Management of pain and pain-related symptoms in hospitalized veterans with cancer

Unrelieved pain continues to be a problem among hospitalized patients with cancer. The purpose of this study was to evaluate pain management outcomes in a group of veterans with cancer receiving inpatient care. The sample consisted of 90 veterans with cancer hospitalized in one of two large veterans medical centers in the southeastern United States. Daily pain was assessed by administering the visual analog scale (VAS) for pain three times in a 24-hour period and averaging these three scores. The Brief Pain Inventory (BPI) and Constipation Assessment Scale (CAS) were administered once. The charts were audited using the Chart Audit for Pain (CAP). The sample was predominantly male (93.3%) and white (82.8%). The length of time since diagnosis ranged from newly diagnosed during this hospitalization to 16 years. Average daily pain was 32.9 on the VAS and 4 on the BPI. However, approximately one-fourth of the patients reported average daily pain above the midpoint (VAS > 50), and some patients reported average daily pain to be as high as 98. Fewer than half of charts (42%) showed evidence that a pain rating scale was used. Other assessment data also were very limited. Patients reported that pain interfered with all activities on the BPI, with highest interference scores for walking and sleep (mean, 5.5). Although 80% of the patients reported some problem with constipation, the chart audit indicated that this was recorded in only 11 patient records. No patient records indicated a problem with sedation. The findings indicate that limited attempts were made to manage pain using nonpharmacologic methods. In addition, only one of the nine charts reporting these attempts showed evidence that results from the attempt were evaluated. It may be concluded that pain management continues to be less than ideal in these veterans hospitals. Study results indicate that nurses are not documenting careful assessment of pain, not documenting evaluation of approaches to pain management, and not attending to the constipation that is inevitable when opioids are administered. Continued emphasis on nursing education related to pain management is needed. Future research should be undertaken to evaluate these outcomes.

Knowledge and attitudes of nurses in veterans hospitals about pain management in patients with cancer

PURPOSE/OBJECTIVES

To assess nurses' knowledge and attitudes about pain management and patients in pain.

DESIGN

Exploratory, descriptive.

SETTING

Seven medical-surgical inpatient units in two large veterans hospitals in Southwest Florida.

SAMPLE

A convenience self-select sample of 85 nurses (RNs and LPNs working on the target units on all shifts).

METHODS

Staff nurses were approached at work and asked to complete the data collection forms.

MAIN RESEARCH VARIABLES

Knowledge about pain management principles and attitudes toward pain management and patients in pain.

FINDINGS

Areas of major knowledge deficits included physiology of pain and pharmacology of analgesics. Nurses were most knowledgeable about the importance of asking patients about their pain, around-the-clock scheduling, tolerance, and use of distraction. Patient behavior, age, and gender seemed to unduly influence nurses in their pain management decisions. Regarding attitudes about pain management, the majority of nurses did not agree that patients and their families should have the most control over analgesic scheduling and that a constant level of analgesic should be maintained in the blood. In fact, 82% indicated that around-the-clock analgesics increase the risk for sedation and respiratory depression.

CONCLUSIONS

Years after the Agency for Health Care Policy and Research published pain guidelines, nurses in veterans hospitals continue to lack knowledge and have negative attitudes that may negatively affect pain management in patients with cancer.

IMPLICATIONS FOR NURSING PRACTICE

Basic and continuing education for nurses needs to include intensive content about pain management. Continued research is needed to document improvements in pain management by nurses.

Increasing students' sensitivity to families of children with disabilities

Families of children with disabilities pose a particular challenge to nurses as each child and family is a unique combination of intellectual, emotional, and medical concerns. The authors describe a project in which families of children with disabilities serve as teachers to baccalaureate nursing students. The goal of the project is to facilitate sensitivity and an understanding of the needs of a child with a developmental disability.

Meeting the challenge of unscheduled outpatient visits

Cancer patients receive multimodal therapy and treatments on an ongoing basis in free-standing cancer centers, infusion centers, and oncology offices and at home. To serve those who require unscheduled evaluation for treatment effects, one hospital developed a program to receive those visits on an inpatient cancer unit.

Correlation of pulse oximetry and co-oximetry

Pulse oximetry is an important advancement in noninvasive monitoring and assessment of arterial blood oxygenation. The purpose of this study was to assess the correlation of arterial oxygen saturation (SaO2) and pulse oximetry (SpO2) in critically ill patients using the ear and finger probes. Arterial oxygen saturation was measured simultaneously by pulse oximetry with a finger and ear probe and an arterial blood gas sample. Results indicated that SpO2 does trend SaO2 but it appears that SpO2 measured by the finger probe is more closely correlated to SaO2 than SpO2 measured with an ear probe in this study sample.

