A Survey of Knowledge and Attitudes of Nurses About Pain Management in End-Stage Liver Disease in a Geriatric Palliative Care Unit

Development and validation of a questionnaire to evaluate the productive engagement of Chinese older adults in the community

BACKGROUND

The evaluation of productive engagement of old adults has become a challenging task because cultural, ethical, religious, and other personal values may influence perceptions of the meaning and consequences of productive engagement. Assessing the productive engagement of the older adults is crucial to promote active and productive aging. The objective of this study was to develop and validate a questionnaire concerning the productive engagement of Chinese older adults in the community.

METHODS

A draft scale was created via a literature review and interviews with 17 older adults in the community, following the cross-cultural framework for productive engagement in later life. Content validity was assessed by seven experts. Subsequently, a preliminary questionnaire containing 33 items was developed and its psychometric properties were evaluated.

RESULTS

The final version of the questionnaire was composed of 27 items distributed across five dimensions. The overall standardized Cronbach's α for the productive engagement questionnaire was 0.904, with individual dimension values ranging from 0.759 to 0.869. Nearly all dimensions displayed satisfactory factor loadings. The correlation coefficient between each item's score and its respective dimension ranged from 0.473 to 0.723.

CONCLUSIONS

The developed questionnaire exhibited good validity and reliability, showing promise for effectively evaluating the productive engagement level of Chinese older adults within the community.

TRIAL REGISTRATION

Not applicable.

Opioid and Nonopioid Analgesic Prescribing Patterns of Hepatologists for Medicare Beneficiaries

INTRODUCTION

Opioids are commonly prescribed to patients with chronic liver disease, but little is known regarding medication prescribing patterns of hepatologists. Opioid use increased until national guidelines limited opioid prescriptions in early 2016. We aimed to describe rates of opioid and nonopioid analgesics to Medicare beneficiaries by hepatologists from 2013 to 2017 and identify demographic characteristics associated with higher prescribing.

METHODS

Prescription data from 2013 to 2017 by 761 hepatologists identified in the Centers for Medicare and Medicaid Services Part D Public Use File were analyzed. Annual prescription volumes were compared for providers with >10 annual prescriptions of a given drug type. Provider characteristics associated with opioid prescriptions were identified through multivariate logistic regression analyses.

RESULTS

The proportion of hepatologists prescribing >10 annual opioid prescriptions decreased from 29% to 20.6%. Median annual opioid prescriptions per hepatologist significantly decreased from 24 to 20. Tramadol remained the most prescribed analgesic. Nonopioid analgesic prescription volume did not increase significantly. Provider characteristics associated with increased opioid prescriptions included male sex, practice location in the South and Midwest (vs West), more years in practice, and a greater proportion of beneficiaries who are white or with low-income subsidy claims. Characteristics associated with fewer prescriptions included non-university-based practice, having a greater proportion of female beneficiaries, and later prescription year.

DISCUSSION

Hepatologists are prescribing less opioids. However, the prevalence of tramadol use and the lack of increase in nonopioid analgesic use highlights the need for advancing the science and training of pain management in chronic liver disease and targeted implementation of nonopioid treatment programs.

Development and validation of a questionnaire to evaluate the knowledge, attitude, behaviour and care preference of family members of Chinese older adults related to palliative care

AIM

To develop and validate a questionnaire on knowledge, attitude, behaviour and care preference of family members of Chinese older adults related to palliative care.

DESIGN

A descriptive study design and STROBE checklist were applied in this research.

METHODS

The theoretical framework of the questionnaire was knowledge-attitude-behaviour model. An additional dimension of palliative care preference of family members was set up in the questionnaire. Items were generated from a rapid review of international literature and interviews with 61 family members of the older adults living either in an aged care service organization or the community. The content validity was examined by five experts. A preliminary questionnaire with 69 items was then set up, and its psychometric property was assessed.

RESULTS

A final version of questionnaire with 42 items under four dimensions was constructed. The content validity index of the overall questionnaire was 0.93 and of each item ranged 0.80-1.00. The factor loading of all items was higher than 0.50 as per exploratory and confirmatory factor analysis; the average variance extracted for each dimension was higher than 0.50; the composite reliability was higher than 0.90; and the absolute value of the correlation coefficient of each dimension was <0.50 and less than the square root of the average variance extracted. The Cronbach's alpha value and the split-half reliability value of the overall questionnaire were 0.93 and 0.97, respectively.

