Understanding the paradox of patient pain and patient satisfaction

Impact of Lavender on Pain and Anxiety Levels Associated With Spine Procedures

Background: To reduce pain and anxiety associated with interventional pain procedures, sedation is often used, with benzodiazepines, opioids, and propofol the most commonly used classes of drugs for sedation. However, patient coherence and ability to communicate procedural pain and abnormal sensations help prevent adverse outcomes. Therefore, discovering alternative therapies to mitigate the anxiety and pain associated with these procedures and to minimize risk is important. The aim of our study was to investigate whether lavender has an effect on pain and anxiety associated with lumbar epidural steroid injections and lumbar medial branch blocks.

Methods: In this randomized controlled study, 54 subjects were randomly assigned to 1 of 3 intervention groups, and 46 patients were included in the final analysis: experimental lavender group (n=17), control almond oil group (n=15), and placebo sterile water group (n=14). Patients wore a mask infused with either lavender, almond oil, or water for 5 minutes prior to and during their procedure. Patients rated their anxiety using the State-Trait Anxiety Inventory prior to and after the procedure based on how they felt during the procedure. Patients rated their pain according to the numerical rating scale. Outcome measures were a comparison of pain among the 3 groups and a comparison of the change in anxiety before and after the procedure among the 3 groups.

Results: The lavender group demonstrated the highest mean change in anxiety scores (9.9) compared to almond oil (5.3) and water (3.6) preprocedurally vs postprocedurally. The lavender group also reported the lowest mean pain level (3.8) compared to almond oil (5.6) and water (5.6). However, none of the differences between groups showed statistical significance at the P<0.05 level.

Conclusion: Lavender may have a clinically beneficial effect on anxiety levels and pain reduction.

A Cross-Sectional Review of Pain Management Interventions Used for Painful Pediatric Blood Draw Procedures in Hospital

BACKGROUND

Hospitalized children continue to experience procedural pain due to inconsistent implementation of readily available, evidence-based pain interventions.

AIMS

To explore the prevalence of painful blood-testing procedures, pain management interventions, child-caregiver perceptions of effectiveness of, and satisfaction with, pain interventions, and adherence to best practice guidelines.

DESIGN

A single-site cross-sectional study using a combination of child-caregiver interviews and chart reviews for hospitalized children, 0-18 years.

METHODS

Interviews gathered information about the child's most recent blood test, procedural pain management intervention use, and participant perceptions of effectiveness of and satisfaction with these interventions. Concurrently, patient charts were reviewed for procedure documentation and pain management strategies used, including topical anesthetic and oral sucrose orders. Data were analyzed using descriptive statistics.

RESULTS

Fifty children were included. At the time of data collection, 34 (68%) had experienced painful blood-testing procedures during their current admission. Pharmacologic pain interventions were documented for only 7 (21%) procedures and were often inconsistent with participant reports. Almost all interview respondents (n = 31, 91%) identified at least one pain intervention for the child's most recent painful blood-test. Twenty (59%) participants perceived pain interventions as effective and most were satisfied with utilized interventions (n = 27, 79%).

CONCLUSIONS

A multi-modal procedural pain management approach was infrequently used and documented, highlighting undertreatment based on recommended practices and guidelines. Perceived intervention effectiveness and satisfaction with pain management were however found to be relatively high.

Pain process of patients with cardiac surgery-Semantic annotation of electronic patient record data

AIMS AND OBJECTIVES

To describe and compare the pain process of the patients' with cardiac surgery through nurses' and physicians' documentations in the electronic patient records.

BACKGROUND

Postoperative pain assessment and management should be documented regularly, to ensure optimal pain care process for patients. Despite availability of evidence-based guidelines, pain assessment and documentation remain inadequate.

DESIGN

A retrospective patients' record review.

METHODS

The original data consisted of the electronic patient records of 26,922 patients with a diagnosed heart disease. A total of 1,818 care episodes of patients with cardiac surgery were selected from the data. We used random sampling to obtain 280 care episodes for annotation. These 280 care episodes contained 2,156 physician reports and 1,327 days of nursing notes. We developed an annotation manual and schema, and then, we manually conducted semantic annotation on care episodes, using the Brat annotation tool. We analysed the annotation units using thematic analysis. Consolidated criteria for reporting qualitative research guideline was followed in reporting where appropriate in this study design.

RESULTS

We discovered expressions of six different aspects of pain process: (a) cause, (b) situation, (c) features, (d) consequences, (e) actions and (f) outcomes. We determined that five of the aspects existed chronologically. However, the features of pain were simultaneously existing. They indicated the location, quality, intensity, and temporality of the pain and they were present in every phase of the patient's pain process. Cardiac and postoperative pain documentations differed from each other in used expressions and in the quantity and quality of descriptions.

CONCLUSION

We could construct a comprehensive pain process of the patients with cardiac surgery from several electronic patient records. The challenge remains how to support systematic documentation in each patient.

