses. Br J Pain 2023; 17:400-407. [PMID: 37538941 PMCID: PMC10395392 DOI: 10.1177/20494637231172496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background The importance and efficacy of Preemptive analgesia in reducing pain for patients undergoing painful procedures still debatable and seldom investigated. The aim of this study was to describe intensive care nurses' perception of the importance of pain assessment and Preemptive analgesia prior painful procedures in critical care settings in Jordan. Method A cross-sectional descriptive design was used. The sample consisted of 300 registered nurses recruited from 22 intensive care units in Jordan. The data was gathered using a self-administered questionnaire. Results The results showed that nurses considered pain assessment moderately and extremely important for surgical (n = 263, 87.7%), burn (n = 261, 87%), and trauma patients (n = 256, 85.3%). The majority of nurses rated pain assessment as moderately to extremely important for invasive line placement 80.3%, wound care 78.3%, and drain removal 69%. Nurses assessed the need for Preemptive analgesia more frequently before wound care 70.7%, and before invasive line placement 69.7%. Nurses perceived pain assessment for Preemptive analgesia as less priority for unconscious patients. Conclusion Effective assessment and management of pain for critically ill patients is mandatory. Thus, it is important to improve nurses' knowledge regarding the Preemptive analgesia and its effects in relieving post-procedural pain in critically ill patient. It is recommended to ensure proper clinical training on how to assess critically ill patients and auditing system.
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Affiliation(s)
- Maysoon S Abdalrahim
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Khaldoun M Hamdan
- Acute and Chronic Care Nursing Department, Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | - Abeer M Shaheen
- Community Health Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Li Y, He J, Fu C, Jiang K, Cao J, Wei B, Wang X, Luo J, Xu W, Zhu J. Children's Pain Identification Based on Skin Potential Signal. SENSORS (BASEL, SWITZERLAND) 2023; 23:6815. [PMID: 37571601 PMCID: PMC10422611 DOI: 10.3390/s23156815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Pain management is a crucial concern in medicine, particularly in the case of children who may struggle to effectively communicate their pain. Despite the longstanding reliance on various assessment scales by medical professionals, these tools have shown limitations and subjectivity. In this paper, we present a pain assessment scheme based on skin potential signals, aiming to convert subjective pain into objective indicators for pain identification using machine learning methods. We have designed and implemented a portable non-invasive measurement device to measure skin potential signals and conducted experiments involving 623 subjects. From the experimental data, we selected 358 valid records, which were then divided into 218 silent samples and 262 pain samples. A total of 38 features were extracted from each sample, with seven features displaying superior performance in pain identification. Employing three classification algorithms, we found that the random forest algorithm achieved the highest accuracy, reaching 70.63%. While this identification rate shows promise for clinical applications, it is important to note that our results differ from state-of-the-art research, which achieved a recognition rate of 81.5%. This discrepancy arises from the fact that our pain stimuli were induced by clinical operations, making it challenging to precisely control the stimulus intensity when compared to electrical or thermal stimuli. Despite this limitation, our pain assessment scheme demonstrates significant potential in providing objective pain identification in clinical settings. Further research and refinement of the proposed approach may lead to even more accurate and reliable pain management techniques in the future.
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Affiliation(s)
- Yubo Li
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (J.H.); (K.J.); (J.C.); (X.W.); (J.L.)
- International Joint Innovation Center, Zhejiang University, Haining 314400, China
| | - Jiadong He
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (J.H.); (K.J.); (J.C.); (X.W.); (J.L.)
| | - Cangcang Fu
- Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China; (C.F.); (W.X.)
| | - Ke Jiang
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (J.H.); (K.J.); (J.C.); (X.W.); (J.L.)
| | - Junjie Cao
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (J.H.); (K.J.); (J.C.); (X.W.); (J.L.)
| | - Bing Wei
- Polytechnic Institute of Zhejiang University, Hangzhou 310015, China;
| | - Xiaozhi Wang
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (J.H.); (K.J.); (J.C.); (X.W.); (J.L.)
- International Joint Innovation Center, Zhejiang University, Haining 314400, China
| | - Jikui Luo
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (J.H.); (K.J.); (J.C.); (X.W.); (J.L.)
- International Joint Innovation Center, Zhejiang University, Haining 314400, China
| | - Weize Xu
- Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China; (C.F.); (W.X.)
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jihua Zhu
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (J.H.); (K.J.); (J.C.); (X.W.); (J.L.)
- Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China; (C.F.); (W.X.)
