1
|
Lamture V, Lamture YR. The Verbal Numerical Rating Scale and Faces Pain Scale-Revised for Children With Acute Pain: A Comparative Study for Determining the Need for Analgesia. Cureus 2024; 16:e56854. [PMID: 38659515 PMCID: PMC11040419 DOI: 10.7759/cureus.56854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The primary complaint in all age groups of patients, including children, is pain, which drives the patient to the hospital. A good assessment of pain severity is necessary to determine the right therapy for this primary complaint. Pain scales, especially in children, are given little importance in all hospitals in India. We need more data about its effectiveness. As a result, we conducted this study to compare the effectiveness of two pain scales in an admitted patient. Methods An observational study was conducted on pediatric patients aged 8-17 admitted to a tertiary care unit in pediatric wards included in the study. The study team identified the participants with painful and nonpainful conditions by asking patients of the above age group if they had "any pain" or "any hurt." The verbal numerical rating scale (vNRS) was determined by asking, "On a scale of zero to 10, where zero signifies no pain and ten means severe pain." The child was advised to select from among the six faces using the faces pain scale-revised (FPS-R), showing increasing levels of pain intensity (from left to right), with score options 0, 2, 4, 6, 8, and 10 demonstrated below each face. Result We enrolled 140 children, of which 22 of vNRS and 15 of FPS-R were removed from the study as these children did not understand vNRS and FPS-R. The two-tailed t-test revealed that the p-value was 0.9144. By conventional criteria, in the context of statistical analysis, conventional criteria typically refer to commonly accepted thresholds for determining statistical significance. The most common threshold for significance is a p-value of 0.05 or less. In the provided scenario, the two-tailed t-test resulted in a p-value of 0.9144. By conventional criteria (i.e., using the threshold of 0.05), this p-value is considered not significant. This means that there is not enough evidence to reject the null hypothesis, which suggests that there is no significant difference between the two groups being compared (in this case, the efficacy and reliability of the two scales). Therefore, based on conventional criteria, the difference in efficacy and reliability between the two scales is considered not significant, indicating that they are likely to be equally effective and reliable. This difference is considered not significant. Hence, it is suggestive of equal efficacy and reliability on both scales. Conclusion Pain scales are a practical guide for managing and recognizing pain in children. It needs to be considered in identifying children's pain. They can provide a valuable outcome for measuring pain, which, when practiced regularly, can save time and extra burden on health staff. In the present study, both pain scales (vNRS and FPR-R) have equal efficacy.
Collapse
Affiliation(s)
- Varsha Lamture
- Pediatrics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education & Research, Nagpur, IND
| | | |
Collapse
|
2
|
Siddiqui A, Belland L, Rivera-Reyes L, Handel D, Yadav K, Heard K, Eisenberg A, Khelemsky Y, Hwang U. A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures. PAIN MEDICINE 2017; 18:41-48. [PMID: 27245631 DOI: 10.1093/pm/pnw072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients. Design Secondary analysis of retrospective cohort study. Setting Five EDs (four academic, one community) in the United States. Participants Patients (1,664) who presented in January, March, July, and October 2009 with a final diagnosis of fracture (774 long bone [LBF], 890 shorter bone [SBF]). Measurements Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type. Results A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR = 2.03; 95 CI = 1.58 to 2.62; P < 0.001) and higher opioid-doses (parameter estimate = 0.268; 95 CI = 0.239 to 0.297; P < 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55-163] vs. 76 [35-149] minutes, P = 0.057), but no other differences in process outcomes were found. Conclusion Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research.
Collapse
Affiliation(s)
- Ammar Siddiqui
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Laura Belland
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Laura Rivera-Reyes
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Daniel Handel
- Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kennon Heard
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amanda Eisenberg
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Yury Khelemsky
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ula Hwang
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
3
|
Heinrich M, Mechea A, Hoffmann F. Improving postoperative pain management in children by providing regular training and an updated pain therapy concept. Eur J Pain 2015; 20:586-93. [PMID: 26311307 DOI: 10.1002/ejp.770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND In recent years, children's hospitals have increasingly implemented postoperative pain management protocols to reduce postoperative pain and improve patient satisfaction. The effectiveness and long-term sustainability of such protocols have rarely been studied. Therefore, we conducted a prospective intervention study to assess the impact of regular training and improvement of clinical processes on the quality of postoperative pain management. METHODS We conducted an initial assessment of the status quo of postoperative pain management (Audit 1) followed by repeated training and improvement of clinical processes (analgesic pocket card, parents' brochure, modification of the patient chart, bimonthly advanced trainings sessions) and a follow-up review after 3 years (Audit 2). We used a data entry form, a patient survey, and an anonymous questionnaire for the nursing staff as measurement tools. RESULTS Our analysis included a total of 93 and 85 patients in the initial and final audits. The return rates of the nursing staff questionnaire were 83% (Audit 1) and 77% (Audit 2). The training and process improvements resulted in significant improvement in the administration of analgesics for pain requiring treatment, the control of pain measurement after the administration of analgesics and the use of non-pharmacological pain therapies. The patients reported faster administration of analgesics for acute pain and improved pain relief following the intervention. CONCLUSIONS Repeated training and improvement of clinical processes can significantly improve the long-term quality of postoperative pain management in children with a tolerable amount of effort on the part of health care professionals and institutions.
