Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study

AimTo evaluate the impact of video education on critical care nurses’ knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses’ experiences with video education.MethodsForty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients’ pain assessment between nurses and the researcher was determined to examine nurses’ skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis.ResultsThe knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction.ConclusionsVideo education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.     

The clinical utility of the pain assessment tool in ventilated,sedated, and muscle-relaxed neonates

BackgroundThe neonatal Pain Assessment Tool (PAT) is considered a reliable and valid tool for assessing neonatal pain. No research has been conducted on the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates.ObjectiveThe objective of the study was to determine the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates.MethodsNeonatal nurses from the Royal Children's Hospital completed online surveys to assess the clinical utility of the PAT. Three focus groups were then conducted to further explore the variation of pain scores from the survey and clarify the challenges in interpreting the pain score.ResultsNurses perceived the PAT clinically useful in neonates who were ventilated and minimally sedated. However, the PAT was not clinically useful in neonates who were ventilated and heavily sedated or muscle-relaxed. Further exploration via focus groups highlighted two themes related to the ‘variation in the timing of the pain score’ and the ‘integration of critical thinking and judgement’ used when assessing pain in neonates.ConclusionsThe clinical utility of the PAT is acceptable for minimally sedated neonates; however, it decreases the more sedated a neonate becomes, and the PAT's usefulness is extremely poor in the muscle-relaxed neonate. A better understanding of the timing and interpretation of the pain score in relation to the neonate's clinical status may enable improved decision-making and pain management. The PAT requires further validity, reliability, and clinical utility research, particularly in critically ill and muscle-relaxed neonates.     

Personal and professional pain experiences and pain management knowledge among Greek nurses

The purpose of this exploratory study was to describe Greek registered nurses' personal and professional pain experiences and to examine the relationship with their pain management knowledge. Forty-six Greek nurses provided written responses to open-ended questions about their personal and professional experiences with pain and beliefs about suffering. Reporting a personal pain experience was associated with describing a positive professional pain experience, Phi=0.44, p < 0.03. The nurses vividly described their personal and professional pain experiences. One nurse wrote " em leader I begged to lose consciousness, in order not to feel". These compelling accounts might motivate nurses to strengthen their understanding of pain management.     

Elderly pain assessment and pain management knowledge of long-term care nurses.

The purpose of this study was to determine the knowledge base of long-term care nurses regarding pain assessment and management in the elderly. Three specific themes related to long-term care nurses were investigated: personal beliefs regarding patients' self-reports of pain, documentation of patients' self-reports of pain, and choice of pain medication and dose. Eighty-nine long-term care nurses, from 6 rural counties in California, responded to a questionnaire that consisted of 2 patient scenarios. The scenarios portrayed 1 patient as smiling and showing no objective signs of pain and the other patient as grimacing. Three questions followed up the scenarios related to elder pain assessment and management. Nurses were asked to indicate their pain assessment on a 0 to 10 scale and to choose the correct pain medication and dose. Frequencies and means were used to analyze demographic data; frequencies, t tests, and chi 2 testing compared nurse responses with the different questions. Results indicated that nurses were more likely to believe and document the grimacing patient's self-report of pain than the smiling patient. Older nurses with more experience were less likely to believe or document their patient's self-report of pain than younger nurses with fewer years of experience. Less than half of the nurses would increase the analgesic dose for either patient scenario. Nursing implications include the importance of ongoing pain assessment and management education tailored to the geriatric population and long-term care.     

Primary care nursing competencies in Canadian undergraduate nursing programs: A national cross-sectional survey

AimTo assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula.BackgroundCanadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in undergraduate nursing programs and to assist in building a robust primary care nursing workforce.DesignWe conducted a national cross-sectional survey of undergraduate baccalaureate nursing programs (n = 74).MethodsThe survey was conducted between April-May 2022. We used a modified version of the “Community Health Nurses’ Continuing Education Needs Questionnaire”. Respondents indicated their level of agreement on a 6-point Likert scale with 47 statements about the integration of the competencies in their program (1 = strongly disagree; 6 = strongly agree).ResultsThe response rate was 51.4%. The overall mean across the six competency domains was 4.73 (SD 0.30). The mean scores of each domain ranged from 4.23 (SD 1.27) for Quality Assurance, Evaluation and Research to 5.17 (SD 0.95) for Communication.ConclusionsThere are gaps in how these competencies are included in undergraduate education programs and opportunities to strengthen education for this growing workforce in Canada.     

