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.     

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.     

Factors associated with self-reported competence of graduating nursing students

BackgroundThe evaluation of nurses’ competence is of paramount importance for educators and administrators, along with identifying factors that facilitate or hinder competence development.AimTo investigate factors associated with self-reported competence of graduating nursing students in Greece and educational issues perceived to improve their competence.MethodsThis cross-sectional survey enrolled a convenience sample of 285 nursing students being at the final semester of their studies. The participants completed electronically a three-section questionnaire, which included the Nurse Professional Competence scale, and questions on educational issues that would lead to higher competence.FindingsThe participants rated their competence as good, considering that the mean scores of the competence areas of the scale ranged between 63.3 ± 16.3 and 81.4 ± 11.7. All scores of the competence areas and overarching themes of the scale were significantly associated with participants' perceived quality of the undergraduate program; some scores were significantly associated with previous professional experience in Nursing, but none of them was associated with degree grades. Most participants reported that higher competence would have been achieved through a higher ratio of clinical and nursing science courses (61.1% and 52.2% respectively), and by the submission of individual or group essays for their performance evaluation (35.2%).ConclusionThe associations between graduating nursing students' self-reported competence and perceived quality of the undergraduate program support the importance of improving program quality, and advocate for more hours of clinical training and the use of critical thinking-based examination methods.     

Self-Perceived Pain Assessment Knowledge and Confidence (Self-PAC) Scale for Cancer and Palliative Care Nurses: A Preliminary Validation Study

BackgroundPain is highly prevalent in all health care settings, and frequently poorly managed. Effective pain management is predicated on a continuous cycle of screening, assessing, intervening and evaluating. Identifying gaps in nurses’ self-perceived pain assessment competencies is an essential first step in the design of tailored interventions to embed effective pain assessment into routine clinical practice, and improve patient reported pain outcomes. Yet, few validated instruments focus on the competencies required for undertaking a comprehensive pain assessment, with most focusing on clinician’s pain management competencies.AimTo examine the validity of the ‘Self-Perceived Pain Assessment Knowledge and Confidence’ (Self-PAC) Scale.DesignPreliminary instrument validation.SettingTwo Australian cancer and palliative care services.Participants/Subjects186 cancer and palliative care nurses.MethodsThe Self-PAC Scale was administered to participants online. Factor Analyses, including Exploratory and Confirmatory, were applied to examine the structural validity, Cronbach’s alpha was calculated for internal consistency. Criterion validity was investigated by comparing responses from experienced and non-experienced nurses.ResultsTwo components resulted with a single factor structure for pain assessment confidence and a two-factor structure for the knowledge of pain assessment. The factor loading for the subscales ranged from 0.653 to 0.969, with large proportions of the variances explained by the factors. Cronbach’s alpha of the subscales ranged from 0.87-0.92 and significant difference in responses were found between experienced and non-experienced nurses.ConclusionPreliminary validation of the Self-PAC Scale suggests that it is a helpful instrument for assessing cancer and palliative care nurse’ pain assessment competencies.     

The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care

Aim. To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects. Background. Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used. Design. Quasi‐experimental crossover design (pre–post‐test). Method. The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t‐test procedures (paired‐samples t‐test). At T₁ vignettes were added to assess the quality of the students’ own analyses. These data were analysed by a Mann–Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool. Results. Ninety‐seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T₁) and over time for the whole cohort of students on all subscales (T₂). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content. Conclusions. The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development. Relevance to clinical practice. The results provide nurse educators with insight into the effects of education in spiritual care on students’ competencies and help them consider a systematic place for spiritual care within the nursing curriculum.     

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.     

Psychometric Evaluation of the Nurses' Cancer Pain Management Competency Scale

BackgroundThere is lack of instruments for assessing nurses' comprehensive pain management competency.AimThis study aimed to assess the psychometric properties of the Nurses' Cancer Pain Management Competency Scale and to conduct a cursory survey of the pain management educational needs/resources of nurses caring for patients with cancer pain.MethodA convenience sample of 230 Korean nurses who met the eligibility criteria completed the researcher developed the Nurses' Cancer Pain Management Competency Scale and a pain management educational needs/resources survey. The Nurses' Cancer Pain Management Competency Scale was based on the pain management core competencies identified by Fishman et al (2013). Internal consistency was assessed using Cronbach's alpha, and construct validity was examined using exploratory factor analysis with varimax rotation.ResultsCronbach's alpha of the scale was 0.89. Nurse cancer pain management competency includes four factors, which accounted for 68.44% of the variance: the context of pain management, pain assessment and measurement, management of pain, and multidimensional nature of pain. Approximately 42% of nurses had no available protocols related to cancer pain management. Nurses preferred multi-component educational modalities, including simulation-based learning.ConclusionsFindings support internal consistency reliability and content and construct validity of the Nurses' Cancer Pain Management Competency Scale that can help examine pain management competency of nurses. Adopting an evidence-based clinical cancer pain management-related protocol and multi-component training programs are needed to achieve optimal cancer pain management competency in nurses.     