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Riffin C, Brody L, Mukhi P, Herr K, Pillemer K, Rogers M, Henderson CR, Reid MC. Establishing the Feasibility and Acceptability of a Caregiver Targeted Intervention to Improve Pain Assessment Among Persons With Dementia. Innov Aging 2023; 7:igad074. [PMID: 38094933 PMCID: PMC10714902 DOI: 10.1093/geroni/igad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Despite its prevalence and impact, pain is underdetected and undermanaged in persons with dementia. Family caregivers are well positioned to detect pain and facilitate its management in their care recipients, but they lack training in symptom recognition and communication. This study reports findings from a pilot trial evaluating the Pain Identification and Communication Toolkit (PICT), a multicomponent intervention that provides training in observational pain assessment and coaching in pain communication techniques. Research Design and Methods Family caregivers of persons with comorbid pain and moderate-to-advanced dementia were randomly assigned to PICT (n = 19) or a control condition (n = 15). Caregivers in the PICT group participated in four weekly sessions delivered by telephone with a trained interventionist; caregivers in the control group received an information pamphlet about pain and dementia. All participants completed surveys at baseline and 12 weeks. Caregivers in the intervention group also completed semistructured interviews at 12 weeks. Quantitative data were analyzed using descriptive statistics and t tests; qualitative data were analyzed using content analysis. Results All participants (100%) in the PICT group completed the intervention and most completed the 12-week assessment (94%). PICT randomized caregivers reported that the intervention helped them to feel more confident in their ability to recognize (67%) and communicate about pain symptoms (83%). At 12 weeks, caregivers in the PICT group showed a statistically significant improvement in self-efficacy in pain-related communication. In qualitative interviews, caregivers emphasized the utility of PICT's components, including pain assessment tools, and offered considerations for future enhancements, such as technology-based adaptations and integration within care delivery systems. Discussion and Implications This pilot trial demonstrates that PICT is feasible to implement, acceptable to caregivers, and has the potential to improve confidence in recognizing and communicating about pain. Results support conducting a fully powered efficacy trial, an important step toward future integration into real-world care delivery. Clinical Trial Registration Number NCT03853291.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Priya Mukhi
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Karl Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Madeline Rogers
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - M Cary Reid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Minaya-Freire A, Subirana-Casacuberta M, Pou-Pujol G, Ramon-Aribau A. Nursing Practice Variations in Pain Management in Older Adults With Dementia Admitted to an Acute Geriatrics Unit During the COVID-19 Pandemic. Res Gerontol Nurs 2023; 16:173-182. [PMID: 37040309 DOI: 10.3928/19404921-20230405-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The current retrospective descriptive study evaluated nursing practice variations on pain management in older adults with dementia admitted to an acute geriatrics unit (AGU) before (2018) and during (2021) the coronavirus disease 2019 (COVID-19) pandemic. Data were gathered from electronic health records. Pain intensity was evaluated a median of 1.9 times per day of stay in the pre-COVID-19 sample, whereas in the COVID-19 sample, the median was 0.7 times per day of stay. Median number of analgesic administrations per day of stay and mean percentage of clinical care records that mentioned pain were higher in patients admitted during the pandemic. Variations in nursing care organization in the AGU due to the COVID-19 pandemic had an impact on the patterns of pain management nursing practice in older adults with dementia. [Research in Gerontological Nursing, 16(4), 173-182.].
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Boon JT, Herr K, Schirle L, Dietrich MS, Maxwell CA. People Living With Dementia: Dementia Characteristics and Family Caregiver Pain Assessment. J Gerontol Nurs 2023; 49:17-23. [PMID: 37379047 DOI: 10.3928/00989134-20230615-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
People living with dementia (PLWD) experience pain like other older adults, but with changes due to dementia, they rely more on family caregivers for pain assessment. Many different elements contribute to a pain assessment. Changes in characteristics of PLWD may be associated with changes in the use of these different pain assessment elements. The current study reports associations between PLWD's agitation, cognitive function, and dementia severity and the frequency with which family caregivers use pain assessment elements. In a sample of family caregivers (N = 48), statistically significant associations were found between worsening cognitive function and greater use of rechecking for pain after intervention (rho = 0.36, p = 0.013), and between lower cognitive scores on a subscale of dementia severity and asking others if they have noticed a behavior change in the PLWD (rho = 0.30, p = 0.044). Limited statistically significant associations suggest that, overall, family caregivers of PLWD do not use pain assessment elements more frequently with changes in characteristics of PLWD. [Journal of Gerontological Nursing, 49(7), 17-23.].