A professional practice model: two key components

Professional practice models provide decentralized approaches to nursing practice. The components of such a model should include a primary nursing delivery system, decentralized decision making, salary compensation, self-scheduling and quality circles. This article describes two of the key components of the model--salaried compensation and self-scheduling--on a unit in one agency.

A descriptive study of the management of pain and pain-related side effects in a cancer center and a hospice

The purpose of this study was to describe the pain and pain-related symptoms experienced by persons receiving treatment in a cancer center or a hospice and to describe the nurses' responses to these problems. The sample consisted of 25 hospice and 19 cancer center patients who were being treated for pain. Pain was assessed three times in a 24-hour period using a visual analogue scale (VAS). Constipation was assessed using the Constipation Assessment Scale. Sedation was assessed on a 0 (fully alert) to 4 (comatose) scale. The nurses' documentation was assessed using the Chart Audit for Pain. Results showed that patients in the cancer center and hospice continued to experience pain (VAS M = 38.6 and 29.7 respectively) in spite of their pain management regimens. The cancer center patients were given an average of 38% of the maximum ordered dose of analgesic while the hospice patients self-administered 93% of the ordered dose. The cancer center nurses documented the efficacy of the analgesics in only 26% of cases while hospice nurses recorded this information in 96% of the charts. Sedation was not found to be a problem. Constipation was reported by 100% of cancer center patients and 84% of hospice patients but was rarely documented by nurses in either setting. It appears that nurses need to do more thorough assessment of patient symptoms and more consistent follow-up evaluation and documentation.

Pain and pain-related side effects in an ICU and on a surgical unit: nurses' management

BACKGROUND: Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. OBJECTIVE: To determine the extent to which nurses manage pain effectively without side effects related to narcotic analgesics in an intensive care and a surgical unit. METHODS: The sample consisted of 44 patients, 20 from an intensive care unit and 24 from a surgical unit. Patients completed a Visual Analogue Scale to measure pain intensity three times in 24 hours. The narcotic side effects of constipation and sedation were measured using the Constipation Assessment Scale and a sedation scale. Documentation was assessed using the Chart Audit for Pain. RESULTS: Patients in both units continued to experience pain even with pain management interventions. The critical care nurses administered an average of 30% of the maximum narcotic dose ordered and the surgical unit nurses, 36.8%. Documentation of the effect of the pain medication was scant on both units. Although sedation was not a problem in either unit, the majority of patients reported symptoms of constipation. Documentation of this problem was scant in both units. CONCLUSIONS: Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.

Pain and pain-related side effects in an ICU and on a surgical unit: nurses' management

BACKGROUND

Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients.

OBJECTIVE

To determine the extent to which nurses manage pain effectively without side effects related to narcotic analgesics in an intensive care and a surgical unit.

METHODS

The sample consisted of 44 patients, 20 from an intensive care unit and 24 from a surgical unit. Patients completed a Visual Analogue Scale to measure pain intensity three times in 24 hours. The narcotic side effects of constipation and sedation were measured using the Constipation Assessment Scale and a sedation scale. Documentation was assessed using the Chart Audit for Pain.

RESULTS

Patients in both units continued to experience pain even with pain management interventions. The critical care nurses administered an average of 30% of the maximum narcotic dose ordered and the surgical unit nurses, 36.8%. Documentation of the effect of the pain medication was scant on both units. Although sedation was not a problem in either unit, the majority of patients reported symptoms of constipation. Documentation of this problem was scant in both units.

CONCLUSIONS

Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.

Analysis of a decade of nursing practice research: 1977-1986

The purpose of this study was to analyze the research focus, theoretical bases, research designs, statistical methods, and research findings of nursing practice research, 1977-1986. A secondary purpose was to assess the fit of nursing practice research topics within the North American Nursing Diagnosis Association's (NANDA) taxonomy. The sample consisted of 720 articles that met the definitional criteria of nursing practice research from six major refereed journals in nursing that primarily publish nursing research. Findings showed that 95% of research in nursing in the last decade was conducted by nurses as first authors, over half with doctoral degrees. Funded research increased as well as the trend toward multidisciplinary research and multisite studies. One-third of the studies focused on nursing intervention, and two-thirds were assessment-oriented. Although use of nursing conceptual models increased over the decade, theories or models from psychology, physiology, and sociology were used most often. There was an increase in use of sophisticated research methods and better reporting of reliability and validity. The use of NANDA as a taxonomy for classifying nursing practice research was assessed.