Nurses’ Opinions of Pain and the Assessed Need for Pain Medication for the Elderly

The undertreatment of pain in the elderly living in nursing homes is a significant problem. In Swedish nursing homes, the registered nurse on duty is often responsible for 20-40 patients during the day with no daily contact from attending physicians. The aim of this study was to investigate the opinions of registered nurses regarding pain and the assessed need for pain medication for elderly patients using patient scenarios. Two patient scenarios were used in this study; a questionnaire and background information was provided. The scenarios consisted of one smiling patient and one grimacing patient, both with the same numeric rating scale value of pain, blood pressure, pulse rate, and respiration rate. Three questions regarding pain assessment and management followed the scenarios. The questionnaire was sent to all 128 registered nurses working daytime in elderly care in both municipal nursing homes and municipal home care in the mid-Sweden region. A total of 56 nurses participated, providing an answering frequency of 45%. Results showed that registered nurses with more experience did not have the same opinion about pain as the smiling patient and gave inadequate medication, which was not in accordance with recommendations from the county hospital and the World Health Organization.     

Family Members’ Experiences with Observing Pain Behaviors Using the Critical-Care Pain Observation Tool

BackgroundCurrent guidelines support family members' participation in care, but little is known regarding their potential contribution to pain assessment using validated behavioral pain scales.AimsThis study aimed to describe family members’ observations of pain behaviors with the Critical-Care Pain Observation Tool and their evaluation of the tool and its use, and to understand their experience and perceptions of their potential role in pain management in the intensive care unit.DesignA mixed methods cross-sectional explanatory design was used.SettingA medical-surgical intensive care unit in Canada.Participants/SubjectsFamily members were eligible if they had a loved one admitted in the intensive care unit who was unable to self-report.MethodsFamily members identified pain behaviors using the Critical-Care Pain Observation Tool after a brief training, completed a self-administered questionnaire, and participated in a follow-up individual interview regarding their experience and perceived potential role in pain management when their loved one is unable to self-report.ResultsTen family members participated. A 15-minute training appeared sufficient for family members to be comfortable with observing pain behaviors included in the Critical-Care Pain Observation Tool. The tool allowed them to confirm their observations of pain behaviors, to focus more on the patient, and to advocate for better pain management.ConclusionsFuture research is needed to explore the views of more family members and to compare their Critical-Care Pain Observation Tool scores to the ones of nurses' for interrater reliability testing.     

Understanding Nurses’ Knowledge and Attitudes Toward Pain Assessment in Dementia: A Literature Review

BackgroundPain is underrecognized and undertreated in patients with dementia. It has been suggested that nurses’ attitudinal barriers may contribute to the challenges surrounding pain assessment and management in dementia.AimsThis integrative literature review aims to identify and explore nurses’ knowledge and attitudes towards pain assessment in older people with dementia and how it may affect pain management in this patient group.MethodElectronic searches were conducted in Web of Science, MEDLINE, Scopus, ProQuest, PubMed, and EBSCOhost from January 2008 to December 2018 for articles specifically focusing on nurses’ knowledge and attitudes towards pain assessment in older patients with dementia.ResultsTen studies were included in the review after meeting the inclusion criteria. Data extracted from each study included study design, aims and objectives, setting/sample, findings, and limitations. Patients with dementia are at greater risk of experiencing underassessment, undertreatment, and delayed treatment of pain due to nurses’ knowledge deficits and uncertainty in the decision-making process. Nurses see providing comfort and reducing pain as ethical obligation. However, they find pain assessment a challenge due to the complexity of recognizing painful behaviors, and difficulty differentiating between pain and behavioral disturbances in dementia. Poor multidisciplinary communication, time constraints, and workload pressure, as well as uncertainty about opioid use, are important barriers to effective pain assessment and management among patients with dementia.ConclusionIt is essential that nurses gain confidence in distinguishing signs and symptoms of pain from behavioral changes in dementia. It is important to improve interdisciplinary communication and to get physicians to listen and prioritize pain assessment and management.     

