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Slatyer S, Myers H, Kelly MA. Understanding Nurse Characteristics that Influence Assessment and Intention to Treat Pain in Postoperative Patients: An Integrative Literature Review. Pain Manag Nurs 2022; 23:663-671. [DOI: 10.1016/j.pmn.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022]
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2
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The role of experiential knowledge in hospital nurses’ management of pain-related agitation in people with dementia: an expert performance simulation study. Int J Nurs Stud 2021; 127:104160. [DOI: 10.1016/j.ijnurstu.2021.104160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022]
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3
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Pozza DH, Azevedo LF, Castro Lopes JM. Pain as the fifth vital sign-A comparison between public and private healthcare systems. PLoS One 2021; 16:e0259535. [PMID: 34731211 PMCID: PMC8565736 DOI: 10.1371/journal.pone.0259535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background The assessment of pain as the fifth vital sign (P5VS) is of paramount importance since it leads to the management of undertreated pain, consequently reducing suffering, readmissions and emergency department visits after hospital discharge. Objective To evaluate the implementation of P5VS in public and private hospitals. Methods Data analysis on validated questionnaires was sent to all 171 Portuguese hospitals via an official letter. Results When compared to private hospitals, public hospitals presented a higher adherence to the process related to the P5VS. It has demonstrated superiority in the charts properly placed to record P5VS, in the number of emergency departments recording P5VS, in the regularity of audits, and in the existence of guidelines and staff training on pain assessment and management. Conclusion The standardization of both evaluation and recording of pain intensity constitutes a measure of good clinical practice. Public hospitals demonstrated better commitment to these procedures that should be properly carried out in all health care institutions.
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Affiliation(s)
- Daniel Humberto Pozza
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Histology, Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health-I3s, University of Porto, Porto, Portugal
- * E-mail:
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - José Manuel Castro Lopes
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health-I3s, University of Porto, Porto, Portugal
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James KE, Aksa A, Mahmood A, Mohammed U, Rehman N, Walsh RJ. Pricing policies and culture at two Singapore hostess bars: Is a grounded cosmopolitan ethics possible in such a setting? WOMENS STUDIES INTERNATIONAL FORUM 2021. [DOI: 10.1016/j.wsif.2021.102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Tesfaye R, Degu A, Abebe B, Ayalew H. Evaluation of Analgesic and Anti-inflammatory Potential of 80% Methanol Leaf Extract of Otostegia integrifolia Benth (Lamiaceae). J Inflamm Res 2021; 13:1175-1183. [PMID: 33380820 PMCID: PMC7767723 DOI: 10.2147/jir.s285932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/01/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Pain and inflammatory disorders are the most prevalent syndromes. Different herbs were used for treatment of pain and inflammation including members of the genus Otostegia. As a result, this research investigated the in vivo analgesic and anti-inflammatory effects of 80% methanol leaf extract of Otostegia integrifolia in mice. Methods The analgesic and anti-inflammatory effects of the plant was evaluated using hot plate method, acetic-acid induced writhing test, and carrageenan and formalin induced paw edema. Three experimental groups (100, 200, and 400 mg/kg) received the extract while morphine 10 mg/kg and aspirin 150 mg/kg were used as a positive control for analgesic and anti-inflammatory tests accordingly. Distilled water (10 mL/kg) was used as negative control. Results From the experimental groups, OI400 displayed significant analgesic and anti-inflammatory activities (P<0.001). In acetic acid induced writhing tests, the number of writhes decreased significantly (P<0.001) in all experimental groups. Similarly, OI400 reduced the mean paw edema significantly in carrageenan and formalin induced paw edema (P<0.05 and P<0.001, respectively). Conclusion In general, the results obtained in this study demonstrated that the extract exhibited significant analgesic and anti-inflammatory potential in mice.
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Affiliation(s)
- Rediet Tesfaye
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abel Degu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Besufekad Abebe
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hiwot Ayalew
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Burdeu G, Lowe G, Rasmussen B, Considine J. Clinical cues used by nurses to recognize changes in patients' clinical states: A systematic review. Nurs Health Sci 2020; 23:9-28. [PMID: 32969179 DOI: 10.1111/nhs.12778] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 01/04/2023]
Abstract
The aim of this systematic review was to examine the clinical cues used by acute care nurses to recognize changes in clinical states of adult medical and surgical patients that occurred as usual consequence of acute illness and treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist were followed. Four databases and reference lists of included studies were searched: from 1,049 studies, 38 were included. There were 26 subjective and 147 objective cues identified; only 6% of all cues described improvements in patients' clinical states. The most common clinical cues used were heart rate, blood pressure and temperature. Many studies (n = 31) focused on only one element of assessment, such as physiological stability, pain, or cognition. There was a paucity of studies detailing the complexity of acute care nurses' assessment practices as they would occur in clinical practice and a disproportionate focus on the objective assessment of deterioration. Studies are needed to understand the full breadth of cues acute care nurses use to recognize clinical change that includes both improvement and deterioration.
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Affiliation(s)
- Gabrielle Burdeu
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Grainne Lowe
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research- Western Health Partnership, Sunshine, Victoria, Australia.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Victoria, Australia.,Faculty of Health Sciences University of Southern Denmark, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
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7
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Bingham G, Fossum M, Hughes L, Digby R, Bucknall T. The pre-Medical Emergency Team response: Nurses' decision-making escalating deterioration to treating teams using urgent review criteria. J Adv Nurs 2020. [PMID: 32432363 DOI: 10.1111/jan.14433] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/24/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
AIM To describe nurses' decision-making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria. DESIGN A qualitative design comprising individual in-depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital. METHOD A purposive sample of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi-structured interviews. An inductive thematic analysis was conducted. RESULTS Identified themes included: detecting the deterioration; countering the problem; getting a response; and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated individual workarounds and organizational structures to mitigate patient risk. CONCLUSION This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail-safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration. IMPACT This is among the first study to investigate barriers influencing decision-making of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients.
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Affiliation(s)
| | - Mariann Fossum
- Alfred Health, Melbourne, Vic., Australia.,Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | | | - Robin Digby
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Tracey Bucknall
- Alfred Health, Melbourne, Vic., Australia.,Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
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Thiel B, Godfried MB, van Huizen EC, Mooijer BC, de Boer BA, van Mierlo RAAM, van Os J, Geerts BF, Kalkman CJ. Patient reported postoperative pain with a smartphone application: A proof of concept. PLoS One 2020; 15:e0232082. [PMID: 32384103 PMCID: PMC7209286 DOI: 10.1371/journal.pone.0232082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 04/07/2020] [Indexed: 01/10/2023] Open
Abstract
Postoperative pain management and pain assessment are still lacking the perspective of the patient. We have developed and studied a prototype smartphone application for patients to self-record postoperative pain. The main objective was to collect patient and stakeholder critique of improvements on the usability in order to develop a definitive version. The secondary objective was to investigate if patient self-recording compared to nurse-led assessment is a suitable method for postoperative pain management. Fifty patients and a stakeholder group consisting of ten healthcare- and ICT professionals and two members of the patient council participated in this study.
