Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea

The effect of shoulder massage on shoulder pain and sleep quality in patients after laparoscopic cholecystectomy: a randomized controlled trial

BACKGROUND

Laparoscopic cholecystectomy patients may suffer from sleep disturbances due to this postoperative pain. Postoperative pain and low sleep quality can lead to various unpredictable complications, including anxiety.The aim of this study is to determine the effect of shoulder massage administered to patients after laparoscopic cholecystectomy on pain and sleep quality.

METHODS

The study was designed as a randomized controlled trial.This study was carried out with 60 patients who underwent surgery at the General Surgery Department of a university's Faculty of Medicine between January 2020 and March 2021. The study was completed with 60 patients (30 in the intervention group and 30 in the control group). The patients in the intervention group received shoulder massage twice at 6-hour intervals. The data for the study were collected using the "Individual Introduction Form", the "VAS", and the "Richard Campbell Sleep Scale".

RESULTS

It was found that the pain of the patients in the intervention group significantly decreased compared to the control group 30 min after the massage (p˂0.05). However, 6 h after the massage, the pain levels in both groups were similar. The sleep quality of the patients in the intervention group was significantly higher compared to those in the control group (p˂0.05).

CONCLUSIONS

It was determined that the massage therapy yielded a short-term alleviation of shoulder pain among the patients while also enhancing their sleep quality. These results suggest that shoulder massage could be effectively incorporated into nursing practice as a means to ameliorate pain levels and enhance sleep quality in postoperative patients.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06480149 (retrospectively registered, Protocol ID: 2019/06-8Last Update Posted 2024-06-28) https://ctv.veeva.com/study/shoulder-massage-after-cholecystectomy .

Non-pharmacological labor pain relive methods: utilization and associated factors among midwives and maternity nurses in Najran, Saudi Arabia

BACKGROUND

Traditionally, pharmacological pain relief methods have been the most acceptable option for controlling labor pain, accompanied by numerous adverse consequences. Non-pharmacological labor pain relive methods can reduce labor pain while maintaining an effective and satisfying delivery experience and delaying the use of pharmacological methods. This study explores the utilization of non-pharmacological labor pain relive methods and its associated factors among midwives and maternity nurses.

METHODS

A cross-sectional research was conducted in Maternal and Children Hospital/Najran, Saudi Arabia, from April to May 2023 and incorporated a convenience sample of 164 midwives and maternity nurses. The data was collected using a self-reported questionnaire composed of five sections; basic data, facility-related factors, non-pharmacological labor pain relive utilization and attitude scales, and knowledge quiz. A logistic regression was used to determine the associated factors with non-pharmacological labor pain relive utilization.

RESULTS

The results revealed that 68.3% of participants utilized non-pharmacological labor pain relive methods. The midwives and maternity nurses helped the parturient to tolerate labor pain by applying the non-pharmacological labor pain relive methods, including; positioning (55.5%), breathing exercises (53.7%), comfortable and relaxing environment (52.4%), therapeutic communication (47%), positive reinforcement (40.9%), relaxation (40.2%), and therapeutic touch (31%). In addition, working unit, providers-patient ratio, working hours, non-pharmacological labor pain relive training, years of experience, and non-pharmacological labor pain relive attitude were significant determinants of non-pharmacological labor pain relive utilization (P < 0.05).

CONCLUSIONS

High non-pharmacological labor pain relive utilization was significantly associated with nurses' older age and higher education, working in the delivery room, lower nurse-patient ratio, lower working hours, in-services training, increased years of experience, and positive attitude. The study sheds light on the importance of handling the pre-mentioned factors to enhance non-pharmacological labor pain relive utilization.

Practice of Nonpharmacological Pain Control Strategies Among Nurses Working in Public Hospitals of West Arsi Zone, Ethiopia

Background

Nonpharmacological pain control strategies combine numerous strategies that contain nondrug measures for pain remedies for sufferers.