Scratching Beneath the Surface: Influencing Factors on Nurses’ Attitudes Toward the Use of Seclusion

Reducing the use of seclusion is now widely identified as a quality issue for mental health services and reflects recognition of the detrimental impact of seclusion on consumers of services. Despite this, the research evidence suggests that nurses continue to support the use of seclusion in order to maintain a safe environment. The aim of this study was to consider how factors such as Therapeutic Optimism, Job Satisfaction, and Burnout might relate to nurses’ attitudes toward seclusion. The Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory, and Minnesota Satisfaction Questionnaires were completed by 123 nurses employed in one of eight participating mental health services. Data analysis included Spearman's rho and independent-samples t-tests statistics. The findings suggested several significant relationships between attitudes toward seclusion and therapeutic optimism, job satisfaction, and burnout. Participants with higher optimism scores, high intrinsic motivation, low emotional exhaustion, and high personal accomplishment were more likely to respond negatively to the use of seclusion. This research enhances our understanding of attitudes toward seclusion and may assist in the development of interventions to influence more positive attitudes.     

Effect of Pain Education Interventions on Registered Nurses’ Pain Management: A Systematic Review and Meta-Analysis

ObjectivesThis review and meta-analysis aims to reveal how pain education interventions affect registered nurses’ pain management.DesignA systematic review and meta-analysisData sourcesPubMed, Scopus, CINAHL (EBSCOhost), and ERICReview methodsA systematic search of four electronic databases was conducted to identify relevant peer-reviewed English or Finnish-language articles published between 2008 and 2021. The review included a quality appraisal and a meta-analysis of articles providing group-level data before and after the intervention (n = 12). The methods followed the PRISMA guidelines.ResultsOverall, 23 articles met the inclusion criteria for the review, of which 15 were evaluated as good quality. Based on the articles on document audits (n = 10), pain education interventions reduced the risk of not receiving the best pain management by 40%, whereas based on the articles on patients’ experiences (n = 4), they reduced the risk by 25%. The study quality and design of these articles were considerably heterogenous.ConclusionsPain education study strategies varied widely among the included articles. These articles used multivariate interventions without systematization or sufficient opportunity to transfer the study protocols. It can be concluded that versatile pain nursing education interventions, as well as auditing of pain nursing and its documentation combined with feedback, can be effective to nurses in adapting pain management and assessment practices and increasing patient satisfaction. However, further research is required in this regard. In addition, well-designed, implemented, and reproducible evidence-based pain education intervention is required in the future.     

Reliability and Feasibility of the Pain Assessment in Advanced Dementia Scale–Korean Version (PAINAD-K)

BackgroundThere is currently no observational instrument for assessing pain in aged patients who are unable to provide self-report in long-term care hospitals in Korea.AimsThe goal of this research was to culturally adapt and test the validity, reliability, and feasibility of the Korean version of the Pain Assessment in Advanced Dementia Scale.DesignThis was a methodologic study aiming to translate the Pain Assessment in Advanced Dementia Scale.Participants/SubjectsThe inpatients in a 270-bed LTC hospital in D metropolitan city were assessed pain levels.MethodsThe Pain Assessment in Advanced Dementia (PAINAD) Scale was used as an observation scale to assess 192 long-term care hospital patients, with observation durations of 1 and 5 minutes.ResultsThe interrater reliability (1 minute) for the scale showed substantial kappa agreement of .62, and scores for the 1- and 5-minute observations showed almost perfect agreement of .95. The criterion validity of the scale (1 minute) was high relative to the Face-Legs-Activity-Cry-Consolability (FLACC) Scale, and low compared with the numeric rating scale (NRS). Discriminant validity was established between patients with and without pain. The feasibility of the Pain Assessment in Advanced Dementia Scale–Korean Version (PAINAD-K) (1 minute) indicated low sensitivity of 41.3% and high specificity of 92.6%.ConclusionsTherefore, the PAINAD-K is a valid and reliable tool to determine the absence of pain in non-verbal aged patients.     