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Affiliation(s)
- Bram Thiel
- Department Anesthesiology, OLVG Hospital, Amsterdam, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Marc B. Godfried
- Department Anesthesiology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Bart C. Mooijer
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bouke A. de Boer
- Department of Information Technology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Johan van Os
- Department of Business intelligence, OLVG Hospital, Amsterdam, The Netherlands
| | - Bart F. Geerts
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Cor J. Kalkman
- Departments of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Nurses' culturally mediated practices influencing pain care provision for older people in acute care: Ethnographic study. Appl Nurs Res 2019; 48:22-29. [DOI: 10.1016/j.apnr.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/07/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022]
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10
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Postoperative Pain Management: A Bedside Perspective. Pain Manag Nurs 2018; 19:608-618. [PMID: 29937229 DOI: 10.1016/j.pmn.2018.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Postoperative pain management is an ongoing challenge in surgical care, during which inadequate relief can contribute to postoperative complications, and nurses are key figures in this process. The aim of the present study was to gain knowledge of how nurses provide postoperative pain management for women undergoing major surgery for endometriosis. DESIGN An ethnographic field study, consisting of semi-structured interviews and participant observations, was conducted in a setting of 2 gynecological units within a large Scandinavian university hospital. METHOD The participants were mainly nurses and patients. The overall focus for the field observations and interviews was on how the participants interacted and made care decisions concerning pain. The analysis focused on nurse-patient interaction in postoperative bedside care. A principal theme, pain-related nursing practice emerged, together with the sub-themes nurse-patient interaction, interpretation and assessment of pain and pain management, which represented a circular process, identified in bedside practice. CONCLUSIONS To some extend the postoperative pain management was influenced by unexpressed health beliefs and routine actions, and patient involvement was not prominent. Furthermore, the existing guidelines for pain management did not seem useful to the nurses. CLINICAL IMPLICATIONS There is a need to develop a new and more practice-oriented postoperative pain management, in ways that also integrate the patient experience.
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11
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Nurses’ responses to interruptions during medication tasks: A time and motion study. Int J Nurs Stud 2018; 82:113-120. [DOI: 10.1016/j.ijnurstu.2018.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 11/22/2022]
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12
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Deldar K, Froutan R, Ebadi A. Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study. BMC Nurs 2018; 17:11. [PMID: 29568232 PMCID: PMC5857143 DOI: 10.1186/s12912-018-0281-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background One helpful strategy adopted for pain management in non-verbal, intubated patients is the use of a proper pain assessment scale. The purpose of the present study is to achieve a better and deeper understanding of the existing nurses' challenges in using pain assessment scales among patients unable to communicate. Methods This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until data saturation. The participants included 20 nurses working in intensive care units. Data was collected using semi-structured interviews and analysis was done using an inductive approach. Results Four categories and ten sub-categories were extracted from the experiences of the nurses working in the intensive care units in terms of nursing challenges in using non-verbal pain assessment scales. The four categories included "forgotten priority", "organizational barriers", "attitudinal barriers", and "barriers to knowledge". Conclusions The findings of the present study have shown that various factors might influence on the use of non-verbal pain assessment scales in patients unable to communicate. Identifying these challenges for nurses can help take effective steps such as empowering nurses in the use of non-verbal pain assessment scales, relieving pain, and improving the quality of care services.
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Affiliation(s)
- Kolsoum Deldar
- 1Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Froutan
- 2Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- 3Behavioral Sciences Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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13
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van Vliet LM, van Dulmen S, Thiel B, van Deelen GW, Immerzeel S, Godfried MB, Bensing JM. Examining the effects of enhanced provider-patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care. BMJ Open 2017; 7:e015505. [PMID: 29101130 PMCID: PMC5695347 DOI: 10.1136/bmjopen-2016-015505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider's communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients' outcomes. METHODS AND ANALYSIS Using a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse-patient interactions. ETHICS AND DISSEMINATION Although communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication. TRIAL REGISTRATION NUMBER NTR5994; Pre-results.
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Affiliation(s)
- Liesbeth M van Vliet
- Department of Communication, NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Sandra van Dulmen
- Department of Communication, NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health Sciences, Science Centre Health and Technology, University College of Southeast Norway, Drammen, Norway
| | - Bram Thiel
- Department of Anesthesiology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Stephanie Immerzeel
- Department of Communication, NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Marc B Godfried
- Department of Anesthesiology, OLVG Hospital, Amsterdam, The Netherlands
| | - Jozien M Bensing
- Department of Communication, NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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van Ransbeeck A, Budilivski A, Spahn DR, Macrea L, Giuliani F, Maurer K. Pain Assessment Discrepancies: A Cross-Sectional Study Highlights the Amount of Underrated Pain. Pain Pract 2017; 18:360-367. [PMID: 28707777 DOI: 10.1111/papr.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 04/23/2017] [Accepted: 07/09/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inadequately treated postoperative pain can lead to longer healing processes, longer hospital stays, and the development of chronic pain. In a 900-bed university hospital in Switzerland, pain scores were assessed systematically. The study's primary aim was to define whether the routine pain assessment on the ward is accurate and reproducible. Subsequently the obtained data were used for a benchmark analysis to determine the hospital's performance in pain assessment quality compared with similar centers. METHODS During a 3-month period, PAIN OUT questionnaires were used for patients' interviews. Patients were included randomly according to the daily surgical schedule. Pain scores were assessed routinely by nursing staff on the wards and compared to PAIN OUT data. The ascertained data were analyzed by descriptive statistics as well as the Wilcoxon test for nonparametric values using IBM SPSS. RESULTS 658 patients were included in the study. Comparing routine pain measurements with PAIN OUT results revealed that within the first 24 hours on the ward, pain scores were significantly lower than measured with PAIN OUT questionnaires. This difference increased with increasing pain scores. The quality of pain management of the hospital in which this study was performed ranged around the 50th percentile when compared to similar centers. CONCLUSION The cross-sectional data comparison of pain assessment by the ward staff and by interviews with the PAIN OUT questionnaire showed a large gap of underrated pain. The benchmark analysis with the method of PAIN OUT suggests a decent pain management among reference groups.