Objective

To assess the practice of nonpharmacological pain control strategies among nurses working in public hospitals of West Arsi zone, Ethiopia, 2022.

Methods

An institutional-based cross-sectional study design was employed from April 15 to May 30, 2022. The total sample size was 422 and a simple random sampling technique was used. Data were entered using Epi-information 4.6 version and analyzed using SPSS version 25. Multicollinearity was checked by considering the variance inflation factor and tolerance. The goodness of fit test was done using the Hosmer-Lemeshow goodness of fit check. Binary logistic regression analysis was done and variables with a p-value of < 0.25 within the bivariable analysis were taken into the multivariable analysis. Statistical significance was declared at a p-value of < 0.05 with an adjusted odds ratio (AOR) and 95% confidence interval (CI).

Result

The practice of nonpharmacological pain control strategies was 53.8% (95% CI: 48.9-58.7). Age of 30-39 years old (AOR: 2.28, 95% CI: 1.34-3.86), educational status bachelor's degree (AOR: 2.25, 95% CI: 1.47-4.45), marital status married (AOR: 0.46, 95% CI: 0.28-0.73), and having training (AOR: 1.98, 95% CI: 1.23-3.17) were found to be significantly associated with practice of nonpharmacological pain control strategies.

Conclusion

About five in 10 nurses working in West Arsi zone public hospitals had good practice of nonpharmacological pain control strategies. Age, educational status, marital status, and training were found to be significantly associated with practice. Therefore, improving the educational status of nurses through various opportunities such as continued professional development and regular updating, and training nurses about methods may increase the nurses' practice toward nonpharmacological pain control strategies.

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

BACKGROUND

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

OBJECTIVE

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

METHODS AND MATERIALS

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

RESULTS

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

CONCLUSION AND RECOMMENDATION

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

Military Veterans' Perspectives on Postoperative Opioid Use: A Secondary Analysis of Qualitative Data

PURPOSE

This qualitative analysis of interviews with surgical patients who received a brief perioperative psychological intervention, in conjunction with standard medical perioperative care, elucidates patient perspectives on the use of pain self-management skills in relation to postoperative analgesics.

DESIGN

This study is a secondary analysis of qualitative data from a randomized controlled trial.

METHODS

Participants (N = 21) were rural-dwelling United States Military Veterans from a mixed surgical sample who were randomized to receive a manual-based, telephone-based Perioperative Pain Self-management intervention consisting of a total of four pre- and postoperative contacts. Semi-structured qualitative interviews elicited participant feedback on the cognitive-behavioral intervention. Data was analyzed by two qualitative experts using MAXQDA software. Key word analyses focused on mention of analgesics in interviews.

FINDINGS

Interviews revealed a dominant theme of ambivalence towards postoperative use of opioids. An additional theme concerned the varied ways acquiring pain self-management skills impacted postoperative opioid (and non-opioid analgesic) consumption. Participants reported that employment of pain self-management strategies reduced reliance on pharmacology for pain relief, prolonged the time between doses, took the "edge off" pain, and increased pain management self-efficacy.

CONCLUSIONS

Perioperative patient education may benefit from inclusion of teaching non-pharmacologic pain self-management skills and collaborative planning with patients regarding how to use these skills in conjunction with opioid and non-opioid analgesics. Perianesthesia nurses may be in a critical position to provide interdisciplinary postoperative patient education that may optimize postoperative pain management while minimizing risks associated with prolonged opioid use.

Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa

Postoperative pain is one of the most prevalent complications following surgery, and more than 47% of surgical patients endure postoperative discomfort worldwide. In Africa, due to resource shortages and other issues, postoperative pain is substantially more common when compared to developed countries. Severe postoperative pain has many negative effects, including possibly death, which can burden both individuals and society as a whole. Therefore, effectively controlling postoperative pain is becoming increasingly important. To enhance the effectiveness of future pain management, a thorough analysis of the current reasons for inadequate postoperative pain management is necessary. In this article, the present situations of occurring postoperative pain, children's postoperative pain, and pain management in Africa are reviewed, based on relevant and recent literature. In particular, the reasons for inadequate postoperative pain management in Africa are detailed in this article from five perspectives: the inadequate assessment of postoperative pain, the knowledge gap among medical professionals, the patients' misconceptions, the scarcity of resources, and the lack of medications. Additionally, we offer appropriate solutions following various factors.

Comparative efficacy and acceptability of non-pharmacological interventions for depression in people living with HIV: A systematic review and network meta-analysis

BACKGROUND

Treatment for depression in people living with HIV has increasingly turned to non-pharmacological treatments due to the adverse reactions of pharmacotherapy. However, it remains unclear which non-pharmacological treatment is the most effective and acceptable for depression in people living with HIV.

OBJECTIVE

To compare and rank the efficacy and acceptability of different non-pharmacological treatments for depression in people living with HIV.

DESIGN

A systematic review and Bayesian network meta-analysis.

METHODS

We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, PsycArticles, CINAHL, ProQuest, OpenGrey, and international trial registers for published and unpublished studies from their inception to September 1, 2022, and searched key conference proceedings from January 1, 2020, to September 25, 2022. We searched for randomized controlled trials of any non-pharmacological treatments for depression in adults living with HIV (≥18 years old). Primary outcomes were efficacy (mean change scores in depression) and acceptability (all-cause discontinuation). We used a random-effects network meta-analysis model to synthesize all available evidence. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. We registered this study in PROSPERO, number CRD42021244230.

RESULTS

A total of 53 randomized controlled trials were included in this network meta-analysis involving seven non-pharmacological treatments for depression in people living with HIV. For efficacy, mind-body therapy, interpersonal psychotherapy, cognitive-behavioral therapy, supportive therapy, and education were significantly more effective than most control conditions (standardized mean differences ranged from -0.96 to -0.36). Rankings probabilities indicated that mind-body therapy (79%), interpersonal psychotherapy (71%), cognitive-behavioral therapy (62%), supportive therapy (57%), and education (57%) might be the top five most significantly effective treatments for depression in people living with HIV, in that order. For acceptability, only supportive therapy and interpersonal psychotherapy were significantly less acceptable than most control conditions (odds ratios ranged from 1.92 to 3.43). Rankings probabilities indicated that education might be the most acceptable treatment for people living with HIV (66%), while supportive therapy (26%) and interpersonal psychotherapy (10%) might rank the worst. The GRADE assessment results suggested that most results were rated as "moderate" to "very low" for the confidence of evidence.

CONCLUSIONS

Our study confirmed the efficacy and acceptability of several non-pharmacological treatments for depression in people living with HIV. These results should inform future guidelines and clinical decisions for depression treatment in people living with HIV.

Non-Pharmacological Pain Management Practice and Associated Factors Among Nurses Working at Comprehensive Specialized Hospitals

Introduction

Non-pharmacological pain management practices are very important for the successful treatment of pain. It has an impact on the patient's quality of life and the family's financial situation owing to missed workdays, direct medical expenses, and incapacity from pain.

Objective

Therefore, this study is intended to assess non-pharmacological pain management practice and associated factors among nurses working at comprehensive specialized hospitals in northwest, Ethiopia.

Methods

Institution-based cross-sectional study design was employed from May 30 to June 30, 2022. A stratified random sampling technique was used to select 322 study participants. A binary logistic regression model was used to identify factors associated with non-pharmacological pain management practice. Variables with a P-value less than .25 in the bi-variable analysis were entered into the multivariable logistic regression analysis and a P-value of less than .05 was considered as having a statistically significant association.

