Barriers to Effective Pain Management in Cancer Patients From the Perspective of Patients and Family Caregivers: A Qualitative Study

BackgroundPain is one of the most common and undesired symptoms in cancer patients, affecting patients’ physical and psychological well-being. Barriers to effective pain management in cancer patients need to be identified and addressed by clinicians.AimsThe purpose of this study was to explore the barriers to effective cancer pain management from the perspective of cancer patients and their family members.MethodsA qualitative research design was employed. Semistructured interviews were conducted with 10 patients and 10 family caregivers to elucidate their perspectives regarding the barriers to effective cancer pain management in Jordan.ResultsRegulatory factors, knowledge deficit, and the use of religious and cultural strategies to cope with pain were major barriers to effective cancer pain management. Although effective cancer pain management is highly recommended, the participants’ cultural beliefs deeply appreciated pain tolerance and discouraged effective treatment of cancer pain.ConclusionTailoring culturally appropriate educational programs regarding effective cancer pain management could facilitate pain management among patients with cancer.     

Person-centred education and advice for people with low back pain: Making the best of what we know

BackgroundThe first-line treatment consistently recommended for people with low back pain is patient education and advice. Regardless of the duration of low back pain, clinicians should provide education on the benign nature of low back pain, reassurance about the absence of a serious medical condition, and advice to remain active. There is little guidance on how best to provide this care.ObjectiveThis Masterclass will draw on recent evidence to explore how physical therapy clinicians could deliver person-centred education and advice to people with low back pain to refine their clinical consultation.DiscussionFirst, we highlight the potential value of providing validation to acknowledge the distressing experience and consequences of low back pain. Second, we describe a tool to open channels of communication to provide education and advice in a patient-centred and efficient way. Clinicians could consider using the Attitude toward Education and advice for Low back pain Questionnaire to gain an insight into patient attitudes toward education and advice at the outset of a clinical encounter. Finally, we provide options for tailoring patient education and advice to promote self-management of low back pain based on patient attitudes. We present evidence that a positive attitude toward messages about causes rather than messages about physical activity predicts intention to self-manage low back pain. We combine this evidence to suggest a pathway for clinicians to provide education and advice to people with low back pain within the time constraints of a clinical consultation.     

Association between cultural intelligence and cultural sensitivity in nursing students: A cross-sectional descriptive study

BackgroundBecause of the multicultural composition of the Turkish population, healthcare providers encounter and serve individuals from various cultural backgrounds.AimTo determine the relationship between cultural sensitivity and cultural intelligence levels among nursing students.MethodsThis study was performed with 336 students attending the Nursing Department of a state university in Turkey. Data were collected using a sociodemographic data form, the Intercultural Sensitivity Scale, and the Cultural Intelligence Scale.ResultsMean age of the Nursing Department students was 20 ± 1.76 years. Mean total scores on the Intercultural Sensitivity Scale and Cultural Intelligence Scale were 90.49 ± 12.68 (maximum 120) and 95 ± 15.8 (maximum 140), respectively. Total scores in both the Intercultural Sensitivity Scale and the Cultural Intelligence Scale were higher among those nursing students who had encounters with people with different cultural backgrounds for any reason and those who wanted to work abroad. The nursing students’ Intercultural Sensitivity Scale and Cultural Intelligence Scale total scores were positively correlated (p < .001).ConclusionIntercultural sensitivity increased with higher cultural intelligence. Enhancing nursing education with programs that improve the students’ cultural sensitivity and cultural intelligence will help them to successfully manage cultural differences and provide culturally appropriate care in their nursing practice.     

Pain management for children with cerebral palsy in school settings in two cultures: action and reaction approaches

Background: Children with cerebral palsy (CP) face particular challenges, e.g. daily pain that threaten their participation in school activities. This study focuses on how teachers, personal assistants, and clinicians in two countries with different cultural prerequisites, Sweden and South Africa, manage the pain of children in school settings.

