Assessment of wound pain: overview and a new initiative

All wounds have the potential to cause pain, and the nature of the pain varies with the type of wound. Many factors may exacerbate wound pain, including infection, trauma at dressing changes and poor technique when applying compression therapy. Failure to assess wound pain or inadequate pain assessment can cause the patient further anguish and extended suffering. Nurses caring for patients with painful wounds need to identify the source of the pain and exacerbating factors, and determine whether it has nocicoceptive and/or neuropathic elements in order to optimize pain management for the individual patient. This article examines the assessment of wound pain and introduces an initiative that has been developed to improve the assessment process. The 'Heal not Hurt' initiative is an excellent example of the profession and industry working together to implement best practice guidance in patient-centred pain-free wound care in clinical care.     

Attitude: impact on pain assessment

Nurses have many attitudes and beliefs about the means with which to navigate the road to pain relief for their patients. The use of an efficient and effective method to "light the path" has been extremely subjective in the past. There are reliable instruments than can be used effectively to measure and treat pain if they are used in the context of cultural appropriateness, a consistent healthcare team effort, and as part of a multidimensional approach. The utilization of the guidelines in this paper can provide direction for nurses to improve best practices and documentation in pain management, so that we may never have to say again "pain assessment instruments don't work.     

The assessment of pain: an audit of physiotherapy practice

This study concerned the adoption of scientific method by the physiotherapy profession, with pain measurement as the research focus. It involved an audit of 1010 patient records from four hospital physiotherapy departments in England, to determine how pain was assessed and recorded. The results show that while pain assessment was recorded in most of the cases audited, there was no record of reassessment in 29 per cent of cases. In the initial assessment only 21 per cent of cases involved quantified methods, reducing to less than 2 per cent during reassessment. These results indicate that the use of recognised quantified methods for pain assessment was not standard practice amongst the physiotherapists audited. Implications for the adoption of scientific method are discussed.     

Improving postoperative pain management: Continuous wound infusion and postoperative pain

Despite various analgesic drugs and techniques, relieving acute postoperative pain remains a challenge. An actual state of the question indicates that there is imperative need for further improvements. After a surgical incision, nociceptive inputs originating from the wound play a major role in both the initiation and the maintenance of postoperative pain. Continuous infiltration of analgesics into the surgical wound is a rational approach, a simple and safe technique which has gained in popularity. Local intrawound analgesics are mainly local anesthetics which block the nociceptive transmission. Non-steroidal anti-inflammatory drugs which modulate the local inflammatory reaction sensitizing the peripheral nociceptors represent an interesting alternative. Moreover, both local anesthetics and anti-inflammatory drugs possess a variety of modes of action, beside those which are conventionally recognized, mechanisms which may participate to their local analgesic effect. However, clinical reports published to date have brought conflicting results regarding the efficacy of intrawound analgesic techniques. These studies have pointed out several important issues like the place of the catheter, choice and dose of the analgesic drug, potential local toxicity. These issues need to be solved to better determine the right place of the technique in postoperative multimodal analgesia.     

高职学生进行伤口疼痛评价的教学实践

该研究通过实践性教学,使高职学生在学习外科护理学时,进一步了解伤口疼痛的发生与发展规律,从而对于患者术后伤口疼痛既具有感性认识,又能掌握客观的评价方法,同时培养高职学生主动学习的能力与团队合作意识。在临床实践中,培养学生的爱伤观点与沟通能力,理解患者伤口疼痛的痛苦,帮助学生树立人性化护理的理念。     

Surgical wound care: current views on minimising dressing-related pain

Managing surgical wounds healing by primary intention is likely to become less problematic with the development of more effective advanced wound dressings; increasingly effective methods of medicated pain management; education; and advances in minimal access surgical (MAS) techniques. Future research is likely to focus on management of patients with surgical wounds healing by secondary intention. If so, management of surgical wound pain must become an integral part of assessment. Theatre practitioners, clinical nurses and surgical practitioners, working as part of the multidisciplinary team, are ideally placed to undertake this work and to include multimodal, holistic approaches to caring for surgical wounds and controlling surgical wound pain (Gould, 1999). Patient support and education is likely to become an increasing priority, particularly in view of the significant move from inpatient care to short-stay and day-case surgery.     

Dressing and wound care pain

Wound care is an important step for promoting wound healing. Nevertheless it is also a major source of pain for patients with wounds. The results of a survey showed that not only burn patients but also non-burn ones suffered from wound care pain which occurred in inpatients and outpatients. One of the significant factors causing wound care pain was that the dressing adhered to the wound bed. Although some agencies claimed that particular dressings with low adhesion can result in painless removal, the actual effects needed to be verified. Results of clinical trials revealed that for relieving wound care pain of certain kinds of wound, it was recommended to use particular dressings, such as banana leaf dressing, boiled potato peel bandage, Acticoat, Mepital or Mefix.     

