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Schofield P, Gnass I. Editorial: Assessment of pain in the older population. Front Pain Res (Lausanne) 2023; 4:1249762. [PMID: 37692329 PMCID: PMC10486893 DOI: 10.3389/fpain.2023.1249762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Pat Schofield
- School of Nursing & Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, Paracelsus Medical University, Salzburg, Austria
| | - Irmela Gnass
- Institute of Nursing Science and Practice, University of Plymouth, Plymouth, United Kingdom
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Lukas A, Bienas M, Mayer B, Radbruch L, Gnass I. Responsive Behaviors and Pain Management in Hospital Dementia Care: A Before and After Comparison of the “Serial Trial Intervention”. Front Pain Res 2022; 3:810804. [PMID: 35599966 PMCID: PMC9121813 DOI: 10.3389/fpain.2022.810804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Responsive behavior, often referred to as behavioral and psychological symptoms of dementia (BPSD), is among the most critical disorders in dementia whereby nursing personnel in hospitals are increasingly confronted with such symptoms. The purpose was to reduce the level of BPSD in an acute hospital environment through a stepwise procedure followed by the initiation of a needs-oriented treatment. Methods An open, prospective, interventional study with before-after comparisons was used to implement “Serial Trial Intervention” (STI) in three hospital wards (internal medicine, surgery, geriatric) after its adaption for hospital setting which was supplemented with a detailed pain assessment. Participants were 65 years and older. Potential causes of BPSD were clarified in a stepwise procedure and, if possible, eliminated. The primary outcome was the reduction in BPSD measured by the Neuropsychiatric Inventory (NPI-Q-12) while secondary outcomes were through the use of non-pharmacological and pharmacological interventions. Results No significant reduction in NPI-Q-12 could be found. However, significantly more mobilizations and changes of position were carried out. Higher antipsychotic use was seen in the after-groups presumably due to the higher rates of delirium and cognitive impairment. Furthermore, the data showed no increase in analgesic use. Conclusion No significant reduction in NPI-Q-12 was observed in the before-after study. The use of antipsychotics even increased most probably due to a higher incidence of deliriousness in the after-group. However, STI seemed to improve attention to underlying causes of BPSD as well as pain. Proof that STI leads to NPI-Q-12 reduction in hospitals is still pending.
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Affiliation(s)
- Albert Lukas
- Competence Center of Geriatric Medicine, Helios Medical Center Bonn/Rhein-Sieg, Academic Teaching Hospital, University Bonn, Bonn, Germany
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
- *Correspondence: Albert Lukas
| | - Melanie Bienas
- Competence Center of Geriatric Medicine, Helios Medical Center Bonn/Rhein-Sieg, Academic Teaching Hospital, University Bonn, Bonn, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University Ulm, Ulm, Germany
| | - Lukas Radbruch
- Helios Medical Center Bonn/Rhein-Sieg, Palliative Medicine, Academic Teaching Hospital, University Bonn, Bonn, Germany
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Irmela Gnass
- Paracelsus Medical University, Institute for Nursing Science and Practice, Salzburg, Austria
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Hoeppchen I, Walter C, Berger S, Brandauer A, Freywald N, Kutschar P, Lex KM, Strobl A, Gnass I. Hygiene management for long-term ventilated persons in the home health care setting: a scoping review. BMC Health Serv Res 2022; 22:244. [PMID: 35197063 PMCID: PMC8864850 DOI: 10.1186/s12913-022-07643-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Evidence and recommendations for hygiene management in home mechanical ventilation (HMV) are rare. In Germany, few regionally limited studies show poor hygiene management or a lack of its implementation. This scoping review of international literature identified the evidence in hygiene management for ventilated patients in the home care setting which has to be implemented for infection prevention and control. Methods A review of international literature was conducted in CINAHL, PubMed and Web of Science. The search focused on four key domains: HMV, hygiene management, home care setting, and methicillin-resistant Staphylococcus aureus (MRSA). Data of included studies were extracted using a data charting sheet. Extracted data were assigned to the categories (1) study description, (2) setting and participants, and (3) hygiene management. Results From 1,718 reviewed articles, n = 8 studies met inclusion criteria. All included studies had a quantitative study design. The approaches were heterogeneous due to different settings, study populations and types of ventilation performed. Regarding aspects of hygiene management, most evidence was found for infectious critical activities (n = 5), quality management for hygiene (n = 4), and training and education (n = 4). This review identified research gaps concerning kitchen hygiene, relatives and visitors of HMV patients, and waste management (n = 0). Discussion Overall evidence was rather scarce. Consequently, this review could not answer all underlying research questions. No evidence was found for measures in hygiene management relating to ventilated patients’ relatives. Evidence for kitchen hygiene, waste management and interaction with relatives is available for inpatient care settings. However, this may not be transferable to outpatient care. Binding legal requirements and audits may help regulate the implementation of HMV hygiene measures. Conclusion Infection control programmes included qualified personnel, hygiene plans, and standards for MRSA and multidrug-resistant organisms (MDRO). The appropriateness of hygiene management measures for outpatient care is the basis for their application in practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07643-w.