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Arabiat D, Mörelius E, Hoti K, Hughes J. Pain assessment tools for use in infants: a meta-review. BMC Pediatr 2023; 23:307. [PMID: 37337167 DOI: 10.1186/s12887-023-04099-7] [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] [Received: 09/14/2022] [Accepted: 05/28/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Identifying pain in infants is challenging due to their inability to self-report pain, therefore the availability of valid and reliable means of assessing pain is critical. OBJECTIVE This meta-review sought to identify evidence that could guide the selection of appropriate tools in this vulnerable population. METHODS We searched Scopus, Medline, Embase, CINAHL, MIDRIS, EMCare and Google Scholar for eligible systematic reviews. Eligible reviews documented psychometric properties of available observational tools used to assess pain in infants. RESULTS A total of 516 reviews were identified of which 11 met our inclusion criteria. We identified 36 pain assessment tools (evaluated in 11 reviews) of which seven were reported in at least three reviews. The level of evidence reported on the psychometric properties of pain assessment tools varied widely ranging from low to good reliability and validity, whilst there are limited data on usability and clinical utility. CONCLUSIONS Currently, no observer administered pain assessment tool can be recommended as the gold standard due to limited availability and quality of the evidence that supports their validity, reliability and clinical utility. This meta-review attempts to collate the available evidence to assist clinicians to decide on what is the most appropriate tool to use in their clinical practice setting. It is important that researchers adopt a standard approach to evaluating the psychometric properties of pain assessment tools and evaluations of the clinical utility in order that the highest level of evidence can be used to guide tool selection.
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Affiliation(s)
- Diana Arabiat
- Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan.
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.
| | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kreshnik Hoti
- Faculty of Medicine, University of Prishtina, Pristina, Kosovo
| | - Jeffery Hughes
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
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Horgas AL, Bruckenthal P, Chen S, Herr KA, Young HM, Fishman S. Assessing Pain in Older Adults: Caregivers play a key role in recognizing and documenting pain at home. Home Healthc Now 2023; 41:128-134. [PMID: 37144927 DOI: 10.1097/nhh.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Horgas, A.L., et al. Assessing Pain in Older Adults. Am J Nurs 2022; 122 (12): 42-48.
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Affiliation(s)
- Ann L Horgas
- Ann L. Horgas is an associate professor and chair of the Department of Biobehavioral Nursing Science at the University of Florida College of Nursing in Gainesville. Patricia Bruckenthal is a professor, associate dean for nursing research and innovation, and chair of doctoral studies in the School of Nursing at Stony Brook University in Stony Brook, NY. Shaoshuai Chen is a doctoral student in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This article was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Ann L. Horgas, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Palomaa AK, Hakala M, Pölkki T. Parents' perceptions of their child's pain assessment in hospital care: A cross-sectional study. J Pediatr Nurs 2023; 71:79-87. [PMID: 37030017 DOI: 10.1016/j.pedn.2023.03.012] [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] [Received: 11/21/2022] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE A prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents' perceptions of their child's pain assessment in hospital care. DESIGN AND METHODS This study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis. RESULTS Parents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child's pain assessment. Parents were satisfied with their child's pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child's pain and that the parents' and child's views on pain would be taken into account. CONCLUSIONS Most children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales. PRACTICE IMPLICATIONS Child's pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.
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Affiliation(s)
- Anna-Kaija Palomaa
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland.
| | - Mervi Hakala
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland
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Tagele TD, Berhe YW, Lema GF. Knowledge and attitude towards pediatric pain management among nurses at Ethiopian tertiary hospitals; a multi-center study. BMC Nurs 2023; 22:84. [PMID: 36973798 PMCID: PMC10041723 DOI: 10.1186/s12912-023-01234-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/06/2023] [Indexed: 03/28/2023] Open
Abstract
Background Pain is the most disturbing and annoying symptom experienced by children. However, it obtains poor attention in low- and middle-income countries particularly. The objective of this study was to assess knowledge, attitude and factors associated with pediatric pain management among nurses in tertiary hospitals in Northwest Ethiopia. Methodology : A multi-center cross-sectional study was conducted from March 1 to April 30, 2021. The knowledge and attitude of nurses were measured by using Nurses’ Knowledge and Attitudes Survey regarding Pain (P-NKAS). Descriptive and binary logistic regression analyses were performed to determine factors associated with knowledge and attitude. The strength of the association was presented by using adjusted odds ratio with 95% confidence interval and p-value < 0.05 was considered as statistically significant. Result A total of 234 (86.03% response rate) nurses were included and 67.1% of nurses had good knowledge and 89.3% had favorable attitudes towards pediatric pain management. The factors associated with good knowledge were having Bachelor’s Degree and above [AOR = 2.1, P = 0.015], having in-service training [AOR = 2.4, P = 0.008] and favorable attitude [AOR = 3.3, CI = 0.008]. The nurses who demonstrated good knowledge [AOR = 3.3, P = 0.003] and those who had Bachelor’s Degree and above [AOR = 2.8, P = 0.03] were found to have favorable attitude. Conclusion The nurses who were working in pediatrics care areas had good knowledge and favorable attitude towards pediatrics pain management. However, improvements are needed to eradicate misconceptions; particularly, on pediatrics pain perception, opioid analgesia, multimodal analgesia, and non-pharmacologic pain therapies. Nurses who had higher level of education, in-service training, favorable attitude were found to be knowledgeable. Furthermore, nurses who had higher levels of education and knowledge were found to have favorable attitude.
