Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: a knowledge, attitudes and practices survey

Care Priorities for Individuals with Lower Extremity Amputations: A Patient Delphi Study

OBJECTIVE

To gather preliminary evidence on short- and long-term care priorities for people with lower extremity amputations.

DESIGN

A three-round modified Delphi study using semi-structured interviews.

PARTICIPANTS

A convenience sample of 20 adult participants who had undergone lower extremity amputations at a tertiary public hospital.

MAIN MEASURE

Consensus on each care priority was defined a priori as an agreement of more than 50%. Semi-structured interviews were conducted to understand the rationales for endorsing the care priorities.

RESULTS

Consensus was reached on 24 short-term care priorities and 12 long-term care priorities in the biomedical, practical and psychological and spiritual domains. The rationales for endorsing each of the care priorities generated three themes: preparedness; mental health, psychological and spiritual well-being; and participating in life, with respect and dignity.

CONCLUSIONS

Our results highlight the substantial need to improve patient access to education and planning support prior to undergoing limb amputation, and optimising post-amputation rehabilitation programmes, enabling people with amputations to participate in meaningful life roles that provide them with purpose, dignity, and self-respect. The knowledge of care priorities revealed in this study may promote effective patient-centred care and improve clinical outcomes.

Acute Pain Management and Perceptions among Emergency Healthcare Workers: Feedback from Greece

Background and Aims

Pain remains the most common reason patients seek assistance in emergency rooms. However, the level of pain management during emergencies, and subsequently during disasters and mass casualty incidents, remainsdisturbing.

Methods

A cross-sectional study was conducted using a structured anonymous questionnaire among a random sample of doctors working in different tertiary hospitals of Athens and of rural regions. The data were analysed using descriptive statistics and statistical significance tests via R-Studio, version 1.4.1103.

Results

The aforementioned sample yielded101 questionnaires. Results show suboptimal knowledge and attitudes regarding acute pain management among emergency healthcare providers in Greece. The majority of responders are unaware of the term multimodal analgesia (52%), of newer pain treatment methods (59%), they have not attended pain management seminars (84%), nor are they aware of pain treatment protocols in their workplace (74%). Participants appeared to disregard successful pain relief due to time constraints (58%), while leaving certain parts of the population (children under 3 years of age -75%, pregnant women-48%) significantly undertreated in terms of analgesia. Demographic correlations showed that clinical experience and pain management education were associated with older and more experienced emergency healthcare workers. Specialties with a previous core training containing pain education (anaesthesiologists, emergency physicians) again showed better results in the majority of the questions.

Conclusions

Educational programs/seminars along with standardised algorithms should be developed in order to cover existing needs and misconceptions.

Polish Experiences of Pain Treatment by Paramedics in relation to Good Practices of Pain Treatment: A Register-Based Study

Background

Pain is frequently encountered in the prehospital setting. The treatment of pain is one of the priority activities for paramedics.

Methods

1048576 patients under the care of EMS over a 7-month period were included in this study. Data included using pain scale and pain score, the initial diagnosis, analgesic treatment and the given drug obtained from the Ambulance Emergency Procedure Cards.

Results

The complete absence of pain was detected in 43.9% (95% CI 43.8–44.0) of patients, mild pain in 17.0% (95% CI 16.9–17.1), moderate pain in 11.6% (95% CI 11.5–11.7), and severe pain in 4.9% (95% CI 4.9–4.9) of cases. In 22.5% (95% CI 22.4–22.6), no pain rating scale was used. 98.0% (95% CI 97.9–98.1) of patients with mild, 96.1% (95% CI 96.0–96.2) with moderate, and 94.0% (95% CI 93.9–94.1) with severe pain did not receive any pain medication. The most commonly used drugs in all groups were metamizole and ketoprofen. The greatest analgesic effect was observed in the group of patients with severe pain. Pain decreased by an average of 3.2 NRS points in the drug-free group and 3.1 NRS points in the treated group. The most commonly documented diagnoses in all groups of patients were signs and diseases not classified in other groups (ICD-10 R00-R99), injuries and consequences of external causes (ICD-10 S00-T98), and diseases of the circulatory system (ICD-10 I00–I99).

Conclusions

Paramedics may use a variety of medications but use them rarely. Adding metamizole to the list of medications used by paramedics has made it one of the most commonly used drugs. Regardless of whether the drug was used or not, the analgesic effect was similar.

Managing acute abdominal pain in the emergency centre: Lessons from a patient's experience

Pain is one of the most common reasons people present to the emergency centre with 7-10% of presentations being due to acute abdominal pain. However, pain is also often neglected by clinicians in emergency centres. The well validated South African Triage Score (SATS) incorporates pain assessment in the prioritising of patients with the aim of guiding clinicians. Based on the SATS, severe pain (a score of ≥8 out of 10) should prompt the clinician to initiate treatment within 10 min of presentation, as unmanaged pain has multiple negative consequences, including poor outcomes of the acute incident with delayed healing and increased risk of developing chronic pain. In this commentary, we present a patient's experience when attending an emergency centre for acute abdominal pain, describe relevant pain mechanisms and highlight the stages where clinical management could have been optimised.

A Nonrandomized Pretest Posttest Study on the Impact of an Educational Pain Management Program on Nurses' Knowledge and Attitudes Regarding Pain in a Middle Eastern Country

BACKGROUND

Although nurse's knowledge and attitudes regarding pain management has been sufficiently studied worldwide, the impact of an educational intervention program in improving such attitudes and knowledge has not been likewise researched, especially in Middle Eastern countries.

AIMS

To examine nurses' knowledge and attitudes regarding pain at a university hospital in Lebanon before and after the introduction of a pain management educational program. And to assess the relationship between the characteristic of nurses and their pain knowledge.

METHODS

Design; A nonrandomized pretest posttest study design was used. Setting; A university hospital in Lebanon. Participants; Included 183 nurses using the Nurses' Knowledge and Attitudes Survey Regarding Pain questionnaire. The pain educational intervention was based on the principles of Ajzen's theory of planned behavior.

RESULTS

A significant difference between the pre and post test scores was noted (p = .016). Questions answered correctly by 80% of participants were related to questions about pain, pain assessment and management, and questions related to medications, such as correct dosages and opioid side effects were not answered correctly by the majority of nurses. There were significant associations between test scores and the nurses' educational level, their age, and their years of experience. Nurses who worked in critical care units, the emergency department and oncology had higher scores than nurses who worked on general units.

CONCLUSIONS

Despite the intensive pain education provided at our institution, the pain knowledge of nurses remains below that recommended level which indicates a dire need for more intensive and continuous education in order to provide a pain free environment.