A pain and stress assessment and management quality improvement initiative to align with the BEST START recommendations

The aim of this quality improvement project was to improve and standardise pain and stress management practices and processes within a 34-bed Level III neonatal unit. Results demonstrated a statistically significant improvement in staff perceptions regarding education and training specific to traumatic stress as well as pain and stress assessment and management practices (p < 0.05). Building more confidence and competence with staff to utilise breastfeeding and skin-to-skin practices as primary non-pharmacologic interventions during painful and stressful procedures is a future opportunity for continued quality improvement. As NICU practice continues to evolve, clinicians must not lose sight of their role as advocates in meeting the human needs of those they serve within this highly technological environment. Pain and stress assessment and management is a first step in providing loving, compassionate, trauma informed, developmental care.     

Validation of an observation method of pain assessment in non-chronic back pain

An observation method for assessing chronic pain in back pain and rheumatoid arthritis has been developed during the last decade in the U.S.A. This study examined the validity and reliability of the method for a non-chronic back pain population from another culture. Two trained observers recorded pain behaviors displayed by 61 Swedish subjects during a 10 min, videorecorded, standardized sequence of maneuvers. Subjects were asked to make ratings of their pain intensity, depression, helplessness and disability level. A physical examination was performed by an orthopedist to obtain objective medical information about the subjects. Results showed that interrater as well as test-retest reliability were satisfactory. Correlations between pain behavior and other measures of pain, e.g., intensity ratings, medication intake, and spinal mobility, were statistically significant but somewhat lower than expected. The results indicate that the behavioral observation method provides reliable and valid information about non-chronic back pain among Swedish females. However, some modifications in the standardized sequence of maneuvers and the definitions of pain behaviors may be necessary to improve the utility of the method in this population.     

疼痛对切口愈合影响的研究

在临床护理工作中，疼痛已成为继体温、脉搏、呼吸、血压四大生命体征之后的第五生命体征。被日益受到重视，解除疼痛已成为护理工作的重要内容之一。疼痛常常导致病人的睡眠不足，造成情绪低落，妨碍组织康复。严重的疼痛还会影响手术切．日的愈合，手术切口愈合不良，会给病人带来额外的痛苦和经济负担，严重者甚至会给病人造成病残或死亡。所以控制疼痛要与维持足够血容量及保证体温正常同等对待。现将我院对此做的研究作一介绍。     

Improving the content and face validity of OSCE assessment marking criteria on an undergraduate midwifery programme: A quality initiative

Objective Structured Clinical Examinations (OSCE's) have been adopted as a means of assessing midwifery students' clinical skills. The purpose of the OSCE is to provide a standardised method for the evaluation of clinical skill performance in a simulated environment. This paper describes how a quality improvement initiative using both internal and external expert review was utilised to improve OSCE assessment marking criteria. The purpose of the quality initiative was to review the content and face validity of the marking criteria for assessing performance. The design and choice of tools used to score students' performance is central to reliability and validity. 20 videos of students from year one of a midwifery preregistration programme undertaking an OSCE assessment on abdominal examination and 18 videos of students response to obstetric emergencies e.g. PPH, and shoulder dystocia were available for review. The quality initiative aimed to strengthen the reliability and validity of the OSCE in assessing student performance. Conclusion: the use of global rating scales allows for the capturing of elements of professional competency that do not appear on specific criteria for skills performance checklists.     

Identifying risks and responding to overdose: piloting of an overdose prevention programme

This paper reports the development and piloting of an Overdose Prevention Programme (OPP) targeted at educating drug users themselves and based on a multi-agency approach utilizing the expertise of specialist agencies and services. In the initial phase of the study, indepth, semi-structured interviews were carried out with a small number of drug users to determine commonly recurring themes and to identify myths and gaps in drug users' knowledge in respect of overdose. From information gathered, an overdose prevention questionnaire (OPQ) was designed and a survey carried out with 111 participants to gather data to determine the incidence of overdose and the accuracy of users' knowledge regarding overdose. A five-session OPP was subsequently designed to educate drug users about overdose (including risks, recognition and response) and to teach them how to pass on information to other drug users as peer educators. At completion of the pilot phase of this study, 28 drug users had enrolled for the programme, with 22 participants completing all five sessions. Initial evaluation indicates that users completing the programme significantly increased their level of knowledge relating to recognition of overdose and their ability to respond appropriately when faced with an overdose situation.