Results

A total of 322 nurses participated, with a response rate of 98.8%. It was found that 48.1% (95% CI: 42.65, 53.62) of nurses had good practice in non-pharmacological pain management. Pain assessment tool availability (AOR = 1.68 [95% CI: 1.02, 2.75]) (P = .04), good pain assessment practice (AOR = 1.74 [95% CI: 1.03, 2.84]) (P = .03), favorable attitude (AOR = 1.71 [95% CI: 1.03, 2.95]) (P = .03), and age (26-35) (AOR = 4.46 [95% CI: 1.24, 16.18]) (P = .02) were factors significantly related to non-pharmacological pain management practice.

Conclusion

According to this work, the prevalence of non-pharmacological pain management practices was found to be low. Good pain assessment practices, availability of pain assessment tools, favorable attitude, and age (26-35) years were significant factors of non-pharmacological pain management practice. Hospitals are better give training on non-pharmacological pain management methods for nurses as they are important to treat pain holistically, increase patient satisfaction, and are cost-effective.

Doctors' and Nurses' Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey

BACKGROUND

Acupuncture and acupressure are not being systematically used in the management of postoperative nausea and vomiting and pain, despite being included in the guidelines.

AIM

To examine the beliefs, attitudes, and knowledge of Australian nurses/midwives and doctors toward the perioperative use of AA for the management of postoperative nausea and vomiting and pain; to explore the barriers and enablers influencing acupuncture and acupressure integration into hospital setting.

METHODS

A mixed-mode approach was undertaken for data collection. An online approach was used to recruit respondents from Australian College of Perioperative Nurses. Three hospitals from three different Australian states were selected via convenience sampling.

RESULTS

A total of 421 usable surveys were included in data analysis. The respondents comprised 14.3% doctors and 72.9% nurses/midwives. Overall, 69.4% were female, 85% were trained in Australia with 35% and 51.4% having knowledge or personal exposure to AA in general respectively. Over 60% of the respondents agreed AA should be routinely integrated into perioperative care, and over 80% would recommend AA to their patients if it was provided at their hospital, and, 75% would be willing to receive further education. The three main reported barriers included: perceived lack of scientific evidence (80.9%), unavailability of credentialed provider (77.2%) and lack of reimbursement (60.4%).

CONCLUSIONS

Positive attitudes are reported by Australian doctors and nurses toward AA. This is despite of low levels of knowledge or personal exposure to AA. Further studies are required to explore the implementation of barriers and address respondent calls for further education.

The Role of Midwives in the Course of Natural Childbirth-Analysis of Sociodemographic and Psychosocial Factors-A Cross-Sectional Study

BACKGROUND

An important role in the course of natural childbirth is played by midwives, who should effectively work on relieving pain. This study aims to present the opinions of midwives on non-pharmacological methods of relieving labor pain; the frequency of their use and reasons for their abandonment; and the relationship between the use of non-pharmacological methods of relieving labor pain and perceived job satisfaction, burnout, and self-efficacy of the midwife.

METHODS

The study was conducted online, with the participation of 135 Polish midwives working in the delivery room. The author's survey questionnaire, the Generalized Self-Efficacy Scale (GSES), the LBQ Burnout Questionnaire, and the Scale of Job Satisfaction were used.

RESULTS

Among the surveyed midwives, 77% use vertical positions in work with a patient giving birth. Almost all respondents consider vertical positions as an example of a non-pharmacological method of relieving labor pain; those with master's degree felt more prepared for their use (p = 0.02). The most common reason for abandoning their use was disagreement on the part of co-workers (p = 0.005). An association was observed between the use of vertical positions and the level of burnout (p = 0.001) and a significant correlation between preparation for their use and self-efficacy assessment, burnout, and job satisfaction.

CONCLUSION

Our research shows that it would be important to conduct additional training on the use of non-pharmacological methods to relieve labor pain and to present their benefits. In contrast to other research results, our results showed that midwives feel well prepared to use these methods; however, similar to other research, we found that they often feel disagreement from colleagues and a lack of support from their leaders. The use of vertical positions is related to burnout.