Nurses’ knowledge within the context of pain management

A small-scale study determined the level of pain management knowledge of general surgical and orthopaedic nurses in three designated wards. Qualified nurses completed a questionnaire. For the surgical nurses, a set of five tutorials encompassed all aspects of pain management. The orthopaedic nurses were given no extra education. Twenty-six out of a possible 55 surgical ward nurses attended one or more of the tutorials. A repeat of the first questionnaire was given to all nurses who had attended tutorials and to the orthopaedic nurses who had completed the first questionnaire. The response was poor and inconclusive as to whether the education for surgical nurses had made a difference to their knowledge of drugs and their uses. The questionnaires from the orthopaedic nurses showed a positive shift within some of the questions.     

Development and Psychometric Testing of a Tool Measuring Nurses’ Competence for Disaster Response

IntroductionThere is a growing awareness among governments, communities, and health care agencies of the need to evaluate roles and competencies in disaster nursing. A validated instrument was developed to evaluate nurses’ competencies for disaster response.MethodsA psychometric evaluation study was developed in 2 stages: 1) content and face validity, and 2) verification of feasibility and reliability with test-retest. Competencies were extracted from the Framework of Disaster Nursing Competencies published by the International Council of Nurses. The participants included 8 experts in emergencies and disasters who were nurses with a PhD and had more than 2 years of experience with education or clinical practice in emergencies or disasters, and 326 nurses from a mobile emergency care service in southern Brazil. The data analysis used a content validity index and intraclass correlation coefficients. The psychometric properties of the instrument included reliability assessed with Cronbach alpha, feasibility and test-retest reliability assessed with t tests and intraclass correlation coefficients, and factor analysis.ResultsThe overall evaluation of the instrument yielded an intraclass correlation coefficient of 0.92 (SD = 0.04), and the mean content validity index was acceptable at 0.88 (SD = 0.12). Out of 51 items, 41 were validated and organized in 3 domains according to factor analysis: 1) care of the community; 2) care of the individual and family; and 3) psychological support and care of vulnerable populations. The instrument demonstrated good internal consistency (Cronbach α = 0.96) and adequate test-retest reliability (intraclass correlation coefficient >0.7).DiscussionThe Nurses’ Disaster Response Competencies Assessment Questionnaire showed good internal consistency, adequate reproducibility, and appropriate feasibility for use to evaluate nurses’ competencies for disaster response.     

Assessment of Saudi Arabian Nurses’ Knowledge and Attitudes Toward Magnetic Resonance Imaging Safety

Patients undergoing magnetic resonance imaging (MRI) require safety measures that need to be reflected in nurses’ practice during patients’ care. The aim of this study was to assess the knowledge of and attitudes about MRI safety standards among nurses in Saudi Arabia. Using a cross-sectional study design, a convenience sample of 105 nurses from 2 government hospitals and multiple primary health centers was included in the study. A three-part self-designed questionnaire was used to assess nurses’ socio-demographic characteristics, knowledge, and attitude. Data were analyzed using a chi-square test and the odds ratio to assess the significance level. The majority of the sample was female, aged 20–29, with bachelor’s degrees. Around half of the sample (51%) showed an intermediate level of knowledge regarding MRIs. However, the attitude was positive among 77% of the sample, meaning that most of the nurses strongly adhered to MR standards. A significant relationship between nurses’ knowledge and attitudes indicates that their adherence to safe practice is strongly associated with their level of knowledge. Nurses have limited knowledge about MRI and moderate adherence to MRI safety procedures.     