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Affiliation(s)
| | - Ana Budilivski
- Department of Quality Management & Patient Safety, University Hospital Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Lucian Macrea
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesca Giuliani
- Department of Quality Management & Patient Safety, University Hospital Zurich, Zurich, Switzerland
| | - Konrad Maurer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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Ortiz MM, Carr E, Dikareva A. An Integrative Review of the Literature on Pain Management Barriers: Implications for the Canadian Clinical Context. Can J Nurs Res 2017; 46:65-93. [PMID: 29509486 DOI: 10.1177/084456211404600305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite decades of pain research, substandard pain management continues to be distressingly prevalent across health-care settings. This integrative literature review analyzes and synthesizes barriers to effective pain management and identifies areas for future investigation in a Canadian context. Three sets of key barriers were identified through thematic analysis of 24 original research studies published in the period 2003-13: patient, professional, and organizational. These barriers rarely occurred in isolation, with many studies reporting examples in all three categories. This suggests that interventions need to reflect the multifactorial nature of pain management. Reframing pain education as a public health initiative could lead to sustainable improvement, as could the strengthening of partnerships between patients and health-care providers. There are tremendous opportunities for the advanced practice nurse to take a lead in pain management. The delivery of high-quality care that encompasses effective pain management strategies must be a priority for nursing. Research approaches, such as pragmatic mixed methods, that offer contextual understanding of how pain is managed are suggested.
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Affiliation(s)
- Mia Maris Ortiz
- BSN student in the Faculty of Nursing, University of Calgary, Alberta, Canada
| | - Eloise Carr
- Faculty of Nursing, and Associate Dean, Faculty of Graduate Studies, University of Calgary
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Denness KJ, Carr ECJ, Seneviratne C, Rae JM. Factors influencing orthopedic nurses’ pain management: A focused ethnography. Can J Pain 2017; 1:226-236. [PMID: 35005357 PMCID: PMC8730550 DOI: 10.1080/24740527.2017.1403285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of this study was to explore the factors influencing orthopedic surgery nurses’ decisions to administer pro re nata (PRN) opioid analgesia for postoperative pain. Background: Fast-track surgery programs reduce length of stay by identifying and addressing factors causing patients to remain in hospital, including pain (H. Kehlet, Lancet. 2013;381:9878(9878)). The management of acute pain is an important component of quality care for patients after total knee arthroplasty. Methods: The study used a qualitative design of focused ethnography. Ten nurses working on an orthopedic surgery unit at a large urban hospital in western Canada participated in semistructured interviews that used a patient vignette to examine factors that influenced participants’ pain management in the context of fast-track surgery. Interviews were transcribed and analyzed using thematic analysis and constant comparison. Findings: Nurses described a complex clinical environment where the interplay of several factors informed decisions to administer PRN opioid analgesia. The unit’s culture and physical space influenced nurses’ assessments of pain and their decisions whether to treat pain with PRN opioids. Each nurse’s self-concept affected pain management decisions because of perceived importance of pain control and perceived duty to provide analgesics. The subjectivity of pain added another layer of complexity as nurses responded to the patient’s expression of pain from within the milieu of the unit culture and their unique self-concept. Conclusion: Understanding the complexity of factors that influence nurses’ postoperative pain management provides clinical nurses and nursing leaders with directions for future education and research, guided by the goal of continued improvement in pain management in the challenging setting of fast-track surgeries.
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Affiliation(s)
- Kayla J. Denness
- Acute Pain Service, Alberta Health Services, South Health Campus, Calgary, Alberta, Canada
| | | | | | - Janice M. Rae
- Acute Pain Service, Alberta Health Services, South Health Campus, Calgary, Alberta, Canada
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Opportunities to improve pain management outcomes in total knee replacements: patient-centered care across the continuum. Orthop Nurs 2016; 34:4-9; quiz 10-1. [PMID: 25607613 DOI: 10.1097/nor.0000000000000109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the importance of pain management to each patient's overall experience with a total knee replacement, opportunities to improve pain care exist. The authors target an unnecessarily fragmented pain management trajectory as one cause of variability in pain outcomes. They propose that a technology-enhanced patient-centered pain management continuum running from the preoperative through the recovery phase offers effective and efficient pain management.
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Closs SJ, Dowding D, Allcock N, Hulme C, Keady J, Sampson EL, Briggs M, Corbett A, Esterhuizen P, Holmes J, James K, Lasrado R, Long A, McGinnis E, O’Dwyer J, Swarbrick C, Lichtner V. Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BackgroundPain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed.Aims and objectivesTwo studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals.MethodsFor the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four carers, informal conversations with staff and carers and analysis of ward documents and policies. Thematic analysis of the data was undertaken by the project team.ResultsData from eight systematic reviews including 28 tools were included in the meta-review. Most tools showed moderate to good reliability, but information about validity, feasibility and clinical utility was scarce. The observational study showed complex ward cultures and routines, with variations in time spent with patients, communication patterns and management practices. Carer involvement was rare. No pain decision support tools were observed in practice. Information about pain was elicited in different ways, at different times, by different health-care staff and recorded in separate documents. Individual staff made sense of patients’ pain by creating their own ‘overall picture’ from available information.LimitationsGrey literature and non-English-language papers were excluded from the meta-review. Sample sizes in the observational study were smaller than planned owing to poor documentation of patients’ dementia diagnoses, gatekeeping by staff and difficulties in gaining consent/assent. Many patients had no or geographically distant carers, or a spouse who was too unwell and/or reluctant to participate.ConclusionsNo single observational pain scale was clearly superior to any other. The traditional linear concept of pain being assessed, treated and reassessed by single individuals did not ‘fit’ with clinical reality. A new approach enabling effective communication among patients, carers and staff, centralised recording of pain-related information, and an extended range of pain management interventions is proposed [Pain And Dementia Decision Support (PADDS)]. This was not tested with users, but a follow-on study aims to codesign PADDS with carers and clinicians, then introduce education on staff/patient/carer communications and use of PADDS within a structured implementation plan. PADDS will need to be tested in differing ward contexts.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Dawn Dowding
- School of Nursing, Columbia University, New York, NY, USA
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Nick Allcock
- Clinical Specialist, Pain Management Solutions, Nottingham, UK
| | - Claire Hulme
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - John Keady
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Michelle Briggs
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | | | - John Holmes
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Kirstin James
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | - Reena Lasrado
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Andrew Long
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - John O’Dwyer
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Caroline Swarbrick
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Lichtner V, Dowding D, Allcock N, Keady J, Sampson EL, Briggs M, Corbett A, James K, Lasrado R, Swarbrick C, Closs SJ. The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective. BMC Health Serv Res 2016; 16:427. [PMID: 27553364 PMCID: PMC4995653 DOI: 10.1186/s12913-016-1690-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigate how pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group. METHODS A qualitative, multi-site exploratory case study. Data were collected in four hospitals in England and Scotland. Methods included non-participant observations, audits of patient records, semi-structured interviews with staff and carers, and analysis of hospital ward documents. Thematic analysis was performed through the lens of decision making theory. RESULTS Staff generally relied on patients' self-report of pain. For patients with dementia, however, communication difficulties experienced because of their condition, the organisational context, and time frames of staff interactions, hindered patients' ability to provide staff with information about their pain experience. This potentially undermined the trials of medications used to provide pain relief to each patient and assessments of their responses to these treatments. Furthermore, given the multidisciplinary environment, a patient's communication about their pain involved several members of staff, each having to make sense of the patient's pain as in an 'overall picture'. Information about patients' pain, elicited in different ways, at different times and by different health care staff, was fragmented in paper-based documentation. Re-assembling the pieces to form a 'patient specific picture of the pain' required collective staff memory, 'mental computation' and time. CONCLUSIONS There is a need for an efficient method of eliciting and centralizing all pain-related information for patients with dementia, which is distributed in time and between personnel. Such a method should give an overall picture of a patient's pain which is rapidly accessible to all involved in their care. This would provide a much-needed basis for making decisions to support the effective management of the pain of older people with dementia in hospital.
