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Bérubé M, Verret M, Bourque L, Côté C, Guénette L, Richard-Denis A, Ouellet S, Singer LN, Gauthier L, Gagnon MP, Gagnon MA, Martorella G. Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review. Pain 2024:00006396-990000000-00630. [PMID: 38888742 DOI: 10.1097/j.pain.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
| | - Michael Verret
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada
| | - Simon Ouellet
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Lesley Norris Singer
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Lynn Gauthier
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
- Oncology Division, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Cancer Research Centre, Université Laval, Québec City, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, Tallahassee, FL, United States
- Florida State University Brain Science and Symptom Management Center, Tallahassee, FL, United States
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Waterfield D, Barnason S. "It Kills Your Soul": A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses. West J Nurs Res 2024; 46:404-415. [PMID: 38676378 DOI: 10.1177/01939459241247690] [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] [Indexed: 04/28/2024]
Abstract
BACKGROUND Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disturbances (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. Ethical sensitivity of everyday nursing practice related to PADIS is an imperative part of implementing evidence-based care for patients. OBJECTIVE The first 2 aims of this study were to determine the measured level of ethical awareness as an attribute of ethical sensitivity among the critical care nurse participants and to explore the ethical sensitivity of critical care nurses related to the implementation of PADIS care. The third aim was to examine how the measured level of ethical awareness and ethical sensitivity exploration results converge, diverge, and/or relate to each other to produce a more complete understanding of PADIS ethical sensitivity by critical care nurses. METHODS This was a convergent parallel mixed methods study (QUAL + quant). Ethical sensitivity was explored by conducting an ethnography of critical care nurses. The participants were 19 critical care nurses who were observed during patient care, interviewed individually, participated in a focus group (QUAL), and were administered the Ethical Awareness Scale (quant). FINDINGS Despite high levels of individual ethical awareness among nurses, themes of ambiguous beneficence, heedless autonomy, and moral distress were found to be related to PADIS care. CONCLUSIONS More effort is needed to establish moral community, ethical leadership, and individual ethical guidance for nurses to establish patient-centered decision-making and PADIS care.
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Affiliation(s)
- Denise Waterfield
- College of Nursing, University of Nebraska Medical Center, Kearney, NE, USA
| | - Susan Barnason
- College of Nursing, University of Nebraska Medical Center, Kearney, NE, USA
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Finstad J, Røise O, Clausen T, Rosseland LA, Havnes IA. A qualitative longitudinal study of traumatic orthopaedic injury survivors' experiences with pain and the long-term recovery trajectory. BMJ Open 2024; 14:e079161. [PMID: 38191252 PMCID: PMC10806614 DOI: 10.1136/bmjopen-2023-079161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES To explore trauma patients' experiences of the long-term recovery pathway during 18 months following hospital discharge. DESIGN Longitudinal qualitative study. SETTING AND PARTICIPANTS Thirteen trauma patients with injuries associated with pain that had been interviewed 6 weeks after discharge from Oslo University Hospital in Norway, were followed up with an interview 18 months postdischarge. METHOD The illness trajectory framework informed the data collection, with semistructured, in-depth interviews that were analysed thematically. RESULTS Compared with the subacute phase 6 weeks postdischarge, several participants reported exacerbated mental and physical health, including increased pain during 18 months following discharge. This, andalternating periods of deteriorated health status during recovery, made the pathway unpredictable. At 18 months post-discharge, participants were coping with experiences of reduced mental and physical health and socioeconomic losses. Three main themes were identified: (1) coping with persistent pain and reduced physical function, (2) experiencing mental distress without access to mental healthcare and (3) unmet needs for follow-up care. Moreover, at 18 months postdischarge, prescribed opioids were found to be easily accessible from GPs. In addition to relieving chronic pain, motivations to use opioids were to induce sleep, reduce withdrawal symptoms and relieve mental distress. CONCLUSIONS AND IMPLICATIONS The patients' experiences from this study establish knowledge of several challenges in the trauma population's recovery trajectories, which may imply that subacute health status is a poor predictor of long-term outcomes. Throughout recovery, the participants struggled with physical and mental health needs without being met by the healthcare system. Therefore, it is necessary to provide long-term follow-up of trauma patients' health status in the specialist health service based on individual needs. Additionally, to prevent long-term opioid use beyond the subacute phase, there is a need to systematically follow-up and reassess motivations and indications for continued use throughout the recovery pathway.
