Effect of personal pain experience on pain assessment

Current attitudes and self-rated abilities of Bosnia and Herzegovina veterinarians toward pain recognition and quantification in domestic animals

In previous years interest has grown in investigating the attitudes and capabilities of veterinarians regarding the recognition, quantification and treatment of animal pain throughout different parts of the world and encompassing various species. This is the first report exploring the attitudes and self-rated abilities of veterinarians in Bosnia and Herzegovina (B&H) concerning recognition and quantification of pain in domestic animals. A study questionnaire was made available to 535 general practice veterinarians throughout B&H and 73 (14%) responded in full. The questionnaire contained polar, multiple choice, ordinal and interval scale questions and consisted of sections asking about demographic data, attitudes to pain recognition and quantification, use and availability of analgesics, estimates of pain intensity during specific surgical procedures, and the perceived need for pain assessment and continuing education programmes for analgesia. Half of the respondents considered the recognition and quantification of pain to be difficult while 89% did not make use of pain assessment scales. Of the respondents, (33/73; 45%) felt a certain level of pain to be advantageous since it reduces the activity of the healing animal, whereas 52% (38/73) did not agreed with this concept. Cost was a consideration when deciding whether or not to use analgesics for 58% (42/73) of the respondents with the most commonly used types being NSAIDs (72/73;99%) and opioids (60/73; 82%). Practitioners in B&H displayed awareness of the importance of pain assessment and management however a significant proportion were unaware of pain scales and relied upon physiological indicators of pain.

High inter-observer agreement of observer-perceived pain assessment in the emergency department

BACKGROUND

Triage is used to prioritize the patients in the emergency department. The majority of the triage systems include the patients' pain score to assess their level of acuity by using a combination of patient reported pain and observer-perceived pain; the latter therefore requires a certain degree of inter-observer agreement. The aim of the present study was to assess the inter-observer agreement of perceived pain among emergency department nurses and to evaluate if it was influenced by predetermined factors like age and gender.

METHOD

A project assistant randomly recruited two nurses, who were not allowed to interact with each other, to assess patient pain intensity on the numeric ranking scale. The project assistant afterwards entered the pain scores in a predesigned electronic questionnaire. We used weighted Fleiss-Cohen (quadratic) kappa statistics, Bland-Altman statistics and logistic regression analysis to assess the inter-observer agreement.

RESULTS

One hundred and sixty-two patients were included. They had a median age of 38 years and 45% were females. 30% of the patients were acute surgical patients and 70% acute orthopedic patients. The average time between the pain assessments were 1,7 min. The Bland Altman analysis found a mean difference in pain score of 0.2 and 95% limits of agreement of +/- 3 point. When the NRS scores were translated to commonly used pain categories (no, mild, moderate or severe pain) we found a 70% agreement with a mean difference in categories of 0.05 and 95% limits of agreement of +/- 1 category. Patient age, gender, localization of pain, examination room or presence of a significant other did not affect the inter-observer agreement.

CONCLUSION

We found 70% agreement on pain category between the nurses and it is justified that nurse-perceived pain assessment is used for triage in the emergency department.

Are doctors who have been ill more compassionate? Attitudes of resident physicians regarding personal health issues and the expression of compassion in clinical care

BACKGROUND

Compassion is an attribute central to professionalism and modern clinical care, yet little is known about how compassion is acquired and preserved in medical training. We sought to understand whether personal illness experiences are thought by residents to foster compassion.

METHODS

The authors surveyed 155 (71% response rate) second- and third-year residents at the University of New Mexico School of Medicine regarding their views of the relationship of personal life experience with illness to compassion and empathy for patients.

RESULTS

Residents believe that experience with personal health issues enhances physician compassion for patients. Residents who report more personal health concerns, such as physical or mental health problems and family health problems, endorse the connection between direct experience with illness and empathy.

CONCLUSION

Health care trainees' own illness experiences may increase compassionate patient care practices and foster empathy.