Method: Participants’ statements collected in focus groups were analysed using a directed qualitative content analysis framed by a Frequency of attendance-Intensity of involvement model, which was modified into a Knowing-Doing model.

Results: Findings indicated that pain management focused more on children’s attendance in the classroom than on their involvement, and a difference between countries in terms of action-versus-reaction approaches. Swedish participants reported action strategies to prevent pain whereas South African participants primarily discussed interventions when observing a child in pain.

Conclusion: Differences might be due to school- and healthcare systems. To provide effective support when children with CP are in pain in school settings, an action-and-reaction approach would be optimal and the use of alternative and augmentative communication strategies would help to communicate children’s pain. As prevention of pain is desired, structured surveillance and treatment programs are recommended along with trustful collaboration with parents and access to “hands-on” pain management when needed.

• Implications for rehabilitation

• ??When providing support, hands-on interventions should be supplemented by structured preventive programs and routines for parent collaboration (action-and-reaction approach).

• ??When regulating support, Sweden and South Africa can learn from each other;

• ○?In Sweden, the implementation of a prevention program has been successful.

• ○?In South Africa, the possibilities giving support directly when pain in children is observed have been beneficial.

     

Pain Management in the Cancer Survivor

ObjectivesTo describe assessment and interdisciplinary management of pain in the cancer survivor over the continuum of cancer care.Data SourcesReview of the literature and treatment standards.ConclusionPain remains a primary concern throughout the cancer trajectory across all age groups and diagnoses, emphasizing the need to integrate pain assessment and management across the continuum of cancer survivorship and across care settings. Types of pain, pain patterns, assessment of cancer pain in cancer survivors, current strategies and challenges for management, and effective communication and documentation of the process are described. Communication between and among health care clinicians in a way that effectively articulates the individual patient experience, including documentation in the electronic medical record, requires consistent workflows and terminology. The opioid crisis increases the urgency in effective strategies for interdisciplinary pain assessment and management.Implications for Nursing PracticeOncology clinicians must be able to adequately assess pain, track pain over time, understand and implement a cadre of strategies to manage pain, and effectively pursue any suspicious pain patterns that may indicate recurrence or progression of cancer or other underlying etiologies. The oncology nurse is at the core of patient-clinician communication, critical to effectively describing pain as experienced by the individual patient and continues to play a key role in maintaining consistency of message that is necessary to manage pain over the continuum of cancer survivorship.     

Contextual and Cultural Influences on Caregivers of Hispanic Cancer Survivors

ObjectivesTo discuss contextual factors (barriers to accessing health care, immigration issues, minority stress, low education/income, challenging employment environments) and cultural values (familism, espíritu, confianza, marianismo, machismo) of Hispanic caregivers that may influence the caregiving experience.Data SourcesLiterature, research.ConclusionHispanic caregivers, like non-Hispanic caregivers, experience poor health during caregiving and have unmet needs for information and emotional support. Few evidence-based supportive care interventions are currently available, and more should be developed and tested for this growing population of Hispanic caregivers.Implications for Nursing PracticeNurses should assess both contextual factors and cultural values as part of treatment planning for quality cancer care.     

Palliative Care in the Greater China Region: A Systematic Review of Needs,Models, and Outcomes

ContextThere is rapidly increasing need for palliative care in Greater China because of rapidly aging populations.ObjectivesThis study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China.MethodsFour databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence.ResultsNineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional, and spiritual supports, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Health care professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among patients with advanced cancer. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care, and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psychospiritual assessment, quality of care, and implementation assessment. Limited rigorous randomized controlled trials are available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence.ConclusionPalliative care services within Greater China should pay more attention to management of nonmalignant disease and to integration into primary services. Policy support is key to establishing culturally appropriate person-centered services.     