Collapse
Affiliation(s)
- M Heinrich
- Department of Pediatric Surgery, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - A Mechea
- Department of Pediatrics, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - F Hoffmann
- Department of Pediatrics, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
4
|
Odai ED, Ehizele AO, Enabulele JE. Assessment of pain among a group of Nigerian dental patients. BMC Res Notes 2015; 8:251. [PMID: 26087661 PMCID: PMC4474451 DOI: 10.1186/s13104-015-1226-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 06/11/2015] [Indexed: 12/19/2022] Open
Abstract
Background Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients’ level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients. Methods A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales. Results Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and pericoronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85. Conclusion It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with patients with multiple diagnoses experiencing more severe pain, and there is a correlation between the VAS and FCT for pain assessment among dental patients.
Collapse
Affiliation(s)
- Emeka Danielson Odai
- Department of Oral and Maxillofacial Surgery and Pathology, University of Benin, Benin City, Nigeria.
| | | | | |
Collapse
|
5
|
The Impact of Assessment and Reassessment Documentation on the Trajectory of Postoperative Pain Severity: A Pilot Study. Pain Manag Nurs 2014; 15:652-63. [DOI: 10.1016/j.pmn.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 12/13/2022]
|
6
|
Messerer B, Sandner-Kiesling A. [Organization of pediatric pain management: Austrian interdisciplinary recommendations for pediatric perioperative pain management]. Schmerz 2014; 28:14-24. [PMID: 24550023 DOI: 10.1007/s00482-013-1383-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postoperative pain management is still in need of vast improvement, especially for children. The aim of this article is to demonstrate which structures and processes must be optimized to ultimately improve patient satisfaction and safety. RESPONSIBILITIES Basic prerequisites are among others personnel continuity and good cooperation in a multiprofessional team. A clear assignment of responsibilities is also of essential importance. PATIENT HISTORY AND INFORMED CONSENT On admission every patient should be questioned on the currently existing pain. Patients or the parents must be informed about the pain therapy in a comprehensible manner. Possible complications, chances of success, advantages and disadvantages of the planned procedure and alternative forms of treatment must be discussed. IMPLEMENTATION The implementation needs a great deal of consideration. The introduction of clearly defined pathways and thorough schooling contribute more to successful pain management than the establishment of pain measurement or the use of special techniques alone. EVALUATION AND DOCUMENTATION Because pain intensity can only be described indirectly it is difficult to assess in children. Assessment is made by another person until children are 5 years old. The gold standard in pain measurement is, however, self-estimation using appropriate scales which is possible for older children. The routinely carried out representation of pain values and prompt documentation of all pain therapeutic measures are indispensible for the control and optimization of pain therapy. QUALITY OF RESULTS Whether improvements in acute pediatric pain therapy will actually be achieved can only be realized by standardized compilation and analysis of the quality of therapy. For this purpose QUIPSInfant was developed.
Collapse
Affiliation(s)
- B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, LKH-Universitätsklinikum Graz, Auenbruggerplatz 29, 8036, Graz, Österreich
| | | |
Collapse
|
7
|
Schmerztherapie an einer zertifizierten Klinik für Kinderchirurgie. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-013-2960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
8
|
Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013; 2013:CD002213. [PMID: 23543515 PMCID: PMC6513239 DOI: 10.1002/14651858.cd002213.pub3] [Citation(s) in RCA: 456] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional education (IPE) offers a possible way to improve interprofessional collaboration and patient care. OBJECTIVES To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the effectiveness of IPE interventions compared to no education intervention. SEARCH METHODS For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all included studies, the proceedings of leading IPE conferences, and websites of IPE organisations. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client or healthcare process outcomes. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study designs and outcome measures. Consequently, the results are presented in a narrative format. MAIN RESULTS This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes 15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care, emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes (positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care. AUTHORS' CONCLUSIONS This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the 2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; third, cost-benefit analyses.
Collapse
Affiliation(s)
- Scott Reeves
- Center of Innovation in Inteprofessional Education, University of California, San Francisco, San Francisco, California, USA.
| | | | | | | | | |
Collapse
|
9
|
Messerer B, Gutmann A, Vittinghoff M, Weinberg A, Meissner W, Sandner-Kiesling A. Postoperative Schmerzmessung bei speziellen Patientengruppen. Schmerz 2011; 25:245-55. [DOI: 10.1007/s00482-011-1060-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
10
|
Messerer B, Gutmann A, Weinberg A, Sandner-Kiesling A. Implementation of a standardized pain management in a pediatric surgery unit. Pediatr Surg Int 2010; 26:879-89. [PMID: 20625751 DOI: 10.1007/s00383-010-2642-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2010] [Indexed: 12/20/2022]
Abstract
Postoperative pain is still a major complication causing discomfort and significant suffering, especially for children. Therefore, every effort should be made to prevent pain and treat it effectively once it arises. Under-treatment of pediatric pain is often due to a lack of both knowledge about age-specific aspects of physiology and pharmacology and routine pain assessment. Factors for long term success require regularly assessing pain, as routinely as the other vital signs together with documentation of side effects. The fear of side effects mostly prevents the adequate usage of analgesics. Essential is selecting and establishing a simple concept for clinical routine involving a combination of non-pharmacological treatment strategies, non-opioid drugs, opioids and regional anesthesia.
