Pain Intensity in Hospitalized Adults: A Multilevel Analysis of Barriers and Facilitators of Pain Management

Pain management education needs for nurses caring for older adults undergoing total knee replacement

INTRODUCTION

Effective postoperative pain management is necessary to improve the outcomes of older adults undergoing total knee replacement (TKR). Discovering what registered nurses (RNs) need to know about pain management may be beneficial to improving the quality of care.

AIM

The study aimed to identify the information needed to develop pain management education for RNs caring for older adults undergoing TKR.

METHODS

A qualitative descriptive design was used in this study. Three focus groups were conducted with 22 staff RNs with experience caring for older adults undergoing TKR at a supra-tertiary care hospital in Bangkok, Thailand; one focus group was conducted with five members of the hospital's nursing pain management committee. Data were analyzed using content analysis.

RESULTS

Two themes relevant to pain assessment education were pain assessment and pain management. Subthemes of pain assessment included challenges in cognitively impaired older adults, inadequate knowledge and misconceptions, and re-assessing pain. Three subthemes of pain management were created, including knowledge of pain medication, new trends in pharmacological pain management and devices, and non-pharmacological pain management using cold compression.

CONCLUSIONS

RNs require current information about pain management to provide effective postoperative care for older adults undergoing TKR. The findings may be used in pain management education to update RNs' knowledge of pain management.

Nurses' pain management practices for admitted patients at the Comprehensive specialized hospitals and its associated factors, a multi-center study

BACKGROUND

Pain is the most common challenge that most hospitalized patients complain of and is influenced by several patients, nurses, and institutional-related factors. Most studies in Ethiopia on pain were focused on surgical illnesses only.

OBJECTIVE

To assess nurses' pain management practice and associated factors for admitted patients at Comprehensive Specialized Hospitals.

METHODS AND MATERIALS

A multi-center institution-based cross-sectional study was conducted at the five randomly selected Comprehensive Specialized Hospitals of the Amhara region from May 01 to June 01, 2022. A multi-stage sampling method was employed to select a total of 430 nurses and patients for whom the nurses were responsible. Data were collected using standard self-administered, structured, and checklist questionnaires from nurses, patients, and patients' charts respectively. The modified Bloom's criteria categorized the overall practice as good, moderate, and poor. Data were checked, coded, and entered into Epi-Data version 4.6 and exported to SPSS version 25. An ordinal logistic regression model was applied, and variables with a p-value < 0.05 with a 95% CI in the multivariable analysis were considered significant.

RESULTS

The study evaluated the pain management practices of 430 nurses and only a quarter had good pain management practices. Those nurses with first degrees and above education level (AOR = 2.282) and who attended in-service training (AOR = 2.465) were found to have significantly higher pain management practice. Expected though patients with painful procedures (AOR = 5.648) and who had severe pain (AOR = 2.573) were receiving better pain management practices from their nurse care provider. Nurses working in the institutions with a pain-free initiative focal person (AOR = 6.339) had higher pain management practices.

CONCLUSION AND RECOMMENDATION

Overall, the majority of nurses had poor pain management practices. Higher educational levels, in-service training, and assigning a pain-free focal person had an impact on pain management services. Patients with higher pain levels and painful procedures were getting better attention. Hospital administrations need to provide due attention to the pain management of hospitalized patients by providing in-service training and educational opportunities to improve the capacity of nurses. Patients would be benefited considerably if hospitals focus on assigning focal persons for advocating regular pain management for admitted patients regardless of their pain level.

