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Hamadeh S, Lambert GW, Willetts G, Garvey L. Pain management of adult sedated and ventilated patients in the intensive care units: A survey with free text responses. Intensive Crit Care Nurs 2024; 84:103770. [PMID: 39032213 DOI: 10.1016/j.iccn.2024.103770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Pain management of sedated and ventilated patients in intensive care units lacks consistency. OBJECTIVES To investigate nurses' training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses' perspectives. METHODS A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to. OUTCOME MEASURES Demographics, training, governance, clinical practice, knowledge, and attitudes. RESULTS/FINDINGS 108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor's preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses' knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between "knowledge scores" and "years of ICU experience" and weak negative relationship r = [-0.119], p = [0.260] between "knowledge scores" and "hours of clinical practice" was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: "Pain assessment, where is it?" And "Priorities of critical illness." CONCLUSION The study uncovered pain management situation and examined nurses' demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management. IMPLICATIONS FOR CLINICAL PRACTICE Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses' role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.
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Affiliation(s)
- Samira Hamadeh
- Institute of Health and Wellbeing, Federation University, Australia. https://federation.edu.au/
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia. https://twitter.com/glamb30004
| | - Georgina Willetts
- Institute of Health and Wellbeing, Federation University, Australia. https://twitter.com/GeorgiWilletts
| | - Loretta Garvey
- Assessment Transformation, Federation University, Australia. https://twitter.com/LorettaGarvey
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Jørgensen JB, Clement SL. Validation of the Danish version of the knowledge and attitudes survey regarding pain. Scand J Pain 2024; 24:sjpain-2023-0140. [PMID: 38452355 DOI: 10.1515/sjpain-2023-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Pain management is critical for nurses; therefore, knowledge assessment is also critical. The Knowledge and Attitudes Survey Regarding Pain (KASRP), designed for testing pain management knowledge among nurses, finds widespread use internationally; yet, key validity evidence according to American Psychological Association standards is missing. Therefore, this study aimed to translate and test the psychometric traits of KASRP based on an item response theory model. METHODS Cronbach's α was included to assess internal consistency, and the Kolmogorov-Smirnov test was included to assess the total score normal distribution goodness of fit. KASRP was tested using the Kaiser-Meyer-Olkin (KMO) test for sphericity to examine its suitability for factor analysis and exploratory factor analysis to examine construct evidence. The Kruskal-Wallis H test was used to assess discriminant evidence. The correlation between KASRP and the Brockopp-Warden Pain Knowledge Questionnaire (BWPKQ) was included as a measure of convergent validity evidence, and correlation with self-assessed knowledge was tested as a divergent validity measure. RESULTS The questionnaire was translated using back-forth and parallel translation. The KMO test for sphericity was 0.49 for all items and 0.53 for the adjusted scale without items 30, 33, and 36, with factor analysis explaining 70.42% of the variation suggesting unacceptable construct validity evidence. Cronbach's α was 0.75, suggesting acceptable reliability evidence; the Kolmogorov-Smirnov test revealed an insignificant skewness of -0.195 and a kurtosis of 0.001, while the Kruskal-Wallis H test revealed a significance of p < 0.001. The correlation between KASRP and the BWPKQ was 0.69 (p = 0.0001), suggesting acceptable convergent validity evidence. A correlation between KASRP and self-assessed knowledge of -0.59 was also found, which suggests acceptable divergent validity evidence. CONCLUSIONS The translated KASRP passed six out of seven tests based on the given sample.
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Affiliation(s)
- Jacob Brauner Jørgensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Sanne Lund Clement
- Institut for Politik og Samfund, Aalborg University, Fibigerstræde 1, 57, 9220 Aalborg Ø, Denmark
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Alotni M, Guilhermino M, Duff J, Sim J. Barriers to nurse-led pain management for adult patients in intensive care units: An integrative review. Aust Crit Care 2023; 36:855-862. [PMID: 36333190 DOI: 10.1016/j.aucc.2022.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This integrative review sought to identify and synthesise quantitative and qualitative evidence on barriers to pain management in adult intensive care units (ICUs). BACKGROUND Pain is experienced by 58% of adult ICU patients, which leads to consequences such as decreased healing and delirium. Managing pain effectively is an integral part of the critical care nurse's role. METHODS An integrative review was conducted based on Whittemore and Knafl's approach. Peer-reviewed research articles were sourced from five databases. Included articles were limited to those published in English and Arabic. The quality of included papers was evaluated using the Mixed Methods Appraisal Tool (MMAT). Identified barriers to pain management in adult ICUs were mapped onto the components of the COM-B model. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Nine hundred and ninety-one papers were identified; 19 studies met the inclusion criteria. Seventeen studies focused on pain management from the perspective of nurses, whereas the remaining two focused on the perspectives of patients and nurses. Using the MMAT, two studies were rated 5 stars (out of 5), nine studies were rated 4 stars, seven studies were rated 3 stars, and one study was rated 2 stars. Lack of knowledge and skills was found to be psychological capability barriers, while nurse dependency on following doctor's orders, poor staffing levels, lack of pain assessment skills, and lack of education were barriers mapped to physical capability. Opportunity was represented by three barriers: inadequate documentation of pain and shortage of nurses were mapped to the physical opportunity, and poor communication to the social opportunity. Nurses' beliefs towards pain assessment were mapped to reflective motivation. CONCLUSIONS The findings of this study suggest that knowledge, nursing beliefs, insufficient numbers of nursing staff, lack of documentation, and lack of communication commonly affect pain management in adult ICUs. PROSPERO REGISTRATION CRD42020179913.
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Affiliation(s)
- Majid Alotni
- School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Department of Medical/Surgical nursing, Nursing College, Qassim University, Buraydah 52571, Saudi Arabia.
| | - Michelle Guilhermino
- School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; John Hunter Hospital, Intensive Care Services, Hunter New England Local Health District, Australia.
| | - Jed Duff
- School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Centre for Nursing and Midwifery Research, Royal Brisbane and Womens Hospital, Herston QLD 4029, Australia.
| | - Jenny Sim
- School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; School of Nursing and Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW, Australia.
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Laures EL, LaFond CM, Marie BS, McCarthy AM. Pain Assessment and Management for a Chemically Paralyzed Child Receiving Mechanical Ventilation. Am J Crit Care 2023; 32:346-354. [PMID: 37652886 DOI: 10.4037/ajcc2023403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pain assessment in the pediatric intensive care unit (PICU) is complex, specifically for children receiving mechanical ventilation who require neuromuscular blockade (NMB). No valid pain assessment method exists for this population. Guidelines are limited to using physiologic variables; it remains unknown how nurses are assessing and managing pain for this population in practice. OBJECTIVES To describe how PICU nurses are assessing and managing pain for children who require NMB. METHODS A cross-sectional quantitative design was used with an electronic survey. Nurses were asked to respond to 4 written vignettes depicting a child who required NMB and had a painful procedure, physiologic cues, both, or neither. RESULTS A total of 107 PICU nurses answered the survey. Nurses primarily used behavioral assessment scales (61.0%) to assess the child's pain. All nurses reported that physiologic variables are either moderately or extremely important, and 27.3% of nurses used the phrase "assume pain present" formally at their organization. When physiologic cues were present, the odds of a nurse intervening with a pain intervention were 23.3 times (95% CI, 11.39-53.92; P < .001) higher than when such cues were absent. CONCLUSIONS These results demonstrate variation in how nurses assess pain for a child who requires NMB. The focus remains on behavioral assessment scales, which are not valid for this population. When intervening with a pain intervention, nurses relied on physiologic variables. Decision support tools to aid nurses in conducting an effective pain assessment and subsequent management need to be created.