Collapse
Affiliation(s)
- B Messerer
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
| | | | | | | |
Collapse
|
11
|
Abstract
Pain as a multidimensional phenomenon needs to be managed or mitigated interprofessionally. This review aimed to assess the efficiency of interprofessional education on the pain documentation of professionals and on the pain intensity reported by patients. Based upon a systematic search, two randomized controlled trails and two quasi-experimental studies were retrieved. An enhancement in pain documentation following interprofessional education was revealed. Two studies demonstrated no significant changes in patient outcomes, while the other revealed significant improvements. The integration of the results was not feasible due to the various methods of measurement employed in the different studies. More rigorous investigations particularly with a holistic approach are recommended.
Collapse
Affiliation(s)
- Alireza Irajpour
- Florence Nightingale School of Nursing & Midwifery, King's College London, UK.
| |
Collapse
|
12
|
Skelly AH, Leeman J, Carlson J, Soward ACM, Burns D. Conceptual model of symptom-focused diabetes care for African Americans. J Nurs Scholarsh 2009; 40:261-7. [PMID: 18840210 DOI: 10.1111/j.1547-5069.2008.00236.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Development of a conceptual model and description of its use to guide the content and format of a community-based intervention. CONCEPTUAL MODEL: We developed a symptom-focused model for type 2 diabetes for older African American women based on the UCSF symptom management model. Key concepts in this model are symptom experience, symptom management, and health outcomes. METHODS Review of literature, intervention protocol. CONCLUSIONS The symptom-focused conceptual model is an innovative approach to tailoring care to a distinct population and to engaging participants in their own self-care. CLINICAL RELEVANCE Diabetes is a major cause of morbidity and mortality in African Americans; and diabetes self-management is the cornerstone of care. To better meet the distinct needs of diverse populations and positively affect health outcomes, new tailored approaches should be developed that are culturally sensitive and acceptable.
Collapse
Affiliation(s)
- Anne H Skelly
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA.
| | | | | | | | | |
Collapse
|
13
|
Belbachir A, Fletcher D, Larue F. Prise en charge de la douleur postopératoire : évaluation et amélioration de la qualité. ACTA ACUST UNITED AC 2009; 28:e1-12. [DOI: 10.1016/j.annfar.2008.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EKB, Kvarstein G, Stubhaug A. Assessment of pain. Br J Anaesth 2008; 101:17-24. [PMID: 18487245 DOI: 10.1093/bja/aen103] [Citation(s) in RCA: 1108] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED Valid and reliable assessment of pain is essential for both clinical trials and effective pain management. The nature of pain makes objective measurement impossible. Acute pain can be reliably assessed, both at rest (important for comfort) and during movement (important for function and risk of postoperative complications), with one-dimensional tools such as numeric rating scales or visual analogue scales. Both these are more powerful in detecting changes in pain intensity than a verbal categorical rating scale. In acute pain trials, assessment of baseline pain must ensure sufficient pain intensity for the trial to detect meaningful treatment effects. Chronic pain assessment and its impact on physical, emotional, and social functions require multidimensional qualitative tools and health-related quality of life instruments. Several disease- and patient-specific functional scales are useful, such as the Western Ontario and MacMaster Universities for osteoarthritis, and several neuropathic pain screening tools. The Initiative on METHODS Measurement, and Pain Assessment in Clinical Trials recommendations for outcome measurements of chronic pain trials are also useful for routine assessment. Cancer pain assessment is complicated by a number of other bodily and mental symptoms such as fatigue and depression, all affecting quality of life. It is noteworthy that quality of life reported by chronic pain patients can be as much affected as that of terminal cancer patients. Any assessment of pain must take into account other factors, such as cognitive impairment or dementia, and assessment tools validated in the specific patient groups being studied.
Collapse
Affiliation(s)
- H Breivik
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Ogle KS, McElroy L, Mavis B. No relief in sight: postgraduate training in pain management. Am J Hosp Palliat Care 2008; 25:292-7. [PMID: 18403575 DOI: 10.1177/1049909108315915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated training in pain management in postgraduate medical education programs. A mail survey of program directors was conducted, evaluating the format of training in pain management and the self-assessed adequacy of the training. The response rate was 70%, with 188 total respondents. It included all programs in a large Midwestern state, representing most specialties. Just over half of all programs offered any formal training in pain management, and even fewer required it. Less than one quarter required a clinical component to such training. Nonetheless, an overwhelming majority of program directors (85%) rated their training as adequate or excellent. Improvements are clearly needed in postgraduate training in pain management, and external incentives, such as requirements in the accreditation process, will be needed.