RELEVANCE TO CLINICAL PRACTICE

The study provides knowledge and guidance of pain process aspects that can be used to achieve an effective pain assessment and more comprehensive documentation.

Enhancing Nurses' Pain Assessment to Improve Patient Satisfaction

Patient satisfaction with pain management has increasing importance with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores tied to reimbursement. Previous studies indicate patient satisfaction is influenced by staff interactions. This single-group pre/post design study aimed to improve satisfaction with pain management in older adults undergoing total joint replacement. This was a single-group pre-/posttest design. Nurse (knowledge assessment) and patient (American Pain Society Patient Outcomes Questionnaire Revised [APS-POQ-R], HCAHPS) responses evaluated pre- and postimplementation of the online educational program. Nurse focus group followed intervention. Nurses' knowledge improved significantly (p < .006) postintervention. HCAHPS scores (3-month average) for items reflecting patient satisfaction improved from 70.2 ± 9.5 to 73.9 ± 6.0. APS-POQ-R scores did not change. Focus group comments indicated need for education regarding linkages between pain management and patient satisfaction. Education on linkages between patient satisfaction and pain management can improve outcomes; education on strategies to further improve practice may enhance ability to achieve benchmarks.

The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis

Background. Aromatherapy refers to the medicinal or therapeutic use of essential oils absorbed through the skin or olfactory system. Recent literature has examined the effectiveness of aromatherapy in treating pain. Methods. 12 studies examining the use of aromatherapy for pain management were identified through an electronic database search. A meta-analysis was performed to determine the effects of aromatherapy on pain. Results. There is a significant positive effect of aromatherapy (compared to placebo or treatments as usual controls) in reducing pain reported on a visual analog scale (SMD = −1.18, 95% CI: −1.33, −1.03; p < 0.0001). Secondary analyses found that aromatherapy is more consistent for treating nociceptive (SMD = −1.57, 95% CI: −1.76, −1.39, p < 0.0001) and acute pain (SMD = −1.58, 95% CI: −1.75, −1.40, p < 0.0001) than inflammatory (SMD = −0.53, 95% CI: −0.77, −0.29, p < 0.0001) and chronic pain (SMD = −0.22, 95% CI: −0.49, 0.05, p = 0.001), respectively. Based on the available research, aromatherapy is most effective in treating postoperative pain (SMD = −1.79, 95% CI: −2.08, −1.51, p < 0.0001) and obstetrical and gynecological pain (SMD = −1.14, 95% CI: −2.10, −0.19, p < 0.0001). Conclusion. The findings of this study indicate that aromatherapy can successfully treat pain when combined with conventional treatments.

Nursing therapeutics: Teaching student nurses care, compassion and empathy

BACKGROUND

Debate continues regarding whether humanitarian values such as care and compassion can be taught or are innate in individuals who wish to become nurses.

OBJECTIVES

To undertake a discursive review of the literature on caring, compassion and empathy. To understand the teaching and learning issues associated with these concepts. To design and implement an Undergraduate Unit of study which addresses the development of caring, compassion and empathy in student nurses.

METHODS/DATA SOURCES

MEDLINE, CINAHL, and a wide range of literature including books and governmental reports were used for a discursive narrative review.

RESULTS

Caring, compassion and empathy are ill-defined; however healthcare users are clear that they know when nurses use skills and attitudes associated with these concepts. Evidence is available to show that caring, compassion and empathy can be taught and there are tools available to measure them in neophytes through their training. Central to the androgogical embedding of these concepts into nursing curricula is the development of therapeutic relationships.

CONCLUSIONS

It is possible to develop materials to enable student nurses to learn how to care using compassion and empathy. Nursing therapeutics is a term devised to describe how student nurses can exploit the therapeutic potential of any patient contact especially when related to specific and routine nursing interventions. Muetzel's model for understanding therapeutic relationships is one framework that can be adopted to help student nurses to appreciate how to build patient relationships and encourage them to move towards therapeutic advantage using care, compassion and empathy.

To intend to but not being able to: frequent attenders' experiences of suffering and of their encounter with the health care system

PURPOSE

Patients who frequently consult the health care system are supposed to cause great economic costs, and they also trouble the health care staff, as it seems as if there are no interventions that will help and keep them healthy. The researcher assumes that these patients attend for a reason and that they attend frequently because they, from a holistic point of view, do not get their health care needs fulfilled. This article aims to describe how frequent attenders experience their suffering and their encounter with the health care system.

DESIGN AND METHOD

The study has an inductive hermeneutic design. Interviews with persons identified as frequent attenders were analyzed by means of a hermeneutic inquiry with three interpretive steps: naive reading, structural analysis, and critical reflection.

FINDINGS

Patients are constantly striving to be and become healthy, to be of use, and to please others. The patients do not attend until suffering is experienced as unbearable. The patients experience, however, that health care staff do not understand their situation. Patients experience feelings of mistrust and rejection, which increases suffering.

CONCLUSION

Holistic care could be a means to relieve suffering and, as a consequence, reduce attendance.