Perspectives on Cancer Pain Assessment and Management in Children

ObjectiveTo report evidence regarding pain assessment and management for children and adolescents receiving treatment for cancer.Data SourcesPublished research and clinical guidelines.ConclusionChildren and adolescents experience multiple sources of pain across the cancer continuum. They require developmentally relevant approaches when assessing and managing pain. This review suggests that consideration of the developmental stage and age of the child are essential in both pain assessment and pain management.Implications for Nursing PracticePediatric oncology nurses play a key role in developmentally appropriate pain assessment, identification of potential strategies to manage pain, and delivery of pharmacologic and nonpharmacologic therapies.     

Cultural factors associated with physical activity among U.S. adults: An integrative review

AIMThe purpose of this integrative review is to identify the cultural factors associated with physical activity (PA) among United States (U.S.) adults.BACKGROUNDPhysical inactivity is a significant public health problem that requires comprehensive community-based efforts. Cultural factors influence behavior and attitudes towards PA. Therefore, identifying the cultural factors is a key requirement for the planning of specific measures to enhance the level of PA and are more promising than campaigns aimed at the general population. This integrative review examined existing research on cultural factors influencing adult PA to inform the development of culturally adapted PA interventions in adults.METHODSLiterature searches were conducted in key scientific databases (PubMed, Cumulative Index to Nursing and Allied Health, and PsycINFO) using several key words related to both culture and PA. Fifteen peer-reviewed articles were identified, reviewed, synthesized, and critically analyzed.RESULTSEight major categories of cultural factors were identified: 1) collectivism and cultural identity; 2) religiosity; 3) cultural attitudes and gender norms in regards to PA; 4) cultural perspectives on health in regards to PA; 5) cultural expectations of familism and lack of time; 6) lack of role models and lack of motivation; 7) lack of culturally appropriate exercise facilities; and 8) cultural expectations of body image and physical appearance.CONCLUSIONSReview findings emphasize the need for health promotion targeted toward improving cultural barriers to PA among U.S. Adults.     

Explaining pain following cancer: a practical guide for clinicians

BackgroundPain is one of the most prevalent and debilitating symptom following cancer treatment.ObjectivesThis paper entails a practical guide for clinicians willing to apply pain neuroscience education (PNE) in this specific population, or clinical researchers willing to examine the effects of PNE in patients suffering from pain following cancer.ResultsPatient-specific information (i.e. beliefs, cognitions, pain memories, social factors) as well as identification of the dominant pain mechanism are needed to tailor the education to the specific needs and beliefs of the patient. Therapists require an in-depth understanding of pain mechanisms, the skills to explain to their patients various pain mechanisms, specific communication skills (e.g. Socratic-style dialogof education) and experience with current evidence-based biopsychosocially-driven pain management strategies for successful implementation of PNE in the clinic. Rather than purely focusing on the biomedical characteristics of pain following cancer (e.g., tissue damage due to past cancer treatment), PNE implies teaching patients about the underlying biopsychosocial mechanisms of pain. Its application is backed-up by mounting evidence supporting the effectiveness of PNE in non-cancer pain populations, and a pilot study in patients having pain following cancer.ConclusionPNE is a potential solution to improve pain outcome in cancer survivors. Further research using sufficiently powered and well-designed randomized clinical trials should be conducted to examine the potential of PNE in patients having pain following cancer.     

Low neonatal pain management practices and associated factors among nurses and midwives working in governmental hospitals of central Ethiopia, 2021

