Search

Aim: To explore registered nurses' experiences with pain management in patients with opioid use disorder (OUD) in home care., Design: Qualitative explorative-descriptive design., Methods: Data were collected via nine individual semi-structured interviews with registered nurses working in home care meeting patients with OUD. Data were analysed using systematic text condensation., Results: Three categories were identified: Reciprocity in relationships and a professional approach enhance pain management; Discrepancies between guidelines, patient-reported pain and RNs' observations challenge pain management; and Interprofessional collaboration makes or breaks pain management., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

This study aims to evaluate the impact of integrating pain nursing with hospice care on the quality of life among patients with advanced lung cancer. This study involving 60 advanced lung cancer patients admitted from January 2022 to January 2023. Participants were randomly assigned to 2 groups: the observation group received a combination of pain nursing and hospice care, while the control group received standard nursing care. The study assessed changes in the numeric rating scale for pain, self-rating anxiety scale (SAS), self-rating depression scale (SDS), cancer fatigue scale (CFS), death attitude, and various quality of life dimensions as measured by the Quality of Life Questionnaire-Core 30. Post-intervention, both groups exhibited reductions in numeric rating scale, SAS, SDS, and CFS scores compared to baseline, with more significant improvements observed in the observation group (P < .05). Additionally, post-intervention scores for death attitude and Quality of Life Questionnaire-Core 30 domains (physical, cognitive, social, role, and emotional functioning, as well as overall health) increased in both groups, with the observation group showing greater improvements than the control group (P < .05). The combination of pain nursing and hospice care significantly reduces pain, anxiety, and depression, decreases cancer-related fatigue, and improves the quality of life and death attitudes in patients with advanced lung cancer, highlighting the benefits of this integrative approach in palliative care settings., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

To investigate the effects of refined nursing strategies on postoperative quality of life, pain level, psychological condition, and other rehabilitation training of patients with cervical spondylosis. This study is a retrospective study, and 500 patients with cervical spondylosis admitted to our hospital from April 2022 to June 2023 were selected as the study objects. They were divided into a control group (250 cases) and an experimental group (250 cases) according to whether they received personalized intensive care. The control group received standard nursing care, while the experimental group was given personalized, high-quality nursing care. The refined nursing strategy comprises individualized rehabilitation training plans, psychological support, nutritional counseling, and pain management. Indicators such as pain level, cervical spine function, quality of life, complication statistics, and nursing satisfaction were employed to evaluate the clinical efficacy of 2 nursing methods. In the pain assessment, patients in the experimental and control groups had pain scores of (1.98 ± 0.84) and (5.78 ± 0.63), respectively, after the nursing intervention. The reduction in pain for patients in the experimental group was highly significant (P < .05) compared to pre-nursing care. Six months after the commencement of healthcare, the cervical spine function scores of the experimental and control groups were (93.36 ± 4.74) and (82.68 ± 5.42), respectively. Moreover, the cervical spine function recovery of the experimental group was deemed significant. The experimental group exhibited a lower probability of complications compared to the control group. Additionally, the quality of life was significantly higher in the experimental group than in the control group (P < .05). Improvement time and healing time were significantly shorter in the patients of the experimental group in comparison to the control group. In terms of nursing satisfaction, the experimental group had a significantly higher satisfaction rate of 87.57% than the control group (P < .05). The refined nursing strategy significantly improved the speed and quality of patients' functional recovery. Additionally, the implementation of personalized and comprehensive nursing techniques during postoperative treatment for cervical spondylosis resulted in a significant improvement in patient's quality of life and satisfaction with the treatment process., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To understand nursing team perceptions about the barriers in pain management in the care of hospitalized children., Method: Descriptive-exploratory study, with a qualitative approach, conducted with eight nurses and seven nursing technicians. Data were collected at the Universidade de São Paulo University Hospital, between June and September 2022, through individual interviews, analyzed from the perspective of thematic content analysis and in the light of Symbolic Interactionism., Results: The following categories emerged: 1) Knowledge translation: is pain management actuallyperformed? and 2) Reflecting changes: how to achieve the potential of pain management? Professionals have theoretical knowledge about pain management, however, they listed numerous barriers at each stage, mainly related to institutional routine, and, when reflecting on this context, they indicated the need for an institutional protocol., Final Considerations: Barriers stand out from theoretical knowledge and make pain management for hospitalized children disregarded. Knowing this context is relevant forimplementing change strategies.

Background. Postoperative pain is a common problem among intensive care patients. Pain management includes pain assessment and documentation, patient care, and pharmacological treatment. Materials and methods. The study used a prospective, cross-sectional design. Nineteen intensive care nurses and 72 intensive care patients after cardiac surgery with sternotomy approach were studied. Toronto Pain Management Inventory was used to assess nurses and the 2010 Revised American Pain Society Patient Outcome Questionnaire was used to assess the patients. A research protocol was used to document pharmacological treatment data and Visual Analog Scale (VAS) pain measurements. The pharmacological therapy data was available for 72 patients, but patient satisfaction measurements were acquired from 52 patients. Results. Postoperative pain for intensive care patients after cardiac surgery is mostly mild (68.66%). Pain intensity had a tendency to decrease over time, from a mean VAS score of 4.66 two hours after extubation to a mean VAS score of 3.12 twelve hours after extubation. Mostly opioids (100%) and nonsteroidal anti‑inflammatory drugs (NSAIDs, 77.8%) were used for pharmacological treatment, and treatment was adjusted according to pain levels and patient needs. Patient satisfaction regarding pain management in the first 24 hours after surgery was high (94.2%), even though the nurses’ pain knowledge was average (X = 60.6 ± 7.3%). Conclusions. An individualized pain management plan requires pain documentation and ensures high patient satisfaction. Pain levels after cardiac surgery with sternotomy approach are mostly mild and patient satisfaction is high.

The American Association of Nurse Anesthesiology Practice Committee and subject matter experts recently evaluated newly published cannabis guidelines titled "ASRA Pain Medicine Consensus Guidelines on the Management of the Perioperative Patient on Cannabis and Cannabinoids." A summative review of the evidence-based guidelines provides essential recommendations, which are directly applicable to certified registered nurse anesthetist clinical practice., Competing Interests: Name: Daniel King, DNP, CRNA, CPPS Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Ewa Greenier, MPH, MBA, CAE Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Maya Caballero, MPH Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Brett Morgan, DNP, CRNA, FAAN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © by the American Association of Nurse Anesthetists.)