Collapse
Affiliation(s)
- Karen S Ogle
- Michigan State University, Department of Family Medicine, East Lansing, MI 48824, USA.
| | | | | |
Collapse
|
16
|
Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2008:CD002213. [PMID: 18254002 DOI: 10.1002/14651858.cd002213.pub2] [Citation(s) in RCA: 197] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patient care is a complex activity which demands that health and social care professionals work together in an effective manner. The evidence suggests, however, that these professionals do not collaborate well together. Interprofessional education (IPE) offers a possible way to improve collaboration and patient care. OBJECTIVES To assess the effectiveness of IPE interventions compared to education interventions in which the same health and social care professionals learn separately from one another; and to assess the effectiveness of IPE interventions compared to no education intervention. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 1999 to 2006. We also handsearched the Journal of Interprofessional Care (1999 to 2006), reference lists of the six included studies and leading IPE books, IPE conference proceedings, and websites of IPE organisations. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client and/or healthcare process outcomes. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the eligibility of potentially relevant studies, and extracted data from, and assessed study quality of, included studies. A meta-analysis of study outcomes was not possible given the small number of included studies and the heterogeneity in methodological designs and outcome measures. Consequently, the results are presented in a narrative format. MAIN RESULTS We included six studies (four RCTs and two CBA studies). Four of these studies indicated that IPE produced positive outcomes in the following areas: emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; management of care delivered to domestic violence victims; and mental health practitioner competencies related to the delivery of patient care. In addition, two of the six studies reported mixed outcomes (positive and neutral) and two studies reported that the IPE interventions had no impact on either professional practice or patient care. AUTHORS' CONCLUSIONS This updated review found six studies that met the inclusion criteria, in contrast to our first review that found no eligible studies. Although these studies reported some positive outcomes, due to the small number of studies, the heterogeneity of interventions, and the methodological limitations, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. More rigorous IPE studies (i.e. those employing RCTs, CBA or ITS designs with rigorous randomisation procedures, better allocation concealment, larger sample sizes, and more appropriate control groups) are needed to provide better evidence of the impact of IPE on professional practice and healthcare outcomes. These studies should also include data collection strategies that provide insight into how IPE affects changes in health care processes and patient outcomes.
Collapse
Affiliation(s)
- S Reeves
- Wilson Centre for Research in Education, Department of Psychiatry, Li Ka Shing Knowledge Institute & Centre for Faculty Development, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
| | | | | | | | | | | | | |
Collapse
|
17
|
Voepel-Lewis T, Malviya S, Tait AR, Merkel S, Foster R, Krane EJ, Davis PJ. A Comparison of the Clinical Utility of Pain Assessment Tools for Children with Cognitive Impairment. Anesth Analg 2008; 106:72-8, table of contents. [DOI: 10.1213/01.ane.0000287680.21212.d0] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
18
|
Treece PD, Engelberg RA, Shannon SE, Nielsen EL, Braungardt T, Rubenfeld GD, Steinberg KP, Curtis JR. Integrating palliative and critical care: description of an intervention. Crit Care Med 2007; 34:S380-7. [PMID: 17057602 DOI: 10.1097/01.ccm.0000237045.12925.09] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care." This five-component intervention includes: 1) critical care clinician education to increase knowledge and awareness of the principles and practice of palliative care in the ICU, 2) critical care clinician local champions to provide role modeling and promote attitudinal change concerning end-of-life care, 3) academic detailing of nurse and physician ICU directors to identify and address local barriers to improving end-of-life care in each ICU, 4) feedback of local quality improvement data, and 5) system supports including implementation of palliative care order forms, family information pamphlets, and other system supports for providing palliative care in the ICU. The goal of this report is to describe the conceptual model that led to the development of the intervention, and for each of the five components, we describe the theoretical and empirical support for each component, the content of the component, and the lessons we have learned in implementing the component. Future reports will need to examine the ability of the interventions to improve outcomes of palliative care in the ICU.
Collapse
Affiliation(s)
- Patsy D Treece
- Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Bédard D, Purden MA, Sauvé-Larose N, Certosini C, Schein C. The Pain Experience of Post Surgical Patients Following the Implementation of an Evidence-Based Approach. Pain Manag Nurs 2006; 7:80-92. [PMID: 16931414 DOI: 10.1016/j.pmn.2006.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Effective pain management has been shown to promote earlier mobilization, adequate rest, reduced hospital stays, postoperative complications, and costs. A multidisciplinary quality improvement team worked together to develop and implement a comprehensive evidence-based program for postoperative pain management. The purpose of this study was to assess surgical patients' pain status, satisfaction, and beliefs with regard to pain management prior to (Phase 1) and following the implementation of the program (Phase II). On postoperative day two, patients rated their pain, its impact on their activity, and answered questions about pain management and their satisfaction with pain treatment. Significant differences were found between Phase I and Phase II patients. More patients in Phase II (83%) received evidence-based orders compared with patients in Phase I (35%). Patients in Phase II had lower pain scores and experienced fewer disturbances in sleep, walking, and general activities. Patients in Phase II were less likely to believe that good patients avoid talking about pain. The results suggest that addressing pain management through a variety of strategies targeted at the level of the institution, the clinician, and the patient may lead to desired changes in practice and better outcomes for patients.
