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Smith AB, Jung M, O'Donnell D, White FA, Pressler SJ. Pain, Return to Community Status, and 90-Day Mortality Among Hospitalized Patients With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00202. [PMID: 38915135 DOI: 10.1097/jcn.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Pain is common among patients with heart failure but has not been examined with short-term discharge outcomes. The purpose was to examine whether pain at discharge predicts return to community status and 90-day mortality among hospitalized patients with heart failure. METHODS Data from medical records of 2169 patients hospitalized with heart failure were analyzed in this retrospective cohort study. The independent variable was a diagnosis of pain at discharge. Outcomes were return to community status (yes/no) and 90-day mortality. Logistic regression was used to address aims. Covariates included age, gender, race, vital signs, comorbid symptoms, comorbid conditions, cardiac devices, and length of stay. RESULTS The sample had a mean age of 66.53 years, and was 57.4% women and 55.9% Black. Of 2169 patients, 1601 (73.8%) returned to community, and 117 (5.4%) died at or before 90 days. Patients with pain returned to community less frequently (69.6%) compared with patients without pain (75.2%), which was a statistically significant relationship (odds ratio, 0.74; 95% confidence interval, 0.57-0.97; P = .028). Other variables that predicted return to community status included age, comorbid conditions, dyspnea, fatigue, systolic blood pressure, and length of stay. Pain did not predict increased 90-day mortality. Variables that predicted mortality included age, liver disease, and systolic blood pressure. CONCLUSION Patients with pain were less likely to return to community but did not have higher 90-day mortality. Pain in combination with other symptoms and comorbid conditions may play a role in mortality if acute pain versus chronic pain can be stratified in a future study.
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Vikan KK, Landmark T, Gjeilo KH. Prevalence of chronic pain and chronic widespread pain among subjects with heart failure in the general population: The HUNT study. Eur J Pain 2024; 28:273-284. [PMID: 37680005 DOI: 10.1002/ejp.2176] [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: 03/06/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Pain in chronic heart failure (HF) is a significant but often unrecognized symptom. Characteristics of pain in subjects with HF are largely undescribed. The study aimed to address a knowledge gap in the relationship between HF and pain by investigating the prevalence of chronic pain and chronic widespread pain (CWP) among subjects with HF. METHODS Population data from the HUNT3 study in Norway (2006-2008, n = 50,802) was used. HF was measured by self-report. CWP was defined as having pain in both sides of the body, pain in the upper and lower limbs, and axial pain for at least 3 months in the last year. Associations between HF and CWP and HF and moderate to high pain intensity were analysed with logistic regression. RESULTS Among subjects with HF in the general population, the prevalence of chronic pain was 67.8%, 20.7% had CWP, and 58.8% had moderate to high intensity pain. Compared to participants with cardiovascular disease but not HF, the odds of both CWP (OR = 1.6; 95% CI: 1.3-2.0) and moderate to high intensity pain (OR = 1.3; 95% CI: 1.3-1.8) were higher among participants with HF-controlled for age, sex, body mass index, and comorbidity. CONCLUSIONS Our study confirmed the high prevalence of pain among HF subjects. This pain could not be explained by comorbidity or sociodemographic factors, which are relevant for clinical and research purposes. Pain management should not be restricted to cardiac-related pain but to chronic pain in general. SIGNIFICANCE This epidemiological study corroborates previous studies reporting a high prevalence of pain in the HF-population. We found that the relationship between HF, CWP, and pain intensity could not be explained by comorbidity or sociodemographic factors, illustrating the burden of chronic pain related to HF. Our results expand the understanding of pain in HF and highlight the need to identify and manage chronic pain among individuals with HF, as widespread pain adds to the symptom burden in individuals with HF.
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Affiliation(s)
- K K Vikan
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian Registry for Vascular Surgery (NORKAR), Department of Medical Quality Registries, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - T Landmark
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K H Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Aleman E, Nairon EB, Sida D, Olson DM. Complementary and alternative medicine carts in the inpatient rehabilitation unit: Access and nurses' use. Nursing 2023; 53:57-61. [PMID: 37973016 DOI: 10.1097/01.nurse.0000991600.58601.a3] [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: 11/19/2023]
Abstract
PURPOSE To determine if increased accessibility to complementary and alternative medicine (CAM) increases the usage of CAM interventions. METHODS A prospective pre-post study with a "run-in" design in a hospital with two inpatient rehabilitation floors was used. Data were analyzed with SAS v9.4. RESULTS CAM use before implementation was 2.8 (1.0); after implementation, 3.1 (0.56). CONCLUSION Greater access to CAM materials did not significantly increase their use (P = .233). Aromatherapy was used more after increased availability, but heat and cold application decreased. Nurses valued CAM even though independent practice was not fully supported.