CONCLUSIONS

This questionnaire has good validity and reliability, but needs further testing in multi-centered settings.

Factors Associated With Knowledge and Attitude Among Vietnamese Nursing Staff Regarding Pain Management in a Vietnam National Hospital

ABSTRACT

BACKGROUND: Nurses play an important role in providing holistic care and effective pain management, which is significantly associated with their knowledge and attitudes. Limited evidence is available from Vietnamese nursing studies evaluating the knowledge and attitudes of nurses toward pain management. The objectives of this study were to evaluate the knowledge and attitudes of Vietnamese nurses and identify factors associated with pain management. METHODS: This study used a descriptive and cross-sectional design and was conducted at a national hospital in Vietnam from May to June 2021. Nurses working in all clinical units were surveyed to collect demographic data and assessed using the structured Knowledge and Attitudes Survey Regarding Pain (KASRP) scale. Multiple linear regression analysis was conducted to identify factors associated with knowledge and attitudes. RESULTS: Two hundred seventy-nine nurses completed the survey, including 152 (54.5%) who read books or journals about pain, 25 (9.0%) who reported the use of unit-based pain guidelines, and 77 (27.6%) who used a numeric rating tool. The mean number of correct answers on the KASRP was 23.34 (mean KASRP correct percentage of 54.9%), and only 16 nurses (5.7%) had passing scores. Having a bachelor's degree or higher, reading books or journals about pain, using a numeric rating tool, and using unit-based pain guidelines were significantly associated with higher KASRP scores (P < .01) among nurses. CONCLUSIONS: The knowledge and attitudes of nurses regarding pain management were far from satisfactory. Regular pain management training, access to pain-related reading materials, and the frequent use of a numeric tool to assess pain intensity are recommended to enhance the quality of care for patients provided by clinical nurses.

Facilitators and Barriers Affecting Implementation of Neonatal Palliative Care by Nurses in Mainland China

Neonatal nurses in mainland China encounter various challenges when it comes to delivering palliative care to neonates. The aim of this study was to determine the barriers and facilitators of neonatal nurses' attitudes to palliative care for neonates in mainland China. A simplified Chinese version of the Neonatal Palliative Care Attitude Scale was piloted, administered, and analyzed using survey methods. Nurses in neonatal intensive care units in mainland China regardless of experience in the field were invited to take part in. Over a five-month period in 2019, we surveyed neonatal nurses from 40 hospitals in five provinces of China. The response rate was 92.5% (N = 550). This study identified eight facilitators and four barriers to neonatal palliative care implementation. In terms of nurses' attitudes on providing palliative care, younger and older nurses were more positive, whereas middle-aged nurses were less so. Nurses' emotional wellbeing was rarely impacted by neonatal death. They considered neonatal palliative care, particularly pain management, to be just as important as curative treatment. Parents were invited to participate in decision-making by nurses. Nurses reported having access to professional counseling and talking about their concerns with other healthcare professionals. The following barriers to neonatal palliative care were identified in this study that were not observed in the original English version scale research in 2009: a lack of clinicians, time, clinical skills, systematic education, neonatal palliative care experience, and social acceptance. Future research is required to investigate each barrier in order to improve the implementation of neonatal palliative care in mainland China.

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions.

The Mediating Effect of Model-Based Learning on Attitude and Pain Management Awareness Among Nurses During COVID 19 Pandemic in Saudi Arabia

Background

All hospitals are required to provide high-quality pain management; one of the most critical issues in achieving high-quality pain management is that the hospitals have a clear plan to manage the patients’ pain and improve the nurses’ awareness of pain management during the COVID 19 pandemic. However, there is a significant gap in the literature that this study can cover.

Aim

This study aimed to investigate the mediating effect of model-based learning on nurses’ attitudes toward nurses’ pain management awareness during the COVID 19 pandemic in Saudi Arabia government hospitals.

