The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center,Controlled before-after Study in China

BackgroundEffective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown.AimsThe current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients.DesignA single-center, propensity score-matched, controlled before–after study.MethodsThe patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses’ pain knowledge and attitude between group A and group B.ResultsA total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X² = 38.926, p < .05; vomit: X² = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05).ConclusionOur study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.     

Exploring barriers and facilitators for successful transition in new graduate nurses: A mixed methods study

BackgroundThe transition phase from student to nurse is an important time when new graduates grow and develop as professional nurses. Globally, the attrition rate of new graduate nurses is reported to range from 24.5 to 70%.PurposeThe study aimed to explore the barriers to, and facilitators of new graduate nurses' successful transition.MethodsA convergent mixed methods design was used. Newly graduated nurses (n = 212) were recruited from two K university medical centers. The quantitative research used a cross-sectional study, and the qualitative research used a focus group interview design. The survey and focus group interview were conducted from October to December 2017. The questionnaire comprised items on demographic characteristics (age, gender, employment duration, orientation duration, etc.) and items on transition experience, job satisfaction, self-efficacy, nursing work stress, and structural empowerment.ResultsThis qualitative study found that significant factors affecting transition (R² = 0.41, F = 35.29, p < .05) included self-efficacy (β = 0.27, p < .01), job satisfaction (β = 0.11, p < .01), nursing stress (β = −0.04, p < .05), and structural empowerment (β = 0.41, p < .01). The qualitative findings supported the quantitative results and also identified the barriers to and facilitators of a successful transition. The barriers were fears, workload, excessive role expectations, and emotional difficulties resulting from bullying. And, the facilitators are self-confidence, interaction with colleagues, positive and supportive work environments, and a phase transition program.ConclusionThis study showed that formal and informal strategies, to strengthen organizational factors (structural empowerment, phase transition program, etc.) and enhance individual factors (self-efficacy, self-confidence, interaction, etc.), are important for new graduate nurses' successful transition into their professional roles.     

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic

BackgroundPain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management.AimExamine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication.MethodsA sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit.ResultsSignificant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001).ConclusionsPatients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.     

Arteriovenous Graft for Hemodialysis: Effect of Cryotherapy on Postoperative Pain and Edema

BackgroundArteriovenous grafting offers an alternative for patients whose vessels are unsuitable for arteriovenous fistula. However, as a result of subcutaneous tunnel dissection, postoperative pain and edema of the operated limb present early after surgery. As a traditional therapeutic approach, cryotherapy has the ability to suppress postoperative pain and edema.AimsThe purpose of the study was to investigate the feasibility of cryotherapy after arteriovenous graft surgery to decrease perioperative medication usage.DesignThis study was a randomized controlled trial.SettingA large integrated health care facility in South China.Participants/SubjectsA total of 85 hemodialysis patients who received arteriovenous graft surgery from March 2011 to February 2017 were enrolled.MethodsThe participants were divided into an intervention group and a control group according to the postoperative management. Ice packs were applied covering the operative forearm for 120 minutes after wound closure in the intervention group. General information, pain score, analgesic consumption, wound inflammation, forearm edema, and participant satisfaction were compared between the two groups.ResultsCryotherapy-treated patients required less analgesia (26.19% vs. 48.84%, p < .05), reported lower pain score from 30 minutes to 48 hours postoperative (p < .05), less wound inflammation (11.90% vs. 25.58%, p < .05), and higher participant satisfaction (8.92 ± 0.57 vs. 6.52 ± 0.63, p < .05), whereas the incidence of forearm edema was equivalent (p > .05). No adverse events were reported in either group.ConclusionsCryotherapy is a preferable intervention for patients after arteriovenous graft implantation as a result of its favorable cost, convenience, and fewer side effects.     

Pain management in the older adult: The relationship between nurses' knowledge,attitudes and nurses' practice in Ireland and Jordan

BackgroundResearch studies regarding nurses' knowledge attitudes and practice in the older adult are limited. Furthermore, none of these studies attempted to investigate the relationship between knowledge attitudes and practice. Furthermore, little studies compared nurses' knowledge, attitudes and practice between Eastern and Western countries.AimTo describe the factors associated with nurses' acute pain management practice in the context of caring for older adult patients.MethodA quantitative, correlational, comparative and cross-sectional survey approach.Data collectionData were collected using survey questionnaire.SampleA sample of 267 registered nurses from Ireland and Jordan (one private hospital in each country).ResultsA multiple linear regression analysis revealed that nurses' general knowledge and attitude towards pain management was associated with their pain management practice, with a regression coefficient of 0.14 (p = 0.002). However, knowledge of pain in the elderly failed to reach a statistically significant relationship with pain management practice. In regards to country and gender, Irish nurses had an average score that was 2.61 points higher than Jordanian nurses (p < 0.001), female nurses had an average score that was 0.67 points higher than male nurses (p = 0.025). The overall regression model was significant (p < 0.001) with an R² value of 43.2%, indicating that 43.2% of the variation in scores was explained by knowledge, attitude and practice.ConclusionMore research studies combining the three concepts (knowledge, attitude and practice) are recommended in the area of pain management.     