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Affiliation(s)
| | - Dawn Dowding
- Columbia University School of Nursing, New York, NY 10032 USA
- Center for Home Care Policy and Research, Visiting Nursing Service of New York, New York, NY USA
| | - Nick Allcock
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - John Keady
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Michelle Briggs
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | - Kirstin James
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | - Reena Lasrado
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Caroline Swarbrick
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - S. José Closs
- School of Healthcare, University of Leeds, Leeds, UK
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Davies K, Bulsara MK, Ramelet AS, Monterosso L. Audit of Endotracheal Tube Suction in a Pediatric Intensive Care Unit. Clin Nurs Res 2016; 26:68-81. [PMID: 26254167 DOI: 10.1177/1054773815598272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes ( N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT
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Affiliation(s)
- Kylie Davies
- 1 Princess Margaret Hospital for Children, Perth, Australia
| | - Max K Bulsara
- 2 The University of Notre Dame, Fremantle, Australia
| | | | - Leanne Monterosso
- 2 The University of Notre Dame, Fremantle, Australia.,4 St. John of God Murdoch Hospital, Murdoch, Australia
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Abstract
Because of its subjective nature, the assessment of pain requires the use of comprehensive practices that accurately reflect a patient’s experiences of pain. The purpose of this study was to determine how nurses make decisions in their assessment of patients’ pain in the postoperative clinical setting. An observational design was chosen as the means of examining pain activities in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were selected. Each 2-hour observation period was examined 12 times thus resulting in 74 observations. In total, 316 pain activities were determined. Five themes relating to assessment were identified from the data analysis: simple questioning, use of a pain scale, complex assessment, the lack of pain assessment, and physical examination for pain. The study identified how nurses’ prioritization of work demands created barriers in conducting timely and comprehensive pain assessment decisions.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Attitude of Health Personnel
- Communication
- Decision Making
- Female
- Health Knowledge, Attitudes, Practice
- Hospitals, Teaching
- Hospitals, Urban
- Humans
- Kinesics
- Male
- Middle Aged
- Nurse-Patient Relations
- Nursing Assessment/methods
- Nursing Evaluation Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/psychology
- Pain Measurement/methods
- Pain Measurement/nursing
- Pain, Postoperative/diagnosis
- Pain, Postoperative/nursing
- Pain, Postoperative/psychology
- Perioperative Nursing/education
- Perioperative Nursing/methods
- Physical Examination/methods
- Physical Examination/nursing
- Surveys and Questionnaires
- Victoria
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22
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Rafati F, Soltaninejad M, Aflatoonian MR, Mashayekhi F. POSTOPERATIVE PAIN: MANAGEMENT AND DOCUMENTATION BY IRANIAN NURSES. Mater Sociomed 2016; 28:36-40. [PMID: 27047265 PMCID: PMC4789620 DOI: 10.5455/msm.2016.28.36-40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/05/2016] [Indexed: 11/21/2022] Open
Abstract
Background: Pain is one of the most common symptoms experienced by patients after surgeries. Inadequate postoperative pain management is an international problem and the need to improve its management is well documented. The aim of the study was to assess nursing reports related to the patients’ pain intensity and quality, concomitant symptoms, use of scales in pain assessment, and compliance with the national guideline after surgery. Methods: This study was a retrospective cohort; samples were nurse records of patients who had elective surgery. Result: Only 6% of the patients’ pain records included pain intensity which was not measured with standard scales. More than half of all injections were opioid analgesic which is in contrast to the guidelines of the Iranian Ministry of Health. Pain assessment was higher in women and by nurses with more than 15 years of working experience. Conclusion: to conclude, the patients’ pain was not assessed properly in terms of intensity, quality, and associated symptoms. Therefore, training and motivating nurses is very important in this context and should be incorporated in nurses’ academic and continuous educational courses.
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Affiliation(s)
- Foozieh Rafati
- Razi Nursing and Midwifery College Kerman, Iran; Psychiatric Nursing Lecturer, Faculty Member of Jiroft University of Medical Sciences, Jiroft, Iran
| | - Maryam Soltaninejad
- Critical Care Nursing, Department of Nursing and Midwifery, Kerman University of Medical, Kerman, Iran
| | - Mohamad Reza Aflatoonian
- Department of Infectious and Tropical Disease Research Center, HSR Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Mashayekhi
- Msc Critical Care Nursing Lecturer, Faculty Member of Jiroft University of Medical Sciences, Jiroft, Iran
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Dowding D, Lichtner V, Allcock N, Briggs M, James K, Keady J, Lasrado R, Sampson EL, Swarbrick C, José Closs S. Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings. Int J Nurs Stud 2016; 53:152-62. [DOI: 10.1016/j.ijnurstu.2015.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/07/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
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Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, Montes A, Pergolizzi J. Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 2015; 31:2131-43. [PMID: 26359332 DOI: 10.1185/03007995.2015.1092122] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain. At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of healthcare may be unwilling or unable to finance. Nevertheless, change is under way and the political will exists for it to continue.
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Affiliation(s)
- Winfried Meissner
- a a Leiter der Sektion Schmerz, Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum der FSU Jena , Germany
| | - Flaminia Coluzzi
- b b Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Dominique Fletcher
- c c Service Anesthésie Réanimation, Hôpital Raymond Poincare , Garches , France
| | - Frank Huygen
- d d University Hospital , Rotterdam , The Netherlands
| | | | - Edmund Neugebauer
- f f Faculty of Health , School of Medicine, Witten/Herdecke University , Cologne , Germany
| | | | - Joseph Pergolizzi
- h h Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
- i i Naples Anesthesia and Pain Associates , Naples , FL , USA
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Shoqirat N. “Sleepless Nights and Sore Operation Site”: Patients' Experiences of Nursing Pain Management After Surgery in Jordan. Pain Manag Nurs 2014; 15:609-18. [DOI: 10.1016/j.pmn.2013.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/24/2022]
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Vatansever NA, Akansel N. Validation study of the strategic and clinical quality indicators in postoperative pain management questionnaire in Turkish surgery patients. Pain Manag Nurs 2014; 15:871-80. [PMID: 24981119 DOI: 10.1016/j.pmn.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
Determining patient satisfaction with postoperative pain management is an important intervention to improve strategies for effective pain control. The aim of this study was to validate an English version of the 14-item Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire in Turkish language. The study included 113 patients who underwent elective surgeries at a university hospital in Bursa, Turkey. The data were collected after translation procedures and final adjustments were done on the original instrument. For the total scale, Cronbach's coefficient α was 0.81 and the main score obtained from the scale was 45.8 ± 10.8. Included were three subscales: nursing interventions, pain management, and environments. Of the patients, 40.7% reported more pain than expected in the postoperative period and their satisfaction with pain relief was 7.4 ± 2.5. This instrument is a reliable and valid instrument in Turkish language and can be used to evaluate the effectiveness of postoperative pain management.