BackgroundNeonatal pain management is a significant problem in the clinical settings of developing countries. Several studies have revealed that neonatal pain management practices among health professionals were overlooked. As a result, the data regarding the factors affecting nurses' and midwives' neonatal pain management practices is essential in designing interventions to address this gap. Therefore, this study aimed to assess neonatal pain management practices and associated factors among nurses and midwives working in government hospitals in central Ethiopia from September 1, 2019 to September 30, 2021.MethodsAn institution-based quantitative cross-sectional study design was employed among randomly selected 268 nurses and midwives after obtaining ethical approval from Ambo University. The data were collected using a pretested, structured, self-administered questionnaire. The collected data were checked, coded, and entered into Epi-data version 3.1 and exported to SPSS version 25 for analyses. Bivariate and multivariate logistic regression analyses were carried out. The odd ratio along with the 95% CI were computed to ascertain the association.ResultsThe study revealed that 37.3% [95% CI: 31.4–43.3] of the study participants had good practices for neonatal pain management. Respondents with less than five years of work experience [AOR = 2.4 (1.16, 4.99)], Nurses or Midwives with no neonatal pain training [AOR = 2.89 (1.58, 5.29), poor neonatal pain knowledge [AOR = 1.09 (1.09, 3.61)], and an unfavorable attitude toward neonatal pain [AOR = 3.19 (1.74, 5.85)] were factors significantly associated with poor neonatal pain management practice.ConclusionsThe overall practice of neonatal pain management is low. Factors like work experience, training, knowledge, and attitude were significantly associated with poor practices in neonatal pain management. All stakeholders should consider the necessary interventions. Moreover, educational and convenient training programs on neonatal pain management are needed to better assess and manage neonatal pain.     

Factors associated with comfort as perceived by older people living in long-term care facilities

BackgroundPerceived comfort levels of older people living in long-term care facilities (LTCFs) influence their health and wellbeing.AimThis study aimed to investigate the comfort levels and factors that contributed to comfort among older people living in LTCFs.MethodsA cross-sectional research design was used. Sociodemographic profile, physical function, pain, depressive symptom, social support, and comfort levels were collected. Stepwise multiple regression was utilised to identify the factors of residents’ comfort level in the LTCFs.FindingsA total of 114 residents were recruited in the study. Depressive symptom (β = -0.630, p < 0.001), social support (β = 0.260, p < 0.001), and pain (β = -0.128, p < 0.01) were the factors identified associated with perceived comfort among older people living in LTCFs (adjusted R²=88.2%). Older people with less depressive symptoms, greater social interaction and lower levels of pain showed higher comfort levels while living in long-term care facilities.DiscussionComfort, as perceived by older people living in LTCFs, is influenced by a combination of physiological and psychological factors. For older people to live comfortably in LTCFs, clinicians need to consider early detection of potential mental health issues such as depression, enhance the social support networks within and external to LTCFs and effectively manage pain.ConclusionThe findings inform gerontological nurses in assessing comfort levels of the residents and in implementing interventions to increase the comfort levels of older people living in long term care facilities.     

Therapeutic Interventions in Perinatal and Infant Mental Health Services: A Mixed Methods Inquiry

Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research.     

Stigma and Developmental Disabilities in Nursing Practice and Education

Individuals with developmental disabilities (DD) experience stigma, discrimination, and barriers, including access to appropriate health care, that restrict their ability to be equal participants in society. In this study, underlying contexts, assumptions, and ways of acting are investigated that perpetuate inequalities and pejorative treatment toward those with disabilities. Several nurse researchers and educators suggest specific content for, or approaches to, education about DD. Critical pedagogy that employs cultural competency and a disability studies’ framework to guide curriculum and course development will allow assumptions underlying common health care practices that oppress and “other” people with disabilities to be exposed and changed.     

Pain intensity,interference and patient pain management strategies the first 12 weeks after coronary artery bypass graft surgery

BackgroundPain is a distressing and often undertreated symptom of cardiac surgery. Little is known about pain levels, interference and treatment strategies beyond the 9 week period.AimThe purpose of this study was to describe pain intensity, interference and strategies used to manage pain in post-operative CABG patients.MethodsBaseline data were collected by interview in the hospital after CABG surgery using the Modified Brief Pain Inventory. One to 12 weeks after discharge, weekly telephone interviews were conducted to collect data.ResultsPain levels and interference with activities of daily living were greatest during hospitalization and decreased over 12 weeks. Pain interfered the most with coughing and sleep. Once opioid medications ran out, activity modification was primarily used to manage pain.ConclusionsActivity modification below recommended levels was reported as a pain management strategy. Patients reported pain lasting longer than they expected and the need for more education about activity and pain management strategies.     

