What do patients think? Results of a mixed methods pilot study assessing sciatica patients' interpretations of satisfaction and improvement

BACKGROUND: Little is known about the issues low back pain patients take into account when deciding their satisfaction with care, the importance placed on such satisfaction, or the factors they consider when assessing their overall improvement. OBJECTIVE: The purpose of this study was to explore these issues and to assess the feasibility of implementing qualitative research methods within a clinical trial. METHODS: Study participants were volunteers taking part in a randomized clinical pilot study comparing nonsurgical treatments for sciatica. Face-to-face interviews were conducted, transcribed, and analyzed using content analysis. RESULTS: All 31 individuals who participated in the pilot study were interviewed. When asked which issues they considered when deciding their satisfaction with care, the most frequently identified themes were change in pain, personnel, and the treatment experience. When assessing their overall improvement, all participants considered whether their pain had changed. In response to the question asking participants which outcomes they considered to be most important, severity of pain and quality of life were most commonly cited. CONCLUSION: This study demonstrated that a "mixed methods" approach using qualitative research methods within a clinical trial is not only feasible but can provide interesting and useful information for trial interpretation and future study design. By providing insight to the multidimensional nature of patients' beliefs and perceptions, this technique may not only shape but also redefine the focus of patient-oriented research and health care for low back pain conditions.     

Nurses' reflections on pain management in a nursing home setting.

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.     

Difficult pain assessment and lack of clinician knowledge are ongoing barriers to effective pain management in children with cognitive impairment

Identification of barriers that inhibit effective pain treatment in children with cognitive impairment (CI) may facilitate targeted interventions to ensure that they receive optimal care. This study was undertaken to identify factors that impede effective treatment of pain in children with CI. Clinicians who provided direct care to children were surveyed regarding perceptions of pain management issues. 215 nurses and physicians completed and returned surveys. Difficulties with pain assessment, the lack of valid pain assessment tools, and poor documentation were ranked by the majority of clinicians as factors that impeded their ability to effectively manage pain in this population. Additionally, 88% believed that inadequate education impedes effective pain management in this population, and 88% would attend continuing education courses on pain in children. These data suggest that development of valid and clinically useful pain assessment tools, and focused continuing education may provide the best interventions toward the improvement of pain management in this and similar vulnerable populations.     

Opioid Prescribing for Chronic Pain in Federally Qualified Health Centers Post–Centers for Disease Control and Prevention Guidelines

This study provides important insight on the demographic characteristics, knowledge, practices, and perceptions of primary care providers (PCPs) prescribing opioids to patients at federally qualified health centers (FQHCs). Findings suggest that FQHCs would benefit from examining their current pain management policies and practices and addressing issues as they arise. FQHCs need to provide continuing education on pain management for PCPs and partner with external organizations and social service agencies to facilitate patient use of recommended alternative pain treatments. Future research should examine the efficacy of such strategies for improving opioid prescribing practices among PCPs at FQHCs.     

Postoperative pain after hospital discharge

Thirty postoperative adults were surveyed using face-to-face interviews in their homes after hospital discharge. Participants were asked to describe their pain communication during their inpatient hospitalization and pain-related problems after discharge. This study reports the content analysis of participant responses to their pain after discharge. Eighteen (60.0%) described pain-related problems after discharge. Seven (23.3%) identified pain-related fears or complications. Six (20.0%) identified analgesic management problems. Six (20.0%) described difficulty with positioning or moving. Four (13.3%) described sleep disruption from pain. The results identify several pain-related problems encountered by postoperative patients after hospital discharge. Shortened hospital stays make effective postdischarge pain management an essential aspect of care for surgical patients. Teaching patients additional pain management skills, including when and how to communicate with health care providers when pain-related issues occur at home, may lead to more effective pain relief for patients.     