Background: Pain is an unpleasant sensory and emotional experience associated with or resembling that actual or potential tissue damage. Different study findings show that about 55% to 78.6% of inpatients experience moderate-to-severe pain. Nurses are one of the health professional who may hear of pain suffered by the patients and who can manage patient suffering by themselves. Therefore, their correct skill is very important in non- pharmacology and pharmacology pain management methods., Objective: To assess non-pharmacological pain management practice and barriers among nurses working in Debre Tabor Comprehensive Specialized Hospital, Ethiopia., Methods: Data were collected using structured observational check list with interviewer administered questionnaires that measure nurses' practice on non-pharmacological pain management. Data were entered using Epi Data version 3.1 and analyzed using SPSS (Stastical Package for Social Sciences) version 23. Bivariable and multivariable analysis were conducted to examine the association between independent and outcome variables., Results: A total of 169 nurses participated in the study, with a response rate of 100%. Among the study participants 94 (55.6%) were females, and the mean age of nurses were 34.9(SD = 5.7) years. Only 44(26%) of nurses had good practice on non- pharmacology pain management methods. About 130(77.55%), 125(74.0%), and 123(72.8%) of nurses reported that inadequate cooperation of physicians, multiple responsibilities of nurses and insufficient number of nurses per patient ratio as barriers for practice of non -pharmacology pain management respectively., Conclusion: Majority of nurses didn't apply non-pharmacological pain management practices for their patients in pain and the overall practice level of nurses was very poor. The major identified obstacle factors for the poor practice of non-pharmacological pain management methods were nurses' fatigue, inadequate cooperation of physicians, heavy workload, multiple responsibilities of nurses, and insufficient number of nurses per patient ratio and unfavorable attitude of nurse on non-pharmacology pain management. Even if nurses experiences different challenges, they shall use non-pharmacological pain management methods complementary to pharmacological treatment of pain as they are low cost and safe. And also boosting nurse's attitude towards the effect of non-pharmacological pain management methods is crucial., Competing Interests: The authors have declared that no competing interests exist.

Competing Interests: The authors have no conflicts of interests to disclose.

Background: Pain management is a very important aspect of nursing care among postoperative patients. Deficit in the knowledge and bad attitude towards pain management among nurses remain a problem in Ghana. In order to manage pain better in the surgical wards, nurses should be well equipped with knowledge of pain assessment and management., Purpose: The purpose of the study was to determine nurse's knowledge and attitude towards pain management among postoperative patients in surgical units in Ghana. Methodology . This study used the quantitative study approach with a descriptive cross-sectional study design. A sample of 211 nurses was recruited using the convenience sampling method. Data were collected using a questionnaire regarding postoperative pain management. Descriptive statistics, Pearson's correlation coefficient, and the chi-squared test were used to analyze the data using SPSS version 16.0., Results: The mean age of the nurses was 29.77, with the youngest nurse being 23 years and oldest being 39 years. Majority (72.5%) of nurses had moderate knowledge, and 89.6% of the nurses had negative attitude towards pain management. There was no significant relationship between nurse's knowledge and years of experience as a nurse (r = -0.03, p =0.64), as well as no significant relationship between knowledge and number of years working in the surgical ward (r = 0.06, p =0.36). Also, there was no significant relationship between nurses' knowledge and nurses' attitude (r = 0.06, p =0.36). Conclusion and recommendation . The level of knowledge and attitude towards postoperative management were generally inadequate among nurses. Therefore, there is the need to implement in-service training on pain management for nurses working in the surgical units frequently., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Shamsu-Deen Mahama Adams et al.)

Background: The quality of pain management in hospitalized older adult patients with dementia is a crucial issue in healthcare. The knowledge and beliefs of nurses are known to predict their pain management intentions toward this particularly vulnerable patient population., Purpose: This study was designed to evaluate the reliability and validity of the Chinese version of the Knowledge and Beliefs About Pain in Elderly Patients With Dementia (KBPED-C) questionnaire using a sample of hospital nurses., Methods: A cross-sectional study was conducted. The 17-item KBPED-C was distributed between September 2013 and August 2014 to 350 nurses working at a hospital in northern Taiwan. Consistency assessment was conducted using Cronbach's alpha, and construct validity was examined using principal component analysis. Three hundred five nurses (19 men and 286 women) were enrolled using convenience sampling., Results: The mean age of the participants was 30.8 ± 5.8 years. The Cronbach's alpha for internal consistency was .86. The item-total correlation was acceptable. The observed content validity was strong, with a content validity index of .86. Construct validity testing revealed a four-factor structure that accounted for 55.2% of the total variance. The four factors of the KBPED-C questionnaire were "general beliefs about pain and aging," "pain management in the workplace," "knowledge about pain management in older adult patients with dementia," and "beliefs about pain in older people.", Conclusions/implications for Practice: This preliminary validation study showed the high acceptability, reliability, and validity of the KBPED-C for hospital nurses. Future studies may use this questionnaire to explore the beliefs and knowledge of nurses regarding pain in older adult patients with dementia.

Introduction . Pain is unpleasant sensory and emotional experience associated with actual and potential tissue damage. Inadequate pain management has been shown to affect patient outcomes by potentially increasing hospital stay and delaying recovery; thus, the management of pain has major implications for nursing. The study was aimed to identify gaps in knowledge and attitude of nurse's level of pain management., Objective: This study aimed to assess knowledge and attitude towards pain management among nurses working at University of Gondar comprehensive specialized referral hospital, Northwest Ethiopia, 2019., Methods: Institution-based cross-sectional study was carried out during May 20-30, 2019. A stratified random sampling technique was used to select 422 nurses. Hospital departments were classified into 5 main strata having nearly the same working conditions: (1) Internal Medicine, (2) Pediatrics, (3) Surgical, (4) Outpatient Clinics, and (5) Emergency and Intensive Care Departments. The proportional allocation was taken from each stratum, and then a simple random technique was applied. Descriptive statistics like frequency, mean, median, standard deviation, and percentage were used to describe the distribution of data. Independent samples t -test was used in comparing the gender knowledge and attitude mean score of the nurses towards pain management. One-way ANOVA was also used in determining the differences between knowledge and attitude towards pain management with sociodemographic characteristics at the p =0.05 level of significance., Result: A total of 411 study participants were involved in this study. More than half of the nurses, 225 (58.1%), were males; 308 (79.5%) of them were in the age category of 19-29 years. The magnitude of good knowledge towards pain management among nurses was 66.9% with a mean score of 7.14 (1.74 SD). The magnitude of favorable attitude towards pain management among nurses was 51.7% with a mean score of 49.33 (7.13 SD). Conclusion and Recommendation . This study revealed that nurses working at University of Gondar hospital had good knowledge and a lower level of attitude towards pain management than those reported in previous studies. Thus, the situation demands various educational and quality improvement initiatives that could enhance the nurse's knowledge and attitude in the area of pain management., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Bikis Liyew et al.)