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Affiliation(s)
| | - Neriman Akansel
- Department of Surgical Nursing, Uludag University School of Health, Bursa, Turkey.
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27
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Rohan AJ. The utility of pain scores obtained during 'regular reassessment process' in premature infants in the NICU. J Perinatol 2014; 34:532-7. [PMID: 24722648 DOI: 10.1038/jp.2014.57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association of pain assessment scores achieved through regular reassessment practice, as required by the Joint Commission (JC), with painful events and the use of analgesics in premature, ventilated infants. STUDY DESIGN A cross-sectional study was performed in two tertiary level neonatal intensive care units. Pain was assessed at regular intervals at each center using validated multidimensional instruments in accordance with the JC standards. RESULT Sample comprised 196 ventilated premature infant patient-days. Overall, 2% of scores suggested the presence of pain, and 0.1% of pain scores were associated with analgesia. Ventilated infants who were exposed to multiple pain-associated procedures in a day never demonstrated pain score elevations despite infrequent preemptive or continuous analgesic administration. CONCLUSION Pain assessment scores achieved using regular reassessment processes were poorly correlated with exposure to pain-associated procedures or conditions. Low pain scores achieved through regular reassessment may not correlate to low pain exposure. Resources that are expended on regular reassessment processes may need to be reconsidered in light of the low yield for clinical alterations in care in this setting.
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Affiliation(s)
- A J Rohan
- 1] School of Nusing, State University of New York at Stony Brook, Stony Brook, NY, USA [2] Cohen Children's Medical Center of the North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA
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28
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Slatyer S, Williams AM, Michael R. Seeking empowerment to comfort patients in severe pain: a grounded theory study of the nurse's perspective. Int J Nurs Stud 2014; 52:229-39. [PMID: 25035166 DOI: 10.1016/j.ijnurstu.2014.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital patients experience significant pain, which can delay healing and increase the risk of developing chronic pain. Nurses are affected by patients' ongoing pain and may cope with consequent anxiety and helplessness by distancing themselves from such patients. Understanding nurses' responses to patients in severe pain will inform strategies to support their coping, their patients and, ultimately, their retention in the nursing workforce. OBJECTIVES The aim of the study was to develop a substantive theory explaining the hospital nurse's perspective of caring for patients in severe pain. DESIGN The study used grounded theory method. SETTINGS Data were collected on four acute care wards in a 610 bed Australian hospital. PARTICIPANTS The sample included 33 nurse participants and 11 patient participants. Selection criteria for nurse participants were those who worked in the four study wards, cared for patients who experienced severe pain, and consented to be included. Selection criteria for patient participants were those who self-reported pain at intensity of seven or more on a scale of 0-10, were aged 18 years or older, could speak and read English, and consented to be included. METHODS Theoretical sampling directed the collection of data using semi-structured interviews with nurses and participant observation, including structured observations of nurses who cared for patients in pain. Data were analysed using constant comparison method. RESULTS Nurse participants encountered a basic psychosocial problem of feelings of disempowerment when their patients experienced persisting severe pain. In response, they used a basic psychosocial process of seeking empowerment to provide comfort in order to resolve distress and exhaustion associated with disempowerment. This coping process comprised three stages: building connections; finding alternative ways to comfort; and quelling emotional turmoil. CONCLUSIONS The substantive theory proposed a link between the stress of nurses' disempowerment and a coping response that provides direction to support nurses' practice. Strategies indicated include enhanced communication protocols, access to advanced practice nurses, use of nonpharmacological comfort measures, utilization of ward-based pain resource nurses, and unit-specific pain management education. Further research to verify and extend the substantive theory to other settings and nursing populations is warranted.
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Affiliation(s)
- Susan Slatyer
- Curtin University, Sir Charles Gairdner Hospital, Edith Cowan University, Australia.
| | - Anne M Williams
- Edith Cowan University, Sir Charles Gairdner Hospital and Murdoch University, Australia
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Kiekkas P, Gardeli P, Bakalis N, Stefanopoulos N, Adamopoulou K, Avdulla C, Tzourala G, Konstantinou E. Predictors of nurses' knowledge and attitudes toward postoperative pain in Greece. Pain Manag Nurs 2014; 16:2-10. [PMID: 24981120 DOI: 10.1016/j.pmn.2014.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 11/18/2022]
Abstract
Undertreatment of postoperative pain can aggravate patient outcomes and is associated with attending nurses' knowledge deficits or negative attitudes toward pain. The aim of this study was to investigate knowledge and attitudes toward postoperative pain of surgical department nurses and to identify predictors of their knowledge and attitudes. This was a descriptive, cross-sectional survey that took place in the departments of general surgery, orthopedics, neurosurgery, ear-nose-throat surgery, and obstetrics/gynecology at five Greek hospitals. Participants were a convenience sample of registered and assistant nurses. Nurses were asked to complete a three-section questionnaire, which included demographics, a Knowledge and Attitudes Survey Regarding Pain (KASRP) tool modified for postoperative pain, and seven questions capturing personal characteristics, working conditions, and feelings about work. One hundred eighty-two questionnaires were completed. Average scores were 45.35% for modified KASRP tool; 28.57% for pain assessment; 55.44% for general pain management; and 47.13% for use of analgesics. Four of the five most commonly missed items referred to use of analgesics. More previous personal experience of postoperative pain (p = .002) and being a registered nurse (p = .015) predicted higher modified KASRP tool score. Participation in continuing education programs and department of employment were also associated with differences in the modified tool score. The knowledge deficits and negative attitudes of the nurses toward postoperative pain highlight the role of pregraduate and continuing education, appropriately specialized for each surgical department, in the development of empathy toward patients in pain and of clinical competency regarding pain assessment and administration of analgesics.
