Nurses' knowledge and skills in colonoscopy patients' pain management

Nurses' experiences of providing nonpharmacological pain management in palliative care: A qualitative study

AIM AND OBJECTIVES

To explore the experiences and views of nurses who provide nonpharmacological therapies for chronic pain management in palliative care.

BACKGROUND

Nursing expertise in palliative care is essential in providing pain relief to patients with chronic diseases. Examinations of the use of nonpharmacological therapies for chronic pain management in palliative care have revealed what nonpharmacological therapies have been used, but there is insufficient knowledge regarding nurses' attitudes, views and experiences regarding pain therapies in this context.

DESIGN

A qualitative descriptive design was chosen.

METHODS

Data were collected through individual interviews in a purposive sample with 15 nurses to ensure maximum variation. The data were analysed using qualitative content analysis. This study aligns with the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

The analysis yielded four categories, as follows: "building and sustaining favourable therapeutic relationships" involved the creation of trust and a solid relationship; in "recognising the diversity of patients' needs," person-centred care is expressed as being vital for individualised nonpharmacological pain management; "incorporating significant others" describes how nurses can help to ease the patient's pain by identifying positive encounters with family members or friends; and in "recognising the existence of barriers," nurses highlight vulnerable groups such as children, for whom nurses require special education to enable optimal nonpharmacological pain management.

CONCLUSION

The unique knowledge that nurses gain about the patient through the nurse-patient relationship is central and crucial for successful nonpharmacological pain management.

RELEVANCE TO CLINICAL PRACTICE

This study emphasises the need for nurses to get to know their patient and to be open and sensitive to patients' descriptions of their unique life situations, as this provides the necessary knowledge for optimal care and pain management. Nurses should be encouraged and given the opportunity to attend specialised training in palliative care and pain management.

The Colorado Behavioral Numerical Pain Scale in assessing medication-free colonoscopy patients' pain

Pain scales have been tested in clinical settings, but rarely with colonoscopy. The aim of this study was to evaluate the Colorado Behavioral Numerical Pain Scale (CBNPS) when assessing medication-free colonoscopy patients' pain intensity. During the first phase in 2005, the expert panelists (n = 17) described medication-free colonoscopy patients' behavior on a scale ranging from 0 to 5 scale. The descriptions were analyzed by quantitative and qualitative content analysis and compared with those of CBNPS. During the second phase in 2006, data from 138 medication- free colonoscopy patients and 11 nurses were collected using questionnaires (CBNPS, visual analogue scale [VAS], and verbal rating scale [VRS]) and analyzed statistically. The descriptions made by expert nurses were found similar to those of the CBNPS. Nurses' estimations with the CBNPS, VAS, and VRS of patients' pain were correlated with each other. According to our results, the CBNPS is an adequate instrument when assessing patients' pain intensity during medication-free colonoscopy. It provides an opportunity to evaluate the total pain intensity and the pain during the phases of the procedure. It is also a proper tool for improving nursing documentation. Results from this study highlight the need for further research to examine the pain scales.

Current nursing models in endoscopy centers

Endoscopic examination and therapy as a special clinical approach can currently be performed in many large general hospitals. With the rapid development and wide utilization of endoscopic techniques in clinical practice, relevant nursing techniques and skills are becoming more complicated. In this article, we discuss the nursing models in endoscopy centers. It seems to be important to adopt centralized and integrated management system in endoscopy centers to protect the rights and interests of patients and guarantee their health and safety.

Endoscopy: a guide for the registered nurse

As an invasive procedure, endoscopic studies require patient care and considerations that are very similar to minor surgical procedures. There are some general guidelines that are applicable to all endoscopic procedures, and there are special considerations that are dictated by the specific endoscopic procedure. It is important for the critical care nurse to understand the procedures because the differences and similarities of each procedure guide nursing actions to effect the best patient outcomes.

Medication-free colonoscopy--factors related to pain and its assessment

AIM

This paper is a report of a study conducted to determine the possibility of performing colonoscopy without medication, elucidate the factors related to a painful colonoscopy experience and compare colonoscopy patients' reported pain assessment to nurses' and endoscopists' observations.