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Affiliation(s)
- Jeanette Finstad
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Røise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Trauma Registry, Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Amalia Havnes
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Gohy B, Opava CH, von Schreeb J, Van den Bergh R, Brus A, Fouda Mbarga N, Ouamba JP, Mafuko JM, Mulombwe Musambi I, Rougeon D, Côté Grenier E, Gaspar Fernandes L, Van Hulse J, Weerts E, Brodin N. Assessing independence in mobility activities in trauma care: Validity and reliability of the Activity Independence Measure-Trauma (AIM-T) in humanitarian settings. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001723. [PMID: 37695762 PMCID: PMC10495016 DOI: 10.1371/journal.pgph.0001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
The importance of measuring outcomes after injury beyond mortality and morbidity is increasingly recognized, though underreported in humanitarian settings. To address shortcomings of existing outcome measures in humanitarian settings, the Activity Independence Measure-Trauma (AIM-T) was developed, and is structured in three subscales (i.e., core, lower limb, and upper limb). This study aimed to assess the AIM-T construct validity (structural validity and hypothesis testing) and reliability (internal consistency, inter-rater reliability and measurement error) in four humanitarian settings (Burundi, Iraq, Cameroon and Central African Republic). Patients with acute injury (n = 195) were assessed using the AIM-T, the Barthel Index (BI), and two pain scores. Structural validity was assessed through confirmatory factor analysis. Hypotheses were tested regarding correlations with BI and pain scores using Pearson correlation coefficient (PCC) and differences in AIM-T scores between patients' subgroups, using standardized effect size Cohen's d (d). Internal consistency was assessed with Cronbach's alpha (α). AIM-T was reassessed by a second rater in 77 participants to test inter-rater reliability using intraclass correlation coefficient (ICC). The results showed that the AIM-T structure in three subscales had an acceptable fit. The AIM-T showed an inverse weak to moderate correlation with both pain scores (PCC<0.7, p≤0.05), positive strong correlation with BI (PCC≥0.7, p≤0.05), and differed between all subgroups (d≥0.5, p≤0.05). The inter-rater reliability in the (sub)scales was good to excellent (ICC 0.86-0.91) and the three subscales' internal consistency was adequate (α≥0.7). In conclusion, this study supports the AIM-T validity in measuring independence in mobility activities and its reliability in humanitarian settings, as well as it informs on its interpretability. Thus, the AIM-T could be a valuable measure to assess outcomes after injury in humanitarian settings.
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Affiliation(s)
- Bérangère Gohy
- Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Humanity & Inclusion, Rehabilitation Technical Direction, Brussels, Belgium
| | - Christina H. Opava
- Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Johan von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm Sweden
| | | | - Aude Brus
- Humanity & Inclusion, Innovation, Impact & Information Division, Brussels, Belgium
| | - Nicole Fouda Mbarga
- Médecins Sans Frontières, Operational Center Geneva, YaoundeYaounde, Cameroon
| | - Jean Patrick Ouamba
- Médecins Sans Frontières, Operational Center Geneva, YaoundeYaounde, Cameroon
| | - Jean-Marie Mafuko
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
| | - Irene Mulombwe Musambi
- Médecins Sans Frontières, Operational Center Paris, Bangui, Central African Republic, Baghdad, Iraq
| | - Delphine Rougeon
- Médecins Sans Frontières, Operational Center Paris, Bangui, Central African Republic, Baghdad, Iraq
| | | | | | | | - Eric Weerts
- Humanity & Inclusion, Rehabilitation Technical Direction, Brussels, Belgium
| | - The AIM-T Study Group
- Médecins Sans Frontières, Operational Center Brussels, Brussels, Belgium
- Médecins Sans Frontières, Operational Center Geneva, YaoundeYaounde, Cameroon
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
- Médecins Sans Frontières, Operational Center Paris, Bangui, Central African Republic, Baghdad, Iraq
- Médecins Sans Frontières, Operational Center Paris, Baghdad, Iraq
- Médecins Sans Frontières, Operational Center Paris, France
| | - Nina Brodin