Collapse
Affiliation(s)
- Denise Bédard
- Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada.
| | | | | | | | | |
Collapse
|
20
|
Hansson E, Fridlund B, Hallström I. Effects of a Quality Improvement Program in Acute Care Evaluated by Patients, Nurses, and Physicians. Pain Manag Nurs 2006; 7:93-108. [PMID: 16931415 DOI: 10.1016/j.pmn.2006.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hospitalized patients have a right to be assessed for pain and receive optimal pain management, but inadequate pain management is still widely prevalent. Different quality improvement (QI) approaches have been used to improve patients' experience of pain, with varied results. The aim of this study was to implement a QI program and evaluate its effects on pain management routines in acute care, experienced by patients, nurses, and physicians. A cross-sectional intervention study was conducted with patients, nurses, and physicians assigned to a control group for 2 months in 2002 and an intervention group for 2 months in 2003. Implementation of a QI program, including pain policy and an educational program for the health care professionals, was evaluated with questionnaires. Nurses' assessment of pain at rest and pain with movement with pain rating scales increased (p < .001) after the intervention. Nurses participating in the educational program increased their knowledge of pain and changed their pain management routines and search habits for pain-related websites on the Internet. The number of patients assessed with pain rating scales increased (p = .011), but no difference was seen in patients' experience of pain severity, interference with function, or use of nonpharmacologic methods. Younger and higher-educated patients seemed to prefer a more active participation role in their pain management than did older and low-educated patients. In future research it would be valuable to illuminate patients' possibilities to participate in pain management further and test different implementation methods with varied length of educational programs including follow-ups for the whole team and the patients in acute care.
Collapse
|
21
|
Abstract
Pain is a prevalent problem in community care and there is evidence that knowledge and understanding of pain management can be lacking among health professionals, leading to under-treatment. This mini-review aimed to assess the effectiveness of interprofessional education on health professionals' pain documentation and on the pain intensity reported by patients. A search of key databases identified two randomized controlled trials and two quasi-experimental studies. Two studies assessed change in pain documentation following interprofessional education; one revealed a statistically significant improvement and another indicated 29% increase in documentation of pain assessments. Two studies demonstrated no significant changes in patient outcomes, while the other revealed significant improvements. However, integration of the results was not possible because of the various methods of measurement used by the different researchers. Although broadly supportive of interprofessional education, the evidence is not helpful in determining the best way of improving pain management in the community.
Collapse
|
22
|
Strassels SA, McNicol E, Suleman R. Postoperative pain management: a practical review, part 2. Am J Health Syst Pharm 2005; 62:2019-25. [PMID: 16174838 DOI: 10.2146/ajhp040490.p2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The pharmacotherapy and assessment of postoperative pain in general pharmacy practice settings are reviewed. SUMMARY Numerous factors related to all levels of society and the health care system contribute to suboptimal treatment of postoperative pain, despite awareness of this challenge for at least the past 30 years and the availability of potent analgesics and tools to help clinicians care for persons with postoperative pain. The consequences of acute pain include clinical, economic, and patient-reported outcomes; thus, improving the treatment of postoperative pain has the potential to improve health care from a broad perspective. Opioids remain the cornerstone of treatment of postoperative pain. Multimodal analgesia also has the potential to improve the pharmacotherapy of postoperative pain. In addition to the appropriate use of drugs, it is important that clinicians be comfortable with equianalgesic dosage conversion, helping ensure that analgesic-related adverse effects are minimal, assessing pain and function, and incorporating this information into patient care. CONCLUSION Providing optimal management of postoperative pain is a vital goal for all health care providers. There is substantial potential for pharmacists to help meet this goal.
Collapse
Affiliation(s)
- Scott A Strassels
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA 98195, USA.
| | | | | |
Collapse
|
23
|
Manias E, Bucknall T, Botti M. Nurses’ Strategies for Managing Pain in the Postoperative Setting. Pain Manag Nurs 2005; 6:18-29. [PMID: 15917741 DOI: 10.1016/j.pmn.2004.12.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies.
Collapse
Affiliation(s)
- Elizabeth Manias
- School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 723 Swanston Street, Carlton, Victoria 3053, Australia.
| | | | | |
Collapse
|
24
|
Innis J, Bikaunieks N, Petryshen P, Zellermeyer V, Ciccarelli L. Patient Satisfaction and Pain Management. J Nurs Care Qual 2004; 19:322-7. [PMID: 15535537 DOI: 10.1097/00001786-200410000-00006] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The importance of assessing and managing pain has become paramount in today's hospital environment. Poor pain management is associated with impaired health, decreased patient satisfaction, and increased healthcare costs. This quality improvement project on an internal medicine unit at an urban teaching hospital examined the impact of pain education on patient satisfaction with pain management. Although pain scores did not improve, there were improvements made with respect to patient assessment, patient satisfaction, and nursing knowledge.