The development and validation of the Khon Kaen University Pediatric Pain Assessment Tool for school-aged Isaan children in Thailand.

This research was aimed at developing a tool for pain assessment specifically for parents to use with children of the Isaan culture of Northeast Thailand. The Khon Kaen University (KKU) Pediatric Pain Assessment Tool was first constructed through the use of a qualitative study and literature reviews. Then, it was modified using the results of a pilot study with 38 stakeholders. Seventeen nurses, 150 postoperative children, and 150 family caregivers participated in a study comparing the tool with the standard Faces Scale and Numeric Rating Scale. Results revealed no difference in children's pain scores, as well as no statistical difference in children's pain score ratings between the three groups, suggesting the new tool is appropriate for Isaan children.     

Clinical tools for the assessment of pain in sedated critically ill adults

Aim: This paper aims to review the evidence regarding pain assessment tools for sedated patients and to establish whether the use of a tool can be recommended in practice. Background: Pain assessment is a challenging area of critical care nursing practice, particularly among sedated patients. Tools to aid in assessing pain among this patient group have been developed and tested recently. Search strategy: In this systematic review five papers that tested pain assessment tools for sedated patients are discussed. These papers were identified via the CINAHL and MEDLINE databases using the search terms: ‘pain assessment’ and ‘sedated’ or ‘unconscious’ or ‘critically ill’ or ‘critical illness’ or ‘critical care’. Conclusions: The Behavioural Pain Scale (BPS) has been tested among the broadest range of patients and was found to be a reliable and valid tool in three studies. Research is needed to further demonstrate the reliability and validity of the Critical‐Care Pain Observation Tool (CPOT), as the paper of Gelinas et al. did not test its internal consistency and domain structure. The CPOT also needs testing among different critical care populations. The design of Odhner et al. study did not allow adequate testing of the Non‐verbal Pain Scale (NVPS). Implications for practice: The implementation of the BPS can be recommended in intensive care units and may improve the management of pain among sedated patients by providing a systematic and consistent approach to pain assessment to guide interventions. The CPOT may also prove useful in assessing pain among sedated patients, but first requires further validation. Also, further research is needed into the effects of pain assessment tools on pain management practices and patient outcomes.     

Cultural competence in action for CAMHS: development of a cultural competence assessment tool and training programme

This article details the development of a tool to measure the cultural competence of individuals working within the Children and Adolescent Mental Health Services (CAMHS). The CAMHS Cultural Competence in Action Tool - known as the CAMHS 'CCATool' - was one of the components of a national project which aimed at promoting cultural competence within CAMHS. The other component was a two day training programme. Both components were based on the Papadopoulos, Tilki and Taylor model of cultural competence development. The article also outlines the educational principles and learning strategies used in the training.     

Instrument Refinement for Measuring Self-Efficacy for Competence in Interprofessional Collaborative Practice: Development and Psychometric Analysis of IPECC-SET 27 and IPECC-SET 9

Assessing competence in interprofessional collaborative practice (ICP) among health professions students is a high priority. This cross-sectional study built on the authors’ prior work that led to the development of the 38-item Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET), an instrument to evaluate health professions students’ self-efficacy in interprofessional collaborative competency, and addressed two primary questions. First, could a unidimensional scale based on the IPEC competencies and assessing perceived self-efficacy for competence in ICP and be constructed? Second, could a shorter version of that instrument still meet criteria for unidimensionality and retain the ability to separate students in distinct levels of perceived self-efficacy for competence in ICP?