Alcohol,Tobacco and Psychotropic Drugs Use Among a Population with Chronic Pain in Southern Spain. A Cross-Sectional Study

BackgroundSubstance use seems to be higher among populations with chronic pain.AimThe aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men.MethodLinear and logistic regression analyses were carried out using data from the 2015-2016 adults’ version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men).ResultsDisabling chronic pain was statistically associated with higher tobacco consumption among men (β = –30.0, 95% confidenct interval [CI] –59.5 to –0.60; t = –2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: β = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: β = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs.ConclusionsChronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.     

Educational Intervention to Strengthen Pediatric Postoperative Pain Management: A Cluster Randomized Trial

BackgroundPediatric postoperative pain is still undertreated.AimsTo assess whether educational intervention increases nurses’ knowledge and improves pediatric postoperative pain management.DesignCluster randomized controlled trial with three measurement points (baseline T1, 1 month after intervention T2, and 6 months after intervention T3).Participants/SubjectsThe study was conducted in postanesthesia care units at six hospitals in Norway. Nurses working with children in the included units and children who were undergoing surgery were invited to participate in this study.MethodsNurses were cluster randomized by units to an intervention (n = 129) or a control group (n = 129). This allocation was blinded for participants at baseline. Data were collected using “The Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain: Norwegian Version” (primary outcome), observations of nurses’ clinical practice, and interviews with children. The intervention included an educational day, clinical supervision, and reminders.ResultsAt baseline 193 nurses completed the survey (75% response rate), 143 responded at T2, and 107 at T3. Observations of nurses’ (n = 138) clinical practice included 588 children, and 38 children were interviewed. The knowledge level increased from T1 to T3 in both groups, but there was no statistically significant difference between the groups. In the intervention group, there was an improvement between T1 and T2 in the total PNKAS-N score (70% vs. 83%), observed increase use of pain assessment tools (17% vs. 39%), and children experienced less moderate-to-severe pain.ConclusionsNo significant difference was observed between the groups after intervention, but a positive change in knowledge and practice was revealed in both groups. Additional studies are needed to explore the most potent variables to strengthen pediatric postoperative pain management.     

Critical thinking among institutional academic advisors and sociodemographic,professional and academic variables: A multicenter correlation study

BackgroundIn nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context.ObjectiveTo analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates.MethodsThe study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators’ CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P < .05.ResultsThe total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p = .007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p = .187), with statistically significant differences only observed in the intellectual and cognitive indicator (P = .022).ConclusionsCT levels are high in teaching healthcare professionals in the clinical environment.     

Providing trans-affirming care for sexual assault survivors: An evaluation of a novel curriculum for forensic nurses

BackgroundTransgender (trans) persons experience high rates of sexual victimization, often face discrimination by healthcare providers, and may have unique and diverse needs post-victimization. However, there remains a lack of comprehensive trans-specific training among healthcare professionals, including nurses.ObjectivesOur primary objective was to develop and evaluate a novel curriculum for its efficacy in improving the competence of forensic nurses in providing sensitive, informed, and appropriate healthcare services for trans survivors of sexual assault.MethodsThe curriculum was evaluated among forensic nurses working in sexual assault treatment centres across Ontario, Canada. Forty-seven nurses participated in this study, all of whom were selected by their respective programs to receive in-depth formal Sexual Assault Nurse Examiner training. Changes in participants' perceived expertise and competence in providing trans-affirming care were assessed on a 5-point Likert scale (5 being the highest level) using pre- and post-training questionnaires. Participants were asked to indicate their level of agreement with 31 competency-based statements, which were organized thematically into four domains: Initial Assessment, Medical Care, Forensic Examination, and Discharge and Referral. A clinical vignette assessed participants' demonstrated competence in providing care across four questions.ResultsParticipants level of expertise improved significantly from pre- to post-training (Mean [M] = 1.89, Standard Deviation [SD] = 0.84 vs. M = 3.47, SD = 0.62, p< 001), as well as their competence across all content domains: initial assessment (M = 3.79, SD = 0.63 vs. M = 4.70, SD = 0.31, p < .001), medical care (M = 3.33, SD = 0.73 vs. M = 4.69, SD = 0.33, p < .001), forensic examination (M = 3.40, SD = 0.75 vs. M = 4.72, SD = 0.35, p < .001), and discharge and referral (M = 3.62, SD = 0.80 vs. M = 4.59, SD = 0.40, p < .001). There were also significant improvements in competence associated with the clinical vignette pre- to post- training (M score = 2.13, SD = 1.06 vs. M score = 3.23, SD = 0.87, p < .001).ConclusionsThe success of this curriculum may have relevance to the more than 5000 members of the International Association of Forensic Nurses who practice and support forensic nursing across the globe, as well as to other healthcare professionals.     