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Affiliation(s)
- Elisabeth Aleman
- At the Texas Southwestern Medical Center, Elisabeth Aleman is an RN; Emerson Nairon is a clinical research associate; Deseary Sida is a clinical research associate, but was a student intern during the study; and DaiWai Olson is a professor
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Smith AB, Jung M, Pressler SJ, Mocci E, Dorsey SG. Differential Gene Expression Among Patients With Heart Failure Experiencing Pain. Nurs Res 2023; 72:175-184. [PMID: 36920122 PMCID: PMC10121868 DOI: 10.1097/nnr.0000000000000648] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND Chronic pain is frequently experienced by patients with heart failure (HF) and is associated with higher mortality, higher symptom burden, and worsened health-related quality of life. However, the genomic mechanisms underlying chronic pain in HF are understudied. Building an understanding of the mechanistic underpinnings of pain may inform novel interventions. OBJECTIVE The objective was to identify genes associated with pain from messenger RNA sequence data collected from patients with HF with and without pain. METHODS The current study analyzed data from 40 patients with HF previously enrolled in a clinical trial. Pain presence was measured using the Health Utilities Index Mark-3. Genes were tested for differential expression using DESeq2, and differentially expressed genes were analyzed for protein-protein interaction (PPI) and relevant ontological pathways using Metascape. Genes located within the core of the PPI network were considered key in disease-relevant biological pathways. Differentially expressed genes within this PPI network were reviewed in existing literature to narrow down candidate genes of interest. These target genes of interest were reanalyzed in a second sample of 24 patients with HF using validation quantitative polymerase chain reaction. RESULTS A total of 334 genes (279 upregulated, 55 downregulated) were differentially expressed between patients with and without pain in the primary sample of 40. These genes were largely aligned with neutrophil degranulation pathways. Seven genes of interest were identified from a core network of 15 co-expressed genes in the PPI network and existing literature. Three of these seven genes, matrix metallopeptidase 8 ( MMP8 ), proprotein convertase subtilisin/kexin type 9 ( PCSK9 ), and neutrophil defensin 3 ( DEFA3 ), were upregulated in patients with pain versus without pain in both the primary and validation samples. All seven genes of interest are involved in immune, inflammatory, and atherosclerotic processes. DISCUSSION These results identify potential genes that may play a mechanistic role in chronic pain in HF. Further research is needed to evaluate these potential genes among clearly delineated pain phenotypes.
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Ichikura K, Matsuoka S, Chiba H, Ishida H, Fukase Y, Murase H, Tagaya H, Takeuchi T, Matsushima E. Health care providers' perspectives on providing end-of-life psychiatric care in cardiology and oncology hospitals: a cross-sectional questionnaire survey. BMC Palliat Care 2023; 22:23. [PMID: 36918867 PMCID: PMC10014396 DOI: 10.1186/s12904-023-01138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Psychological distress is a major concern for patients with end-stage heart failure (HF). However, psychiatric care for patients with HF is not as organized as that for patients with cancer. Therefore, the aim of this study was to elucidate and compare the barriers faced by health care providers of cardiology and oncology hospitals in providing end-of-life psychiatric care to patients with HF and cancer, respectively. METHODS We conducted a cross-sectional questionnaire survey among the health care providers of Japan. Questionnaires were mailed to physicians and nurses of 427 cardiology and 347 oncology hospitals in March 2018 to assess health care providers' perspectives. First, we compared the scores of the Palliative Care Difficulties Scale and the original scale of end-of-life psychiatric care difficulties between health care providers of cardiology and oncology hospitals. Second, we asked the health care providers to describe the barriers to providing end-of-life psychiatric care with an open-ended question and then compared the freely-provided descriptions using content analysis. RESULTS A total of 213 cardiology and 224 oncology health care providers responded to the questionnaire. No significant differences were found between health care providers of cardiology and oncology hospitals in the frequency of experiencing barriers to providing end-of-life psychiatric care (59.8% and 62.2%, respectively). A content analysis identified the following eight barriers: "patients' personal problems," "family members' problems," "professionals' personal problems," "communication problems between professionals and patients," "problems specific to end-of-life care," "problems specific to psychiatric care," "problems of institution or system," and "problems specific to non-cancer patients." The "problems specific to noncancer patients" was described more frequently by health care providers in cardiology hospitals than that in oncology hospitals. However, there were no significant differences in other items between the two. CONCLUSION Although health care providers of both cardiology and oncology hospitals faced barriers to providing end-of-life psychiatric care, those of cardiology hospitals particularly faced challenges pertaining to non-cancer patients, such as unpredictability of prognosis or insufficiency of guideline development. A system of psychiatric care, specifically for patients with HF, should be established.