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Affiliation(s)
- Elyse L Laures
- Elyse L. Laures is a nurse scientist, University of Iowa Hospitals and Clinics, and instructional track faculty, University of Iowa College of Nursing, Iowa City
| | - Cynthia M LaFond
- Cynthia M. LaFond is a senior nurse scientist, University of Iowa College of Nursing, Iowa City, and Ascension Illinois, Chicago
| | - Barbara St Marie
- Barbara St. Marie is an associate professor, University of Iowa College of Nursing, Iowa City
| | - Ann Marie McCarthy
- Ann Marie McCarthy is a professor, University of Iowa College of Nursing, Iowa City
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Zaabi AA, Al-Saadi M, Alaswami H, Al-Musalami A. Assessing Nurses' Knowledge and Attitudes towards Cancer Pain Management in Oman. Cancers (Basel) 2023; 15:3925. [PMID: 37568741 PMCID: PMC10417855 DOI: 10.3390/cancers15153925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/09/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Cancer care in the Gulf Cooperation Countries, including Oman, faces challenges due to increasing incidence and late-stage diagnoses. Cancer patients at later stages suffer complex symptoms, pain being a prominent one. Access to adequate pain relief is a global problem, including in the Middle East, where palliative care is lacking. Nurses play a crucial role in pain assessment and management but often lack the necessary training, resulting in inadequate relief and prolonged hospital stays. This study aims to examine the knowledge and attitudes of nurses in a national cancer center toward the management of cancer pain, with the goal of identifying any gaps in their knowledge. This is a cross-sectional descriptive study conducted among nurses at the national cancer center in the Royal Hospital. The Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) was used to determine the pain-related knowledge and attitudes of the nurses. Out of 150 registered nurses, 118 participated in this study (78% response rate). The mean NKASRP score was 49.6%. Half of the participants (50%) had a poor level of knowledge and attitude, 46% had fair knowledge and attitude, and only five participants (4%) had a good level of knowledge and attitude. A statistically significant association existed between knowledge and education level, years of experience caring for cancer patients, and prior pain management training (p < 0.05). A low level of knowledge and attitude among nurses in cancer pain management is a significant challenge in providing comprehensive cancer care. Adequate training of nurses in cancer pain management is essential to providing effective pain management and improving the quality of life of cancer patients.
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Affiliation(s)
- Adhari Al Zaabi
- Department of Human and Clinical Anatomy, College of Medicine, Sultan Qaboos University, Muscat 123, Oman
| | - Maeen Al-Saadi
- College of Medicine, Sultan Qaboos University, Muscat 123, Oman; (M.A.-S.); (H.A.)
| | - Husain Alaswami
- College of Medicine, Sultan Qaboos University, Muscat 123, Oman; (M.A.-S.); (H.A.)
| | - Atika Al-Musalami
- Oncology Center, Royal Hospital, Ministry of Health, Muscat 393, Oman
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Okbai T, Fessehaye S, Yohannes Gebray A, Tewelde Kahsay D. Final-semester nursing studentś knowledge and attitude regarding pain management in resources limited setting. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Sweity EM, Salahat AM, Sada AA, Aswad A, Zabin LM, Zyoud SH. Knowledge, attitude, practice and perceived barriers of nurses working in intensive care unit on pain management of critically ill patients: a cross-sectional study. BMC Nurs 2022; 21:202. [PMID: 35883057 PMCID: PMC9317059 DOI: 10.1186/s12912-022-00990-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is a major obstacle and one of the main reasons people seek medical attention and is a frequent stressor for many clients in the intensive care unit (ICU). However, clients should not be left complaining, especially when solutions are available; each patient has the right to assess and manage their pain in the best way possible. Therefore, the objective of this study was to analyze nurses' knowledge, attitudes, and practice (KAPs) regarding pain management in Palestinian ICU settings and to determine the possible obstacles that may hinder effective and competent pain management for critically ill clients. METHODS This cross-sectional research was conducted online through social media. An approved questionnaire was used to assess KAPs and obstacles in pain treatment approaches for critically ill patients. Bloom's cutoff points for adequate practice, appropriate knowledge, and a positive attitude were applied. IBM SPSS Statistics for Windows, Version 21.0 was used for analyses. RESULTS One hundred ninety-one nurses were approached, the majority of the participants in this investigation were males (n = 127, 66.5%), and the mean age of the study participant was 29 ± 7 (year). The overall knowledge score was 15, measured for median knowledge = 7 with an interquartile range (IQR) of 4-8, and higher scores indicate more knowledge about the management and control of pain. The total attitude score = 11, the median = 6, with an IQR of 5-7. The reluctance to prescribe opioids was 79.6%, the lack of proficiency in pain management knowledge was 78.5%, and rigorous controls over opioid use were 77.5%, which was the lion's share of commonly recognized hurdles. The overall practice score was 10, with a median of 5.0 with an IQR of 3.0 to 6.0, and nurses revealed that they would evaluate all the steps involved in pain management in each round they have. CONCLUSIONS This research reveals a knowledge, attitude, and practice gap among the working nurses. Therefore, adequate and efficient plans must be aimed at ICU nurses to foster the level of knowledge and direct attitudes toward pain control through applicable interventional programs.
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Affiliation(s)
- Essa M. Sweity
- grid.11942.3f0000 0004 0631 5695Department of Cardiology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Ahmad M. Salahat
- College of Nursing and Midwifery, Women’s Federation Society, Nablus, 44839 Palestine
| | - Abd alrhman Sada
- grid.11942.3f0000 0004 0631 5695Department of Cardiology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Ahmad Aswad
- grid.11942.3f0000 0004 0631 5695Department of Cardiology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Loai M. Zabin
- grid.11942.3f0000 0004 0631 5695Department of Nursing, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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Rababa M, Al-Sabbah S, Hayajneh AA. Nurses' Perceived Barriers to and Facilitators of Pain Assessment and Management in Critical Care Patients: A Systematic Review. J Pain Res 2021; 14:3475-3491. [PMID: 34764688 PMCID: PMC8577531 DOI: 10.2147/jpr.s332423] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/27/2021] [Indexed: 12/18/2022] Open
Abstract
Aim This review aims to examine nurses’ perceived barriers to and facilitators of pain assessment and management in adult critical care patients. Background Pain is one of the worst memories among critically ill patients. However, pain among those patients is still undertreated due to several barriers that impede effective management. Therefore, addressing the perceived barriers and facilitators to pain assessment management among critical care nurses is crucial. Methods A systematic search of pain assessment and management in critical care patient-relevant literature from four databases was done, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results The barriers and facilitators were categorized into four groups: nurse-related, patient-related, physician-related, and system-related. The most frequently reported barriers in this study included nurses’ lack of knowledge regarding the use of pain assessment tools, patients’ inability to communicate, physicians’ prescription of analgesics being independent of pain scores evaluation, and absence of standardized guidelines and protocols for pain evaluation and control. For the facilitators, the most reported ones include ongoing education and professional training related to pain assessment and management, patients’ ability to self-report pain, effective collaboration between physicians and nurses, and productive discussion of patients’ pain scores during nurse-to-nurse handovers. Conclusion Various barriers and facilitators to pain assessment and management were identified and examined in this review. However, future research is still needed to further investigate these barriers and facilitators and examine any other potential associated factors among critical care nurses. Relevance to Clinical Practice The findings of our study could help hospital managers in developing continuous education and staff development training programs on assessing and managing pain for critical care patients. Also, our findings could be used to develop an evidence-based standard pain management protocol tailored to effectively assess and promptly treat pain in critical care patients.