- Department of Neurobiology, Division of Physiotherapy, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd Hospital Corp., Division of Physiotherapy, Danderyd, Sweden
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Bérubé M, Côté C, Gagnon MA, Moore L, Tremblay L, Turgeon AF, Evans D, Berry G, Turcotte V, Belzile ÉL, Dale C, Orrantia E, Verret M, Dercksen J, Martel MO, Dupuis S, Chatillon CE, Lauzier F. Interdisciplinary strategies to prevent long-term and detrimental opioid use following trauma: a stakeholder consensus study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:933-940. [PMID: 36944264 PMCID: PMC10391591 DOI: 10.1093/pm/pnad037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Prolonged opioid use is common following traumatic injuries. Although preventive strategies have been recommended, the evidence supporting their use is low. The objectives of this study were to select interdisciplinary strategies to prevent long-term, detrimental opioid use in trauma patients for further evaluation and to identify implementation considerations. DESIGN A consensus study using the nominal group technique. SETTING Four trauma systems in Canada. SUBJECTS Participants included expert clinicians and decision makers, and people with lived experience. METHODS Participants had to discuss the relevance and implementation of 15 strategies and then rank them using a 7-point Likert scale. Implementation considerations were identified through a synthesis of discussions. RESULTS A total of 41 expert stakeholders formed the nominal groups. Overall, eight strategies were favored: 1) using multimodal approach for pain management, 2) professional follow-up in physical health, 3) assessment of risk factors for opioid misuse, 4) physical stimulation, 5) downward adjustment of opioids based on patient recovery, 6) educational intervention for patients, 7) training offered to professionals on how to prescribe opioids, and 8) optimizing communication between professionals working in different settings. Discussions with expert stakeholders revealed the rationale for the selected strategies and identified issues to consider when implementing them. CONCLUSION This stakeholder consensus study identified, for further scientific study, a set of interdisciplinary strategies to promote appropriate opioid use following traumatic injuries. These strategies could ultimately decrease the burden associated with long-term opioid use.
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Affiliation(s)
- Mélanie Bérubé
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Faculty of Nursing, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
| | - Caroline Côté
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Faculty of Nursing, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
| | - Marc-Aurèle Gagnon
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Social Preventive Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
| | - Lorraine Tremblay
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - Alexis F Turgeon
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
| | - David Evans
- Department of Surgery, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Greg Berry
- Departement of Orthopaedic Surgery, McGill University Health Centre, Montréal, Quebec H3G 1A4, Canada
| | - Valérie Turcotte
- Department of Nursing, CIUSSS du Nord-de-l’île-de-Montréal, Montréal, Quebec H4J 1C5, Canada
| | - Étienne L Belzile
- Department of Surgery, Division of Orthopeadic Surgery, CHU de Québec-Université Laval, Québec City, Quebec GIV 1Z4, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario M5T 1P8, Canada
- University of Toronto Centre for the Study of Pain (UTCSP), Toronto, Ontario M5T 1P8, Canada
| | - Eli Orrantia
- Marathon Family Health Team, Marathon, Ontario P0T 2E0, Canada
| | - Michael Verret
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Judy Dercksen
- Quesnel Primary Care Clinic, Quesnel, British Columbia V2J 2K8, Canada
| | - Marc-Olivier Martel
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
- Faculty of Medicine & Dentistry, McGill University, Montréal, Quebec H3A 1G1, Canada
| | - Sébastien Dupuis
- Department of Pharmacy, CIUSSS du Nord-de-l’île-de-Montréal,Montréal, Quebec H4J 1C5, Canada
| | - Claude-Edouard Chatillon
- Division of Neurosurgery, CIUSSS de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Quebec G9A 5C5, Canada
| | - François Lauzier
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
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