Barriers to pain management: caregiver perceptions and pain talk by hospice interdisciplinary teams

As patients are cared for in their homes by family caregivers, several challenges arise in effective pain and symptom management. Despite hospice's reputation as the gold standard for terminal care, there is still a need to improve pain management practices, including challenges that caregivers face, related to pain assessment, reluctance and fear of administering medication, noncompliance with pain medicine regimens, and hesitance to report pain. The hospice philosophy of care promotes service for both patients and their family by an interdisciplinary team, and total pain management is a goal of this care. The aim of this control phase of a larger National Cancer Institute-funded mixed methods study was to understand the current practice of hospice assessment and collaboration on informal caregiver issues related to pain management. This study of 30 hospice caregiver--patient dyads from one rural hospice found that 87% of caregivers indicated concern with at least one question on the Caregiver Pain Medicine Questionnaire. Interdisciplinary team discussions for 23 of the dyads were recorded over nine months for a total of 86 sessions. Although caregiver concerns were identified with the Caregiver Pain Medicine Questionnaire by the research team, there was only one discussion of caregiver pain-related concerns during the hospice team meeting. This despite the finding that 38% of the time involved in a patient discussion is spent on pain-related talk. These findings indicate an opportunity for improvement by hospice teams through focusing on caregiver assessment and intervention.     

Sexual behaviour of nursing home residents: staff perceptions and responses

AIMS: This paper presents the results of a study that investigated nursing home staff perceptions of affectionate and sexual behaviour of residents. BACKGROUND: Despite growing recognition of the importance of sexual expression among residents and a increasing willingness to discuss the topic, sexual activity for nursing home residents remains an ignored component of life satisfaction. Even when 'sexuality' has been included as part of a resident's plan of care, this may not mean that attention has been paid to maintaining that aspect of their life. Thus, nursing homes can mark the end of many types of freedom for older people. Given that intimate basic care is performed by others and often by members of the opposite sex, loss of sexual freedom may also occur. METHOD: A grounded theory approach was used to study staff working in nursing homes in Australia and Sweden. Data were generated through interviews and nominal groups with nursing home staff. Thirty women volunteered to be interviewed, and 18 others were involved in the three nominal group discussions; a further five participants were involved as key informants. FINDINGS: Staff perceptions and responses to residents' sexual behaviour were found to be influenced by their own level of comfort related to sexuality issues, and the ethos within the organization where they worked. The conceptual paradigm was termed 'Guarding Discomfort' and specified the ways in which staff guard against sexuality discomfort as well as the ways their behaviour fits within different types of organizations. CONCLUSION: Both staff and nursing home managers need to work toward developing a home environment that is supportive of residents' sexuality rights, that permits sexuality expression and promotes a culture where all people concerned are comfortable with sexuality issues.     

Family and staff perceptions of the role of families in nursing homes

Family and staff perceptions of the role of families in nursing homes Admission to a nursing home is generally regarded as the termination of family care and the commencement of institutional care. Research suggests that following placement families are often expected to relinquish their dependent older relative to the bureaucracy of the institution. The aim of this study was to investigate family and nursing home staff perceptions of the role of families caring for residents in nursing homes. A convenience sample of 44 family carers and 78 nursing home staff completed questionnaires, and interviews were conducted with 10 family carers and 10 nursing home staff. The results suggest that family carers perceived themselves to have a greater role in caring for relatives than that perceived by the nursing home staff. Either families overestimated their involvement, or staff underestimated family involvement in caring for residents in nursing homes. Families were mostly satisfied with their role and with the care provided in nursing homes. They perceived nurses as providers of technical care and they perceived themselves as having an important role in providing social and emotional care. Families trusted the clinical judgement of the staff but the staff were reluctant to trust family carers, especially in situations where care involved an element of risk. Family roles were limited by members' own ability to care and the dependency of the resident, while professional responsibility and accountability discouraged nurses from sharing some caring roles. The results indicate that families in this study were more willing to help in nursing home care and were perhaps under-valued as a resource within the nursing home setting.     