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Affiliation(s)
- Panagiotis Kiekkas
- Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece.
| | | | - Nick Bakalis
- Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
| | - Nikolaos Stefanopoulos
- Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
| | - Katerina Adamopoulou
- Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
| | - Christos Avdulla
- Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
| | - Georgia Tzourala
- Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
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Gosselin E, Bourgault P, Lavoie S, Coleman RM, Méziat-Burdin A. Development and validation of an observation tool for the assessment of nursing pain management practices in intensive care unit in a standardized clinical simulation setting. Pain Manag Nurs 2014; 15:720-30. [PMID: 24675281 DOI: 10.1016/j.pmn.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/22/2013] [Accepted: 05/30/2013] [Indexed: 10/25/2022]
Abstract
Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p < .001) for the whole tool, with variations from 0.619 to 0.920 (p < .01) between dimensions. The expert panel was satisfied with the content and face validity of the tool. The psychometric qualities of the NOTPaM developed in this study are satisfactory. However, the tool could be improved with slight modifications. Nevertheless, it was useful in assessing intensive care nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose.
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Affiliation(s)
- Emilie Gosselin
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Patricia Bourgault
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Stephan Lavoie
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Robin-Marie Coleman
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne Méziat-Burdin
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Twycross A, Finley GA. Nurses' aims when managing pediatric postoperative pain: is what they say the same as what they do? J SPEC PEDIATR NURS 2014; 19:17-27. [PMID: 24393225 DOI: 10.1111/jspn.12029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/15/2013] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to explore nurses' aims when managing postoperative pain and whether reported aims reflect actual practices. DESIGN AND METHODS Participant observation was used to collect data regarding nurses' (n = 17) pain management practices. Nurses (n = 19) were asked: When managing postoperative pain, what is your overall aim? RESULTS Around half the participants (n = 10) aimed for patients to be comfortable while others aimed for a pain score of 2-3 (n = 7), or below 5 (n = 2). Observed practices matched aims for just more than half the participants (n = 9). PRACTICE IMPLICATIONS There is evidence of individual variation in practices. This may impact on the care provided.
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Affiliation(s)
- Alison Twycross
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, London, UK
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Parahoo K. Observations. Nurs Res 2014. [DOI: 10.1007/978-1-137-28127-2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aziato L, Adejumo O. The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight. Pain Manag Nurs 2013; 15:265-72. [PMID: 23352730 DOI: 10.1016/j.pmn.2012.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/26/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
Nurses form an indispensable part of the clinical team that manages postoperative pain (POP). Within a particular clinical context, nurses perceive and respond to pain based on specific factors. This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients' POP. It also identified the factors that influenced nurses' pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients' pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses' response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.
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Affiliation(s)
| | - Oluyinka Adejumo
- School of Nursing, University of the Western Cape, Bellville, South Africa
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Tocher J, Rodgers S, Smith MAC, Watt D, Dickson L. Pain management and satisfaction in postsurgical patients. J Clin Nurs 2012; 21:3361-71. [PMID: 22938034 DOI: 10.1111/j.1365-2702.2012.04253.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS AND OBJECTIVES To examine the relationship between patient satisfaction and the incidence of severe and enduring pain through a health board wide hospital satisfaction questionnaire. BACKGROUND The incidence and management of acute postoperative pain and its relationship to patient satisfaction have been of great interest to clinicians over the last 20 years. Evidence suggests that despite many moves to address this problem with the advent of acute pain nurse specialists and dedicated pain teams, severe and enduring pain continues to be a problem. However, patients appear to report high satisfaction levels. DESIGN The study design was a postal questionnaire the results of which were analysed statistically. METHODS The postal questionnaire was sent to patients who had been discharged from acute hospitals in one health board in the previous two weeks. A total of three large acute hospitals were included. The data were analysed to produce descriptive statistics for all patients on the pain questions and then for patients with severe and enduring pain on the variables of age, gender, ethnic group, responses to pain questions and type of admission. RESULTS Twenty-six percent of patients reported having pain all or most of the time. Patients suffering from severe and enduring pain were younger females. CONCLUSION Acute postoperative pain continues to be a problem, although patients continue reporting moderate satisfaction levels. RELEVANCE TO CLINICAL PRACTICE Acute postoperative pain is an ongoing issue for postsurgical patients. It is crucial to understand and recognise issues that can adversely contribute to increased pain severity.
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Affiliation(s)
- Jennifer Tocher
- School of Health in Social Science, Old Medical School, University of Edinburgh, Edinburgh, UK.
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Gregory J, Waterman H. Observing pain management practice on a medical unit following changes arising from an action research study. J Clin Nurs 2012; 21:3523-31. [DOI: 10.1111/j.1365-2702.2012.04096.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stenner K, Carey N, Courtenay M. Prescribing for pain - how do nurses contribute? A national questionnaire survey. J Clin Nurs 2012; 21:3335-45. [DOI: 10.1111/j.1365-2702.2012.04136.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Elliott M, Coventry A. Critical care: the eight vital signs of patient monitoring. ACTA ACUST UNITED AC 2012; 21:621-5. [DOI: 10.12968/bjon.2012.21.10.621] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Malcolm Elliott
- Faculty of Health Science and Community Studies, Holmesglen Institute, Victoria, Australia
| | - Alysia Coventry
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Victoria, Australia
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Ranger M, Gélinas C. Innovating in pain assessment of the critically ill: exploring cerebral near-infrared spectroscopy as a bedside approach. Pain Manag Nurs 2012; 15:519-29. [PMID: 24882029 DOI: 10.1016/j.pmn.2012.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 03/09/2012] [Accepted: 03/13/2012] [Indexed: 11/30/2022]
Abstract
Nurses play a crucial role in the evaluation and treatment of pain in the critically ill patient. This responsibility is all the more critical with this particular population because many may not be able to self-report their pain level and the typical behavioral signs of pain may be subtle or absent. According to recent recommendations, vital signs should not be used as primary indicators of pain but rather considered as a cue to begin further assessment. Other than vital signs, human brain reactivity to pain has been extensively studied with the use mainly of magnetic resonance imaging and positron-emission tomography. However, the use of these sophisticated methods may be unrealistic in the critically ill. Of interest to assessing these patients in a clinical setting is the noninvasive measurement of regional cerebral tissue oxygenation with the near-infrared spectroscopy (NIRS) technique. There are indications that NIRS is capable of detecting the cerebral hemodynamic changes associated with sensory stimuli, including pain. The objective of this review paper is to provide nurses with a better understanding of NIRS technology, including a review of the literature on functional studies that have used NIRS in critically ill populations, and how it could be used in both research and practice. Current NIRS techniques have well recognized limitations which must be considered carefully during the measurement and interpretation of signals. Thus, its clinical use is yet to be fully established. Nonetheless, cerebral NIRS technique as an approach to assess brain activity in response to pain should not be abandoned.