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Affiliation(s)
- Mohammad Rababa
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Shatha Al-Sabbah
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Audai A Hayajneh
- Adult Health Nursing Department, Jordan University of Science and Technology, Irbid, Jordan
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Rahman MA, Hanna J, Zein BE, Badr LK. A Nonrandomized Pretest Posttest Study on the Impact of an Educational Pain Management Program on Nurses' Knowledge and Attitudes Regarding Pain in a Middle Eastern Country. Pain Manag Nurs 2021; 23:324-329. [PMID: 34389238 DOI: 10.1016/j.pmn.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/09/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although nurse's knowledge and attitudes regarding pain management has been sufficiently studied worldwide, the impact of an educational intervention program in improving such attitudes and knowledge has not been likewise researched, especially in Middle Eastern countries. AIMS To examine nurses' knowledge and attitudes regarding pain at a university hospital in Lebanon before and after the introduction of a pain management educational program. And to assess the relationship between the characteristic of nurses and their pain knowledge. METHODS Design; A nonrandomized pretest posttest study design was used. Setting; A university hospital in Lebanon. Participants; Included 183 nurses using the Nurses' Knowledge and Attitudes Survey Regarding Pain questionnaire. The pain educational intervention was based on the principles of Ajzen's theory of planned behavior. RESULTS A significant difference between the pre and post test scores was noted (p = .016). Questions answered correctly by 80% of participants were related to questions about pain, pain assessment and management, and questions related to medications, such as correct dosages and opioid side effects were not answered correctly by the majority of nurses. There were significant associations between test scores and the nurses' educational level, their age, and their years of experience. Nurses who worked in critical care units, the emergency department and oncology had higher scores than nurses who worked on general units. CONCLUSIONS Despite the intensive pain education provided at our institution, the pain knowledge of nurses remains below that recommended level which indicates a dire need for more intensive and continuous education in order to provide a pain free environment.
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Affiliation(s)
- Maya Abdul Rahman
- Department of Nursing, American University of Beirut Medical Center, Beirut, Lebanon
| | - Janane Hanna
- Department of Nursing, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bana El Zein
- Department of Nursing, American University of Beirut Medical Center, Beirut, Lebanon
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Kerbage SH, Garvey L, Lambert GW, Willetts G. Pain assessment of the adult sedated and ventilated patients in the intensive care setting: A scoping review. Int J Nurs Stud 2021; 122:104044. [PMID: 34399307 DOI: 10.1016/j.ijnurstu.2021.104044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is frequently encountered in the intensive care setting. Given the impact of pain assessment on patient outcomes and length of hospital stay, studies have been conducted to validate tools, establish guidelines and cast light on practices relating to pain assessment. OBJECTIVE To examine the extent, range and nature of the evidence around pain assessment practices in adult patients who cannot self-report pain in the intensive care setting and summarise the findings from a heterogenous body of evidence to aid in the planning and the conduct of future research and management of patient care. The specific patient cohort studied was the sedated/ ventilated patient within the intensive care setting. DESIGN A scoping review protocol utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping review checklist (PRISMA-ScR). METHODS The review comprised of five phases: identifying the research question, identifying relevant studies, study selection, charting the data and collating, summarizing, and reporting the results. Databases were systematically searched from January to April 2020. Databases included were Scopus, Web of Science, Medline via Ovid, CINAHL COMPLETE via EBSCO host, Health Source and PUBMED. Limits were applied on dates (2000 to current), language (English), subject (human) and age (adult). Key words used were "pain", "assessment", "measurement", "tools", "instruments", "practices", "sedated", "ventilated", "adult". A hand search technique was used to search citations within articles. Database alerts were set to apprise the availability of research articles pertaining to pain assessment practices in the intensive care setting. RESULTS The review uncovered literature categorised under five general themes: behaviour pain assessment tools, pain assessment guidelines, position statements and quality improvement projects, enablers and barriers to pain assessment, and evidence appertaining to actual practices. Behaviour pain assessment tools are the benchmark for pain assessment of sedated and ventilated patients. The reliability and validity of physiologic parameters to assess pain is yet to be determined. Issues of compliance with pain assessment guidelines and tools exist and impact on practices. In some countries like Australia, there is a dearth of information regarding the prevalence and characteristics of patients receiving analgesia, type of analgesia used, pain assessment practices and the process of recording pain management. In general, pain assessment varies across different intensive care settings and lacks consistency. CONCLUSION Research on pain assessment practices requires further investigation to explore the causative mechanisms that contribute to poor compliance with established pain management guidelines. The protocol of this review was registered with Open Science Framework (https://osf.io/25a6) Tweetable abstract: Pain assessment in intensive care settings lacks consistency. New information is needed to understand the causative mechanisms underpinning poor compliance with guidelines.
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Affiliation(s)
| | - Loretta Garvey
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Georgina Willetts
- Department of Nursing and Allied Health; Faculty of Health, Arts and Design; Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
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Pain management in the older adult: The relationship between nurses' knowledge, attitudes and nurses' practice in Ireland and Jordan. Appl Nurs Res 2021; 57:151388. [PMID: 33549291 DOI: 10.1016/j.apnr.2020.151388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research studies regarding nurses' knowledge attitudes and practice in the older adult are limited. Furthermore, none of these studies attempted to investigate the relationship between knowledge attitudes and practice. Furthermore, little studies compared nurses' knowledge, attitudes and practice between Eastern and Western countries. AIM To describe the factors associated with nurses' acute pain management practice in the context of caring for older adult patients. METHOD A quantitative, correlational, comparative and cross-sectional survey approach. DATA COLLECTION Data were collected using survey questionnaire. SAMPLE A sample of 267 registered nurses from Ireland and Jordan (one private hospital in each country). RESULTS A multiple linear regression analysis revealed that nurses' general knowledge and attitude towards pain management was associated with their pain management practice, with a regression coefficient of 0.14 (p = 0.002). However, knowledge of pain in the elderly failed to reach a statistically significant relationship with pain management practice. In regards to country and gender, Irish nurses had an average score that was 2.61 points higher than Jordanian nurses (p < 0.001), female nurses had an average score that was 0.67 points higher than male nurses (p = 0.025). The overall regression model was significant (p < 0.001) with an R2 value of 43.2%, indicating that 43.2% of the variation in scores was explained by knowledge, attitude and practice. CONCLUSION More research studies combining the three concepts (knowledge, attitude and practice) are recommended in the area of pain management.
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Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital. ScientificWorldJournal 2020; 2020:6829153. [PMID: 32848513 PMCID: PMC7439173 DOI: 10.1155/2020/6829153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
This study examined the postoperative pain management practices among registered nurses in an urban hospital in Vietnam. Data of 90 nurses about postoperative pain management practices and pain management at the department were collected. Results indicated that 83.3% of nurses reported that they regularly assessed the degree of pain for postoperative patients. Only 32.2% used assessment tools such as the numeric rating scale to measure pain. Experience in pain management and having guidelines in the department were associated with a higher score in pain management practice. Findings suggested that facilitating the use of pain instruments and developing pain management guidelines should be prioritized.