Knowledge, Attitude, and Associated Factors towards Nonpharmacological Pain Management among Nurses Working at Amhara Region Comprehensive Specialized Hospitals, Ethiopia

Background

Nonpharmacological pain management refers to providing pain management intervention that does not involve the use of drugs. Effective management of a patient's pain is a vital nursing activity, and it needs a nurse's adequate pain-related knowledge and a favorable attitude. Globally, many studies stated that the lack of knowledge and unfavorable attitude of nurses towards nonpharmacological pain management was the prevailing persistent challenge.

Objective

To assess knowledge, attitude, and associated factors towards nonpharmacological pain management among nurses working in Amhara region Comprehensive Specialized Hospitals, Ethiopia, 2021.

Method

An institutional-based cross-sectional study was conducted from April to May 30, 2021. A total of 845 nurses were selected using a simple random sampling technique. Data were collected by using a pretested self-administered structured questionnaire. Then, data were checked, coded, and entered into Epi Info version 7.0 and exported to SPSS version 25.0 software for analysis.

Results

A total of 775 nurses participated in this study, with a response rate of 91.8%. Of the total participants, 54.2% (95% CI: 50.6-57.9) and 49.8% (95% CI: 46.1-53.2) of nurses had adequate knowledge and a favorable attitude, respectively. The study revealed that educational status (AOR = 3.51 (95% CI: 1.37, 8.99)), years of experience (AOR = 5.59 (95% CI: 2.86, 10.94)), working unit (AOR = 5.61 (95% CI: 2.25, 13.96)), nurse-to-patient ratio (AOR = 2.33 (95% CI: 1.44, 3.78)), and working hours (AOR = 2.15 (95% CI: 1.27, 3.62)) were significantly associated. This finding also revealed that monthly income (AOR = 4.38 (95% CI: 1.64, 11.69)), nurse-to-patient ratio (AOR = 1.89 (95% CI: 1.19, 3.01)), and nurses' adequate knowledge (AOR = 4.26 (95% CI: 2.91, 6.24)) were significantly associated with the attitude of nurses. Conclusion and Recommendations. More than half and nearly half of the nurses had adequate knowledge and a favorable attitude towards nonpharmacological pain management, respectively. Educational qualification, years of experience, working unit, nurse-to-patient ratio, and prolonged working hours per day were significantly associated with nurse's adequate knowledge. Monthly income, nurse-to-patient ratio, and nurse's knowledge were significantly associated with the attitudes of nurses. It is better to give attention to reviewing the nursing curriculum, achieving a standardized nurse-to-patient ratio, recruiting additional nurses, training, and upgrading nurses with continuing education.

Are nurses utilizing the non-pharmacological pain management techniques in surgical wards?

The non-pharmacological pain management therapies have a valuable effect in managing moderate to mild pain intensity, especially if demonstrated in the pre-operative phase. The study aimed to explore the nurses’ practice toward using non-pharmacological pain management techniques in surgical wards. In a cross-sectional research design, a convenient sample of 47 nurses in the surgical wards in Egyptian hospital (Third Level) participated in the study. Data gathered using modified Non-pharmacological Methods Questionnaire. Results of the study indicated that nurse’s perception regarding applying the cognitive-behavioral methods as a distraction and Positive reinforcement techniques were more common (68.1%,53.2%), whereas most of them used emotional support (93.6%) and preferred to demonstrate physical methods. Meanwhile, nurses addressed the barriers to apply nonpharmacological pain management as lack of time, patient unwillingness, and patients’ health beliefs. Nevertheless, nurses reported the non-pharmacological pain management is less expensive and has fewer side effects than medication and can demonstrated post-discharge. Nurses play a key role in applying effective and different non-pharmacological therapies in surgical wards. Thus, nurses should be encouraged to demonstrate the non-pharmacological pain management therapies with patients undergoing surgical procedures.