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Affiliation(s)
- Manon Ranger
- School of Nursing, McGill University, Montreal, Quebec, Canada; Research Institute, McGll University Health Center, Montreal, Quebec, Canada.
| | - Céline Gélinas
- School of Nursing, McGill University, Montreal, Quebec, Canada; Centre for Nursing Research, Jewish General Hospital, Montreal, Quebec, Canada
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Wadensten B, Fröjd C, Swenne CL, Gordh T, Gunningberg L. Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden. J Clin Nurs 2011; 20:624-34. [PMID: 21320191 DOI: 10.1111/j.1365-2702.2010.03482.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to investigate the prevalence of pain and pain assessment among inpatients in a university hospital. BACKGROUND Pain management could be considered an indicator of quality of care. Few studies report on prevalence measures including all inpatients. DESIGN Quantitative and explorative. METHOD Survey. RESULTS Of the inpatients at the hospital who answered the survey, 494 (65%) reported having experienced pain during the preceding 24 hours. Of the patients who reported having experienced pain during the preceding 24 hours, 81% rated their pain >3 and 42.1% rated their pain >7. Of the patients who reported having experienced pain during the preceding 24 hours, 38.7% had been asked to self-assess their pain using a Numeric Rating Scale (NRS); 29.6% of the patients were completely satisfied, and 11.5% were not at all satisfied with their participation in pain management. CONCLUSIONS The result showed that too many patients are still suffering from pain and that the NRS is not used to the extent it should be. Efforts to overcome under-implementation of pain assessment are required, particularly on wards where pain is not obvious, e.g., wards that do not deal with surgery patients. Work to improve pain management must be carried out through collaboration across professional groups. RELEVANCE TO CLINICAL PRACTICE Using a pain assessment tool such as the NRS could help patients express their pain and improve communication between nurses and patients in relation to pain as well as allow patients to participate in their own care. Carrying out prevalence pain measures similar to those used here could be helpful in performing quality improvement work in the area of pain management.
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Affiliation(s)
- Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Maia ACA, Coutinho SB. Fatores que influenciam a prática do profissional de saúde no manejo da dor do recém-nascido. REVISTA PAULISTA DE PEDIATRIA 2011. [DOI: 10.1590/s0103-05822011000200020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Apresentar revisão sobre as principais variáveis que podem influenciar as ações e as atitudes dos profissionais de saúde no manejo adequado da dor no período neonatal. FONTES DOS DADOS: Pesquisa bibliográfica, nas bases de dados Medline, SciELO e Lilacs, entre 1995 e 2009, restrita aos artigos escritos em inglês e português. Foram utilizados os seguintes descritores: "dor", "Terapia Intensiva Neonatal" e "profissional de Saúde". Avaliaram-se 88 artigos, sem seleção pelo desenho, sendo incluídos os 55 mais relevantes e recentes. SÍNTESE DOS DADOS: Os estudos confirmaram que o manejo da dor no neonato pelos profissionais de saúde é inadequado. Essa prática pode estar relacionada aos seguintes fatores: conhecimento insuficiente quanto à fisiopatologia da dor; não utilização de métodos de avaliação; falta de normatização sistemática ou protocolos; e falha na comunicação e incorporação da teoria na prática diária por parte da equipe multiprofissional. São acrescidos ainda os fatores subjetivos, pessoais e profissionais, que podem interferir na avaliação e no tratamento da dor no recém-nascido. CONCLUSÕES: Os obstáculos para um manejo adequado da dor são multifatoriais e o conhecimento das atitudes e crenças das equipes de saúde que trabalham com neonatos é muito importante. Há necessidade de investimentos na capacitação, formação e sensibilização dos profissionais acerca do controle e do tratamento da dor, com o intuito de proporcionar um cuidado mais humanizado ao neonato.
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Bergeron DA, Leduc G, Marchand S, Bourgault P. [Descriptive study of the postoperative pain assessment and documentation process in a university hospital]. Pain Res Manag 2011; 16:81-6. [PMID: 21499582 PMCID: PMC3084408 DOI: 10.1155/2011/480479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several studies have shown that patients often receive inadequate treatment of postoperative pain. The aim of the present descriptive study was to examine and analyze various data related to the postoperative pain assessment of 40 patients who underwent elective surgery. Pain journals were to be completed by patients during every waking hour for the first three postoperative days to assess both pain intensity and pain unpleasantness. A post hoc analysis of patient records permitted verification of pain assessment by nurses for each patient. The results showed that not only was postoperative pain rarely assessed using a valid scale, it was also poorly documented. In addition, when nurses assessed and documented postoperative pain using a numerical scale, their results were very different from patients' assessments. For the first postoperative day, the mean (± SD) pain intensity documented by nurses on a 0 to 10 numerical scale was 1.57±0.23, while the mean pain intensity noted by patients using the same scale was 3.82±0.41. Statistical analysis showed that there was no significant correlation between mean pain intensity documented by nurses and the mean pain intensity noted by patients.
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Affiliation(s)
- Dave A Bergeron
- École des sciences infirmières de l’Université de Sherbrooke
| | - Geneviève Leduc
- Faculté de médecine et des sciences de la santé de l’Université de Sherbrooke
| | - Serge Marchand
- Centre de recherche Étienne-Lebel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec
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Harmon JR, Higgins I, Summons P, Bellchambers H. Efficacy of the use of evidence-based algorithmic guidelines in the acute care setting for pain assessment and management in older people: a critical review of the literature. Int J Older People Nurs 2010; 7:127-40. [PMID: 21631883 DOI: 10.1111/j.1748-3743.2010.00261.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of the literature review was to identify all examples of primary research using an algorithmic approach for the implementation of a clinical practice guideline relating to pain assessment and/or management within acute care, with a specific focus on older people. DESIGN Critical literature review. DATA SOURCES Inclusion criteria were; English language publications within the past 13 years; peer reviewed; research conducted within a hospital; about adult inpatients. Exclusion criteria; research located outside of a hospital context; quality improvement studies; rehabilitation studies and literature reviews. REVIEW METHODS Critical appraisal of the literature by using a qualitative interpretation of a translational approach. The literature was thematically mapped according to the criteria of credibility, transferability, plausibility and applicability. RESULTS No clinical practice guideline was found that directly related to both assessment and management of pain using an algorithm in acute care for older people. Five studies were found to have relevance and were critically evaluated. CONCLUSION A critique of the literature shows that an algorithmic approach is feasible for translation into a clinical practice guideline for assessment and management of pain in older people within the acute care setting. IMPLICATIONS FOR PRACTICE Implementation of any algorithmic approach requires consideration of the environment, culture and availability of resources.