Nurse competencies for person-directed care in nursing homes

A national movement to transform U.S. nursing homes is occurring with the intent to support self-determination, dignity and choice for nursing home residents facilitated by the continuation of their routines and preferences. Ten competencies for nurses were identified to facilitate this culture change in nursing homes. These competencies are intended to: model resident-directed care; foster effective team work with direct care workers to solve problems and make decisions that support residents; and promote a positive work and home environment. The strategies used to identify and disseminate the ten competencies are described as well as implications of the competencies for practice, education, and research.     

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.     

广西省养老机构护理人员状况的调查与分析

目的了解养老机构护理人员学历、职称结构和培训教育现状，为创建学习型组织提供依据。方法采用自设问卷对广西省20所养老机构中358名护理人员的学历、职称结构、在职培训情况进行调查。结果护士学历以中专为主，护师、主管护师和副主任护师分别占10．00％、4．90％和2．00％，已获得护士执业资格证书者仅有35．52％。护理员学历以初中为主，持有养老护理员执业资格证者仅为5．71％。只有3所养老机构将在职培训纳入工作日程。结论目前广西省养老机构的护理人员学历、职称结构欠合理，整体素质偏低，在职培训状况不容乐观，满足不了日益高涨的养老需求。必须建立学习型的护理队伍，不断提升养老机构的整体护理水平。     

Core competencies for family and community nurses: A European e-Delphi study

AimTo identify the core competencies of family and community nurses.BackgroundThe European Union is facing common health challenges in the field of primary care, according to European health policies and the World Health Organization, which need to be addressed through better and innovative ways of working that require joint actions. There is evidence that ‘Family and Community Nurses’ play a key role in the field of primary care, but there is no agreement on which core competencies they are required to have.DesignAn e-Delphi studyMethodsA 4-round e-Delphi study was conducted from March to July 2018 as part of the Erasmus+ Project “EuropeaN curriculum for fAmily aNd Community nursE” (ENhANCE). A panel of 23 experts from 10 European countries were asked to approve, modify, or add items and then prioritize each skill.ResultsThis e-Delphi, as part of the ENhANCE project, produced core 28 competencies, which were used by the “ENhANCE” partners to develop the European Core Curriculum for Family and Community Nurses. The ENhANCE partners ensured that the core competencies were consistent with World Health Organization recommendations, the European Skills/Competencies, Qualifications and Occupations (ESCO) and with the European Credit System for Vocational Education and Training (ECVET).ConclusionsThe results of this study will provide the basis for universities across Europe to develop their own post-graduate teaching programs with common educational goals for Family and Community Nurses and a cadre of nurse practitioners with transferrable skills across the continent.Tweetable AbstractThis e-Delphi, as part of the ENhANCE project, produced 28 competencies for the European Core Curriculum for Family and Community Nurses.     

Edmonton symptom assessment scale: Italian validation in two palliative care settings

In the palliative care setting, the Edmonton Symptom Assessment Scale (ESAS) was developed for use in daily symptom assessment of palliative care patients. ESAS considers the presence and severity of nine symptoms common in cancer patients: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath plus an optional tenth symptom, which can be added by the patient. The aim of this study was to validate the Italian version of ESAS and to evaluate an easy quality of life monitoring system that uses a patients self-rating symptom assessment in two different palliative care settings: in-patients and home patients. Eighty-three in-patients and 158 home care patients were enrolled. In the latter group, the Italian validated version of the Symptom Distress Scale (SDS) was also administered at the admission of the patients. The two groups of patients have similar median survival, demographic and clinical characteristics, symptom prevalence and overall distress score at baseline. ESAS shows a good concurrent validity with respect to SDS. The correlation between the physical items of ESAS and SDS was shown to be higher than the correlation between the psychological items. The association of ESAS scores and performance status (PS) showed a trend: the higher the symptom score was, the worse was the PS level. Test–retest evaluation, applied in the in-patient group, showed good agreement for depression, well-being and overall distress and a moderate agreement for all the other items. In conclusion, ESAS can be considered a valid, reliable and feasible instrument for physical symptom assessment in routine palliative care clinical practice with a potentially different responsiveness in different situations or care settings.     