Pain is one of the commonest reasons why children visit the hospital. Inadequately treated pain in children can negatively affect their physical, psychological, and social well-being; it also places financial burden on families of affected children and healthcare systems in general. Considering the eventual suffering of vulnerable children and their families if nursing students are insufficiently educated and ill-prepared, the current study aimed at assessing final year nursing student's knowledge and attitudes pertaining to pediatric pain. A descriptive cross-sectional study was conducted among 100 final year undergraduate nursing students at a private university college in Ghana. In addition to their ages and gender, the students responded to the 42 individual items on the Pediatric Nurses' Knowledge and Attitudes Survey regarding pain (PNKAS) instrument. Descriptive statistical analysis was aided by the Statistical Package for Social Sciences version 25 software. The mean age of the final year nursing students was 29 years (range of 21 to 47 years); a majority of them were females (78%). Participants had an average (SD) correct answer score of 44.0% (10.6%). Good pediatric pain knowledge and attitudes were observed in items that were related to the individualized and multidimensional nature of the pain experience and its treatment, benefits of pre-emptive analgesia, pharmacodynamics, and pain assessment. Poor pediatric pain knowledge and attitudes occurred in items that focused on pain perceptions, opioid drug administration, useful pain medications, pain physiology, and nonpharmacological pain management interventions. Final year nursing students have insufficient knowledge and attitudes toward children's pain management. Areas of good and poor pediatric pain knowledge and attitudes should be considered when designing and implementing educational interventions on this subject. Curricular revisions should be made on existing nursing curriculum to lay more emphasis on children's pain management and use educational interventions that support knowledge translation for improved care., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Abigail Kusi Amponsah et al.)

Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children's pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children's pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children's pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females ( n  = 24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses' inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children's pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children's pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management., Competing Interests: The authors declare they have no conflicts of interest., (Copyright © 2020 Abigail Kusi Amponsah et al.)

Background: Accurate knowledge and good pain evaluation and documentation practices should be present for efficient pain management. In this study, we aimed to assess the knowledge and practices of nurses relating to the management of cancer pain in Palestine, and to determine the barriers to efficient pain control in cancer patients., Methods: A cross-sectional survey took place at 8 hospitals across Northern West Bank. A convenience sample of 220 Nurses working in governmental and private hospitals in West Bank/Palestine was studied. For that purpose, a questionnaire was developed to assess knowledge, practices, perceived barriers, and delaying processes relating to cancer pain management (CPM)., Results: In total, 220 questionnaires were completed with a response rate of 88%. Participants' mean age was 30.34 years. Overall, 69.5% worked in governmental hospitals, 26.8% worked in the private sector and the remainder worked in both governmental and private sectors. The correct response rate to questions that assess knowledge relating to cancer pain control was calculated and a mean knowledge score was found to be 5.1 with a standard deviation of 2.1. A relationship between the knowledge score and the sample characteristics was made and showed that males scored significantly higher (p = 0.001) than females with median scores of 6 [4-7] and 5 [3-6] for males and females, respectively. Inadequate pain assessment (76.8%), insufficient knowledge of pain control (70.5%) and strict regulation on opioid use (69.5%) were the most frequently perceived barriers. Nurses reported that they would assess pain on every round and check all items related to pain assessment. Contacting the physician for the prescription of opioids was cited as the main delaying process by 56.4% of participants., Conclusions: This study allowed us to recognise the knowledge deficit and the barriers to effective management. On the other hand, the analysis has shown good pain documentation practices among nurses. Those knowledge deficits demonstrate the need for more education about CPM. The improvement of coordination and communication between physicians and nurses seems to play a crucial role in CPM, as contacting physicians was cited as the most delaying process in CPM by nurses.

Background: Postoperative pain is a common problem among intensive care patients. Pain management includes pain assessment and documentation, patient care, and pharmacological treatment., Materials and Methods: The study used a prospective, cross-sectional design. Nineteen intensive care nurses and 72 intensive care patients after cardiac surgery with sternotomy approach were studied. Toronto Pain Management Inventory was used to assess nurses and the 2010 Revised American Pain Society Patient Outcome Questionnaire was used to assess the patients. A research protocol was used to document pharmacological treatment data and Visual Analog Scale (VAS) pain measurements. The pharmacological therapy data was available for 72 patients, but patient satisfaction measurements were acquired from 52 patients., Results: Postoperative pain for intensive care patients after cardiac surgery is mostly mild (68.66%). Pain intensity had a tendency to decrease over time, from a mean VAS score of 4.66 two hours after extubation to a mean VAS score of 3.12 twelve hours after extubation. Mostly opioids (100%) and nonsteroidal anti-inflammatory drugs (NSAIDs, 77.8%) were used for pharmacological treatment, and treatment was adjusted according to pain levels and patient needs. Patient satisfaction regarding pain management in the first 24 hours after surgery was high (94.2%), even though the nurses' pain knowledge was average ( X = 60.6 ± 7.3%)., Conclusions: An individualized pain management plan requires pain documentation and ensures high patient satisfaction. Pain levels after cardiac surgery with sternotomy approach are mostly mild and patient satisfaction is high.

Background: Pain is a frequent reason for consultation. Poor vocational training is referred to as a critical component for proper treatment. The objective of this study was to describe the knowledge and practices of the nursing staff of the Pediatric Hospital, Pereira Rossell Hospital Center, regarding the assessment and approach of pain in children., Methods: Descriptive, cross-sectional study, anonymous survey on 1/12/2016. All the nurses present that day were included. Variables: age, gender, years of work, educational level. For the association of variables, Chi square test was used; a value of p < 0.05 was considered significant., Results: The survey was answered by 89.3% of the personnel present; median age 39 years (20-63), women 81%; median of years as pediatric nurse 10 years (1 month-38 years); maximum degree of training: auxiliary (73%). Acceptable level of global knowledge (61%); no significant association was found between knowledge and age, gender, years of work and educational level. Infant pain assessment scales less reported: neonates, children 1 to 3 years and children with cognitive disorder. Other deficits of knowledge detected: interval morphine interdosis, interpreting distraction of the child as absence of pain and considering the perception of the experienced health personnel as the most appropriate tool to measure pain., Conclusions: The surveys demonstrated acceptable knowledge about pain assessment and management. However, aspects to improve in the knowledge of scales of evaluation in special populations, lack of familiarity with the use of opioids and conceptions of subjective evaluation of pain were objectified., (Copyright: © 2018 Permanyer.)

Background: Morbidity and mortality from prescription opioids has reached unprecedented levels. Opioids remain part of chronic pain treatment in primary care. This study was designed to determine whether one-on-one care management increases procurement of Naloxone, an opioid antagonist shown to reduce morbidity and mortality in opioid overdoses., Methods: Participants included all patients ≥18 years enrolled in a primary care-based chronic pain management program and who were prescribed a daily dose of opioids for treatment of chronic pain. In total, 153 patients chose to participate. Each had a 1 h one-on-one education meeting with a registered nurse., Results: Among the enrolled, eight patients (5.2%) had procured Naloxone prior to intervention. Overall, 31 additional patients (20.2%) procured Naloxone after intervention, a 288% relative improvement in the attainment of Naloxone (P < 0.0001) (χ2 = 29.032 with 1 degree freedom). Of the 114 participants who never procured Naloxone, 69.3% believed it was unnecessary, 20% forgot about Naloxone, 8% said it was cost prohibitive, 3.5% had access concerns and 0.9% had concerns about side effects., Conclusion: Direct one-on-one nurse care management sessions were associated with an increased procurement of Naloxone in a primary care-based pain management program. A significant number of patients believed Naloxone was unnecessary after the intervention.