Collapse
Affiliation(s)
- Jennifer Innis
- Pain Service, St Michael's Hospital, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
25
|
Tcherny-Lessenot S, Karwowski-Soulié F, Lamarche-Vadel A, Ginsburg C, Brunet F, Vidal-Trecan G. Management and relief of pain in an emergency department from the adult patients' perspective. J Pain Symptom Manage 2003; 25:539-46. [PMID: 12782434 DOI: 10.1016/s0885-3924(03)00147-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To estimate the prevalence of pain in adult patients attending an emergency department (ED) and to identify risk markers for insufficient pain relief, a cross-sectional survey was conducted for 16 days, 24 hours each day, in the ED of a Paris university hospital. A structured questionnaire was used to collect characteristics of pain and its management from patients. Pain intensity was evaluated both on arrival and before discharge using two scales (a numerical descriptor scale or a verbal pain intensity scale). On arrival, 78% of the patients complained of pain; among them, 54% complained of intense pain and 47% suffered procedural pain. Insufficient pain relief was assessed in 289 (77%) patients. We identified the following risk markers for insufficient pain relief: moderate or low pain intensity, no intervention in the ED before the medical examination, and no use of medication before arrival.
Collapse
Affiliation(s)
- Stéphanie Tcherny-Lessenot
- Public Health Service, Hospital Group Cochin Saint Vincent de Paul, Faculty of Medicine, Cochin Port-Royal, Renë Descartes University, Paris, France
| | | | | | | | | | | |
Collapse
|
26
|
Klotz RS, McNicol E, Sansgiry SS, Shringarpure GS, Stumpf JL, Walker PC, Berardi RR, Kaplan LL. Payment for Services, Pain Management Needs, OTC Confusion. J Am Pharm Assoc (2003) 2003. [DOI: 10.1331/154434503321831030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
27
|
Carlson J, Youngblood R, Dalton JA, Blau W, Lindley C. Is patient satisfaction a legitimate outcome of pain management? J Pain Symptom Manage 2003; 25:264-75. [PMID: 12614961 DOI: 10.1016/s0885-3924(02)00677-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Though many studies have measured patient satisfaction with pain management using the American Pain Society (APS) Satisfaction Survey or its variants, little is known about the relationship among the survey items, or whether items relate to satisfaction at all. In an effort to refine the measurement of patient satisfaction, a modified version of the APS survey, which was given to 787 patients as part of a study of postoperative pain management in six community hospitals, was subjected to principal components analysis to determine the survey's empirical structure. Correlations among the five components found were low; a weak relationship (r = -0.24) was discovered between pain intensity and satisfaction. A heuristic model estimated by structural equations analysis yielded additional insights. Though many items thought to influence patient satisfaction were not closely related to patient-reported satisfaction, they indicate important clinical factors relevant to quality of care, and thus, to continuing quality improvement (CQI) efforts. Results suggest that satisfaction was influenced by effectiveness of medication, independent of pain intensity, and by communication. Pain severity ratings near the time satisfaction was measured were more influential than earlier ratings.
Collapse
Affiliation(s)
- John Carlson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA
| | | | | | | | | |
Collapse
|
28
|
Bell A, Wheeler R. Improving the pain management standard of care in a community hospital. CANCER PRACTICE 2002; 10 Suppl 1:S45-51. [PMID: 12027969 DOI: 10.1046/j.1523-5394.10.s.1.11.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this article is to outline the development, implementation, and progress of one community hospital in improving the pain management standards of care and to describe why collaboration within the community and with a nationally recognized research facility, such as the City of Hope in California, is beneficial for the educational needs of a community-based hospital and for a framework-improvement model of pain management. OVERVIEW Most patients with cancer receive care in community facilities. It is essential that optimal pain relief be provided to these patients. A model used by Mercy Health Center in Oklahoma demonstrates how community facilities can tap into national resources. The adaptation of research and educational information that was made available by the City of Hope National Medical Center has allowed multiple strategies to be implemented to target pain management education and clinical practice effectively to meet the American Pain Society quality improvement standards. Ongoing data collection and monitoring of pain management outcomes can provide direction and support for improved pain management patient satisfaction and other pain management outcomes. With continuous quality improvement monitoring, education, and administrative support, a pain management patient "safety net" can been developed to improve the standard of care for all patients within the organization. CLINICAL IMPLICATIONS Effective pain management according to accepted national clinical standards can be implemented and improved on by adapting national resources to guide multidisciplinary strategic planning.