The Burden of Pain of Inpatients Undergoing Radiotherapy – Discrepancies in the Ratings of Physicians and Nurses

BACKGROUND

The aim of this study was to rate the burden of pain of cancer patients receiving radiotherapy from the point of view of the patients themselves as well as the physicians and nurses caring for the patient, and to examine possible differences in the ratings.

PATIENTS AND METHODS

68 cancer patients received a pain questionnaire about pain intensity and subjective well-being. At the same time, physicians and nurses answered 7 pain-related questions about each patient.

RESULTS

34% of the patients reported strong or very strong pain in the past week, 8% even unbearable pain. 66% felt psychologically distressed, 70% developed anxiety because of pain. 74% believed that pain is an essential part of the disease. Nurses and physicians often underestimate patients' burden of pain. Nevertheless, the rating of the nurses is more accurate than that of the physicians.

CONCLUSION

Physicians and nurses often underestimate pain intensity. It seems that several patients are unable or unwilling to express their pain or that therapists lack adequate methods of pain assessment. To optimize pain treatment, communication between patients, physicians and nurses needs to be improved.

Personal past experience with opioid consumption affects attitudes and knowledge related to pain management

The personal past experience with opioid consumption by hospital health care providers was examined for its influence on their attitudes toward and knowledge of pain management. Data were collected through a questionnaire that elicited demographic information, attitudes toward pain management, barriers to pain relief, and self-assessment of pain management knowledge. The sample ( N = 163) was divided into two groups according to past experience with opioids: 52% of participants had used opioids (UO) for pain relief in the past, and the rest had never done so (NO). UO participants noted that pain control treatment was not sufficient for pain relief, in contrast to NO participants ( p = .013). Pain management was considered a low priority relative to overall treatment by the UO group compared with the NO group ( p = .016). The former group also attributed major responsibility for inappropriate pain relief to the clinical staff (12% of the UO group vs. 1.4% of the NO group; p = .048) rather than to the patients (22.9% of the UO group vs. 32.9% of the NO group; p = .019). UO participants felt extremely competent in their ability to manage several aspects of pain therapy ( p < .05). These aspects included assessing cause of the pain (42.9% of the UO group vs. 29.3% of the NO group), selecting a starting dose for opioid therapy (26.9% of the UO group vs. 13.3% of the NO group), and using opioids intravenously (20.5% of the UO group vs. 8.3% of the NO group). Personal past experience regarding analgesic use is an important factor in evaluating attitudes toward pain and achieving optimal pain management outcomes.

'I had this horrible pain': the sources and causes of pain experiences in 4- to 11-year-old hospitalized children

Researchers have relied, almost without exception, on adults for qualitative information about children's pain. However, adults may provide only a limited view of children's pain experience. The purpose of this article is to describe the events considered painful by children. Forty-four children participated in the study. They had been admitted for different reasons into different wards of a university hospital. The data consisted of qualitative child interviews and was analysed using inductive content analysis. The pain experience of children came from four main sources: 1. pain as a symptom of a diagnosed illness, 2. pain caused by medical and diagnostic procedures and basic nursing, 3. pain caused by accidents and 4. inexplicable pain not caused by a particular illness or injury. Children are able to report and describe their pain. Children should be regarded as experts on their pain in order to maximize the options for pain management.

Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7-86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education.

Quality indicators in postoperative pain management: a validation study

Quality indicators in postoperative pain management: a validation study. In a previous study, strategic and clinical quality indicators were developed from a tentative model to assess high quality in postoperative pain management. The aim of the present study was to investigate the content validity of these 15 indicators. The indicators were compiled in a questionnaire, and two groups of nurses (n=210, n=321) scored each indicator on a 5-point scale (strongly disagree to strongly agree) from three different standpoints: whether it was essential for achieving high quality, whether it was realistic to carry out, and whether it was possible for nurses to influence management. The respondents were also asked to choose the most crucial indicators for the quality of care. The results showed that both groups of nurses judged the 15 indicators to have content validity from all three standpoints. Both groups also found the same six indicators to be the most crucial. These indicators concerned detecting and acting on signs and symptoms, performing prescriptions, informing and educating, acting on behalf of patients, competence/knowledge, and attitudes. The validated indicators should be useful to consider when implementing a strategy for postoperative pain management and when planning to evaluate the quality of care.