BACKGROUND

Sedation and pain medication are routinely administered for colonoscopies in many countries. However, medication-free colonoscopies have attracted attention because the use of medication requires a time commitment from patients and increases complications. Earlier studies show that, for instance, gender, age and pelvic operations may increase the risk of painful colonoscopy and those healthcare professionals and patients appear to assess pain differently.

METHOD

A cross-sectional descriptive study was conducted in a Finnish university hospital using questionnaires developed for this study and analysed statistically. The sample of 138 colonoscopy patients, 11 nurses and 11 endoscopists was recruited in 2006.

RESULTS

Over three-quarters of patients reported mild pain or no pain at all. Patients' nervousness is a risk factor for experiencing pain during colonoscopy. Both nurses and endoscopists slightly underestimated the intensity of pain experienced by patients.

CONCLUSION

It is possible to perform colonoscopy without medication with most patients and focus sedation and pain medication on at-risk patients, especially those who are nervous. Before the procedure, nurses must devote time to discovering which patients are nervous and at risk of having a painful colonoscopy to present them for sedation. To improve pain management for patients having colonoscopy, endoscopists and nurses should participate systematically in pain education and use pain scales.

Pilot feasibility study of the method of water infusion without air insufflation in sedated colonoscopy

One study in sedated patients demonstrated a reduction in pain score but not midazolam dosage when warm water infusion was used to manage colonic spasm. We describe pilot data with a modified warm water infusion technique. We tested the hypothesis that patients receiving even only half of the usual dose of sedation medications would have acceptable cecal intubation and tolerate the procedure well, based on retrospective review of prospectively collected data from a single Veterans Affairs (VA) medical center. Group 1 included 32 consecutive patients who received full-dose and group 2 included 43 consecutive patients who received half-dose premedication. Insertion of colonoscope was aided by warm water infusion in lieu of air insufflation. Pain scores during insertion, cecal intubation rate, and total amount of medications were monitored. The novel technique permitted equal cecal intubation rate at reduced total dose of medications. Pain scores were not significantly different. The uncontrolled nonrandomized observational nature of the data is one limitation. The nonsignificant difference in pain scores may be affected by a type II error. These pilot data suggest that insertion is feasible without air when water infusion is used. The novel technique may be a useful adjunct for minimizing the dosage of sedation medications without adversely affecting cecal intubation. Further study is needed to compare air insufflation and water infusion with regard to patient tolerance and success, particularly in the presence of an on-demand sedation policy.

Effects of patients' anxiety, previous pain experience and non-drug interventions on the pain experience during colonoscopy

AIMS

This paper is a report of a study evaluating anxiety in patients prior to colonoscopy and identifying correlations between that anxiety, previous pain experience, non-drug interventions and pain intensity during colonoscopy.

BACKGROUND

Waiting for forthcoming procedures, such as colonoscopy, is stressful. However, a few studies have evaluated the influence of patients' anxiety, previous pain experience and non-drug interventions during colonoscopy.

DESIGN

A quantitative cross-sectional survey design was used. The data were collected from colonoscopy patients by using the Spielberger State Trait Anxiety Inventory and a questionnaire developed for the study.

METHODS

We assigned one hundred and thirty patients scheduled for diagnostic colonoscopy in a Finnish university hospital during 2006. Patients completed the State Trait Anxiety Inventory before and a questionnaire developed for the study after colonoscopy.

RESULTS

Most of the patients suffered from pain but they considered it to be tolerable. Women were more anxious before colonoscopy and experienced more pain and discomfort than men. Previous pain experiences and high state anxiety level decreased patients' perceptions of colonoscopy. Non-drug interventions, such as peaceful talk, explanation of the reason for pain and guidance helped both anxious and non-anxious patients to ease the pain.

CONCLUSION

Awareness and understanding of previous pain experiences and anxiety levels in patients are essential and must be taken into account.

RELEVANCE TO CLINICAL PRACTICE

Colonoscopy patients' clinical education should be developed so as to be more individual. Furthermore, nurses should be better aware of the positive effects of non-drug interventions and should use them as an element of pain management for colonoscopy patients.