The development of a measurement tool for the assessment of pain behaviour in real time

Background and purpose Chronic pain is a multifactorial problem. It is therefore important to assess the chronic pain patient from a variety of perspectives. A reduction in pain behaviour is a specifically cited aim of some clinical interventions. Pain behaviour measures have involved video recordings and subsequent ratings, or observations over a prolonged period of time. These methods have been criticised as time consuming and impractical in the clinical setting. The present pilot study developed a pain behaviour measurement tool, which could be delivered in ‘real time’ during a standardised functional assessment to give immediate feedback to clinicians and that could be used as an outcome measure.Methods Frequently occurring pain behaviours were identified, criteria were standardised, and a measurement tool and scoring system were developed. Forty-seven subjects with chronic pain were included in the inter-rater reliability study. Each subject was observed by 2 raters as they carried out a standardised physiotherapy functional assessment before and after a pain management programme. The occurrence of pain behaviour was scored using the developed measurement tool. Inter-rater reliability and internal consistency were assessed.Results and conclusion There was a high level of inter-rater reliability. 84% of the Kappa scores obtained fell between 0.61 and 1.0. Internal consistency was excellent (Alpha score 0.85 pre-programme and 0.84 post-programme). Given the limitations of self-report and self-monitoring methods of pain, pain behaviour and disability, a tool that more reliably captures this additional dimension of pain is appealing, and would be a valuable adjunct in the clinical assessment of the chronic pain patient.     

老年人疼痛强度评估量表的选择

目的:调查老年人使用4种常用疼痛强度评估量表的情况,为选择合适的老年疼痛评估工具提供依据.方法:广州市两家老人院的61例65岁以上老年人参加了研究.用随机顺序排列的直观模拟量表(VAS)、数字评定量表(NRS)、词语描述量表(VDS)和修订版面部表情疼痛量表(FPS-R),对老年人的回忆性疼痛进行评估.结果:受试对象中男性17例,女性44例,平均年龄81.7岁,54例(88.5%) 认知正常,7例(11.5%)有一定程度的认知受损.4种量表疼痛评分间的Spearman相关系数为0.84～0.94.老年人能够用至少一种量表来主诉疼痛强度.FPS-R是错误率最低而首选率最高的量表.结论:4种量表均可用于评估老年人的疼痛,但FPS-R是最佳量表.将FPS-R、VDS和NRS 3种量表合并,制成简易疼痛评估尺,适合老年人认知功能且实用的疼痛评估方法.     

急诊科护士疼痛管理知识和态度现状的调查

目的 通过对急诊护士进行疼痛管理知识和态度问卷调查,了解急诊护士疼痛管理相关知识掌握情况及实践现状,为持续改进急性疼痛护理质量、提高急诊疼痛患者管理效果提供参考.方法 应用KASRP(疼痛管理知识和态度的调查)(2008)中文版问卷对132名急诊护士进行疼痛管理知识和态度调查,采用SPSS 17.0对收集数据进行描述性分析、方差分析.结果 急诊科护士KASRP问卷答对率在25%～65%,平均答对率为(44.65±7.85)%;答对10～26条目,平均答对(17.86±3.14)条目.不同年龄、性别及工作年限答对率差异无统计学意义;不同学历及职称答对率差异有显著性.结论 急诊科护士疼痛管理知识和态度显著缺乏,疼痛基础知识点掌握不足,疼痛管理知识与临床实践之间存在偏差,有待提高和改善.