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Affiliation(s)
- Joanne R Harmon
- Division of Surgery, School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
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Lindberg JO, Engström Å. Critical care nurses' experiences: "a good relationship with the patient is a prerequisite for successful pain relief management". Pain Manag Nurs 2010; 12:163-72. [PMID: 21893305 DOI: 10.1016/j.pmn.2010.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/10/2010] [Accepted: 03/24/2010] [Indexed: 11/15/2022]
Abstract
There is a lack of studies describing how critical care nurses experience assessing and treating pain in patients receiving postoperative care in an intensive care unit (ICU). The aim of this study was to describe those experiences. Qualitative personal interviews with six critical care nurses in an ICU in northern Sweden were conducted during 2009. The interview texts were subjected to qualitative content analysis, which resulted in the formulation of one theme and four categories. It was important to be able to recognize signs of pain in patients unable to communicate verbally. In older patients, anxiety could be interpreted as an indication of pain. Pain was primarily assessed by means of a visual analog scale. Being unable to treat pain successfully was experienced as failing in one's work. Pharmacologic treatment was always the first choice for relief. The environment was experienced as a hindrance to optimal nursing care, because all postoperative patients shared a room with only curtains between them. The work of assessing and treating pain in patients receiving postoperative care is an important and frequent task for critical care nurses, and knowledge in the field is essential if the patients are to receive optimal nursing care and treatment. Patients cared for in an ICU might benefit from nonpharmacologic treatment. Being without pain after surgery implies increased well-being and shorter hospitalization for the patient.
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Affiliation(s)
- Jan-Olov Lindberg
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Abdalrahim MS, Majali SA, Bergbom I. Jordanian surgical nurses' experiences in caring for patients with postoperative pain. Appl Nurs Res 2010; 23:164-70. [DOI: 10.1016/j.apnr.2008.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Revised: 06/16/2008] [Accepted: 06/27/2008] [Indexed: 11/26/2022]
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Bååth C, Wilde-Larsson B, Idvall E, Hall-Lord ML. Registered nurses and enrolled nurses assessments of postoperative pain and risk for malnutrition and pressure ulcers in patients with hip fracture. Int J Orthop Trauma Nurs 2010. [DOI: 10.1016/j.joon.2009.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Prior conditions influencing nurses' decisions to adopt evidence-based postoperative pain assessment practices. Pain Manag Nurs 2009; 11:245-58. [PMID: 21095599 DOI: 10.1016/j.pmn.2009.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 04/27/2009] [Accepted: 05/18/2009] [Indexed: 11/20/2022]
Abstract
Over the past 30 years, postoperative pain relief has been shown to be inadequate. To provide optimal postoperative pain relief, it is imperative for nurses to use evidence-based postoperative pain assessment practices. This correlational descriptive study was conducted to identify factors, termed prior conditions, that influenced nurses' decisions to adopt three evidence-based postoperative pain assessment practices. A convenience sample of nurses who cared for adult postoperative patients in two Midwestern hospitals were surveyed, and 443 (46.9%) nurses responded. The previous practice and innovativeness of nurses were supportive of adoption of the three practices. Nurses felt that patients received adequate pain relief, which is unsupportive of adoption of the three practices because there is no impetus to change. Nurses who perceived the prior conditions as being supportive of adoption of pain management practices used multiple sources to identify solutions to clinical practice problems, and those who read professional nursing journals were more likely to have adopted the three practices and were more innovative. The number of sources used to identify solutions to clinical practice problems, previous practices, and innovativeness were predictive of nurses' adoption of the three evidence-based postoperative pain assessment practices. Nurses need to be encouraged to use multiple sources, including professional nursing journals, to identify solutions to clinical practice problems. Innovative nurses may be considered to be opinion leaders and need to be identified to promote the adoption of evidence-based postoperative pain assessment practices. Further exploration of the large unexplained variance in adoption of evidence-based postoperative pain assessment practices is needed.
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Wilding JR, Manias E, McCoy DGL. Pain assessment and management in patients after abdominal surgery from PACU to the postoperative unit. J Perianesth Nurs 2009; 24:233-40. [PMID: 19647660 DOI: 10.1016/j.jopan.2009.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 01/28/2009] [Accepted: 03/20/2009] [Indexed: 11/25/2022]
Abstract
The aim of this exploratory study was to determine the effectiveness of pain relief for surgical patients (N = 52) in transition from the PACU to the postoperative unit. The study also explored whether there was an association between a verbal numeric pain score (0 to 10) on discharge from the PACU and the duration of time until analgesia was administered in the postoperative unit. Information was obtained about pain management, time of discharge, and patient pain scores on discharge from the PACU, as well as pain scores and the time of first analgesic administered in the postoperative unit. Most patients were discharged from the PACU with a pain score in the mild range (0 to 4), indicating reasonable pain relief. An association existed between the pain score on discharge from the PACU and the duration of time to the first analgesic dose administered on the postoperative unit.
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Affiliation(s)
- Jane R Wilding
- Barwon Health, Centre for Education and Practice Development, Geelong, Victoria, Australia.
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Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: qualitative observation and interview study. Int J Nurs Stud 2009; 47:154-65. [PMID: 19577752 DOI: 10.1016/j.ijnurstu.2009.05.021] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/24/2009] [Accepted: 05/31/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is increasing emphasis on person-centred care within the literature and the health care context. It is suggested that a person-centred approach to medication activities has the potential to improve patient experiences and outcomes. OBJECTIVES This study set out to examine how nurses and patients interact with each other during medication activities in an acute care environment with an underlying philosophy of person-centred care. DESIGN A qualitative approach was used comprising naturalistic observation and semi-structured interviews. SETTING The study setting was an acute care ward with a collaboratively developed philosophy of person-centre care, in an Australian metropolitan hospital. PARTICIPANTS Eleven nurses of varying levels of experience were recruited to participate in observations and interviews. Nurses were eligible to participate if they were employed on the study ward in a role that incorporated direct patient care, including medication activities. A stratified sampling technique ensured that nurses with a range of years of clinical experience were represented. Patients who were being cared for by participating nurses during the observation period were recruited to participate unless they met the following exclusion criteria: those less than 18 years of age, non-English speaking patients, and those who were unable to give informed consent. Twenty-five patients were observed and 16 of those agreed to be interviewed. RESULTS The results of the study generated insights into the nature of interactions between nurses and patients where person-centred care is the underlying philosophy of care. Three major themes emerged from the findings: provision of individualised care, patient participation and contextual barriers to providing person-centred care. While the participating nurses valued a person-centred approach and perceived that they were conducting medication activities in a person-centred way, some nurse-patient interactions during medication activities were centred on routines rather than individualised patient assessment and management. These interactions were based on nurses' perceptions of what was important for the patient and did not provide opportunities for patient participation. Two main contextual barriers in relation to a person-centred approach to medication activities were identified as multidisciplinary communication and time constraints. CONCLUSIONS While some nurse-patient interactions during medication activities were consistent with the principles of person-centred care, the study results highlighted factors that influence the nature of these interactions, and identified opportunities to improve nursing practice. To ensure person-centred care is applied to medication activities, nurses should undertake ongoing assessment of patients' needs in relation to their medications and encourage opportunities for increased patient participation.
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