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Barriers to Cancer Pain Management Among Nurses in Kenya: A Focused Ethnography. Pain Manag Nurs 2020; 21:283-289. [DOI: 10.1016/j.pmn.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022]
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Zuazua-Rico D, Mosteiro-Diaz MP, Maestro-Gonzalez A, Fernandez-Garrido J. Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records. Pain Manag Nurs 2020; 21:510-515. [PMID: 32362473 DOI: 10.1016/j.pmn.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the relationship between frequency of pain assessment and nursing workload, and also to analyze the frequency of pain assessment and its relation to knowledge and attitudes toward pain on nursing professionals in intensive care unit. METHODS An ambispective study was conducted in a Spanish tertiary-level intensive care unit between October 2017 and April 2018. For measurement of workload, the Nursing Activities Score scale was used, and for measurement of pain knowledge, the Knowledge and Attitudes Survey Regarding Pain was used. RESULTS There were 1,207 measurements among 41 nurses and 1,838 among 317 patients. The average nursing workload was high (70.97 points). We found statistically significant positive association between nursing workload and the frequency of assessment (p < .001), as well as frequency of assessment and patients with communicative capacity (p = .008). CONCLUSIONS Nursing workload affects the registration and assessment of patients' pain, resulting in a greater number of records as the workload performed by nurses increases. It is necessary to study in greater depth how the severity of pain, gender of the patients, and workload of nurses influence pain registration and assessment.
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Affiliation(s)
- David Zuazua-Rico
- Medicine Department, Nursing Area, University Of Oviedo, Oviedo, Spain
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Sedighie L, Bolourchifard F, Rassouli M, Zayeri F. Effect of Comprehensive Pain Management Training Program on Awareness and Attitude of ICU Nurses. Anesth Pain Med 2020; 10:e98679. [PMID: 32754429 PMCID: PMC7341110 DOI: 10.5812/aapm.98679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 01/08/2023] Open
Abstract
Background Pain is one of the main complaints of many patients in intensive care units. However, most nurses and physicians are unable to properly monitor and relieve pain in these patients. Factors such as patients' inability to describe their pain and insufficient knowledge of nurses and physicians have made pain management difficult. Given that the knowledge and attitude of nurses play an important role in the effective implementation of the pain management process, this study aimed to investigate the effect of comprehensive pain management training program on the awareness and attitude of intensive care unit nurses. Methods This quasi-experimental single-group study was conducted in two phases (pre and post-intervention) to investigate the awareness and attitude of all nurses employed in the intensive care unit of Tehran Modarres Hospital, based on the determined inclusion and exclusion criteria. In the pre-intervention phase, the awareness and attitudes of the nurses were assessed using a questionnaire. After conducting the pain management training course, an executive program and algorithm were implemented for pain management in ICUs. Then, the nurses’ awareness and attitude toward pain management were assessed again. Finally, changes in the scores of the nurses’ awareness and attitude were analyzed by SPSS V. 22 software in two phases before and after applying the interventions using the Wilcoxon test. The relationship between some demographic variables and the level of awareness and attitude of nurses was also investigated using the Kruskal-Wallis and Mann-Whitney tests. Results The results of this study indicated that the mean score of the nurses’ awareness was significantly different in pre- and post-intervention phases (P < 0.05). Despite an increase in the post-intervention mean score of the nurses’ attitude (71.03), no statistically significant change was observed. Additionally, among the demographic variables, there was only a significant relationship between the nurses' job experience in ICUs and their attitudes. Conclusions Based on the results of this study, teaching and implementing a comprehensive program for pain management can play an effective role in promoting the nurses’ awareness. Therefore, it is proposed to use pain management models to improve the nurses' knowledge and attitude toward pain management in ICU patients.
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Affiliation(s)
- Ladan Sedighie
- Department of Nursing, Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Bolourchifard
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Ph.D. in Nursing, Assistant Professor, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Areas of Knowledge Deficit and Misconceptions Regarding Pain among Jordanian Nurses. Pain Manag Nurs 2019; 20:649-655. [DOI: 10.1016/j.pmn.2019.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/13/2019] [Accepted: 02/23/2019] [Indexed: 11/20/2022]
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Kahsay DT, Pitkäjärvi M. Emergency nurses´ knowledge, attitude and perceived barriers regarding pain Management in Resource-Limited Settings: cross-sectional study. BMC Nurs 2019; 18:56. [PMID: 31832015 PMCID: PMC6873521 DOI: 10.1186/s12912-019-0380-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background Pain is a common phenomenon among emergency patients which may lead to chronic pain conditions and alteration of physiological function. However, it is widely reported that proper pain assessment and management, which is often accomplished by adequately trained nurses reduce the suffering of patients. Therefore, the aim of this study was to assess the emergency nurses´ knowledge, attitude and perceived barriers regarding pain management. Methods A cross-sectional quantitative study design was applied to determine the nurses´ knowledge level, attitude and the perceived barriers related to pain management. Hundred twenty-six nurses from the emergency departments of seven referral hospitals of Eritrea participated in the study. Data were collected in August and September 2017. Both descriptive and inferential statistics were used to summarize and elaborate on the results. Result In general, the knowledge level and attitude of the emergency nurses was poor. The participants’ correct mean score was 49.5%. Nurses with Bachelor’s Degree had significantly higher knowledge and attitude level compared to the nurses at the Diploma and Certificate level of professional preparation (95% CI = 7.1–16.7 and 9.4–19.1; p < 0.001) respectively. Similarly, nurses who had previous training regarding pain scored significantly higher knowledge level compared to those without training (95% CI =1.82–8.99; p = 0.003). The highest perceived barriers to adequate pain management in emergency departments were measured to be overcrowding of the emergency department (2.57 ± 1.25), lack of protocols for pain assessment (2.45 ± 1.52), nursing workload (2.44 ± 1.29) and lack of pain assessment tools (2.43 ± 1.43). There was no significant difference in perceived barriers among nurses with different demographic characteristics. Conclusion The emergency nurses’ knowledge and attitude regarding pain management were poor. Nurses with higher educational level and nurses with previous training scored significantly higher knowledge level. This indicates the need for nursing schools and the ministry of health to work together to educate nurses to a higher level of preparation for pain assessment and management.