Health literacy, pain-related interference and pain-related distress of patients with musculoskeletal pain

The present study aimed to compare pain-related interference and pain-related distress in patients with musculoskeletal pain and differing levels of health literacy. A cross-sectional study was conducted among 243 patients with chronic musculoskeletal pain. Short Test of Functional Health Literacy in Adults classified the level of health literacy. Outcome measures included pain-related interference (pain intensity and functional limitation) and pain-related distress (psychosocial factors). Analysis of variance methods were used. One hundred twenty-three (50.62%) participants were classified as adequate, 24 (9.88%) as marginal and 96 (39.50%) as inadequate health literacy. Patients with inadequate health literacy had higher values of pain severity compared to the other groups, when controlled for age. The group adequate health literacy showed less kinesiophobia compared to their counterparts. Functional limitations and other psychosocial factors were similar among groups. Pain severity and kinesiophobia had disadvantageous findings in participants with inadequate health literacy. Still, the results of pain severity must be approached cautiously because the differences were observed when controlled for age solely.

How Hospital Patients Experience Pain the Previous 24 Hours-A Prevalence Assessment of Pain in Five Hospitals in Sweden

BACKGROUND

Previous studies show that pain is common among hospital inpatients.

AIM

This study measures the prevalence of pain and the impact of pain on sleep in patients admitted to five hospitals in Sweden.

METHODS

The patients were admitted to a surgical or a medical ward. They answered on a self-reported questionnaire about their average pain intensity and how much their pain interfered with their sleep the previous 24 hours, on a 010 numerical rating scale (NRS).

RESULTS

Of the 500 patients, 308 experienced pain (62%), (NRS ≥ 3) and 111 (22%) rated their pain as NRS ≥ 7. We found no difference between surgical and medical specialty regarding pain prevalence. The results suggest that roughly the same proportion of patients with pain also experienced poor sleep due to pain265 patients (53%) reported pain interference on sleep, NRS ≥ 3.

CONCLUSIONS AND CLINICAL IMPLICATIONS

This study shows that there is still an unacceptable high pain prevalence in inpatients and that patients experience pain as negatively impacting their sleep. Future pain care is likely to include a more comprehensive implementation strategy for the dissemination of knowledge, especially related to the complex context of today's healthcare system. That is, the possibility that anchoring new knowledge also benefits the patient is probably associated with optimization of the structural context. Future research should take this question further by examining how the organizational structure should be optimized for the dissemination of knowledge in healthcare professionals about pain and pain interference with sleep.

Pharmacologic Pain Management Trends among Adults Hospitalized with Cellulitis: An Evidence-Based Practice Project

BACKGROUND

Nurses commonly administer opioids, following "as needed" order sets, to patients hospitalized for acute pain conditions like cellulitis. Practice guidelines recommend limiting opioid administration for acute pain management. At two hospitals in the Pacific Northwest, an opioid stewardship committee was formed to align with best practice.

AIMS

The main objective was to describe changes to inpatient rates of opioid and non-opioid administration following implementation of evidence-based opioid stewardship efforts.

DESIGN

Observational, retrospective, evidence-based practice project.

SETTINGS

One 200-bed and one 680-bed hospital in Washington State.

PARTICIPANTS/SUBJECTS

Data were included from patients aged 18 years or older hospitalized for cellulitis.

METHODS

Demographic and pain-related data were extracted from the electronic health record (n = 4,523 encounters) guided by the symptom management framework. The proportion of patients receiving opioid or non-opioid medications before and after implementation of evidence-based practice opioid stewardship interventions was calculated descriptively. A logistic regression tested factors related to administration of an opioid medication.

RESULTS

The proportion of patients receiving an opioid decreased following opioid stewardship efforts while those receiving non-opioid analgesics remained stable. Factors significantly influencing inpatient opioid administration were: average inpatient pain score, pre-hospital opioid prescription, length of stay, and year of hospitalization.

CONCLUSIONS

Analgesic administration treating painful, acute cellulitis at two hospitals in the Pacific Northwest included opioid and non-opioid medications. The proportion of patients receiving opioids decreased following best practice opioid stewardship actions. Opportunities may exist for nurses to collaborate with providers to improve inpatient analgesic administration practices.

Psychometric Evaluation of the Nurses' Cancer Pain Management Competency Scale

BACKGROUND

There is lack of instruments for assessing nurses' comprehensive pain management competency.