This study evaluated a nurse-delivered, telehealth intervention of cognitive-behavioral therapy (CBT) versus supportive psychotherapy for chronic back pain. Participants (N = 61) had chronic back pain (pain "daily" ≥6 months at an intensity of ≥4 of 10 scale) and were randomized to an 8-week, 12-session, CBT or to supportive care (SC) matched for frequency, format, and time, with each treatment delivered by a primary care nurse. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included the numeric rating scale (NRS) and the Patient Global Impressions Scale (CGI). CBT participants (n = 30) showed significant improvements on the RMDQ (mean = 11.4 [SD = 5.9] vs 9.4 [SD = 6.1] at baseline and post-treatment, respectively, P < .05; d = .33), NRS (mean = 4.9 [SD = 2.1] vs 4.0 [SD = 1.9], respectively, P < .05; d = .45), and on the CGI (39.1% reporting "much improved" or "very much improved"). SC participants (n = 31) also showed significant improvements on the RMDQ (mean = 11.1 [SD = 5.4] vs 9.1 [SD = 5.2], respectively, P < .05; d = .38), the NRS, (mean = 5.0 [SD = 1.9] vs 3.8 [SD = 2.1], respectively, P < .05; d = .60), and 26.7% reporting "much improved" or "very much improved" on the CGI. Between groups comparisons of CBT and SC showed no differences on the study outcomes (Ps > .10). The results suggest that telehealth, nurse-delivered CBT, and SC treatments for chronic back pain can offer significant and relatively comparable benefits., Perspective: This article describes the benefits of training primary care nurses to deliver evidence-based behavioral therapies for low back pain. Because of the high prevalence of chronic pain and the growing emphasis on nonopioid therapies, training nurses to provide behavior therapies could be a cost-effective way to improve pain management., (Published by Elsevier Inc.)

Purpose: Postoperative pain is a complex physiological and psychological response caused by noxious stimulation and almost occurs in every patient. The purpose of this study was to investigate the outcome of an NBASS-APS pain management model, which refers to nurse-based, anaesthesiologist and specialist-supervised (NBASS) acute pain services (APS), in postoperative analgesia for gastric cancer patients., Methods: 228 patients were included and were randomly divided into an observation group of 113 individuals and a control group of 115 individuals. The observation group subjects were provided with an NBASS-APS pain management model; the control group subjects were provided with customary APS (C-APS), which included postoperative analgesia services managed by pain care nurses and physicians. In addition, a comparative study was performed to examine the postoperative analgesic outcome, postoperative recovery of physiological function, and the patient satisfaction levels of the two groups., Results: The observation group had significantly lower values for the postoperative visual analogue score (VAS) after return to the ward compared with those in the control group (p<0.05), the postoperative VAS mean, duration of the maximal VAS value, and duration of the VAS value >3 than those in the control group (p<0.05), and the patients in the observation group exhibited the same effect in the first ambulation time and postoperative hospital stay (p<0.05). The observation group had a significantly greater sleep duration within the first postoperative 48 hrs (p<0.05), and also showed a significantly greater score in the satisfaction level for the postoperative analgesic effect (p<0.05)., Conclusion: These findings suggest that the NBASS-APS pain management model effectively reduced the postoperative pain of gastric cancer patients, benefited their recovery of physiological functions, and improved their satisfaction with the postoperative analgesic effect.

Objectives: The aim of this study was to investigate patient satisfaction with nursing practices regarding postoperative pain management., Methods: A systematic review of the literature published between 2005 and 2015 was conducted, comprising a search of 7 databases: ScienceDirect, Turkish Medline, PsycINFO, Ovid, Prequest, Google Scholar, and the ULAKBIM Turkish Medical Database. Five articles were identified as eligible for review. The methodological quality of the studies was assessed using the Turkish version of the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI -MAStARI) Critical Appraisal Checklist. The data were extracted using a standard data extraction form developed for this study, and subsequently evaluated., Results: In the articles eligible for this review, the study samples comprised patients with blunt or penetrating trauma sent to the emergency room (n=418) and those who underwent total knee replacement (n=120); heart, lung, or gastrointestinal system surgery (n=559); or open heart surgery (n=52). The maximum pain score was 7.20±1.95 (min-max: 0-10) and the maximum satisfaction score was 100%. The findings revealed that pharmacological methods were most frequently used for postoperative pain management and non-pharmacological methods were not used sufficiently by nurses. Nevertheless, the patients were satisfied with the postoperative pain relief nursing care., Conclusion: In this systematic review, scientific evidence indicated that patient satisfaction with nursing practices related to postoperative pain management was high; however, non-pharmacological methods were used insufficiently in the last decade.

Background: After hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation., Methods: In a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15-23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual. The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden., Discussion: This study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care., Trial Registration: NTR6316 . Date of registration: April 6, 2017.

Objective: To describe the profile of nurses who work in hospital units that care for newborns; to verify nurses' prior knowledge on breastfeeding, skin-to-skin care and sweet tasting solutions for neonatal procedural pain relief; and to evaluate nurses' perceptions on the feasibility, acceptability and usefulness of the Portuguese version of the "Be Sweet to Babies" video., Method: A cross-sectional study conducted in four units of a university affiliated hospital in São Paulo. Forty-five (45) nurses who answered the questionnaire and watched the video were included. Thirty-eight (38) nurses subsequently evaluated the video. Descriptive statistics were used to analyze the variables, in addition to content analysis of the open question., Results: Forty-five (45) nurses participated in the study; 97.4% were aware of the analgesic strategies, and after watching the video nurses reported that they intend to use or encourage the use of these strategies during painful procedures. All participants would recommend the video to other professionals, and considered the resource as useful, easy to understand and easy to apply in real situations., Conclusion: Nurses are aware of the analgesic strategies and they considered the video as a feasible, acceptable and useful tool for knowledge translation to health care providers, which can also favor parental involvement in their children's pain management.

Background: Self-administration of medicines by patients whilst in hospital is being increasingly promoted despite little evidence to show the risks and benefits. Pain control after total knee replacement (TKR) is known to be poor. The aim of the study was to determine if patients operated on with a TKR who self-medicate their oral analgesics in the immediate post-operative period have better pain control than those who receive their pain control by nurse-led drug rounds (Treatment as Usual (TAU))., Methods: A prospective, parallel design, open-label, randomised controlled trial comparing pain control in patient-directed self-management of pain (PaDSMaP) with nurse control of oral analgesia (TAU) after a TKR. Between July 2011 and March 2013, 144 self-medicating adults were recruited at a secondary care teaching hospital in the UK. TAU patients (n = 71) were given medications by a nurse after their TKR. PaDSMaP patients (n = 73) took oral medications for analgesia and co-morbidities after two 20 min training sessions reinforced with four booklets. Primary outcome was pain (100 mm visual analogue scale (VAS)) at 3 days following TKR surgery or at discharge (whichever came soonest). Seven patients did not undergo surgery for reasons unrelated to the study and were excluded from the intention-to-treat (ITT) analysis., Results: ITT analysis did not detect any significant differences between the two groups' pain scores. A per protocol (but underpowered) analysis of the 60% of patients able to self-medicate found reduced pain compared to the TAU group at day 3/discharge, (VAS -9.9 mm, 95% CI -18.7, - 1.1). One patient in the self-medicating group over-medicated but suffered no harm., Conclusion: Self-medicating patients did not have better (lower) pain scores compared to the nurse-managed patients following TKR. This cohort of patients were elderly with multiple co-morbidities and may not be the ideal target group for self-medication., Trial Registration: ISRCTN10868989 . Registered 22 March 2012, retrospectively registered.