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Affiliation(s)
- Desale Tewelde Kahsay
- Department of Anaesthesia and Critical Care, Asmara College of Health Sciences, Mai Bela Ave, Asmara, Eritrea
| | - Marianne Pitkäjärvi
- Metropolia University of Applied Sciences, Myllypurontie 1, PO BOX 4000, 00079 Helsinki, Metropolia Finland
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Roos-Blom MJ, Dongelmans D, Stilma W, Spijkstra JJ, de Jonge E, de Keizer N. Association between organizational characteristics and adequate pain management at the intensive care unit. J Crit Care 2019; 56:1-5. [PMID: 31765909 DOI: 10.1016/j.jcrc.2019.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/25/2019] [Accepted: 11/15/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Half of the patients experience pain during their ICU stay which is known to influence their outcomes. Nurses and physicians encounter organizational barriers towards pain assessment and treatment. We aimed to evaluate the association between adequate pain management and nurse to patient ratio, bed occupancy rate, and fulltime presence of an intensivist. MATERIALS AND METHODS We performed unadjusted and case-mix adjusted mixed-effect logistic regression modeling on data from thirteen Dutch ICUs to investigate the association between ICU organizational characteristics and adequate pain management, i.e. patient-shift observations in which patients' pain was measured and acceptable, or unacceptable and normalized within 1 h. All ICU patients admitted between December 2017 and June 2018 were included, excluding patients who were delirious, comatose or had a Glasgow coma score < 8 at the first day of ICU admission. RESULTS Case-mix adjusted nurse to patient ratios of 0.70 to 0.80 and over 0.80 were significantly associated with adequate pain management (OR [95% confidence interval] of respectively 1.14 [1.07-1.21] and 1.16 [1.08-1.24]). Bed occupancy rate and intensivist presence showed no association. CONCLUSION Higher nurse to patient ratios increase the percentage of patients with adequate pain management especially in medical and mechanically ventilated patients.
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Affiliation(s)
- Marie-José Roos-Blom
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands.
| | - Dave Dongelmans
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands; Amsterdam UMC, location AMC, University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands
| | - Willemke Stilma
- Amsterdam UMC, location AMC, University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands; ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jan Jaap Spijkstra
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands; Amsterdam UMC, location VUmc, Vrije Universiteit Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands
| | - Evert de Jonge
- Leiden University Medical Center, Department of Intensive Care Medicine, Leiden, The Netherlands
| | - Nicolette de Keizer
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands
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Hamdan KM. Nurses' Assessment Practices of Pain Among Critically Ill Patients. Pain Manag Nurs 2019; 20:489-496. [PMID: 31133409 DOI: 10.1016/j.pmn.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/24/2019] [Accepted: 04/10/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Systematic pain assessment is necessary to ensure effective pain management. Despite the availability of recommendations, guidelines, and valid tools for pain assessment, the actual implementation in clinical practice is inconsistent. AIMS The purpose of this study was to investigate intensive care nurses' pain assessment practices among critically ill patients in Jordanian hospitals. DESIGN A descriptive cross sectional design was used in this study. SETTINGS This study was conducted in 22 intensive care unites located in eight hospitals in Jordan. PARTICIPANTS/SUBJECTS Convenience sampling was used to recruit a sample of 300 nurses working in intensive care units. METHODS The Pain Assessment and Management for the Critically Ill survey was used to collect data. Descriptive statistics, χ2, and correlational analysis were used to analyze data. RESULTS A total of 89.7% of nurses (N = 300) used pain assessment tools with patients able to communicate, and the numeric rating scale was the most commonly used tool. A total of 81.7% of the nurses used a pain assessment tool with patients unable to communicate, and the Adult Nonverbal Pain Scale was the most commonly used tool. Nurses' perceived importance of pain assessment was positively associated with frequent use of pain assessment tools. Nurses perceived the use of pain assessment tools for patients able to communicate as being more important than the use of pain assessment tools for patients unable to communicate. CONCLUSIONS The majority of intensive care unit nurses used pain assessment tools for patients both able and unable to communicate; however, the most valid and reliable tools were not used often. Nurses were not aware of the pain behaviors most indicative of pain among critically ill patients.
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Asman O, Slutsker E, Melnikov S. Nurses' perceptions of pain management adequacy in mechanically ventilated patients. J Clin Nurs 2019; 28:2946-2952. [PMID: 31013381 DOI: 10.1111/jocn.14896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/24/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. BACKGROUND Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. DESIGN The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. METHODS A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February-May 2015. The "STROBE" EQUATOR checklist was used. RESULTS Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. CONCLUSION Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. RELEVANCE TO CLINICAL PRACTICE Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.
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Affiliation(s)
- Oren Asman
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medical Law, Sechenov First Moscow State Medical University, Moskva, Russia
| | - Elena Slutsker
- Nursing Administration, Wolfson Medical Center, Holon, Israel
| | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nurses' Knowledge, Attitudes, and Barriers Toward Pain Management Among Postoperative Patients in Jordan. J Perianesth Nurs 2018; 34:359-367. [PMID: 30293792 DOI: 10.1016/j.jopan.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to measure nurses' knowledge, attitudes, and barriers regarding pain management (PM) of postoperative patients in Jordan. DESIGN A descriptive survey research design was used. METHODS This descriptive study adopted a modified version of the "Knowledge and Attitudes Survey Regarding Pain" tool, administered to 120 nurses working in surgical wards. FINDINGS Nurses had inadequate knowledge of PM, with a mean knowledge score of 63.9%. Knowledge of PM and attitudes toward PM were associated positively with the age of the participant (P = .001), years of experience in the surgical area (P = .026), and academic degree of participants (P = .026). CONCLUSIONS Surgical nurses in this study had low knowledge levels and poor attitudes regarding PM in postoperative patients. Unless identified barriers to PM are seriously addressed, this vital aspect of holistic care will continue to be marginalized.
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Determinants of Knowledge and Attitudes Regarding Pain among Nurses in a University Hospital: A Cross-sectional Study. Pain Manag Nurs 2017; 18:144-152. [DOI: 10.1016/j.pmn.2017.02.200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/05/2017] [Accepted: 02/28/2017] [Indexed: 11/21/2022]
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Stalpers D, De Vos MLG, Van Der Linden D, Kaljouw MJ, Schuurmans MJ. Barriers and carriers: a multicenter survey of nurses' barriers and facilitators to monitoring of nurse-sensitive outcomes in intensive care units. Nurs Open 2017; 4:149-156. [PMID: 28694979 PMCID: PMC5500986 DOI: 10.1002/nop2.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 06/05/2016] [Accepted: 02/27/2017] [Indexed: 12/25/2022] Open
Abstract
Aim To identify nurses’ barriers and facilitators to monitoring of nurse‐sensitive outcomes in intensive care units (ICUs), and to explore influential nurse characteristics and work environment factors. Design A cross‐sectional survey in three Dutch ICUs between October 2013 ‐ June 2014. Methods A questionnaire with questions regarding facilitators and three types of barriers: knowledge, attitude and behaviour. The Dutch Essentials of Magnetism II was used to examine work environments. Results All 126 responding nurses identified pressure ulcers and patient satisfaction as outcomes that are nurse‐sensitive and nurses’ full responsibility. Lack of time (behaviour) was perceived as the most prominent barrier, followed by unfamiliarity with mandatory indicators (knowledge), and unreliability of indicators as benchmark data (attitude). Education and clear policies were relevant facilitators. Of nurse characteristics, only regularity of shifts was related to perceived attitude related barriers. The work environment factor “clinical autonomy” was potentially associated with behaviour related barriers.
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Affiliation(s)
| | | | | | | | - Marieke J Schuurmans
- Department of Revalidation Nursing Science & Sports University Medical Centre Utrecht Utrecht the Netherlands.,University of Applied Sciences Utrecht The Netherlands
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Björn A, Pudas-Tähkä SM, Salanterä S, Axelin A. Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study. Intensive Crit Care Nurs 2017; 42:68-74. [PMID: 28431797 DOI: 10.1016/j.iccn.2017.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 01/23/2023]
Abstract
AIM To evaluate the impact of video education on critical care nurses' knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses' experiences with video education. METHODS Forty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients' pain assessment between nurses and the researcher was determined to examine nurses' skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis. RESULTS The knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction. CONCLUSIONS Video education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.