近5年国外护理院研究热点的共词聚类分析

目的分析Pubmed数据库中2014-2018年护理院的研究热点和发展现状,旨在为我国护理院的发展提供参考依据。方法在Pubmed数据库中以"nursing homes"为主题进行检索,应用BICOMB 2.0对主题进行统计分析,采用SPSS 22.0进行系统聚类分析。结果共纳入1710篇文献,截取41个高频主题词,归纳出6个研究类团:护理院组织管理与流行病学研究;老年评估研究;护理院用药管理与疼痛管理研究;姑息护理与临终关怀研究;医护工作满意度研究;痴呆症患者及照顾者精神心理研究。结论国外护理院的研究热点分析利于了解该领域的研究现状和发展趋势,可为我国护理院的理论研究与实践发展提供参考。     

Ethical dilemmas in pain management.

The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that asked respondents to describe clinical situations in which they had encountered ethical dilemmas. A total of 1,105 surveys were analyzed, with physicians (N = 612), nurses (N = 189), and psychologists (N = 166) representing the professions with the greatest response. Management of pain at the end of life, general undertreatment of pain, and undertreatment of pain in the elderly were the most frequently encountered dilemmas. Qualitative data were analyzed to identify ethical issues in the case examples provided by the respondents. Major themes included inappropriate pain management, barriers to care, interactions and conflicts with others, regulatory/legal issues, euthanasia, assisted suicide, and research issues. We conclude that ethical dilemmas are common in pain management practice and that resolution of these dilemmas requires commitment by individual professionals as well as health systems.     

Nursing staff members' perceptions of pain indicators in persons with severe dementia.

OBJECTIVES: The aims of this study were to (1) identify behaviors that occur in noncommunicative nursing home residents that are perceived by nurses to be indicators of pain, (2) determine factors affecting the differentiation of pain behaviors from similar behaviors due to other causes, and (3) assess nurses' perceptions of the prevalence and importance of specific indicators of pain as well as barriers to the detection of pain in this population. SETTING AND PATIENTS: Seventy-two staff members of three nursing homes were interviewed and surveyed about specific behaviors associated with pain. Focus groups were conducted with staff to validate pain indicators and investigate perceptions of their own ability to identify pain. RESULTS: Nursing staff members agreed on a core group of behaviors that they perceive as pain indicators in elderly persons suffering from dementia. These indicators include specific physical repetitive movements, vocal repetitive behaviors, physical signs of pain, and changes in behavior from the norm for that person. The nursing staff members' level of familiarity with the residents was reported to have a significant effect on staff members' ability to identify and differentiate pain behaviors from other behaviors of impaired residents. Barriers to the detection of pain pertain to staff issues, resident behaviors, and resident-staff relationships. CONCLUSIONS: The study of pain among the noncommunicative elderly and, in particular, the development of a tool that can be used to assess their pain may greatly improve the quality of life of the estimated 20% to 35% of nursing home residents who cannot adequately express their needs.     

Nurses' knowledge of pain in the elderly

The purpose of this study was to investigate nurses' knowledge of pain and pain management with respect to elderly persons. Registered nurses at several general hospitals and nursing homes were surveyed by questionnaire concerning their knowledge of pain management in the elderly. The findings indicated a significant knowledge deficit in this area. There were also significant differences in knowledge levels between general hospital nurses and those working in nursing homes. We conclude that more education about pain management in elderly patients is needed for nurses. This deficit needs to be addressed in both undergraduate nursing programs and hospital in-service courses. Presently, the majority of patients entering hospitals are aged 65 years and over. Hence, nurses in all areas of care, not just specifically those working in aged care facilities, need a sound knowledge of pain management of the elderly to facilitate compassionate and effective nursing care.     