The Impact of Burnout on Emergency Nurses’ Intent to Leave: A Cross-Sectional Survey

IntroductionEmergency nurses work in one of the busiest and most stressful departments in a hospital and, as such, may experience burnout more often than nurses working in other nursing units. This study examined the relationship among orientation, burnout (emotional exhaustion, depersonalization, and low sense of personal accomplishment), and intent to leave.MethodsA cross-sectional survey design was used. Emergency nurses who were members of the Emergency Nurses Association were invited to participate in an anonymous survey. The Maslach Burnout Inventory tool was used to explore emotional exhaustion, depersonalization, and sense of personal accomplishment. Emergency nurses’ intent to leave was assessed with the Turnover Intention Scale. A logistic regression analysis was used to investigate the odds of intent to leave for those who scored at or above versus below the median on each burnout subscale.ResultsThe findings revealed that a formal orientation enhanced emergency nurses’ sense of personal accomplishment and was associated with lower intent to leave. The odds of intent to leave were almost 9 times greater for participants with 5 or more years of experience, approximately 13 times greater for those with above-median emotional exhaustion, and more than 6 times lower for those with above-median sense of personal accomplishment.DiscussionEmotional exhaustion and low sense of personal accomplishment were key factors influencing emergency nurses’ intent to leave. Emergency nurse leaders may find that a formal orientation program enhances sense of personal accomplishment and decreases intent to leave. Creating work environments to help emergency nurses find joy in their work may be critical to work–life balance and staff retention.     

Implementing an Obstetrics-Specific Triage Acuity Tool to Increase Nurses’ Knowledge and Improve Timeliness of Care

Objective

To implement an obstetrics-specific triage acuity tool called the Maternal Fetal Triage Index (MFTI) in two maternity units, test the change in nurses’ knowledge of triage assessment, and improve timeliness of care.

Nurses’ perceptions of dealing with death in the emergency department

BackgroundProviding end-of-life care to patients and their families in the emergency department (ED) is challenging, with high workloads, the busy environment, and a focus on providing lifesaving treatments to patients at odds with providing end-of-life and palliative care.AimThe purpose of this study was to investigate nurses’ experiences of providing end-of-life care in EDs, including their perceptions of the most vital elements of care, ability to provide aspects of care, as well as perceptions of their role, communication processes, family presence/involvement, and the ED environment.MethodsNurses (n = 211) working in Australian EDs for at least 12 months completed an anonymous online survey.FindingsNurses identified vital elements of care for dying patients including adequate pain control and a move away from burdensome treatments, sensitive care of families and family access to loved ones, and a quiet environment. However, nurses were not always able to provide such care to their patients. Often, the ED was seen as an unsuitable place for end-of-life care or care of families once the patient had died, and communication between staff and between staff and families was challenging.DiscussionThe ED physical environment, lack of staff training and debriefing, and lack of time to communicate with family, particularly after death, may compromise nurses’ ability to provide end-of-life care that is satisfying to them, their patients, and families.ConclusionThere is a need for focus on the ED physical environment, staff training, and consideration of the emotional experiences of frontline nurses caring for patients at the end of life.     

A Nonrandomized Pretest Posttest Study on the Impact of an Educational Pain Management Program on Nurses’ Knowledge and Attitudes Regarding Pain in a Middle Eastern Country

BackgroundAlthough nurse's knowledge and attitudes regarding pain management has been sufficiently studied worldwide, the impact of an educational intervention program in improving such attitudes and knowledge has not been likewise researched, especially in Middle Eastern countries.AimsTo examine nurses’ knowledge and attitudes regarding pain at a university hospital in Lebanon before and after the introduction of a pain management educational program. And to assess the relationship between the characteristic of nurses and their pain knowledge.MethodsDesign; A nonrandomized pretest posttest study design was used. Setting; A university hospital in Lebanon. Participants; Included 183 nurses using the Nurses' Knowledge and Attitudes Survey Regarding Pain questionnaire. The pain educational intervention was based on the principles of Ajzen's theory of planned behavior.ResultsA significant difference between the pre and post test scores was noted (p = .016). Questions answered correctly by 80% of participants were related to questions about pain, pain assessment and management, and questions related to medications, such as correct dosages and opioid side effects were not answered correctly by the majority of nurses. There were significant associations between test scores and the nurses’ educational level, their age, and their years of experience. Nurses who worked in critical care units, the emergency department and oncology had higher scores than nurses who worked on general units.ConclusionsDespite the intensive pain education provided at our institution, the pain knowledge of nurses remains below that recommended level which indicates a dire need for more intensive and continuous education in order to provide a pain free environment.     