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Affiliation(s)
- Isabel Hoeppchen
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Carola Walter
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria.
| | - Stefanie Berger
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Anna Brandauer
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Nicole Freywald
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Katharina Maria Lex
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Annemarie Strobl
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Irmela Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
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Ritschel M, Kuske S, Gnass I, Andrich S, Moschinski K, Borgmann SO, Herrmann-Frank A, Metzendorf MI, Wittgens C, Flohé S, Sturm J, Windolf J, Icks A. Assessment of patient-reported outcomes after polytrauma - instruments and methods: a systematic review. BMJ Open 2021; 11:e050168. [PMID: 34916311 PMCID: PMC8679059 DOI: 10.1136/bmjopen-2021-050168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We (1) collected instruments that assess health-related quality of life (HRQoL), activities of daily living (ADL) and social participation during follow-up after polytrauma, (2) described their use and (3) investigated other relevant patient-reported outcomes (PROs) assessed in the studies. DESIGN Systematic Review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, as well as the trials registers ClinicalTrials.gov and WHO ICTRP were searched from January 2005 to April 2018. ELIGIBILITY CRITERIA All original empirical research published in English or German including PROs of patients aged 18-75 years with an Injury Severity Score≥16 and/or an Abbreviated Injury Scale≥3. Studies with defined injuries or diseases (e.g. low-energy injuries) and some text types (e.g. grey literature and books) were excluded. Systematic reviews and meta-analyses were excluded, but references screened for appropriate studies. DATA EXTRACTION AND SYNTHESIS Data extraction, narrative content analysis and a critical appraisal (e.g. UK National Institute for Health and Care Excellence) were performed by two reviewers independently. RESULTS The search yielded 3496 hits; 54 publications were included. Predominantly, HRQoL was assessed, with Short Form-36 Health Survey applied most frequently. ADL and (social) participation were rarely assessed. The methods most used were postal surveys and single assessments of PROs, with a follow-up period of one to one and a half years. Other relevant PRO areas reported were function, mental disorders and pain. CONCLUSIONS There is a large variation in the assessment of PROs after polytrauma, impairing comparability of outcomes. First efforts to standardise the collection of PROs have been initiated, but require further harmonisation between central players. Additional knowledge on rarely reported PRO areas (e.g. (social) participation, social networks) may lead to their consideration in health services provision. PROSPERO REGISTRATION NUMBER CRD42017060825.