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Affiliation(s)
- Takele Dereje Tagele
- grid.448640.a0000 0004 0514 3385Department of Anesthesia, College of Medicine and Health Sciences, Aksum University, Aksum, Ethiopia
| | - Yophtahe Woldegerima Berhe
- grid.59547.3a0000 0000 8539 4635Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girmay Fitiwi Lema
- grid.59547.3a0000 0000 8539 4635Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Enninga A, Waninge A, Post WJ, van der Putten AAJ. Reliable assessment of pain behaviour in adults with profound intellectual and multiple disabilities: The development of an instruction protocol. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:653-663. [PMID: 36915941 DOI: 10.1111/jar.13089] [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: 10/10/2022] [Revised: 01/22/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Persons with profound intellectual and multiple disabilities (PIMD) are vulnerable when it comes to experiencing pain. Reliable assessment of pain-related behaviour in these persons is difficult. Aim To determine how pain items can be reliably scored in adults with PIMD. METHODS We developed an instruction protocol for the assessment of pain-related behaviour in four phases. We used videos of 57 adults with PIMD during potentially painful situations. The items were assessed for inter-rater reliability (Cohen's kappa or percentage of agreement). RESULTS The developed instruction protocol appeared to be adequate. Twelve items had satisfactory inter-rater reliability (n = 9: .30-1.00; n = 3: 85%-100%). DISCUSSION Calibrating and adjustments to the instructions and item set appeared to be crucial to reliably score 12 items in adults with PIMD. Further research should focus on creating an assessment instrument based on these reliably scored items.
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Affiliation(s)
- Annemieke Enninga
- Department of Inclusive and Special Needs Education, University of Groningen, Groningen, The Netherlands
| | - Aly Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Wendy J Post
- Department of Inclusive and Special Needs Education, University of Groningen, Groningen, The Netherlands
| | - Annette A J van der Putten
- Department of Inclusive and Special Needs Education, University of Groningen, Groningen, The Netherlands
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Kodagoda Gamage MW, Todorovic M, Moyle W, Pu L. Cultural Influence on Nurses' Pain Observations Related to Dementia: An Integrative Review. Pain Manag Nurs 2023:S1524-9042(23)00028-0. [PMID: 36907689 DOI: 10.1016/j.pmn.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Nurses play a pivotal role in pain observation in people living with dementia. However, currently, there is little understanding of the influence culture may have on the way nurses observe pain experienced by people living with dementia. AIM This review explores the influence of culture on nurses... pain observations experienced by people living with dementia. SETTINGS Studies were included regardless of the setting (e.g., acute medical care, long-term care, community). DESIGN An integrative review. PARTICIPANTS/SUBJECTS PubMed, Medline, Psychological Information Database, Cochrane Library, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and ProQuest were included in the search. METHODS Electronic databases were searched using synonyms for "dementia," "nurse," "culture," and "pain observation." The review included ten primary research papers following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS Nurses reported that pain observation in people living with dementia is challenging. Four themes were identified by data synthesis: (1) using behaviors for pain observation; (2) information from carers for pain observation; (3) pain assessment tools for pain observation; and (4) role of knowledge, experience, and intuition in pain observation. CONCLUSIONS There is a limited understanding of the role of culture on nurses' pain observations. However, nurses take a multifaceted approach to observing pain using behaviors, information from carers, pain assessment tools, and their knowledge, experience, and intuition.
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Affiliation(s)
- Madushika Wishvanie Kodagoda Gamage
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia; Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka.
| | - Michael Todorovic
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
| | - Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Nathan, Griffith University, Brisbane, Queensland, Australia
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