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Affiliation(s)
- Annika Björn
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland; Helsinki University Hospital, HUCH Perioperative, Intensive Care and Pain Medicine, Helsinki, Finland.
| | | | - Sanna Salanterä
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland; Turku University Hospital, Hospital District of South-West Finland, Finland
| | - Anna Axelin
- University of Turku, Department of Nursing Science, Turku FIN-20014, Finland
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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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Farrington M, Hanson A, Laffoon T, Cullen L. Low-Dose Ketamine Infusions for Postoperative Pain in Opioid-Tolerant Orthopaedic Spine Patients. J Perianesth Nurs 2017. [PMID: 26210565 DOI: 10.1016/j.jopan.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Perri GA, Yeung H, Green Y, Bezant A, Lee C, Berall A, Karuza J, Khosravani H. A Survey of Knowledge and Attitudes of Nurses About Pain Management in End-Stage Liver Disease in a Geriatric Palliative Care Unit. Am J Hosp Palliat Care 2016; 35:92-99. [PMID: 28256899 DOI: 10.1177/1049909116684765] [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: 12/16/2022] Open
Abstract
BACKGROUND Palliative care is often initiated late for patients with end stage liver disease (ESLD) with pain being a common morbidity that is under-treated throughout the disease trajectory. When admitted to a palliative care unit (PCU), nurses play a pivotal role and must be highly informed to ensure effective pain management. The aim of this study is to determine the baseline level of knowledge and attitudes of PCU nurses regarding pain management in patients with ESLD. METHODS A descriptive, cross-sectional self-administered survey design was used for this study. The sample comprised 35 PCU nurses working at a continuing chronic care facility in Toronto, Ontario, Canada. Data on the knowledge and attitudes of the nurses regarding pain management in patients with ESLD, was obtained using a modified version of the "Nurses Knowledge and Attitudes Survey Regarding Pain" (NKASRP) tool. RESULTS Thirty-one PCU nurses were included for the analysis, giving a response rate of 89%. The mean total percentage score for the nurses on the modified version of the NKASRP was 72%. Only 26% of the nurse participants obtained a passing score of 80% or greater. There were no significant differences in mean total scores by age, gender, years of nursing experience or education level. CONCLUSIONS The findings of this study provide important information about the inadequate knowledge and attitude in nurses regarding pain management for patients with ESLD. It is suggested that targeted educational programs and quality improvement initiatives in pain management for patients with ESLD could improve knowledge and attitudes for PCU nurses.
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Affiliation(s)
- Giulia-Anna Perri
- 1 Baycrest Health Sciences, Division of Palliative Care, Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Herman Yeung
- 2 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yoel Green
- 3 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Abby Bezant
- 1 Baycrest Health Sciences, Division of Palliative Care, Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carman Lee
- 1 Baycrest Health Sciences, Division of Palliative Care, Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Berall
- 1 Baycrest Health Sciences, Division of Palliative Care, Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jurgis Karuza
- 1 Baycrest Health Sciences, Division of Palliative Care, Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Houman Khosravani
- 4 Division of Critical Care Medicine, Department of Medicine, Western University, London, Ontario, Canada
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Wireklint Sundström B, Holmberg M, Herlitz J, Karlsson T, Andersson H. Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial. BMC Nurs 2016; 15:52. [PMID: 27594805 PMCID: PMC5010668 DOI: 10.1186/s12912-016-0175-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/30/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses' (ANs') prehospital care of patients experiencing suspected ACS, related to pain intensity. METHODS This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria. RESULTS The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine. CONCLUSIONS An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials. TRIAL REGISTRATION The ClinicalTrials.gov Protocol Registration System (registration number NCT00792181).
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Affiliation(s)
- Birgitta Wireklint Sundström
- PreHospen − Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- School of Health Sciences, University of Borås, SE-501 90 Borås, Sweden
| | - Mats Holmberg
- PreHospen − Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Johan Herlitz
- PreHospen − Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Karlsson
- Department of Public Health and Community Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Henrik Andersson
- PreHospen − Centre for Prehospital Research, University of Borås, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Han JY, Park HS, Jin MJ. Nurses' Knowledge and Performance of Pain Management at a General hospital. ACTA ACUST UNITED AC 2016. [DOI: 10.7739/jkafn.2016.23.1.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kizza IB, Muliira JK, Kohi TW, Nabirye RC. Nurses’ knowledge of the principles of acute pain assessment in critically ill adult patients who are able to self-report. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2016. [DOI: 10.1016/j.ijans.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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D’emeh WM, Yacoub MI, Darawad MW, Al-Badawi TH, Shahwan B. Pain-Related Knowledge and Barriers among Jordanian Nurses: A National Study. Health (London) 2016. [DOI: 10.4236/health.2016.86058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yassin K, Rankin J, Al-Tawafsheh A. The Social Organization of Nurses' Pain Management Work in Qatar. Pain Manag Nurs 2015; 16:759-69. [PMID: 26460281 DOI: 10.1016/j.pmn.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/30/2015] [Accepted: 06/03/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to explore the social organization of nurses' pain management work in Qatar. The research data drew our attention to unacceptable delays in intervening with patients in pain. We describe and analyze delays in opioid administration. Institutional ethnography was the method of inquiry used to guide the study. The main findings of the study reveal that there is a socially organized system of delays built into nurses' work to manage pain. Nurses are subject to time-consuming processes of securing, handling, and administering opioids. This study's innovative approach introduces a promising "alternate" analysis to prior work investigating hospital nurses' pain management practices. Both the method of inquiry and the findings have international relevance for researchers interested in undertreated pain.
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Affiliation(s)
- Khadra Yassin
- University of Calgary-Qatar, Doha, Qatar; Hamad Medical Corporation, Doha, Qatar.
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Dualé C, Gayraud G, Taheri H, Bastien O, Schoeffler P. A French Nationwide Survey on Anesthesiologist-Perceived Barriers to the Use of Epidural and Paravertebral Block in Thoracic Surgery. J Cardiothorac Vasc Anesth 2015; 29:942-9. [DOI: 10.1053/j.jvca.2014.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Indexed: 12/25/2022]
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Witkop M, Lambing A. Knowledge and attitudes survey in bleeding disorders providers regarding pain. Haemophilia 2015; 21:e465-71. [PMID: 26496002 DOI: 10.1111/hae.12749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The National Pain Study identified respondents (39%) were not satisfied with their pain management yet over 50% seek out their Haemophilia Treatment Centre (HTC) providers for pain management. This study's purpose was to assess the knowledge and attitudes of HTC providers regarding pain assessment and treatment. METHODS One hundred and fifty-two HTC providers responded to a Survey Monkey™ Questionnaire. RESULTS Knowledge deficits noted in pharmacology included (i) potentiators of opioids, (ii) time to peak effect of oral morphine, (iii) benzodiazepines usage as effective pain relievers and (iv) dose escalation/respiratory depression in an opioid tolerant patient. Areas of deficit in the substance abuse category involved (i) likelihood of a previous alcohol/drug abuse problem and (ii) signs and symptoms of discontinuation syndrome. Despite 100% confirmation from all providers that the patient is the best source of pain reporting, when presented with two identical case scenarios except for the patient's visual pain presentation; pain ratings were reported differently for patients who rated their pain similarly (8/10), yet displayed their pain symptoms differently resulting in different pain medication regimens. Responses were consistent between the provider groups but varied between case studies suggesting disparity between personal attitudes of providers when prescribing pain medication in the haemophilia population. CONCLUSIONS Continued research in the area of haemophilia pain as well as treatment is needed. In addition, continuing pain education is recommended for HTC provider's at the local, regional and national levels so providers could remain up to date in the changes and progress of pain management theory.