Method

The Heath Beliefs Model was used, with a quasi-experimental design, with per experimental one group pre-test post-test design, and a quantitative approach using self-administered questionnaires obtained from 330 nurses working with patients suffering from pain. IBM SPSS V23 and Analysis of Moment Structures (AMOS)V23 were applied to analyze the causal relationships between the variables.

Results

A two-step approach to analyze the study: the first step was to test the measurement models’ constructs’ reliability and validity. The second step was to test research hypotheses in the structural models. The results show a significant positive relationship between model-based learning and pain management awareness among nurses during COVID 19 pandemic. Furthermore, model-based learning fully mediated the relationship between nurses’ attitudes and pain management awareness.

Conclusions

The study successfully improved nurses’ attitudes toward pain management awareness among nurses during COVID 19 pandemic. These findings will help strengthen the debate in the existing literature, and this is a new development window in the pain management area.

Effects of Education on Nurses' Knowledge and Attitudes of Pain Management in a Postoperative Cardiovascular Unit

BACKGROUND

This project explores the impact of an educational in-service on nurses' knowledge and attitudes toward pain on a postoperative cardiovascular unit.

METHOD

A convenience sample of nurses employed on the postoperative cardiovascular intensive care unit (n = 82) were asked to participate in this project, with 74 nurses attending the in-service training. Surveys that were 70% complete were used for analysis (preeducation, n = 22; posteducation, n = 24).

RESULTS

The results from this project demonstrated that the use of a brief educational in-service is effective and efficient in increasing nurses' knowledge and attitudes related to pain management in this group of nurses. Posteducation survey scores were significantly higher than preeducation survey scores (p < .001).

CONCLUSION

These findings suggest that a brief educational in-service on pain management can improve nurses' knowledge and attitudes on pain management in this postoperative cardiovascular unit. [J Contin Educ Nurs. 2020;51(8):377-383.].

Factors Related to Nurses' Knowledge and Attitudes Toward Pain in Hospitals in Low-Income Areas

BACKGROUND

Effective pain management is closely related to nurses' knowledge and attitudes toward pain. Limited studies have been performed related to nurses' knowledge and attitudes toward pain in hospitals in low-income areas.

AIMS

This study surveyed the knowledge and attitudes of nurses toward pain management in county hospitals from low-income areas in Hunan Province, China.

SETTING AND PARTICIPANTS

The study included 4,668 registered nurses working in 48 county hospitals in low-income areas in China.

METHODS

A cross-sectional study examined the knowledge and attitudes of nurses with regard to pain using the Chinese version of the Knowledge and Attitude Survey Regarding Pain (KASRP) via the WeChat application.

RESULTS

The 4,668 registered nurses completed the survey; of these, 43.6% indicated they had never received continuing education for pain. The mean percentage score for KASRP was (40.3 ± 7.95), and none of the respondents achieved a percentage score of >80%. Further, of the 40 items, only two had a correct rate of >80%. Continuing pain education did not significantly affect KASRP. Multiple stepwise linear regression showed that education level, ethnicity, professional title, position, and department were independent influencing factors for KASRP scores.

CONCLUSION

Almost all nurses in county hospitals of low-income areas had deficiencies in various aspects of pain management knowledge. Better educated nurses with higher professional title or management position, those from the Han ethnicity, and those from the oncology department had higher mean KASRP scores. Current continuing education programs for pain did not improve the pain management capability of the nurse. High-quality and standardized pain educational programs should be implemented to improve pain management.

Current Knowledge, Barriers to Implementation, and Future Directions in Palliative Care for End-Stage Liver Disease

End-stage liver disease (ESLD) is associated with a high degree of morbidity and mortality as well as symptom burden. Despite this, the rate of consultation with palliative care (PC) providers remains low, and invasive procedures near the end of life are commonplace. Studies show that involvement of PC providers improves patient satisfaction, and evidence from other chronic diseases demonstrates reduced costs of care and potentially increased survival. Better integration of PC is imperative but hindered by patient and provider misconceptions about its role in the care of patients with ESLD, specifically among candidates for liver transplantation. Additionally, reimbursement barriers and lack of provider knowledge may contribute to PC underutilization. In this review, we discuss the benefits of PC in ESLD, the variability of its delivery, and key stakeholders' perceptions about its use. Additionally, we identify barriers to more widespread PC adoption and highlight areas for future research.