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Affiliation(s)
- Michaela Ritschel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Silke Kuske
- Fliedner Fachhochschule Düsseldorf, University of Applied Sciences, Düsseldorf, Germany
| | - Irmela Gnass
- Paracelsus Medical University, Institute of Nursing Science and Practice, Salzburg, Austria
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Kai Moschinski
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sandra Olivia Borgmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Annegret Herrmann-Frank
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Charlotte Wittgens
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sascha Flohé
- Department of Trauma, Orthopaedics and Hand Surgery, Städt. Klinikum Solingen, Solingen, Germany
- Department of Orthopaedics and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Joachim Windolf
- Department of Orthopaedics and Traumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Strobl A, Nestler N, Gnass I. Tätigkeiten und Rollen von neu graduierten Bachelorabsolvent_innen der Pflege im akutstationären Setting. Pflege 2021; 35:67-76. [DOI: 10.1024/1012-5302/a000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: Institutionen im deutschsprachigen Gesundheitswesen sind trotz Bedarf nicht auf Bachelorabsolvent_innen von berufsqualifizierenden Pflegestudiengängen vorbereitet, da keine Tätigkeits- und Rollenprofile zu deren Einsatz in bestimmten Settings vorliegen. Ziel: Ziel ist ein nationaler und internationaler Überblick über Tätigkeiten und Rollen von neu graduierten Bachelorabsolvent_innen im akutstationären Setting. Methoden: Deutsch- und englischsprachig publizierte Studien wurden zwischen 2010 und 2021 in den Datenbanken CINAHL und MEDLINE gesucht und unabhängig ihres Studiendesigns in das Scoping Review aufgenommen. Ergebnisse: Die acht eingeschlossenen Studien folgen qualitativen (n = 5), einem Querschnitt (n = 2) und Mixed-Method Design (n = 1). Sie wurden überwiegend im skandinavischen (n = 3) und nordamerikanischen Raum (n = 3) durchgeführt. Die Ergebnisse zeigen einen Mix an Tätigkeiten und Rollen, in dem Absolvent_innen in der primären pflegerischen Versorgung als Edukator_innen (inkl. Lehrende) und im Medikamentenmanagement bei allen Altersgruppen genauso eingesetzt werden wie für fortgeschrittene pädiatrische Lebensrettung, Überwachung und Wartung von Geräten zur Beurteilung und Diagnostik und als Manager_innen von Bereichspflegeteams. Schlussfolgerungen: Die Entwicklung von Tätigkeits- und Rollenprofilen für spezifische Versorgungssettings, die sich aus Kompetenzzuschreibungen ableiten, sind notwendig. Darauf basierende Traineeprogramme unterstützen die Einarbeitung und fördern die Sicherung einer qualitativen interprofessionellen Versorgung.
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Affiliation(s)
- Annemarie Strobl
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg
| | - Nadja Nestler
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg
| | - Irmela Gnass
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg
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Gnass I, Berkemer E, Drebenstedt C, Laekeman M, Sirsch E, Fischer T. An Evidence-Based Guideline on Pain Assessment in Nursing Homes For Residents and Informal Caregivers. Pain Manag Nurs 2021; 22:565-570. [PMID: 34334320 DOI: 10.1016/j.pmn.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 05/28/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nursing home residents are often affected by pain. Pain assessment aims to determine pain intensity and quality. An evidence-based guideline on pain assessment in nursing homes was developed to support residents and informal caregivers in archiving an adequate pain assessment prerequisite to pain treatment. AIM The residents' guideline presents key recommendations that is comprehensible and accessible to residents and informal carers. DESIGN We conducted a content analysis. SETTING/SUBJECTS Therefore, all recommendations of an evidence-based guideline for pain assessment in nursing home were evaluated on relevance for supporting residents' decision-making process. METHODS Two researchers conducted the content analysis independently and as a result, 29 recommendations could be included. In addition, representatives of a support-group organization for patients with pain validated the derived recommendations. RESULTS The present residents' guideline of pain assessment consists of nine thematic categories, written in laymen's terms to enable older persons to make informed choices and optimizing their own pain management process. CONCLUSIONS The Guideline is available in print format and ready for implementation to enhance the effects on maintaining the physical and psychological well-being and optimal care of older adults in Nursing Homes.