Objectives: The aim of this study was to conduct a randomized, controlled comparison of outcomes associated with parent/nurse-controlled analgesia (PNCA), with and without a basal (background) opioid infusion, with intravenous (IV) opioids intermittently administered by a nurse on an "as needed" basis (IV PRN) for postoperative pain management in children with developmental delay (DD)., Methods: Participants included children with DD expected to require IV opioids for at least 24 postoperative hours. Patients were randomized to one of three groups: PNCA with a basal infusion, PNCA without a basal infusion, or IV PRN opioids. Demographics, pain scores, opioid consumption, and frequency of side effects were collected beginning 12 hours after emerging from anesthesia to decrease the impact of anesthetic agents on outcomes., Results: The 81 participants (median = 12.0, 9.0-15.0 years) were primarily Caucasian (74%) males (58%), with severe DD (69%) having spinal surgery (41%). The proportion of patients in each group with pain scores ≤3 vs ≥ 4 revealed no between-group differences in any epoch (P = 0.09-0.27). Patients in the PNCA with a basal group consumed significantly more opioid (median = 0.03 mg/kg/h morphine equivalents, 0.02-0.03 mg/kg/h) than the PNCA without a basal infusion. No difference was found between the PNCA without a basal (median = 0.01 mg/kg/h morphine equivalents, 0.00-0.02 mg/kg/h) and the PRN groups (median = 0.01 mg/kg/h morphine equivalents, 0.01-0.02 mg/kg/h). There were no statistically significant differences in side effects, with the exception that more children in the PNCA group required supplemental oxygen (P = 0.05)., Conclusions: Results suggest there may be no advantage to PNCA over PRN opioids in this patient population after the first 12 postoperative hours with regard to pain scores, opioid consumption, or side effects.

Background: The emergency department (ED) setting is an environment where children may experience intense physical pain and emotional stress. This study sought to determine the availability of pain and anxiety management practices in all Israeli emergency departments which accept children, specifically looking for differences between accredited pediatric emergency medicine departments and others., Methods: A cross-sectional survey of all Israeli emergency departments that accept children was performed. One person at each institution was approached to complete the survey. Data were collected between May and June 2016 using an electronic survey tool., Results: Responses were collected from 21 of 22 hospitals (95% response rate). Commonly available in all types of emergency departments were nurse ordered analgesia, medical clowns (in 95% of the hospitals), topical analgesia and oral sucrose solution. The accredited pediatric emergency medicine departments showed a tendency for more frequent use of all pharmacologic methods for pain and anxiety relief, specifically oxycodone and ketamine., Conclusions: Overall, Israeli emergency departments have similar access to pharmacologic and non-pharmacologic pain and anxiety management strategies in children, but gaps still exist, especially where not all attending physicians are pediatric emergency medicine trained. We suggest that certified pediatric emergency medicine physicians should advise all emergency departments that accept children to promote the use of the various methods of pain and anxiety reduction.

Objective: To describe how nurses identify the pain in children with sickle cell disease (SCD) and to list the strategies used by them in the evaluation and control of pain., Method: This is a qualitative, descriptive and exploratory research, performed through semi-structured interviews with 13 nurses. The interviews were transcribed and after this process the qualitative data were organized according to thematic analysis., Results: This study showed that the nurses can identify pain in children with SCD from the signals they emit, such as: constant crying, restlessness, facial expressions and verbal reports. Pain is difficult to evaluate due to the lack of instruments, such as a pain scale. For pain control they use emotional support, promotion of comfort and the administration of drugs prescribed by the doctor., Final Considerations: The nurses recognize the pain of the child and use pharmacological and non-pharmacological methods to control it but have difficulties to assess it.

Background: It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home., Methods: A quasi-experimental nurse-led intervention trial based on a convenience sample of four nursing homes in the Swiss Canton of Zurich examines the effects on dementia patients (n = 411), the healthcare institution and the qualification level of the healthcare workers compared to historical controls, using an event analysis and a multilevel analysis. Healthcare workers will be individually trained how to assess, intervene and evaluate acute and chronic pain. There are three data-monitoring cycles (T0, T1, T2) and two intervention cycles (I1, I2) with a total study duration of 425 days. There is also a process evaluation based on Dobbins analyses that analyse in particular the potentials for change in clinical practice of change agents., Discussion: The aim of the intervention trial is to improve pain management strategies in older people with dementia in nursing homes. Clinically significant findings will be expected that will help reduce suffering in the sense of "total pain" for people with dementia. The joint intra- and interdisciplinary collaboration between practice and supply-oriented (nursing) research will have both a lasting effect on the efficiency measurement and provide scientifically sound results. Nursing homes can integrate the findings from the intervention trial into their internal quality control process. The potential for improvements can be directly influenced by the nursing home itself., Trial Registration: Registration trial number: DRKS00009726 on DRKS, registered 10 January 2017, retrorespectively registered. Clearance certificate is available of the ethics committees of the canton of Thurgau, Switzerland, number: TG K201-02, and Zurich, Switzerland, number: ZH 01-2016.

Objective: To analyze nurses' knowledge and practices regarding pain management of newborns admitted to Neonatal Intensive Care Units., Method: A descriptive and cross-sectional study. Data were collected from 51 nurses based on an adapted questionnaire aimed at evaluating knowledge and practices regarding the management of neonatal pain in six hospitals in Curitiba and its Metropolitan Region., Results: For most nurses (86.0%), neonates feel pain. A total of 34.7% of the nurses reported never using pain assessment scales. Pain management was recorded by 84.3% of the nurses. Administered pharmacological measures were Paracetamol and Fentanyl (47.1%) and Morphine (17.6%); while non-pharmacological measures adopted were sweetened solution (68.6%), non-nutritive sucking (58.8%) and positioning (56.9%)., Conclusion: Nurses considered neonatal pain a real event; however, they do not perform pain assessment or treatment of newborns in a systematized way.It is necessary to implement knowledge translation strategiesin order to improve pain management in newborns., Objetivo: Verificar o conhecimento e as práticasdos enfermeiros sobreo manejo da dor de recém-nascidos admitidos em Unidades de Tratamento Intensivo Neonatal., Método: Estudo descritivo e transversal. Os dados foram coletados com 51 enfermeiros, a partir de um questionário adaptado que visa avaliar o conhecimento e as práticas sobre o manejo da dor neonatal, em seis hospitais de Curitiba e Região Metropolitana., Resultados: Para a maioria dos enfermeiros(86,0%), os neonatos sentem dor. Um total de 34,7% afirmaramnunca utilizar escalas de avaliaçãoda dor. O registro do manejo da dor foi realizado por 84,3% dos enfermeiros. As medidas farmacológicas realizadas foram Paracetamol e Fentanil (47,1%) e Morfina (17,6%);as não farmacológicas adotadas foram solução adocicada (68,6%), sucção não nutritiva (58,8%) e posicionamento (56,9%)., Conclusão: Os enfermeiros consideraram a dor neonatal como um evento real, porém não realizavam avaliação ou tratamento da dor no recém-nascido de modosistematizado. É necessário implementarestratégias de tradução do conhecimento paraaprimorar o manejo da dor de recém-nascidos.