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Affiliation(s)
- M Witkop
- Northern Regional Bleeding Disorders Center, Munson Medical Center, Traverse City, MI, USA
| | - A Lambing
- Henry Ford Adult Bleeding and Thrombosis Treatment Center, Detroit, MI, USA
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Al-Azawy M, Oterhals K, Fridlund B, Aßmus J, Schuster P. Premedication and preoperative information reduces pain intensity and increases satisfaction in patients undergoing ablation for atrial fibrillation. A randomised controlled study. Appl Nurs Res 2015; 28:268-73. [PMID: 26608424 DOI: 10.1016/j.apnr.2015.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pain and discomfort are common during radiofrequency ablation (RFA) for atrial fibrillation. AIMS To compare and evaluate the effect of premedication, standardised preoperative information and preoperative anxiety on pain intensity, drug consumption and patients' satisfaction. METHODS Preoperative anxiety at baseline, pain intensity during RFA, and patient satisfaction after the procedure were measured in 3 random groups. Group A (n=20) received standard pain management, group B (n=20) received premedication and group C (n=20) received premedication and standardised preoperative information. RESULTS Patients in groups B and C experienced less pain intensity (p<0.001) and needed fewer anxiolytics (p=0.023) and analgesics (p=0.031) compared to group A. Patient satisfaction was higher in group C (p=0.005) compared to group A. Increased preoperative anxiety is related to elevated drug demand (p<0.05). CONCLUSION Premedication alone or combined with preoperative information reduces and higher preoperative anxiety increases pain intensity and drug consumption during RFA. Preoperative information improves patient satisfaction.
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Affiliation(s)
- Mawahib Al-Azawy
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Institute of Nursing, Bergen University College, Bergen, Norway.
| | - Kjersti Oterhals
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Institute of Nursing, Bergen University College, Bergen, Norway; Department of Clinical Science, Institute of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Bengt Fridlund
- Institute of Nursing, Bergen University College, Bergen, Norway; School of Health Sciences, Jönköping University, Jönköping, Sweden.
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
| | - Peter Schuster
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Institute of Medicine and Dentistry, University of Bergen, Bergen, Norway.
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Quantitative study of oncology nurses' knowledge and attitudes towards pain management in Saudi Arabian hospitals. Eur J Oncol Nurs 2015; 19:44-9. [DOI: 10.1016/j.ejon.2014.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/19/2014] [Accepted: 07/22/2014] [Indexed: 11/22/2022]
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Overcoming barriers to effective pain management: the use of professionally directed small group discussions. Pain Manag Nurs 2014; 16:121-7. [PMID: 25439127 DOI: 10.1016/j.pmn.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 11/20/2022]
Abstract
Inadequate assessment and management of pain among critical care patients can lead to ineffective care delivery and an increased length of stay. Nurses' lack of knowledge regarding appropriate assessment and treatment, as well as negative biases toward specific patient populations, can lead to poor pain control. Our aim was to evaluate the effectiveness of professionally directed small group discussions on critical care nurses' knowledge and biases related to pain management. A quasi-experiment was conducted at a 383-bed Magnet(®) redesignated hospital in the southeastern United States. Critical care nurses (N = 32) participated in the study. A modified Brockopp and Warden Pain Knowledge Questionnaire was administered before and after the small group sessions. These sessions were 45 minutes in length, consisted of two to six nurses per group, and focused on effective pain management strategies. Results indicated that mean knowledge scores differed significantly and in a positive direction after intervention [preintervention mean = 18.28, standard deviation = 2.33; postintervention mean = 22.16, standard deviation = 1.70; t(31) = -8.87, p < .001]. Post-bias scores (amount of time and energy nurses would spend attending to patients' pain) were significantly higher for 6 of 15 patient populations. The strongest bias against treating patients' pain was toward unconscious and mechanically ventilated individuals. After the implementation of professionally directed small group discussions with critical care nurses, knowledge levels related to pain management increased and biases toward specific patient populations decreased.
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Vickers N, Wright S, Staines A. Surgical nurses in teaching hospitals in Ireland: understanding pain. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:924-9. [PMID: 25251173 DOI: 10.12968/bjon.2014.23.17.924] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nurses play a crucial role in pain management and must be highly knowledgeable to ensure their practices are of a high standard. AIM The purpose of this study was to determine the baseline level of knowledge and attitudes regarding pain of nurses working in three teaching hospitals in Dublin. METHODS This descriptive study explored the knowledge and attitudes of nurses regarding pain management. A modified version of the 'Knowledge and Attitudes Survey Regarding Pain' tool was used to collect data. The sample comprised a convenience sample of 94 nurses working in the acute surgical wards of three hospitals. FINDINGS Three per cent of respondents achieved a passing score of 80% or greater. Results revealed that the mean percentage score overall was 65.7%. Widespread knowledge deficits were noted in this study, particularly in the domain of pharmacological management of pain. Further analysis revealed respondents had an inaccurate self-evaluation of their pain management knowledge. CONCLUSION The results of this study support the concern of inadequate knowledge and attitudes of nurses regarding pain. Educational and quality improvement initiatives in pain management should be used, which could foster and enhance nurses' knowledge base in the area of pain and possibly improve practices.
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Affiliation(s)
- Niamh Vickers
- Student Public Health Nurse, Health Services Executive Dublin South East/Wicklow
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Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag 2014; 18:e107-14. [PMID: 24308026 DOI: 10.1155/2013/263104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group. OBJECTIVES To evaluate the validity and clinical utility of two pain assessment tools, the revised Adult Non-Verbal Pain Scale (NVPS-R) and the Critical Care Pain Observation Tool (CPOT), in a trauma and neurosurgical patient population. METHODS Patients were assessed using the NVPS-R and CPOT by trained intensive care unit nurses (n=23) and research assistants before, during and after two procedures: turning of the patient (nociceptive procedure) and noninvasive blood pressure cuff inflation (non-nociceptive procedure). Communicative patients were also asked to report their level of pain during each assessment. RESULTS A total of 66 patients (34 communicative, 32 noncommunicative) were included in the study. CPOT and NVPS-R scores increased significantly when participants were exposed to turning, but not during noninvasive blood pressure measurement (repeated measures ANOVA: CPOT, F=5.81, P=0.019; NVPS-R, F=5.32, P=0.025) supporting discriminant validity. CPOT and NVPS-R scores were significantly higher during the turning procedure for patients who had indicated that they were in pain versus those who were not, indicating criterion validity. Inter-rater reliability was generally higher for the CPOT than NVPS-R. Nurses rated the feasibility of the two tools as comparable but provided higher ratings of acceptability for the CPOT. CONCLUSIONS While the present study supports the use of the CPOT and the NVPS-R with critically ill trauma and neurosurgical patients, further research should explore the role of vital signs in pain.