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Affiliation(s)
- Irmela Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.
| | - Esther Berkemer
- Department of Social Work and Health Care, Ludwigshafen University of Business and Society, Germany
| | | | - Marjan Laekeman
- Department of Nursing Sciences, Faculty of Health, University Witten/Herdecke, Witten, Germany; Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Erika Sirsch
- Faculty of Nursing Science, Philosophisch-Theologische Hochschule Vallendar (Catholic University), Germany
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Kutschar P, Berger S, Brandauer A, Freywald N, Osterbrink J, Seidenspinner D, Gnass I. Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial. J Pain Res 2020; 13:633-648. [PMID: 32273749 PMCID: PMC7105359 DOI: 10.2147/jpr.s237056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016-2018). PARTICIPANTS Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included. INTERVENTION In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses. METHODS Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10-30) using self-report instruments or observed (MMSE 0-9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatment-relevant pain above cut-off (≥2) on the Pain Assessment in Advanced Dementia (PAINAD). RESULTS Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10-30) and logistic regression (n=222 residents, MMSE 0-9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=-0.07, p<0.001), and was lower when dementia diagnoses were present (B=-1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05). CONCLUSION While no significant positive intervention effect was measured, findings suggest nurses' raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.
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Affiliation(s)
- P Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - S Berger
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - A Brandauer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - N Freywald
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - J Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - D Seidenspinner
- Nursing Science and Practice Development, University Hospital of Munich-Großhadern (LMU), Munich, Germany
| | - I Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Sirsch E, Lukas A, Drebenstedt C, Gnass I, Laekeman M, Kopke K, Fischer T. Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline. J Am Med Dir Assoc 2020; 21:149-163. [DOI: 10.1016/j.jamda.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 10/25/2022]
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Zwakhalen S, Docking RE, Gnass I, Sirsch E, Stewart C, Allcock N, Schofield P. Pain in older adults with dementia : A survey across Europe on current practices, use of assessment tools, guidelines and policies. Schmerz 2019; 32:364-373. [PMID: 29931391 DOI: 10.1007/s00482-018-0290-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings. METHODS A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom. RESULTS Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70-80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management. CONCLUSION Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.
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Affiliation(s)
- S Zwakhalen
- School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.,Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - R E Docking
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
| | - I Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - E Sirsch
- Faculty of Nursing Science, Philosophisch-Theologische Hochschule Vallendar (Catholic University), Vallendar, Germany
| | - C Stewart
- NHS Research Scotland, The Golden Jubilee National Hospital, Clydebank, UK
| | - N Allcock
- Professional and Clinical Development Lead, InHealth Pain Management Solutions Limited, Barnsley, UK
| | - P Schofield
- Faculty of Education and Health, Department of Adult Nursing and Paramedic Sciences, University of Greenwich, London, UK
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Gnass I, Ritschel M, Andrich S, Kuske S, Moschinski K, Herrmann-Frank A, Metzendorf MI, Flohé S, Sturm J, Windolf J, Icks A. Assessment of patient-reported outcomes after polytrauma: protocol for a systematic review. BMJ Open 2018; 8:e017571. [PMID: 29549198 PMCID: PMC5857702 DOI: 10.1136/bmjopen-2017-017571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Survivors of polytrauma experience long-term and short-term burden that influences their lives. The patients' view of relevant short-term and long-term outcomes should be captured in instruments that measure quality of life and other patient-reported outcomes (PROs) after a polytrauma. The aim of this systematic review is to (1) collect instruments that assess PROs (quality of life, social participation and activities of daily living) during follow-up after polytrauma, (2) describe the instruments' application (eg, duration of period of follow-up) and (3) investigate other relevant PROs that are also assessed in the included studies (pain, depression, anxiety and cognitive function). METHODS AND ANALYSIS The systematic review protocol is developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials and the trials registers ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be searched. Keywords, for example, 'polytrauma', 'multiple trauma', 'quality of life', 'activities of daily living' or 'pain' will be used. Publications published between January 2005 and the most recent date (currently: August 2016) will be included. In order to present the latest possible results, an update of the search is conducted before publication. The data extraction and a content analysis will be carried out systematically. A critical appraisal will be performed. ETHICS AND DISSEMINATION Formal ethical approval is not required as primary data will not be collected. The results will be published in a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42017060825.