Collapse
Affiliation(s)
- Anita Bell
- Mercy Health Center, Oklahoma City, Oklahoma 73120, USA
| | | |
Collapse
|
29
|
|
30
|
Abstract
BACKGROUND In the last decade, there has been heightened awareness that pain management needs to be a priority for all health care settings and clinicians. The article will overview practice guidelines and new technology, and assess their impact on pain relief in inpatient and outpatient surgeries from a patient's perspective. METHODS Literature was retrieved by searches from 1996 to 2000 Medline and CINAHL (nursing database), using keywords "postoperative pain," "postsurgical pain," "patient outcomes," "pain outcomes," "survey," "questionnaire," and "practice guidelines." RESULTS Overall, current practice standards have had minimal impact on decreasing patients' reports of pain. The incidence of moderate to severe pain with cardiac, abdominal, and orthopedic inpatient procedures has been reported as high as 25% to 50%, and incidence of moderate pain after ambulatory procedures is 25% or higher. CONCLUSIONS Despite the advances, the incidence of pain remains high. Yet the future is promising, with new standards from the Joint Commission on Accreditation of Health care Organizations paving the way for reduction of institutional barriers and improved implementation of guidelines.
Collapse
Affiliation(s)
- N Huang
- University of Illinois College of Pharmacy, M/C 886, 833 S. Wood St., Rm. 164, Chicago, IL 60612-7230, USA
| | | | | | | |
Collapse
|
31
|
Chapman CR, Lande SD, McCarberg BH, Nash DB. Pain Control in Healthcare Organizations: Developing Effective Disease Management Programs. ACTA ACUST UNITED AC 2001. [DOI: 10.1089/10935070152596016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - David B. Nash
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
32
|
Abstract
In recent years, increased emphasis has been placed on the ethical duty of physicians to relieve pain and suffering. According to a 1992 report from The Agency for Health Care Policy Research (AHCPR), the "ethical obligation to manage pain and relieve the patient's suffering is at the core of a health care professional's commitment." However, despite the increased emphasis on the ethical duty to relieve pain, the undertreatment of pain continues to be a serious problem. This problem has been widely discussed, but so far efforts to respond to it have focused almost exclusively on institutional and educational solutions. Yet surprisingly in this discussion very little attention has been paid to articulating a constructive role for the patient in combating this problem. In this article I argue that adequate pain treatment will often require the active participation of the patient in the decision making process. Given the special nature of pain and the special problems that arise in the treatment of pain, adequate pain treatment requires that physicians and patients realize a particular model of shared decision making--one that I refer to as deliberative decision making. As will become clear, my defense of this model is limited to the context of pain management and may not apply in other clinical contexts.
Collapse
Affiliation(s)
- L A Jansen
- New York Medical College, John J. Conley Department of Ethics, St. Vincent's Hospital/Medical Center, New York, New York, USA.
| |
Collapse
|
33
|
Cullen L, Greiner J, Titler MG. Pain Management in the Culture of Critical Care. Crit Care Nurs Clin North Am 2001. [DOI: 10.1016/s0899-5885(18)30046-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Dalton JA, Carlson J, Blau W, Lindley C, Greer SM, Youngblood R. Documentation of pain assessment and treatment: how are we doing? Pain Manag Nurs 2001; 2:54-64. [PMID: 11706771 DOI: 10.1053/jpmn.2001.23918] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this analysis was to evaluate documentation of practice provided by a multidisciplinary team of nurses, physicians, and pharmacists who participated in an educational program on postoperative pain management. Chart audit of 787 patient charts at 6 sites revealed documentation of pain histories in approximately 75% of the charts, most often in the surgeon's history and physical examination. Examination of multiple assessment items indicated that the experimental group, relative to the control group, experienced an increase of more than 10% in the documentation of pain intensity, pain quality, pain duration, numeric rating scale used, pain behavior, factors that increase pain, vital signs, sedation level, cognitive status, social interaction, and mood from before the program to 6 months after the program. Across all sites, documentation of assessment, treatment, and treatment outcome data was infrequent and inconsistent. Calculation of documentation of 4 items that constituted a focused assessment of postoperative pain on the surgical floor revealed a significant program effect for assessment of pain quality and pain intensity. A postprogram survey of participants in the educational program revealed an increase in discussion of postoperative pain management with other practitioners and an increase in use of a 0 to 10 scale to rate pain. More documentation of patient pain history, clinical problems, treatment, and follow-up action is needed to improve practice and research.
Collapse
Affiliation(s)
- J A Dalton
- School of Nursing, CB# 7460, Carrington Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Greer SM, Dalton JA, Carlson J, Youngblood R. Surgical patients' fear of addiction to pain medication: the effect of an educational program for clinicians. Clin J Pain 2001; 17:157-64. [PMID: 11444717 DOI: 10.1097/00002508-200106000-00008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The appropriate and optimal use of analgesics is essential for the adequate management of postoperative pain. Concern that use of opioid analgesics contributes to the development of addiction is a barrier to effective pain relief. The purpose of this study was to determine the prevalence of fear of addiction in postoperative patients in relation to surgical outcomes and staff participation in an educational program. DESIGN Two treatment levels (program vs. control) and three data collection periods (before program, immediately after the program, and 6 months after the program). SETTING Six community hospitals with 100-500-bed capacities in a southeastern state. PATIENTS Seven hundred eighty-seven patients who had undergone orthopedic or laparotomy procedures. INTERVENTIONS Staff at three of the six hospitals received an educational program to promote implementation of Agency for Health Care Policy and Research acute pain management guidelines. OUTCOME MEASURES Patient report of preoperative and postoperative fear of addiction, satisfaction with pain treatment, communication with clinicians, and pain intensity. RESULTS Only 10.8% of the sample reported preoperative or postoperative fear of addiction. Staff participation in the educational program was found to decrease fear of addiction in this sample. Fear of addiction was also related to surgery type, with disc surgery patients more likely to report fear of addiction as compared with patients undergoing other types of surgery. Fear of addiction was not related to other outcomes in this sample. CONCLUSIONS Fear of addiction is not prevalent among postoperative patients, yet clinician education can further decrease the proportion of surgical patients who fear of addiction to pain medication.