Study participants were two cohorts of students from 11 health professions programs participating in an institutional interprofessional immersion event in 2015 and 2016. Statistical stepwise analyses were conducted using a Rasch rating scale model. The original 38 IPECC-SET items did not meet the criteria to generate a valid unidimensional measure of self-efficacy for competence in ICP, but could be condensed into a 27-item scale that met all set criteria for unidimensionality, with an explained variance of 61.2% and a separation index of 3.02. A shorter, 9-item scale demonstrated a separation index of 2.21. The nine items included also demonstrated a relatively equivalent range (54.93–45.65) as compared to the 27-item scale (57.26–46.16). Findings confirm empirically the conceptual suggestion from our earlier work that the four dimensions in the original IPEC competencies contribute to a shared underlying construct: perceived competence in interprofessional collaboration. Given the emphasis on ICP, psychometrically sound instruments are needed to evaluate the effectiveness of educational efforts to promote competency for ICP. Based on the findings from this study, both the IPECC-SET 27 and IPECC-SET 9 can be used to measure perceived self-efficacy for competence in ICP.     

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.     

FLACC Behavioral Pain Assessment Scale: a comparison with the child's self-report

The purpose of this study was to further test the validity of the Faces, Legs, Activity, Cry and Consolability (FLACC) Behavioral Pain Assessment Scale for use with children. Thirty children aged 3-7 years (5.01 +/- 1.44) who had undergone a variety of surgical procedures were observed and assessed for pain intensity at 20 + 2 hours after surgery. FLACC scores were assigned by one of the nurse investigators, and a self-report of pain using the FACES scale was obtained from the child. There were significant and positive correlations between the FLACC and FACES scores for the entire sample and for the scores of children 5-7 years of age, but not for children < age 5. These findings provide additional support for the construct validity of the FLACC Pain Assessment Tool.     

Developing an integrated approach to the assessment of student nurse competence using the Total Client Care (TCC) assessment tool

The aim of this study was to evaluate the validity and reliability of an integrated assessment of competence using the Total Client Care (TCC) assessment tool within an undergraduate Nursing course. The Total Client Care Assessment Tool aims to assess multiple competencies in an integrated way thereby mirroring the way in which registered nurses are expected to practice. TCC is a tool designed to assess the student's ability to provide holistic care to a client over a specified period of time. TCC measures the student's performance around four constructs, these are: Communication, Planning and Responding, Care Delivery and Assessing and Evaluating.G-theory analysis revealed satisfactory levels of global reliability on single use G co-efficient 0.90 although this dropped to 0.76 when used on eight occasions to assess the same students over a two-year period. Analysis of variance revealed that students and assessment occasions accounted for most of the variance. The TCC assessment tool is useful as it provides data about the student's performance when providing actual care. When used as part of a wider system of assessment involving triangulation of evidence from a number of sources the tool can support mentor judgements about the achievement of competence.     

Validation of the critical-care pain observation tool in adult patients.

BACKGROUND: Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. OBJECTIVE: To validate the Critical-Care Pain Observation Tool. METHODS: A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation. RESULTS: The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest. CONCLUSIONS: The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.     

重症监护病房语言交流障碍患者疼痛评估的研究进展

疼痛评估是做好患者疼痛管理的第一步。本文综述了重症监护病房语言交流障碍患者5个疼痛评估量表的研究与应用,包括疼痛行为量表、疼痛干预计数法、成人非语言疼痛量表、非语言疼痛评估量表及重症监护疼痛观察量表;介绍了疼痛评估生理指标的意义,为我国医护工作者科学地评估该类患者的疼痛程度提供参考。     

Competence profiles of recently registered nurses working in intensive and emergency settings

BACKGROUND: Preceptorship is an essential method of supporting nurse competence, guaranteeing high quality care and increasing job satisfaction. AIM: To describe recently registered nurses' perceptions of their competence level, and to identify factors influencing these perceptions. METHOD: The survey was conducted by using Meretoja's Nurse Competence Scale. The sample comprised 235 registered nurses working in intensive and emergency settings. The data were analysed by using statistical methods. RESULTS: Nurses' self-assessed competence level ranged from moderate to good. A statistically significant association was seen between competence level and age, length of current work experience and the frequency of using competencies. CONCLUSIONS: The results shed useful light on the educational needs of nurses and provide important clues for the development of preceptorship programmes. The Nurse Competence Scale proved to be a reliable and valid instrument in assessing the competence of recently registered nurses. Implications for nursing management We recommend that management strategies be developed to enhance and support positive learning environments for competence development. We recommend preceptorship programmes based on systematic competence assessments made by nurses themselves, their preceptors and managers.