AIM

This study aimed to assess the psychometric properties of the Nurses' Cancer Pain Management Competency Scale and to conduct a cursory survey of the pain management educational needs/resources of nurses caring for patients with cancer pain.

METHOD

A convenience sample of 230 Korean nurses who met the eligibility criteria completed the researcher developed the Nurses' Cancer Pain Management Competency Scale and a pain management educational needs/resources survey. The Nurses' Cancer Pain Management Competency Scale was based on the pain management core competencies identified by Fishman et al (2013). Internal consistency was assessed using Cronbach's alpha, and construct validity was examined using exploratory factor analysis with varimax rotation.

RESULTS

Cronbach's alpha of the scale was 0.89. Nurse cancer pain management competency includes four factors, which accounted for 68.44% of the variance: the context of pain management, pain assessment and measurement, management of pain, and multidimensional nature of pain. Approximately 42% of nurses had no available protocols related to cancer pain management. Nurses preferred multi-component educational modalities, including simulation-based learning.

CONCLUSIONS

Findings support internal consistency reliability and content and construct validity of the Nurses' Cancer Pain Management Competency Scale that can help examine pain management competency of nurses. Adopting an evidence-based clinical cancer pain management-related protocol and multi-component training programs are needed to achieve optimal cancer pain management competency in nurses.

A systematic review of the association between health literacy and pain self-management

OBJECTIVE

To synthesize the impact of health literacy on pain self-management contexts, processes, and outcomes.

METHODS

This systematic review employed a narrative synthesis. We used databases, including PubMed and PsycINFO, and handsearching of the reference lists to identify articles published before December 2020. Pain self-management variables were chosen based on the Individual and Family Self-Management Theory. Quality was assessed using the National Institute of Health quality assessment tool for observational and cross-sectional studies.

RESULTS

Twenty studies that included 6173 participants were used. Most studies measured functional domains of the health literacy concept. Twelve studies reported small to large associations between health literacy and pain knowledge, medication regimen adherence, or pain. Thirteen studies considered health literacy clinical risks in tailoring education, while seven viewed it as personal assets developed via education.

CONCLUSIONS

Limited information on the contribution of health literacy to pain self-management context factors and processes exists. Current evidence was limited by a lack of temporality, theoretical basis, and a priori sample estimation.

PRACTICE IMPLICATIONS

Using brief functional literacy scales in the clinical environment can be more practical. Identifying patients' literacy levels helps clinicians personalize education, which then promotes patients' knowledge of pain, medication regimen adherence, and pain control.

Association Between Symptoms of Patients With Heart Failure and Patient Outcomes Based on Electronic Nursing Records

We examined the association between symptoms (ie, dyspnea and pain) and patient outcomes (ie, length of stay, 30-day readmission, and death in hospital) among patients with heart failure using EMRs. This was a descriptive study that was conducted from July 1, 2014, to November 30, 2017. Participants were 754 hospitalized patients with heart failure (mean age, 70.62 ± 14.78 years; male-to-female ratio, 1:1.1). Data were analyzed using descriptive statistics, χ2 tests, and logistic regression analyses. Patients' average length of stay was 8.92 ± 13.12 days. Thirty-two patients (4.2%) were readmitted, and 100 patients (13.3%) died during hospitalization. Two-thirds (67.7%) experienced dyspnea, and 367 (48.7%) experienced pain. Symptoms and ICU admission were significantly related to patient outcomes. In the regression analyses, dyspnea, pain, and ICU admission were significantly related to higher-than-average lengths of stay. Dyspnea and ICU admission were related to death in hospital. Information regarding patients' symptoms, which was extracted from records, was a valuable resource in examining the relationship between symptoms and patient outcomes. The use of EMRs may be more advantageous than self-reported surveys when examining patients' symptom and utilizing big data.