Collapse
Affiliation(s)
- S M Greer
- School of Nursing, University of North Carolina at Chapel Hill, USA.
| | | | | | | |
Collapse
|
36
|
Furrow BR. Pain management and provider liability: no more excuses. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2001; 29:28-51. [PMID: 11521268 DOI: 10.1111/j.1748-720x.2001.tb00038.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Pain is undertreated in the American health-care system at all levels: physician offices, hospitals, long-term care facilities. The result is needless suffering for patients, complications that cause further injury or death, and added costs in treatment overall. The health-care system's failure to respond to patient pain needs corrective action. Excuses for such shortcomings are simply not acceptable any longer.Physicians have long been accused of poor pain management for their patient. The term “opiophobia” has been coined to describe this remarkable clinical aversion to the proper use of opioids to control pain. If the professional mandate of the health-care professional is to relieve suffering, then physicians are falling far short of their obligations by accepting myths about the use of opioids in the face of evidence to the contrary.
Collapse
|
37
|
Sherwood G, Adams-McNeill J, Starck PL, Nieto B, Thompson CJ. Qualitative assessment of hospitalized patients' satisfaction with pain management. Res Nurs Health 2000; 23:486-95. [PMID: 11130607 DOI: 10.1002/1098-240x(200012)23:6<486::aid-nur7>3.0.co;2-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patient evaluations of effectiveness of care and satisfaction with care are useful outcome indicators of pain management. The subiective, multidimensional nature of pain is best evaluated when outcome measures include the richness of qualitative data to more fully capture the range of patient experiences. A descriptive qualitative component was added to the American Pain Society Patient Outcome Questionnaire--Modified (1995) to determine critical indicators in the pain experience affecting patient satisfaction. Four themes emerged from the data as factors affecting patient satisfaction or dissatisfaction: Patient Pain Experience, Patient Views of Health Care Providers, Patient Pain Management Experiences, and Pain Management Outcomes. The result is a typology of factors affecting patient reports of satisfaction. Satisfaction was most likely when providers effectively addressed pain control with the patient as an informed partner. Patients expressed dissatisfaction, even when pain was relieved, when providers appeared uncaring, were slow to respond, or lacked knowledge and skill. Our results offer clinicians new insights into how patients respond to pain, which could enable development of patient-oriented approaches to pain management improving quality and effectiveness of care and increasing patient satisfaction.
Collapse
Affiliation(s)
- G Sherwood
- Community and Educational Outreach, School of Nursing, The University of Texas-Houston Health Science Center, 77030, USA
| | | | | | | | | |
Collapse
|
38
|
Dalton JA, Carlson J, Lindley C, Blau W, Youngblood R, Greer SM. Clinical economics: calculating the cost of acute postoperative pain medication. J Pain Symptom Manage 2000; 19:295-308. [PMID: 10799796 DOI: 10.1016/s0885-3924(00)00105-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few data are available that address the cost of postoperative pain management, although such knowledge would enhance our understanding of caregiver choices related to direct medical costs, such as type, frequency, and route of medication. This article describes the cost of postoperative pain medications before and after an educational program provided to nurses, pharmacists, and physicians in six community hospitals. Medication costs were calculated by averaging across all brands the average wholesale price of the most common dose administered in the sample for each medication. The median cost of postoperative pain medication across all days, all surgeries, was $9.46. Calculating the cost of acute postoperative pain medication suggested that cost over stay is highly influenced by the use of a few expensive medications. The relationship of medication cost to length of stay (LOS), function, and pain intensity is discussed.
Collapse
Affiliation(s)
- J A Dalton
- School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
The number of elderly, both in society at large and in the critical care population, is increasing at an unprecedented rate. Critical care nurses must address how best to provide care to these elders. The authors focus on physiologic, cognitive, and psychosocial characteristics of the elderly that place them at risk for complications during their stay in critical care. The critical care environment also contributes to complications such as sleep deprivation, sensory deprivation or overload, painful procedures, and decreased social support. The critical care environment may also be a factor in facilitating delirium, common in critically ill elders. Critical care nurses can proactively help to create a healing environment for these elders by facilitating sleep, implementing strategies to reduce delirium, preventing or minimizing painful experiences, and liberalizing family visitations.
Collapse
Affiliation(s)
- D F Tullmann
- Department of Nursing, California State University, Bakersfield, USA
| | | |
Collapse
|