Validation of a pain evaluation scale for patients with severe cerebral palsy

Polyhandicapped children are extremely limited by severe mental retardation, motor deficiency, perception disability and expression troubles. So pain is very difficult to assess in these patients. We have developed a specific scale for rapid evaluation of pain based on the observation of their behaviour. A first questionnaire listing 22 items was elaborated by physicians and nurses on the basis of their clinical experience. The first part of our study was designed to select the most pertinent items in order to define a final scale for simple and reliable everyday use. The second part of our study was designed to demonstrate the construct validity and the psychometric qualities and to determine the threshold of decision of the 10-item final scale. This tool seems to be sensitive and reliable enough to assess pain in severely cerebrally palsied children and young adults.

A phenomenologic study of chronic pain

Researchers have seldom invited patients with chronic pain to describe their lived experiences. This phenomenologic study involved in-depth interviews with nine women and four men with nonmalignant chronic pain. The essence of participants' experiences was unremitting torment by a force or monster that cannot be tamed. The body was altered and recalcitrant, the life world was shrunken, and the pain set up a barrier that separated them from other people. Time seemed to stop; the future was unfathomable. Findings of this study contribute to the phenomenological literature that explores the human body and its symbolic meanings and call into question the idealized positive depiction of chronic illness that is prominent in contemporary literature.

Nurses' Personal Pain Experiences and Their Pain Management Knowledge

BACKGROUND

This study examined nurses' personal experiences with pain and whether nurses' personal pain experiences were associated with initial pain management knowledge and ability to learn more about pain management.

METHOD

This descriptive correlational study was a secondary analysis of a study that used a one-group pretest-posttest design to examine the effect of a pain management education program on nurses' pain management knowledge. The sample consisted of 177 nurses who answered yes to having had a personal pain experience requiring treatment.

RESULTS

Nurses reported 13 types of pain, with pharmacological interventions comprising 94.4% of the pain treatments. Nurses' previous personal pain experiences were negatively related to their initial pain management knowledge (r = -.23, p < .01).

CONCLUSION

Nurses' personal pain experience may impact their learning of pain management knowledge and should be considered when designing pain management education.

Influences on nurses' perceptions of children's pain

Individuals have their own perceptions of pain. Nurses' do not always perceive their patients' pain. There are a number of factors which influence nurses' perceptions of their patients' pain. Further research is needed in this area.

A Comparison of Educational Methods to Enhance Nursing Performance in Pain Assessment

The purpose of this study was to identify an effective method of teaching nurses to assess and document pain severity using a numerical rating scale prior to narcotic administration. Nurses received a combination of educational methods. Although overall nurse performance using the pain scale was low, nurses receiving video were significantly more likely to use the scale, a finding that remained significant after controlling for nurses' education and years of experience, and for patient age and acuity.

Student nurses' assessment of children in pain

A self-administered questionnaire was developed to ascertain the criteria that student nurses used to assess children in pain. The sample consisted of 17 second-year registered general nurse students who had just completed their paediatric secondment. The questionnaire required the students to provide their own definition of pain, to rate the pain of four hypothetical children, giving reasons for their ratings and provide data about their assessment of a child they had cared for. Definitions of pain concentrated mainly on the physical effects of pain on patients. The students attributed a wide range of pain ratings to the hypothetical children, though the reasons for reaching these differing conclusions were often based on similar statements. There was limited reference to either personal episodes of pain or previous nursing experience. In their own assessment of children in pain the students appeared to use all the acknowledged criteria. The use of physiological signs was in some circumstances possibly inappropriate.