Migraine and chronic daily headache management: a qualitative study of patients' perceptions

AIM: The aim of the study was to gain insight into the patients' perceptions of migraine and chronic daily headache (CDH) management. METHODS: Thirteen, semi-structured and individual interviews with seven migraine and five CDH patients were carried out and analysed in QSR NUD*IST5, using a grounded theory methodology. RESULTS: The participants described using five areas of management: 1) health care use; 2) medication use; 3) alternative therapies; 4) social support; and 5) lifestyle and self-help. The participants described their expectations, preferences, worries and (dis)satisfaction in relation to these five areas of management. The participants adapted headache management to suit their needs and preferences, making migraine and CDH management highly individual and giving the headache patient a central role within their own care. CONCLUSION: Health care is changing towards a greater involvement of the patients in their own care. Therefore, it is important to increase understanding of the patients' perspective of chronic diseases, including migraine and CDH. The results from this study inform health care professionals of the range of their patients' needs and preferences. This knowledge can be used to shape clinical practice, to develop patient education programmes and to further research efforts into issues that are important to the headache patient.     

Nursing homes as learning environments: the impact of professional dialogue

Nursing students' clinical experiences are important with respect to their impact on attitudes towards care for older people and preferences for future workplaces. The purpose of this paper is to explore how professional dialogue has an impact on nursing students' clinical learning and professional development in nursing homes. A qualitative design based on field work, field notes and qualitative research interviews was employed with 12 third year nursing students undergoing clinical practise in three nursing homes in Norway. The nursing students who participated in this study displayed positive attitudes towards older people. However, their experiences and perceptions of the learning environment in the nursing homes, varied. The nursing students expressed that a positive learning environment included participation in nursing care and professional dialogue to support their learning process and outcomes. Their primary wish was to develop their knowledge about care for older people through participation and dialogue as critical and reflective processes in a community of practise.     

Parents' support and satisfaction with their child's postoperative care

It is recognized that parents' presence during their child's hospitalization is of benefit to the parents and the child. However, the level of parental involvement in their child's care may be influenced by many factors, such as the amount of support nurses provide for parents. This article reports on two themes from the findings of a larger study on parental involvement in children's postoperative pain management - parental support and parents' satisfaction with their child's postoperative pain management. The aim of the larger study was to explore both nurses' and parents' perceptions of parental involvement in their child's postoperative pain management. The methods used were both qualitative and quantitative. The qualitative method of phenomenology was used to guide 20 nurse and 20 parent interviews. Quantitative methods involved surveying the nurses and parents on their perceptions of how supportive the nurses were towards the parents. The charts of 20 children were reviewed for pain-related data. This article reports on the issues of parent support from the results of the survey, and on satisfaction relating to their child's postoperative pain management from the parent interviews. The findings demonstrated that nurses perceived that parents were receiving more support from them than that which parents felt they were receiving. Parents were more satisfied with their child's pain management and children received more analgesia when they were cared for by a lower grade nurse.     

Jordanian nurses'' roles in the management of postoperative pain in the postanesthesia care unit

One of the most important patient care issues for nurses is pain because of its significant impact on patients' well-being. Therefore, the main purpose of this exploratory study was to describe the role of Jordanian nurses in the management of postoperative pain in the PACU. A convenience sample of 42 postoperative patients was included in this study. Forty-two nurse-patient encounters involving 20 different nurses were observed during data collection. Findings from this study indicated that nurses in Jordan pay little attention to the area of assessment and management of postoperative pain. Cultural issues were discussed in light of the perception of pain and management of postoperative pain among Jordanian patients. Recommendations related to nursing practice, education, and research were developed to improve the quality of nursing care provided to postoperative patients in Jordan.     

Evaluation of a Standardized Sedation Assessment for Opioid Administration in the Post Anesthesia Care Unit