Doctors’ and Nurses’ Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey

BackgroundAcupuncture and acupressure are not being systematically used in the management of postoperative nausea and vomiting and pain, despite being included in the guidelines.AimTo examine the beliefs, attitudes, and knowledge of Australian nurses/midwives and doctors toward the perioperative use of AA for the management of postoperative nausea and vomiting and pain; to explore the barriers and enablers influencing acupuncture and acupressure integration into hospital setting.MethodsA mixed-mode approach was undertaken for data collection. An online approach was used to recruit respondents from Australian College of Perioperative Nurses. Three hospitals from three different Australian states were selected via convenience sampling.ResultsA total of 421 usable surveys were included in data analysis. The respondents comprised 14.3% doctors and 72.9% nurses/midwives. Overall, 69.4% were female, 85% were trained in Australia with 35% and 51.4% having knowledge or personal exposure to AA in general respectively. Over 60% of the respondents agreed AA should be routinely integrated into perioperative care, and over 80% would recommend AA to their patients if it was provided at their hospital, and, 75% would be willing to receive further education. The three main reported barriers included: perceived lack of scientific evidence (80.9%), unavailability of credentialed provider (77.2%) and lack of reimbursement (60.4%).ConclusionsPositive attitudes are reported by Australian doctors and nurses toward AA. This is despite of low levels of knowledge or personal exposure to AA. Further studies are required to explore the implementation of barriers and address respondent calls for further education.     

Prevalence and Predictors of Prehospital Pain Assessment and Analgesic Use in Military Trauma Patients, 2010–2013

Introduction: Pain is the most common symptom in patients presenting for prehospital (PH) care. Research in civilian emergency medical systems has shown wide variability in PH pain assessment and analgesic practices, yet a minimal amount is known about pain assessment and analgesic intervention practices in the military, particularly when PH care is delivered in a combat zone. Objective: To describe prehospital (PH) pain care practices for U.S. military personnel injured in Iraq and Afghanistan 2010–2013 and explore potential relationships to explain variation. Methods: An exploratory retrospective, cross-sectional study of Department of Defense Trauma Registry data from 2010 to 2013 was performed. Demographic, clinical, or health system variables for associations with three outcomes: 1) pain assessment documentation; 2) pain severity (0–10 scale); and 3) analgesic administration (yes/no). Including only variables with significant associations, backward stepwise regression was used to develop explanatory models for each outcome. Results: Patient records (n = 3,317) were evaluated for documentation of PH pain assessment and analgesic administration. The prevalence of PH pain score documentation was 37.8% (n = 1,253). Overall, the proportion of records with PH pain scores increased over time: 19.8% (2010), 35.1% (2011), 58.2% (2012), and 62.2% (2013). Severity of pain scores ranged 0–10; mean = 5.5 (SD = 3.1); median = 6 (IQR = 3–8). Analgesics were reported for 50.8% (n = 1,684), of whom 38.3% had a pain severity score documented. The pain assessment documentation model included any documented vital signs, injury year, and mechanism of injury and explained 19.3% of the variance in documentation. The pain severity model included vital signs and injury severity score (ISS) and explained 5.0% of the variance in severity. The analgesic model included any vital signs, pain severity, trauma type, mechanism of injury, ISS, and year. Conclusions: Pain assessment and treatment documentation improved each year, but remain suboptimal. Available data yielded poor prediction of the outcomes of interest, emphasizing the importance of individual assessment. Analgesic effectiveness could not be evaluated.