BMI influences relationships among health factors for adults with persistent pain who use prescription opioids

BACKGROUND

Long-term use of prescription opioids for pain results in negative health outcomes. Overweight and pain are related, and adults with either condition commonly report poor sleep quality, high levels of depression, low levels of self-efficacy, and high pain interference and intensity. Insufficient research exists regarding how weight may influence pain outcomes in the context of common symptoms.

PURPOSE

To investigate how body mass index (BMI) influences relationships between health factors and pain outcomes among adults with pain prescribed opioids.

METHODS

The sample included 226 adults. Linear regression models tested relationships among variables and outcomes of pain intensity and pain interference.

FINDINGS

BMI significantly strengthened relationships between health factors and pain interference but not pain intensity.

DISCUSSION

Adults with persistent pain suffer worsened pain interference in the context of increased weight status. Nurses should consider addressing BMI as part of a holistic pain management care plan.

Health literacy, pain intensity and pain perception in patients with chronic pain

Background

Chronic pain poses a large burden for the healthcare system and the individuals concerned. The impact of health literacy (HL) on health status and health outcomes is receiving more and more attention. The aim of this study was to evaluate the association of HL with chronic pain intensity and pain perception.

Methods

A total of 121 outpatients suffering from chronic pain (pain duration >3 months) were evaluated. The HL was measured using the health literacy screening questions. Pain intensity was measured with a Visual Analogue Scale (VAS) and pain perception with the short-form McGill Pain Questionnaire (SF-MPQ).

Results

Individuals with low HL had significantly higher VAS values (Pearson correlation coefficient= −0.270, p = 0.003). Stepwise regression analysis showed that HL has a significant association with pain intensity (odds ratio [OR] = 2.31; 95% confidence interval [CI] 1.11–4.83), even after controlling for age and sex (OR = 2.27; 95% CI 1.07–4.82), but no longer after controlling for education (OR = 2.10; 95% CI 0.95–4.64).

Conclusion

Individuals with a higher HL showed less pain intensity, which seems to be caused by a better pain management; therefore, supporting the development of HL in patients with chronic pain could be seen as an important objective of integrated care.

Barriers Perceived by Nurses in the Optimal Treatment of Postoperative Pain

It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. On a national level, the greatest burden of inadequate treatment is borne, among others, by elderly patients. The purpose of the paper was to compare the prevalence of barriers to optimum post-operative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. The research project was a multi-center one and took over a year. The study was questionnaire-based. It used the Polish version of the Nurses' Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1602 nurses working at a clinical, provincial and municipal hospital. In the university hospital, difficulties in pain assessment related to the healthcare system occurred statistically significantly more often.

Is pain at discharge a risk factor for unplanned hospital readmission?

INTRODUCTION

Unplanned readmissions are associated with a high cost to health insurances and the incidence of preventable readmissions could be considered as a quality indicator for the initial hospital admission. We aimed to assess the predictive value for unplanned readmission of higher pain scores at discharge of the initial admission as well as of other pain and demographic characteristics. The documentation of significant associations would provide further support for a structured pain management policy.

METHODS

A retrospective analysis of a large single university hospital data-set of 33.122 admissions within a 13-month period allowed for the assessment of the predictive relationship of pain toward unplanned readmission at 7 and at 30 days after discharge through logistic regression, and of other characteristics through linear regression.

RESULTS

Pain scores at discharge of the initial admission were not significantly different (p > 0.05) with or without unplanned readmission and hence have no predictive value on the individual patient level. The prediction of the number of patients for each group, for example the number of patients that will be readmitted (size of the group), shows significance for pain at the moment of discharge (p_initial = 0.000), pain medication (p = 0.0044), and age (p = 0.0017). Pathology (p = 0.6151) and gender (p = 0.7029) have no significant predictive value.

CONCLUSION

Pain as dichotomous variable upon discharge cannot be used as single risk predictor for unplanned readmission. However, the pain score at discharge in combination with the use of pain medication and age is a risk factor for the number of short-term unplanned readmissions.