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Affiliation(s)
- Irmela Gnass
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Michaela Ritschel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Institute for Diabetes Research at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Silke Kuske
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Institute for Diabetes Research at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Kai Moschinski
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Annegret Herrmann-Frank
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Sascha Flohé
- Department of Trauma,Orthopedics and Hand Surgery, Städt. Klinikum, Solingen, Germany
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Joachim Windolf
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center Düsseldorf at the Heinrich-Heine University Düsseldorf, Leibniz Institute for Diabetes Research at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Moschinski K, Kuske S, Andrich S, Stephan A, Gnass I, Sirsch E, Icks A. Drug-based pain management for people with dementia after hip or pelvic fractures: a systematic review. BMC Geriatr 2017; 17:54. [PMID: 28196525 PMCID: PMC5310008 DOI: 10.1186/s12877-017-0446-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/08/2017] [Indexed: 01/17/2023] Open
Abstract
Background Studies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings. Treatment could be surgical or conservative. We also analysed study designs, methods and variables, as well as which assessments were applied to measure pain management and mental status. Method/design The development of this systematic review protocol was guided by the PRISMA-P requirements, which were taken into consideration during the review procedures. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect were searched. Studies published up to January 2016 were included. The data extraction, content and quantitative descriptive analysis were carried out systematically, followed by a critical appraisal. Results Eight of the 13 included studies focusing on patient data showed that people with dementia received less drug-based pain management than people without cognitive impairment. Four studies based on surveys of healthcare professionals stated that cognitive impairment is a major barrier for effective pain management. There was heterogeneity regarding the assessment of the mental status and the pain assessment of the patients. The assessment of the drugs administered in all of the studies working with patient data was achieved through chart reviews. Conclusion People with dementia do not seem to receive the same amount of opioid analgesics after hip fracture as people without cognitive impairment. There is need to enhance pain assessment and management for these patients. Future research should pay more attention to the use of the appropriate items for assessing cognitive impairment and pain in people with dementia. Trial registration This systematic review was registered at Prospero (CRD42016037309); on 11 April 2016, and the systematic review protocol was published (Syst Rev. 5(1):1, 2016).
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Affiliation(s)
- Kai Moschinski
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Silke Kuske
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Silke Andrich
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Astrid Stephan
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany.,Department of Nursing, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Irmela Gnass
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Erika Sirsch
- Faculty of Nursing Science, Vallendar College of Philosophy and Theology (PTHV Catholic University), Palottistraße 3, 56179, Vallendar, Germany
| | - Andrea Icks
- Heinrich Heine University, Faculty of Medicine, Institute for Health Services Research and Health Economics, Moorenstraße 5, 40225, Düsseldorf, Germany
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12
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Kutschar P, Bauer Z, Gnass I, Osterbrink J. Does item overlap render measured relationships between pain and challenging behaviour trivial? Results from a multicentre cross-sectional study in 13 German nursing homes. Nurs Inq 2017; 24. [DOI: 10.1111/nin.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Patrick Kutschar
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
| | - Zsuzsa Bauer
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
| | - Irmela Gnass
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice; Paracelsus Medical University; Salzburg Austria
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13
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Kuske S, Moschinski K, Andrich S, Stephan A, Gnass I, Sirsch E, Icks A. Drug-based pain management in people with dementia after hip or pelvic fractures: a systematic review protocol. Syst Rev 2016; 5:113. [PMID: 27412448 PMCID: PMC4944510 DOI: 10.1186/s13643-016-0296-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies show that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent and how drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review is to identify studies addressing drug-based pain management for people with dementia who have had a hip or pelvic fracture for which they had either an operation or conservative treatment. We will analyse to what extent and how the drug-based pain treatment for people with dementia is performed across all settings and how it is assessed in the studies. METHODS The development of this systematic review protocol was guided by the PRISMA-P requirements, which will be taken into consideration during the review procedure. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect will be searched, using keywords such as "analgesia", "dementia", "cognitive impairment", "pain treatment", "hip fracture" or "pelvic fracture". Publications published up to January 2016 will be included. The data extraction and a content analysis will be carried out systematically, followed by a critical appraisal. DISCUSSION This review will provide a valuable overview on the current evidence on drug-based pain management for PwD in all settings who were conservatively treated after a hip or pelvic fracture. The review may expose a need to enhance pain management for PwD. It may also provide motivation for healthcare providers and policymakers to give this topic their attention and to facilitate further research by considering aspects of care transitions in all settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016037309.