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Affiliation(s)
- Kanako Ichikura
- Department of Health Science, Kitasato University School of Allied Health Sciences, Kanagawa, Japan. .,Department of Clinical Neuropsychology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan. .,Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. .,, 1-15-1 Kitasato, Minami-ku, 252-0373, Sagamihara, Kanagawa, Japan.
| | - Shiho Matsuoka
- Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Chiba
- Department of Medical Education, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hina Ishida
- Department of Clinical Neuropsychology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Yuko Fukase
- Department of Health Science, Kitasato University School of Allied Health Sciences, Kanagawa, Japan.,Department of Clinical Neuropsychology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Hanako Murase
- Department of Health Science, Kitasato University School of Allied Health Sciences, Kanagawa, Japan.,Department of Clinical Neuropsychology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Hirokuni Tagaya
- Department of Health Science, Kitasato University School of Allied Health Sciences, Kanagawa, Japan.,Department of Clinical Neuropsychology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Takashi Takeuchi
- Department of Clinical Neuropsychology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan.,Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisuke Matsushima
- Department of Clinical Neuropsychology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan.,Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Loomis BR, Yee LM, Hayes L, Badreldin N. Nurses' Perspectives on Postpartum Pain Management. WOMEN'S HEALTH REPORTS 2022; 3:318-325. [PMID: 35415715 PMCID: PMC8994431 DOI: 10.1089/whr.2021.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Introduction: There is variation in postpartum opioid use by prescriber characteristics that cannot be explained by patient or birth factors. Thus, our objective was to evaluate nursing training, clinical practices, and perspectives on opioid use for postpartum pain management. Materials and Methods: In this survey study, postpartum bedside nurses at a single, large academic center were asked about training, factors influencing clinical decisions, and viewpoints regarding pain management and opioid use. Findings were summarized using descriptive analyses. Results: A total of 92 nurses completed the survey. A majority (77%) reported having received some formal training on opioid use for pain management. About a quarter (25.7%) felt their training was not adequate. Regarding clinical practices, the majority (71% and 70%, respectively) reported that “routine habit” and “patient preference” most influenced the type and amount of pain medication they administered. Finally, nurses' perspectives on pain management demonstrated a wide range of beliefs. Most nurses strongly agreed with the importance of maximizing nonopioid pain medication before opioid administration. The majority agreed that patient-reported pain score is important to consider when deciding to administer opioids. Conversely, most nurses disagreed that patients should be encouraged to endure as much pain as possible before using an opioid. Similarly, beliefs about the reliability of use of vital signs in assessing pain intensity varied widely. Conclusions: Bedside nurses rely on routine habits, patient preference, and patient-reported pain score when administering opioids for postpartum pain management. Increased training opportunities to improve consistency and standardization of opioid administration may be beneficial.
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Affiliation(s)
- Benjamin R. Loomis
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Hayes
- Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Nurse and Provider Pain Management Education Priorities and Barriers. Pain Manag Nurs 2021; 22:579-585. [PMID: 34393038 DOI: 10.1016/j.pmn.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this research was to describe health care nurse and providers' pain management education priorities and barriers for pediatric cardio-thoracic surgical (CTS) patients and their caregivers. DESIGN This was a qualitative-descriptive study design using survey methodology. METHODS A convenience sample of 206 (CTS) health care professionals including 172 nurses, 11 advanced practice providers, and 23 physicians were invited to participate in this study. The survey was distributed through a work e-mail within a 145-bed tertiary pediatric hospital and focused on collaborative pain management educational priorities and barriers. RESULTS Of the 206 cardio-thoracic service health care nurses/providers surveyed, 45.6 % (N = 94) responded to the survey. The top pain management education priority for these nurses/providers included immediate postoperative pain management knowledge for the caregiver and pediatric CTS patient. The lowest priority 13.8% (N = 13) included education related to pain management needs after discharge. Of the 94 nurses/providers who responded, 31.9% (n = 30) identified the presence of timing and communication barriers in providing pain management education with caregivers and pediatric CTS patients. AIMS The aim of this research was to describe health care providers pain management education priorities and barriers for cardio-thoracic surgical (CTS) pediatric patients and their caregivers. SETTING 145-bed tertiary pediatric hospital. PARTICIPANTS/SUBJECTS Nurses, advanced practice providers [APP's], and physicians. CONCLUSIONS Nurses and providers prioritize immediate postoperative pain management education; however, there remains a need to focus more on the outcomes of pain management education for caregivers and pediatric CTS patients after discharge.