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Gerber A, Thevoz AL, Ramelet AS. Expert clinical reasoning and pain assessment in mechanically ventilated patients: A descriptive study. Aust Crit Care 2014; 28:2-8; quiz 9. [PMID: 25028160 DOI: 10.1016/j.aucc.2014.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pain assessment in mechanically ventilated patients is challenging, because nurses need to decode pain behaviour, interpret pain scores, and make appropriate decisions. This clinical reasoning process is inherent to advanced nursing practice, but is poorly understood. A better understanding of this process could contribute to improved pain assessment and management. OBJECTIVE This study aimed to describe the indicators that influence expert nurses' clinical reasoning when assessing pain in critically ill nonverbal patients. METHODS This descriptive observational study was conducted in the adult intensive care unit (ICU) of a tertiary referral hospital in Western Switzerland. A purposive sample of expert nurses, caring for nonverbal ventilated patients who received sedation and analgesia, were invited to participate in the study. Data were collected in "real life" using recorded think-aloud combined with direct non-participant observation and brief interviews. Data were analysed using deductive and inductive content analyses using a theoretical framework related to clinical reasoning and pain. RESULTS Seven expert nurses with an average of 7.85 (±3.1) years of critical care experience participated in the study. The patients had respiratory distress (n=2), cardiac arrest (n=2), sub-arachnoid bleeding (n=1), and multi-trauma (n=2). A total of 1344 quotes in five categories were identified. Patients' physiological stability was the principal indicator for making decision in relation to pain management. Results also showed that it is a permanent challenge for nurses to discriminate situations requiring sedation from situations requiring analgesia. Expert nurses mainly used working knowledge and patterns to anticipate and prevent pain. CONCLUSIONS Patient's clinical condition is important for making decision about pain in critically ill nonverbal patients. The concept of pain cannot be assessed in isolation and its assessment should take the patient's clinical stability and sedation into account. Further research is warranted to confirm these results.
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Affiliation(s)
- Anne Gerber
- Institute of Higher Education and Nursing Research, University of Lausanne, CHUV, Switzerland; Haute Ecole de Santé Vaud (HESAV), University of Applied Sciences Western Switzerland, Lausanne, Switzerland
| | - Anne-Laure Thevoz
- Institute of Higher Education and Nursing Research, University of Lausanne, CHUV, Switzerland; Institut et Haute Ecole La Source, School of Nursing, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Nursing Research, University of Lausanne, CHUV, Switzerland; Haute Ecole de Santé Vaud (HESAV), University of Applied Sciences Western Switzerland, Lausanne, Switzerland.
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Yaakup H, Eng TC, Shah SA. Does Clinical Experience Help Oncology Nursing Staff to Deal with Patient Pain Better than Nurses from other Displines? Knowledge and Attitudes Survey Amongst Nurses in a Tertiary Care in Malaysia. Asian Pac J Cancer Prev 2014; 15:4885-91. [DOI: 10.7314/apjcp.2014.15.12.4885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Bedside nurses care for patients with pain every day but the task is often challenging. A previous qualitative study that investigated nurses’ experiences as they treated patients with pain suggested that nurses may suffer from moral distress if they are unsuccessful in providing adequate pain relief. As 20 of the original 48 nurses interviewed described frustration and distress when constrained from doing the right thing to provide pain relief for their patients, the purpose of this secondary qualitative analysis was to answer new research questions on nurse moral distress related to managing pain. Findings indicated that difficulties in nurse/physician communication and lack of pain education were contributors to nurses’ frustrations and provided barriers to optimal pain management. Many participants indicated a need for interprofessional pain management education. Further investigation is needed to clarify the impact of moral distress on nurses managing hospitalized patients’ pain.
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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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Moceri JT, Drevdahl DJ. Nurses’ Knowledge and Attitudes Toward Pain in the Emergency Department. J Emerg Nurs 2014; 40:6-12. [DOI: 10.1016/j.jen.2012.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 03/07/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Postoperative Pain: Nurses’ Knowledge and Patients’ Experiences. Pain Manag Nurs 2013; 14:351-357. [DOI: 10.1016/j.pmn.2012.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 05/02/2012] [Accepted: 05/24/2012] [Indexed: 11/18/2022]
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Aziato L, Adejumo O. Determinants of nurses' knowledge gap on pain management in Ghana. Nurse Educ Pract 2013; 14:195-9. [PMID: 24011564 DOI: 10.1016/j.nepr.2013.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/21/2013] [Accepted: 08/20/2013] [Indexed: 12/01/2022]
Abstract
There are concerns about adequacy of nurses' knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses' inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses' inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required.
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Affiliation(s)
- Lydia Aziato
- School of Nursing, University of Ghana, P.O. Box LG43, Legon, Ghana.
| | - Oluyinka Adejumo
- School of Nursing, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa
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Siedlecki SL, Modic MB, Bernhofer E, Sorrell J, Strumble P, Kato I. Exploring how bedside nurses care for patients with chronic pain: a grounded theory study. Pain Manag Nurs 2013; 15:565-73. [PMID: 23466194 DOI: 10.1016/j.pmn.2012.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 12/27/2012] [Indexed: 11/24/2022]
Abstract
In the United States it is estimated that over 30% of the population suffers from some form of chronic pain (Institute of Medicine of the National Academies Report, 2011). Therefore, it is likely that 30% of patients who are admitted to the hospital for acute care needs also have an underlying chronic pain issue. When patients are admitted for concerns that are not related to their chronic pain, the chronic pain may be overlooked in deference to acute medical issues. Nurses dealing with pain in the acute care setting may limit their assessment and management of pain to acute pain. Although there is a significant body of research related to the management of acute pain (Bell & Duffy, 2009; Brennen, Obs, Carr, & Cousins, 2007; Dihle, Bjolseth, & Helseth, 2006; McDonnell, Nicholl, & Read, 2003; Wang & Tsai, 2010) and the management of chronic pain (Bruckenthal, 2010; Clarke & Iphofen, 2005; Kaasalainen et al., 2011; Matthews & Malcom, 2007; Papaleontiou et al., 2010, Reid et al., 2008), few studies were found that explained how nurses care for patients with pre-existing chronic pain in the acute care setting. The purpose of this study was to develop a theoretical understanding of nurses' assessment and decision-making behaviors related to the care of patients with chronic pain in the acute care setting.
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Wøien H, Vaerøy H, Aamodt G, Bjørk IT. Improving the systematic approach to pain and sedation management in the ICU by using assessment tools. J Clin Nurs 2012. [DOI: 10.1111/j.1365-2702.2012.04309.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hilde Wøien
- Division of Emergencies and Critical Care; Oslo University Hospital; Oslo
- Institute of Health and Society; University of Oslo; Oslo
| | - Henning Vaerøy
- Department of Psychiatric R & D; Lørenskog, Akershus University Hospital; Oslo
| | - Geir Aamodt
- Division of Epidemiology; Norwegian Institute of Public Health; Oslo
| | - Ida T Bjørk
- Institute of Health and Society; University of Oslo; Oslo
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Kwak EM, Oh H. Validation of a Korean Translated Version of the Critical Care Pain Observation Tool (CPOT) for ICU Patients. J Korean Acad Nurs 2012; 42:76-84. [DOI: 10.4040/jkan.2012.42.1.76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eun-Mi Kwak
- Nurse, Eulji University Hospital, Deajeon, Korea
| | - Heeyoung Oh
- Professor, College of Nursing, Eulji University, Deajeon, Korea
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