Pain assessment in the pediatric population is challenging because of age, developmental stage, and patient cooperation. Cognitive impairment, impaired communication, and physical disability that may accompany traumatic brain injury (TBI) further complicate pain assessments. A pilot descriptive qualitative research study was conducted to investigate nurse perceptions of pain in pediatric patients diagnosed with TBI. Specifically, this study sought to answer the following questions: a) Is pain accurately assessed in this population? b) Is pain adequately treated in this population? and c) What obstacles exist, if any, to the assessment and treatment of pain? A convenience sample of three registered nurses employed in a pediatric neurosurgery setting participated in this study. Each nurse participated in one individual, semi-structured, face-to-face interview lasting approximately 30 minutes. Interviews were transcribed verbatim and analyzed for common themes. Common themes identified across all interviews were a) challenging assessments; b) limited, although effective, treatments; and c) communication as an area of opportunity for improvement. Implications for practice and policy include a need for more sensitive pain assessment tools to improve the objectivity and accuracy of pain assessment, clarification of care priorities and organization of care from clinical and management perspectives, and additional research in alternative pain treatments for this population. Findings from this study will guide the development of a larger, more comprehensive study, with the aim of improving practice and policy in pain management for this population.

Pain treatment begins with a nurse’s assessment, which relies on effective assessment skills. Hospital settings have implemented pain assessment education, but there is limited evidence in pediatric transitional care settings. The purpose of this quality improvement (QI) initiative was to develop, implement, and evaluate an evidence-based pain education session with 20 nurses in a pediatric specialty hospital that provides transitional care. Specific aims were to assess nurses’ knowledge and attitudes of pain, and evaluate assessment skills based on nurses’ documentation. A prospective pre-post design with three assessments (baseline, post-intervention, and one-month follow-up) was used. The Shriner’s Pediatric Nurses’ Knowledge and Attitudes Regarding Pain questionnaire and an electronic health record review were completed at each assessment. There was significant improvement in nurses’ knowledge and attitudes of pain after the education session (F[2,6] = 50.281, p < 0.0001) from baseline to post-intervention (p < 0.0001), which was maintained at follow-up (p = 0.009). Pain assessment frequency by nurses significantly increased from 43.1% at baseline to 64.8% at post-intervention, and 67.7% at follow-up (χ²[2] = 20.55, p < 0.0001). Developmentally appropriate pain scale usage increased significantly, from 13.1% at baseline to 77.4% at post-intervention, and 81.8% at follow-up (χ²[2] = 169.19, p < 0.0001). Nursing interventions for pain increased significantly, from 33.3% at baseline to 84.0% at post-intervention, and stabilized at 80.0% at follow-up (χ²[2] = 8.91, p = 0.012). Frequency of pain reassessments did not show a statistically significant change, decreasing from 77.8% at baseline to 44.0% at post-intervention and 40.0% at follow-up (χ²[2]= 3.538, p = 0.171). Nurses’ pain knowledge and documentation of assessment skills were improved in this QI initiative.

Complex regional pain syndrome (CRPS) is a clinically diagnosed chronic pain syndrome characterized by severe pain and functional disability following a minor injury. The affected limb often has evidence of changes in sensory, vasomotor, sudomotor/edema, and/or motor/tropic function. The diagnosis of CRPS in the pediatric population is increasingly common, especially among female adolescents. The pain experience of adolescents with CRPS is best understood using the biopsychosocial framework, and the most effective treatment programs target biological, psychological, and social factors. Treatment for CRPS is multidisciplinary and typically includes physical therapy, occupational therapy, and psychology. The parent-child dyad that develops when the child has CRPS is complex and characterized by significant psychological distress, ineffective parenting, and poor coping. The purpose of this article is to describe the role of parents in the treatment of adolescents with CRPS. To promote successful remission from pain and restoration of functional ability, parents should be included in treatment programs. Nurses caring for adolescents with CRPS can assist parents in developing adaptive parenting skills.

Background: Beliefs surrounding pain during childbirth has biblical foundations that contribute to labour pain being viewed as a natural phenomenon. Contemporary health care promotes evidence-based labour pain management but the faith of the midwife may influence her midwifery practice regarding labour pain management. Therefore this study sought to gain in-depth insight into the experiences and perceptions of midwives regarding labour pain and the religious beliefs and practices influencing their care of women in labour in Ghana., Methods: The design of the study was an interpretive phenomenology using individual in-depth interviews. The study participants were 27 Ghanaian female midwives of various religious backgrounds. Interviews were conducted in English, audio-taped and transcribed verbatim. Colaizzi's qualitative analysis procedures were employed concurrently with data collection., Results: Three major themes were generated: religious beliefs about labour pain, religious practices in labour and religious artefacts used in labour. The midwives' faith and their experiences during their midwifery practice were inter-connected. The midwives believed labour pain was natural and religious practices are important to prevent complications. Religious artefacts used in labour included anointing oil and water, necklaces, rubber bands, bracelets, stickers and beads., Conclusion: It is important that midwives provide an enabling environment for women in labour to practice their faith and they should employ context-appropriate strategies to effectively manage labour pain that takes into account the religious beliefs and practices of women.

Objective: To describe responses issued by pregnant women, and the improvement of the gravidic discomforts after the use of the acupressure technique., Method: Qualitative and descriptive study conducted with 15 pregnant women between November 2013 and February 2014 in a Basic Health Unit in Natal, RN, Brazil. The data were collected through unstructured interviews and depositions that were then transcribed and treated according to Minayo's operative proposal, carefully read, compared and organized into two groups., Results: The categories that resulted were: Positive effects of acupressure, and the recommended use of acupressure. According to pregnant women, the discomforts of pregnancy cramps, fatigue in the legs, lower back pain and headaches decreased with the use of acupressure., Conclusions: Based on the results, acupressure should be introduced by the nurse in pre-natal care as a therapeutic resource for the pregnant woman's well-being.

Background: Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour., Methods: We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management., Results: We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role., Conclusion: Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity.