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Affiliation(s)
- S Kuske
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany. .,Paul Langerhans Group for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich-Heine-University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany. .,Fliedner Fachhochschule, University of Applied Sciences, Geschwister-Aufricht-Straße 9, 40489, Düsseldorf, Germany.
| | - K Moschinski
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - S Andrich
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Paul Langerhans Group for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich-Heine-University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - A Stephan
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Department of Nursing, RWTH Aachen University Hospital, 52074, Aachen, Germany
| | - I Gnass
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Institute of Nursing Science and Education, Paracelsus Medicine University, Salzburg, Austria
| | - E Sirsch
- Faculty of Nursing Science, Vallendar Philisophic-Theological College, Palottistraße 3, 56179, Vallendar, Germany
| | - A Icks
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Economics, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.,Paul Langerhans Group for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, Heinrich-Heine-University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.,German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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Marx G, Schindler AW, Mosch C, Albers J, Bauer M, Gnass I, Hobohm C, Janssens U, Kluge S, Kranke P, Maurer T, Merz W, Neugebauer E, Quintel M, Senninger N, Trampisch HJ, Waydhas C, Wildenauer R, Zacharowski K, Eikermann M. Intravascular volume therapy in adults: Guidelines from the Association of the Scientific Medical Societies in Germany. Eur J Anaesthesiol 2016; 33:488-521. [PMID: 27043493 PMCID: PMC4890839 DOI: 10.1097/eja.0000000000000447] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gernot Marx
- From the Department of Cardiothoracic and Vascular Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz (JA); Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena (MB); Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne (ME); Institute of Nursing Science and Practice, Paracelsus Private Medical University, Salzburg, Austria (IG); Department of Internal Medicine, Neurology and Dermatology, Leipzig University Hospital, Leibzig (CH); Department of Cardiology, St Antonius Hospital, Eschweiler (UJ); Centre for Intensive Care Medicine, Universitätsklinikum, Hamburg-Eppendorf (SK); Department of Anaesthesia and Critical Care, University Hospital of Würzburg, Würzburg (PK); Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen (GM); Urological Unit and Outpatient Clinic, University Hospital rechts der Isar, Munich (TM); Department of Obstetrics and Gynaecology, Bonn University Hospital, Bonn (WM); Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne (CM, EN); Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen (MQ); Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen (AWS); Department of General and Visceral Surgery, Münster University Hospital, Münster (NS); Department of Health Informatics, Biometry and Epidemiology, Ruhr-Universität Bochum, Bochum (HJT); Department of Trauma Surgery, Essen University Hospital, Essen (CW); Department of General Surgery, University Hospital of Würzburg, Würzburg (RW); and Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany (KZ)
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Affiliation(s)
- I. Gnass
- Paracelsus Medizinische Privatuniversität, Institut für Pflegewissenschaft und -praxis, Salzburg
| | - S. Krutter
- Paracelsus Medizinische Privatuniversität, Institut für Pflegewissenschaft und -praxis, Salzburg
| | - F. Elsner
- Uniklinik RWTH Aachen, Klinik für Palliativmedizin
| | - J. Osterbrink
- Paracelsus Medizinische Privatuniversität, Institut für Pflegewissenschaft und -praxis, Salzburg
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Abstract
Old people's experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.