The impact of opioid-related sedation progressing to respiratory depression in the Post Anesthesia Care Unit (PACU) can be extensive; however, there is a paucity of research on the subject of standardized assessment tools to prevent adverse events. The purposes of this study were: (1) to measure the efficacy of a standardized method of assessing sedation and administering opioids for pain management via the Pasero Opioid-Induced Sedation Scale (POSS) with interventions in the PACU; (2) to increase PACU nurses’ confidence in assessing sedation associated with opioid administration for pain management and in the quality of care provided in their clinical area; and (3) to facilitate PACU and postoperative clinical unit nurses’ communications during patient handoffs regarding safe opioid administration. A quasi-experimental design was used to evaluate the POSS protocol. Two PACUs and six nursing units receiving postsurgical patients in a Midwestern inner-city hospital served as the setting for this research. Medical records were surveyed for outcome data to evaluate the efficacy of the care protocol in two patient cohorts before and after implementation of the POSS protocol. Nurses completed a written survey to identify changes in satisfaction with nurse-to-nurse communication, perceptions of quality of care, and confidence with opioid administration. The final sample included 842 PACU patients and 67 nurses from the PACU and clinical units. The intervention did not significantly change PACU length of stay or amount of administered opioids and patients were noted to be more alert at time of discharge from the PACU. Nurses reported increased perceptions of quality of care and confidence in opioid administration. The findings from this study support the use of the POSS Scale with interventions in the PACU care protocols.     

The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia

The need for a specialized clinical regimen for patients with dementia who require palliative care has only recently been recognized. Structured approaches to palliative care are not well developed. The recognition and treatment of pain is an important part of this management risk. However, pain is consistently underdiagnosed and undertreated in this population. A factor contributing to this has been a lack of appropriate tools to help recognize and document pain. This study sought to develop and validate an easy-to-use pain scale for use in residential aged care homes. The tool was developed with residents with end- or late-stage dementia who were unable to articulate their needs, identified by the registered nurses who knew them. Results showed that following pain-relief intervention the average pain score recorded using the scale fell by more than half. A paired Student's t-test showed the reduction to be highly significant (P<0.001). Validity and internal reliability, assessed by calculating Gamma and Cronbach's alpha, were found to be satisfactory. Qualitative evidence gathered from users of the scale indicated that it was considered a useful clinical device that could be completed within one minute. Further analysis of the use of the scale in clinical settings, testing of inter-rater reliability and examination of the limitations found in this study will commence early in 2004.     

A comparison of working in small-scale and large-scale nursing homes: A systematic review of quantitative and qualitative evidence

Background and objectiveOngoing shortages of care workers, together with an ageing population, make it of utmost importance to increase the quality of working life in nursing homes. Since the 1970s, normalised and small-scale nursing homes have been increasingly introduced to provide care in a family and homelike environment, potentially providing a richer work life for care workers as well as improved living conditions for residents. ‘Normalised’ refers to the opportunities given to residents to live in a manner as close as possible to the everyday life of persons not needing care. The study purpose is to provide a synthesis and overview of empirical research comparing the quality of working life – together with related work and health outcomes – of professional care workers in normalised small-scale nursing homes as compared to conventional large-scale ones.DesignA systematic review of qualitative and quantitative studies.Data sourcesA systematic literature search (April 2015) was performed using the electronic databases Pubmed, Embase, PsycInfo, CINAHL and Web of Science. References and citations were tracked to identify additional, relevant studies.Review methodsWe identified 825 studies in the selected databases. After checking the inclusion and exclusion criteria, nine studies were selected for review. Two additional studies were selected after reference and citation tracking. Three studies were excluded after requesting more information on the research setting.ResultsThe findings from the individual studies suggest that levels of job control and job demands (all but “time pressure”) are higher in normalised small-scale homes than in conventional large-scale nursing homes. Additionally, some studies suggested that social support and work motivation are higher, while risks of burnout and mental strain are lower, in normalised small-scale nursing homes. Other studies found no differences or even opposing findings. The studies reviewed showed that these inconclusive findings can be attributed to care workers in some normalised small-scale homes experiencing isolation and too high job demands in their work roles.ConclusionThis systematic review suggests that normalised small-scale homes are a good starting point for creating a higher quality of working life in the nursing home sector. Higher job control enables care workers to manage higher job demands in normalised small-scale homes. However, some jobs would benefit from interventions to address care workers’ perceptions of too low social support and of too high job demands. More research is needed to examine strategies to enhance these working life issues in normalised small-scale settings.