Background: Inadequate pain monitoring and management in hospitalized patients poses a serious clinical problem which has been extensively covered in literature for over 25 years., Objectives: The purpose of the paper was to learn about and compare the existing barriers to effective analgesia controlled by nurses on surgical wards in Polish hospitals., Material and Methods: The study was carried out upon the approval of the study protocol by the Independent Bioethics Committee for Scientific Research of the Medical University of Gdańsk. The research project was multi-center and took a year. The study was questionnaire-based. It used the Polish version of the Nurses' Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1300 nurses working on surgical wards., Results: The barriers most frequently observed by the respondents were: disorganization of the healthcare system, physicians' mistrust of pain assessment by nursing staff, difficulty contacting and communicating with physicians to discuss the results of patients' pain assessments and difficulties experienced by elderly patients with completing pain assessment scales., Conclusions: The barriers most frequently impeding pain therapy in elderly patients are associated with the healthcare system, and they were more frequently present on the anesthesiology and intensive care ward and in the emergency department, and occurred the least frequently on the surgical ward. Patient-related problems were more frequent on the anesthesiology and intensive care wards than in the emergency department. Doctor-related problems most frequently occurred on the gynecological ward, while nurse-related problems were more frequent on the anesthesiology and intensive care ward.

Numerous studies have shown that in comparison to adults, children do not receive analgesia (oligoanalgesia) and are not adequately treated for pain. Several organizations, including The Joint Commission and Institute of Medicine (IOM) have emphasized patients' rights to pain management and the need for initial assessment and ongoing evaluation. Nurses are responsible for assessing patients' pain and implementing appropriate pain management in the emergency department (ED). Evidence suggests that nurses' lack of knowledge about pain assessment in children contributes to inadequate pain management. Studies also show that the use of pain assessment tools appropriate to a child's age and cognitive development play a vital role in improving pain assessment documentation, prompting nurses to provide pain medication. The purpose of this quality improvement project was to improve nurses' assessment and management of children's pain in an emergency department. A total of 1,200 EMRs of pediatric patients ages 3 months to 6 years of age were reviewed before and after an educational intervention (600 before and 600 after the intervention). Pain education for ED nurses improved pain assessment and management among children.

Background: Adapting educational tools to meet user needs is a critical aspect of translating research evidence into best clinical practices. The objectives of this study were to evaluate usability and effectiveness of educational tools about infant vaccination pain management directed to postnatal nurses., Methods: Mixed methods design. A template pamphlet and video included in a published clinical practice guideline were subjected to heuristic usability evaluation and then the revised tools were reviewed by postnatal hospital nurses in three rounds of interviews involving 8 to 12 nurses per round. Nurses' knowledge about evidence-based pain management interventions was evaluated at three time points: baseline, after pamphlet review, and after video review., Results: Of 32 eligible postnatal nurses, 29 agreed to participation and data were available for 28. Three overarching themes were identified in the interviews: 1) utility of information, 2) access to information, and 3) process for infant procedures. Nurses' knowledge improved significantly (p < 0.05) from the baseline phase to the pamphlet review phase, and again from the pamphlet review phase to the video review phase., Conclusions: This study demonstrated usability and knowledge uptake from a nurse-directed educational pamphlet and video about managing infant vaccination pain. Future studies are needed to determine the impact of implementing these educational tools in the postnatal hospital setting on parental utilization of analgesic interventions during infant hospitalization and future infant vaccinations.

Objective: We investigated palliative care knowledge, difficulty and self-reported practice among a region-wide sample of nurses who cared for cancer patients in Japan., Methods: A cross-sectional questionnaire survey was distributed to 9 designated cancer centers, 17 community hospitals and 73 district nurse services across 4 regions in 2008. We used the Palliative Care Knowledge Test, the Palliative Care Difficulty Scale (five-point Likert scale) and the Palliative Care Self-Reported Practices Scale (five-point Likert scale)., Results: In total, 2378 out of 3008 nurses (79%) responded. The knowledge, difficulty and self-reported practice scores were 51 ± 20%, 3.2 ± 0.7 and 3.7 ± 0.6, respectively. In the knowledge test, philosophy scored highest (88 ± 26%) and psychiatric problems scored lowest (37 ± 29%). In the difficulty test, alleviating symptoms scored most difficult (3.5 ± 0.8) and providing expert support scored least difficult (2.9 ± 1.3). In the self-reported practice questionnaire, pain and delirium relief were most frequently (4.0 ± 0.8) and least frequently (3.1 ± 0.9) provided, respectively. Knowledge was significantly poorer in community hospitals (P = 0.035); difficulty scores were significantly higher in community hospitals (P < 0.001) and district nurse services (P = 0.013); and self-reported practice scores were significantly poorer in community hospitals (P < 0.001) but superior in district nurse services (P < 0.001) than in designated cancer centers., Conclusions: Knowledge, difficulty and self-reported practice for symptom management, particularly psychological symptoms, were insufficient, particularly in community hospitals. Education, expert support and adequate clinical experiences would help provide quality palliative care., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: The purpose of this study was to determine knowledge, attitude, and performance vis-à-vis pain management in neonates by nurses working in neonatal units in Bandar Abbas University hospitals., Method: This descriptive and analytical study was executed from March-August 2011 in the neonatal units and NICU in Bandar Abbas educational hospitals. A total of 50 nurses and nurse assistants working in the neonatal units participated in the study. The data collection tool was a structured questionnaire investigating knowledge (28 items), attitude (20 items) and practices (5 items). Data was analyzed using descriptive statistical tests (Frequency, Mean and Standard deviation tables) and inferential statistic (T-test, Variance analysis)., Results: The knowledge scores of participants had a mean value of 13.51 (48.2%) out of 28. The mean score of attitude was 54.22 out of 60 and the mean score for the nurses' level of practices was found to be 4.22 out of 10. There was a significant relationship between nurses' knowledge scores and the level of education, i.e. nurses with more education had more knowledge., Conclusion: Results showed that the nurses had poor performance regarding the assessment, measurement, and relief of pain. However, they showed positive attitudes towards pain control in neonates.

Introduction: Patients with a proximal femur fracture are often difficult to evacuate from the accident scene. Prehospital pain management for this vulnerable group of patients may be challenging. Multiple co-morbidities, polypharmacy and increased age may limit the choice of suitable analgesics. The fascia iliaca compartment (FIC) block may be an alternative to intravenous analgesics. However this peripheral nerve block is mainly applied by physicians.In the Netherlands, prehospital emergency care is mostly provided by EMS-nurses. Therefore we examined whether well-trained EMS-nurses are able to successfully perform a FIC block in order to ensure timely and appropriate effective analgesia.The study was study was registered in the Netherlands Trial Register (NTR-nr 3824)., Methods: Ten EMS nurses were educated in the performance of a FIC-block. Indications, technique, side-effects and complications were discussed. Hereafter the trained EMS-nurses staffed ambulance teams were dispatched to patients with a suspicion for a proximal femur fracture. After confirmation of the diagnosis, the block was performed and 0.3 ml/kg lidocaine (10 mg/ml) with adrenaline 5 μg/ml was injected. The quality of pain relief, occurrence of complications and patient satisfaction were evaluated., Results: In 108 patients a block was performed. One hundred patients could be included. Every EMS nurse performed at least 10 FIC blocks. The block was effective in 96 patients. The initial median (NRS)-pain score decreased after block performance to a score of 6 (after 10 minutes), 4 (after 20 minutes) and 3 (after 30 minutes). At arrival at the Emergency Department the median pain score was 3. Dynamic NRS-pain scores when transferring the patient from the accident scene to the ambulance stretcher, during transportation to the hospital and when transferring the patient to a hospital bed were, 4, 3 and 3.5 respectively. Patient satisfaction was very high. No complications were noted., Conclusion: Additional educated EMS-nurses are able to successfully perform a FIC-block for providing acute pain relief to patients with a suspected proximal femur fracture.