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Chen J, Zhang Y, Simonsick E, Starkweather A, Chen MH, McCauley P, Chyun D, Cong X. Back pain and heart failure in community-dwelling older adults: Findings from the Health ABC study. Geriatr Nurs 2021; 42:643-649. [PMID: 33823422 DOI: 10.1016/j.gerinurse.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/07/2023]
Abstract
This study explored the association of back pain and heart failure (HF) with health outcomes among community-dwelling older adults. Older adults who completed a follow-up in the 11th year (2007-2008) of the Health, Aging, and Body Composition (Health ABC) study were included. The mean age was 83.4 ± 2.78 years. Back pain and heart failure were reported by 55.40% (n = 657) and 8.09 % (n = 96) of the total subjects (N = 1186), respectively. Regression analysis indicated that older adults with back pain reported worse depressive symptoms, fatigue, and physical performance and function compared with those without back pain (p < 0.05), and HF presence increased fatigue levels and decreased physical function (p < 0.05) among older adults with back pain. The high incidence and negative impact of back pain highlight the need to develop strategies for pain management among older adults with and without HF.
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Affiliation(s)
- Jie Chen
- School of Nursing, University of Connecticut, Storrs, CT, USA.
| | - Yiming Zhang
- Department of Statistics, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, USA
| | - Eleanor Simonsick
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | - Ming-Hui Chen
- Department of Statistics, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, USA
| | - Paula McCauley
- Intermediate Unit, UConn John Dempsey Hospital, University of Connecticut Health Center, Farmington, CT, USA
| | - Deborah Chyun
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
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Issa MR, Awanis Muslim N, Mat Sharif Z. The Mediating Effect of Model-Based Learning on Attitude and Pain Management Awareness Among Nurses During COVID 19 Pandemic in Saudi Arabia. SAGE Open Nurs 2021; 7:23779608211065213. [PMID: 35155775 PMCID: PMC8832294 DOI: 10.1177/23779608211065213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background All hospitals are required to provide high-quality pain management; one of the most
critical issues in achieving high-quality pain management is that the hospitals have a
clear plan to manage the patients’ pain and improve the nurses’ awareness of pain
management during the COVID 19 pandemic. However, there is a significant gap in the
literature that this study can cover. Aim This study aimed to investigate the mediating effect of model-based learning on nurses’
attitudes toward nurses’ pain management awareness during the COVID 19 pandemic in Saudi
Arabia government hospitals. Method The Heath Beliefs Model was used, with a quasi-experimental design, with per
experimental one group pre-test post-test design, and a quantitative approach using
self-administered questionnaires obtained from 330 nurses working with patients
suffering from pain. IBM SPSS V23 and Analysis of Moment Structures (AMOS)V23 were
applied to analyze the causal relationships between the variables. Results A two-step approach to analyze the study: the first step was to test the measurement
models’ constructs’ reliability and validity. The second step was to test research
hypotheses in the structural models. The results show a significant positive
relationship between model-based learning and pain management awareness among nurses
during COVID 19 pandemic. Furthermore, model-based learning fully mediated the
relationship between nurses’ attitudes and pain management awareness. Conclusions The study successfully improved nurses’ attitudes toward pain management awareness
among nurses during COVID 19 pandemic. These findings will help strengthen the debate in
the existing literature, and this is a new development window in the pain management
area.
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Affiliation(s)
- Marwan Rasmi Issa
- King Saud Medical City, Riyadh, Saudi Arabia
- College of Graduate Studies (COGS), Universiti Tenaga Nasional(UNITEN), Kajang, Selangor, Malaysia
| | - Noor Awanis Muslim
- College of Graduate Studies (COGS), Universiti Tenaga Nasional(UNITEN), Kajang, Selangor, Malaysia
| | - Zainon Mat Sharif
- College of Graduate Studies (COGS), Universiti Tenaga Nasional(UNITEN), Kajang, Selangor, Malaysia
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