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Affiliation(s)
- E Sirsch
- Fakultät für Pflegewissenschaft, Philosophisch-Theologische Hochschule Vallendar, PTHV gGmbH, Pallottistr. 3, 56179, Vallendar, Deutschland,
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Gnass I, Ralic N, Hübner-Möhler B, Sirsch E. [Expert standard "pain management in nursing of chronic pain". An unpleasant sensory and emotional experience]. Pflege Z 2014; 67:520-523. [PMID: 25265691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Nestler N, Gnass I, Krutter S, Pree E, Bauer Z, Osterbrink J. Emerging Standards of Care in Pain Management in Germany. J Pain Palliat Care Pharmacother 2014; 28:46-8. [DOI: 10.3109/15360288.2013.879246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- J Osterbrink
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Strubergasse 21, Salzburg, Austria.
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Sirsch E, Laekeman M, Gnass I. [A broad spectrum in expertise and perspectives]. Pflege Z 2013; 66:138-140. [PMID: 23513581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Sirsch E, Schuler M, Fischer T, Gnass I, Laekeman M, Leonhardt C, Berkemer E, Drebenstedt C, Löseke E, Schwarzmann G, Kopke K, Lukas A. Schmerzassessment bei älteren Menschen in der vollstationären Altenhilfe. Schmerz 2012; 26:410-5, 418. [DOI: 10.1007/s00482-012-1209-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fischer T, Berkemer E, Drebenstedt C, Gnass I, Kopke K, Laekemann M, Leonhardt C, Löseke E, Lukas A, Schuler M, Schwarzmann G, Sirsch E. [Interdisciplinary team develops S3 guideline for pain assessment in nursing home residence. Experts work on a mammoth project]. Pflege Z 2011; 64:582-583. [PMID: 22032028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Sirsch E, Gnass I. [The relevance of pain intensity for nursing assessment. The one who can report, has the advantage...]. Pflege Z 2011; 64:602-605. [PMID: 22032034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Erika Sirsch
- Deutschen Zentrum fur Neurodegenerative Erkrankungen.
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Osterbrink J, Ewers A, Nestler N, Pogatzki-Zahn E, Bauer Z, Gnass I, Sirsch E, Krüger C, Mitterlehner B, Kutschar P, Hemling S, Fischer B, Marschall U, Aschauer W, Weichbold M, van Aken H. [Health services research project "action alliance pain-free city Münster" : Objectives and methods]. Schmerz 2011; 24:613-20. [PMID: 20957393 DOI: 10.1007/s00482-010-0983-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inadequate pain care in health care facilities is still a major concern. Due to structural and organizational shortcomings the potential of modern analgesia is far from being exhausted. The project "Action Alliance Pain-free City Münster" is designed to analyze the multiprofessional pain management in health care facilities in the model City of Münster in an epidemiologic study and aims to optimize pain management in accordance with nursing standards and medical guidelines. Hospitals, nursing homes, outpatient nursing services, hospices and pain care centers will be examined. After an analysis of the current state on the basis of a pre-test, the necessary optimization measures will be developed and implemented. Subsequently, the pain management will be reevaluated in a post-test. In partly still unexplored health care areas of Germany, epidemiologic data will be generated, barriers to the implementation of standards and guidelines revealed and measures of improvements developed and tested. In addition, interface problems between the evaluated sectors will be identified. In this article the objective and the methods of the project are described.
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Affiliation(s)
- J Osterbrink
- Institut für Pflegewissenschaft, Paracelsus Medizinische Privatuniversität, Strubergasse 21, 5020 Salzburg, Österreich
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Gnass I, Schlarmann JG, Haut A, Sirsch E. [Summer school of the European Academy of Nursing Science: encounter is the primary aim]. Pflege Z 2010; 63:114-115. [PMID: 20218171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Irmela Gnass
- Universität Witten/Herdecke, Fakultät für Medizin, Institut für Pflegewissenschaft, Witten.
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Gnass I. Der chronische Schmerz – eine interdisziplinäre Herausforderung. Pflege 2008. [DOI: 10.1024/1012-5302.21.3.190a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gnass I. [Children as visitors in adult intensive care units--literature review: guided interventions support adaptation work]. Pflege Z 2006; 59:405-9. [PMID: 16883736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Irmela Gnass
- Institut für Pflegewissenschaft, Universität Witten/Herdecke.
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