Purpose: The purpose of this study was to develop evidence-based guidelines on postoperative pain management via the web and to examine the effects in terms of pain level of patients undergoing abdominal surgery and nurses' knowledge of postoperative pain management., Methods: First, evidence-based pain guidelines were developed via the web in a tertiary hospital. Second, a special educational program on evidence-based pain guidelines for nurses was developed after validation of content by experts. Third, diverse strategies were adopted in order to facilitate incorporation of evidence-based pain guidelines in practice. Fourth, nurses in the study units were educated on evidence-based guidelines using the developed educational program for 3 weeks before their implementation of evidence-based pain guidelines to patients. Patients were assigned to the control group (from July 29 to August 20, 2011) and the experimental group (from September 24 to October 25, 2011) according to interrupted time interval. The data were analyzed using chi-square test, analysis of variance test with Scheffé's test as a post hoc and repeated measure of analysis of variance., Results: Patients in the experimental group showed a significantly lower level of pain. Nurses' knowledge of management of postoperative pain showed a significant increase after installation of evidence-based guidelines., Conclusion: Evidence-based pain guidelines were effective in reducing the pain level of patients as well as improving nurses' knowledge of pain management., (Copyright © 2014. Published by Elsevier B.V.)

Context: General practitioners (GPs) and community nurses (CNs) have a central role in palliative care. With health policy focusing more and more on enabling patients to die at home, primary health care professionals are increasingly responsible for symptom management of patients near the end of life., Objectives: 1) To investigate GPs' and CNs' training and knowledge in palliative care and 2) to identify the characteristics of GPs and CNs with lower levels of palliative care knowledge., Methods: A postal questionnaire was sent to all GPs and CNs in two areas of the U.K. A panel of doctors and nurses with palliative care expertise rated the response categories with regard to correctness and questions with regard to importance for their professional group. These weightings were combined and applied to answers to assess knowledge levels., Results: Response rates were 54% and 35% for GPs and CNs, respectively. Respondents reported receiving training in most areas of palliative care throughout their careers, with the exceptions of syringe driver use and bereavement care. High levels of knowledge concerning pain management and syringe driver use were found, with no significant differences in the overall knowledge between the professions. Some important gaps were identified for future educational focus. Regression analyses did not identify characteristics that explained the variation in knowledge scores., Conclusion: Both groups had a high level of knowledge concerning key issues in pain management and syringe driver use that should equip them well for their central role in palliative care. Recommendations for the focus of future education sessions are made., (Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

This investigation consisted on a prospective cross-sectional study that aimed to describe the nursing team knowledge on behavioral assessment of pain. The study was conducted in a private hospital in the city of Sao Paulo, Brazil in November 2011, with nursing professionals from a general adult intensive care unit. They answered a questionnaire that contained sociodemographic data and questions related to knowledge about a behavioral assessment of pain. Descriptive data analysis was carried out and the average positive score was compared among categories using the Mann-Whitney test. Out of the 113 participants, over 70% have demonstrated knowledge of the main aspects of this assessment and there was no statistical significant difference among the professional categories. It was concluded that the knowledge of the professionals was satisfactory, but it can be improved.

Background and Objectives: Pain, erectile dysfunction (ED), and depression are common yet frequently untreated in chronic hemodialysis patients. This study compared two management strategies for these symptoms in this patient population., Design, Setting, Participants, & Measurements: Pain, ED, and depression were assessed monthly during an observation usual care phase. Patients were then randomized to 12-month participation in either a feedback arm in which these symptoms were assessed monthly, renal providers were informed of patients' symptoms, and treatment was left treatment at their discretion; or a nurse management arm in which symptoms were assessed monthly and trained nurses were used to evaluate patients and generate and facilitate the implementation of treatment recommendations., Results: Of 288 patients enrolled into observation between January 1, 2009 and March 30, 2010, 220 (76%) were randomized. Compared with the feedback approach, the results (shown as Δ symptom score [95% confidence interval]) indicated that nurse management was not associated with improved pain (0.49 [-0.56, 1.54]), ED (0.20 [-0.55, 0.95]), or depression (0.32 [-0.94, 1.58]). Relative to their symptoms during observation, feedback patients experienced small, statistically significant improvements in pain (-0.98 [-1.67, -0.28]), ED (-0.98 [-1.54, -0.41]), and depression (-1.36 [-2.19, -0.54]), whereas nurse management patients experienced small, statistically significant improvements in ED (-0.78 [-1.41, -0.15]) and depression (-1.04 [-2.04, -0.04])., Conclusions: Compared with informing renal providers of their patients' pain, ED, and depression and leaving management at their discretion, a nurse-implemented management strategy does not improve these symptoms. Both approaches modestly reduced symptoms relative to usual care.

Descriptive survey of daily practical experiences of pediatric nurses in the assessment and intervention to pain relief in children, during nursing care provided in pediatric and neonatal intensive care units, and the influence of the infrastructure of care and system organization. The sample was made up of 109 nurses. The principal results indicated that the majority of the nurses considered the academic training obtained as insufficient to support this aspect of nursing care; that they had not received local training in evaluating pain or in relief interventions; that the staff ratio is inadequate and as well as the availability of institutional guidelines to improve the quality of analgesia. It was concluded that nurses value the assessment and intervention to pain relief in children, but describe aspects which compromise practice: lack of collaborative practice, lack of processes definition, lack of formal and continuing education and lack of infrastructure. These aspects compromise the implementation of scientific evidences capable of improving practical aspects of analgesia in children under intensive care.

Despite decades of research, national mandates, and widespread implementation of guidelines, recent reports suggest that the quality of pain assessment and management in hospitalized children remains suboptimal. The mismatch between what is advocated and what is done in practice has led experts to argue for a conceptual shift in thinking, where the pain assessment process is viewed from a complex social communication or transaction framework. This article examines the empirical evidence from the recent pediatric pain assessment and decision-making literature that supports adaptation of Schiavenato and Craig's "Pain Assessment as a Social Transaction" model in explaining pediatric acute pain management decisions. Multiple factors contributing to children's pain experiences and expressions are explored, and some of the difficulties interpreting their pain scores are exposed. Gaps in knowledge related to nurses' clinical pain management decisions are identified, and the importance of children's and parents' preferences and roles and the influence of risks and adverse events on decision making are identified. This review highlights the complexity of pediatric nurses' pain management decisions toward the clinical goal of improving comfort while minimizing risk. Further study evaluating the propositions related to nurses' decisions to intervene is needed in pediatric clinical settings to better synthesize this model for children., (Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)