The relationship between the undergraduate clinical learning environment and work readiness in new graduate nurses: A pre-post survey study

BackgroundDue to projected nurse shortages, it is necessary that undergraduate programs optimise work readiness outcomes in new graduate nurses. Research that quantitatively evaluates characteristics of clinical nursing programs that predict increased work readiness is required.ObjectivesTo explore the relationship between the undergraduate clinical learning environment and nurse perceptions of work readiness prior to and following, commencement as a new graduate nurse.DesignA pre-post follow-up study. Undergraduates were surveyed at the end of their Bachelor's degree (baseline) and at 8–10 weeks after commencement as a graduate nurse (Time 1).SettingA multi-site, metropolitan private hospital in Victoria, Australia.ParticipantsNursing graduates who completed a university fellowship program (n = 26), or were undertaking their graduate year and had completed placement blocks within (n = 18) or outside (n = 31) the healthcare organisation.MethodsParticipants self-completed the Clinical Learning Environment Inventory (CLEI) and Work Readiness Scale for Graduate Nurses (WRS-GN) at baseline and Time 1. Multiple regression analyses were performed.ResultsCLEI scores significantly predicted work readiness outcomes (all p-values<.05), accounting for 16–36% and 17–28% of the variance of WRS-GN scores at baseline and Time 1, respectively. After adjusting for clustering due to clinical placement groups, CLEI Individualisation (p = .023) and Valuing Nurses Work (p = .01) predicted improved Time 1 WRS-GN Organisational Acumen. CLEI Innovative and Adaptive Culture scores predicted poorer Time 1 Organisational Acumen (p = .001).ConclusionsLearning environments that offered high levels of individualised attention and valued nurses' work appeared to facilitate post-graduation engagement and identification with nursing practice. However, highly innovative and adaptive education may detract from optimal work readiness. Findings revealed that while important, the clinical learning environment only accounted for a small-to-moderate degree of nursing graduates' work readiness. To facilitate robust evidence-based improvement of clinical nursing education, future research should attempt to empirically establish the value of additional facilitators of work readiness.     

Impact of Different Illness Perceptions and Emotions Associated with Chronic Back Pain on Anxiety and Depression in Patients Qualified for Surgery

BackgroundAnxiety and depression are known comorbidities of chronic back pain. Their psychological predictors are not well established in patients with chronic back pain qualified for neurosurgery.AimsThe purpose of this study was to determine the psychological predictors of depression and anxiety in patients with chronic back pain qualified for surgery.DesignThis was a cross-sectional study.SettingsA neurosurgical ward in Gdańsk, Poland.Participants/SubjectsAll patients who were admitted to the neurosurgical ward and met the inclusion criteria were recruited for the study. Finally, 83 patients with chronic back pain waiting for surgery were recruited.MethodsA battery of questionnaires, including Illness Perceptions Questionnaire–Revised, Multidimensional Health Locus of Control Scale, Hospital Anxiety and Depression Scale, and Brief Pain Inventory, was used in 83 spinal surgery candidates.ResultsHigher anxiety was predicted by stronger beliefs about negative consequences of illness (β = .205, p < .05), worse illness coherence (β = .204, p < .05), negative emotional representations of illness (β = .216, p < .05), and depression (β = .686, p < .001). Higher depression was predicted by anxiety (β = .601, p < .001), pain interference (β = .323, p < .01), lower personal control over pain (β = −.160, p < .05), and lower external control of health (β = −.161, p < .05) but, surprisingly, higher internal control of health (β = .208, p < .01).ConclusionsAnxiety and depression commonly coexist in chronic back pain sufferers qualified for spine surgery but are derived from dissimilar beliefs. The results highlight the usefulness of advising about the disease and treatment in comprehensive care for this group of patients.     

Nursing Workload,Knowledge about Pain,and Their Relation to Pain Records

PurposeTo study the relationship between frequency of pain assessment and nursing workload, and also to analyze the frequency of pain assessment and its relation to knowledge and attitudes toward pain on nursing professionals in intensive care unit.MethodsAn ambispective study was conducted in a Spanish tertiary-level intensive care unit between October 2017 and April 2018. For measurement of workload, the Nursing Activities Score scale was used, and for measurement of pain knowledge, the Knowledge and Attitudes Survey Regarding Pain was used.ResultsThere were 1,207 measurements among 41 nurses and 1,838 among 317 patients. The average nursing workload was high (70.97 points). We found statistically significant positive association between nursing workload and the frequency of assessment (p < .001), as well as frequency of assessment and patients with communicative capacity (p = .008).ConclusionsNursing workload affects the registration and assessment of patients’ pain, resulting in a greater number of records as the workload performed by nurses increases. It is necessary to study in greater depth how the severity of pain, gender of the patients, and workload of nurses influence pain registration and assessment.