Strengthening global midwifery education to improve quality maternity care: Co-designing the World Health Organization Midwifery Assessment Tool for Education (MATE)

AimsTo describe a three-phase co-designed project to develop a culturally appropriate and relevant education assessment tool, and report on pilot and field-testing phases.BackgroundHigh-quality midwifery education is essential for high-quality maternity care (WHO 2019); however midwifery education and maternity care vary in quality throughout Europe. To support countries in strengthening their midwifery education, World Health Organization (WHO) European Region commissioned development of the Midwifery Assessment Tool for Education (MATE). The tool was developed over three years, using an iterative, collaborative process with regional experts. Published by WHO in May 2020, MATE provides focused questions and evidence-informed resources to stimulate and inform discussions within country.DesignThree-phase co-design approach to develop, pilot and field-test an education assessment tool.MethodsPhase 1: initial development of MATE with expert midwifery support; Phase 2: MATE piloting workshops in Czech Republic and Lithuania focusing on clarity, usability and relevance; Phase 3: MATE field-testing workshop in Bulgaria exploring the process of using MATE and its effectiveness for generating discussion. Purposive selection of workshop participants ensured a broad range of perspectives: clinicians, educators, students, policy makers and service users. All participants were invited to give narrative feedback during workshops and via completion of a post-workshop online survey. The XX University Research Ethics Committee advised that formal ethical review was unnecessary.ResultsFeedback from collaborators in all phases indicated that engaging with MATE co-design and testing was a positive experience. A ‘bottoms up’ approach ensured that MATE content was relevant to regional needs, culturally acceptable and appropriate.Seventy-nine individuals participated in Phases 2 and 3 and all were sent a post-workshop online survey, with 31 responses (39 %). Qualitative and quantitative data indicated that the aim of MATE was well understood, and its usability and relevance were evaluated positively. In Phase 2, improvements to wording and format were suggested. MATE was subsequently amended prior to field testing. Phase 3 feedback indicated that MATE was highly effective for generating in-country dialogue and frank discussions about the future of midwifery education and practice.ConclusionsUsing a co-design approach has ensured that MATE is culturally relevant, accessible and appropriate. This initial evaluation indicates that MATE can facilitate in-country dialogue and support the strengthening of midwifery education in accordance with WHO aims.Next steps are a fully evaluated trial of MATE in a selected partner country, where we will continue to work collaboratively to optimise engagement and ensure cultural appropriateness.     

Demographic,Clinical, and Pain Characteristics Are Associated With Average Pain Severity Groups in a Sample of Oncology Outpatients

Cut-points (CP) for pain severity are useful because they may help clinicians to identify patients with clinically significant pain. However, a need exists to evaluate whether different pain severity groups differ on selected demographic, clinical, and pain characteristics, as well as on factors that may be amenable to psychoeducational interventions such as self-efficacy for pain management, coping strategies, and barriers to pain management. In this cross-sectional study of 210 oncology outpatients with pain, an optimal CP of 4 was found using ratings of average pain intensity. The variables that provided a unique contribution to the prediction of membership in the >4 CP group were gender, presence of breakthrough pain, comorbidities, barriers to pain management, and total self-efficacy for pain management. In addition, patients in the >4 CP group reported lower scores on physical, role, cognitive, and global health function.PerspectiveAn average pain CP of >4 could be used to screen oncology outpatients with clinically significant pain. Clinicians must consider a number of demographic, clinical, and pain characteristics as part of their pain assessment procedures. The effectiveness of psychoeducational interventions aimed at barriers and patients self-efficacy for pain management need to be tested.