Factors influencing the control of post-operative pain in older people

2005 ◽  
Vol 15 (2) ◽  
pp. 149-156 ◽  
Author(s):  
Donna N Brown ◽  
Brendan G McCormack ◽  
Helen McGarvey
Keyword(s):  
Pain Management ◽  
Older People ◽  
Pain Assessment ◽  
Management Practices ◽  
Ethnographic Study ◽  
Post Operative Pain ◽  
Multidisciplinary Working ◽  
Key Issues ◽  
Care Culture ◽  
Knowledge Strategies

The purpose of this review is to discuss how healthcare professionals, and particularly nursing practice, impact upon pain management with older people (65 years and over), following surgery. The review commences with an introduction presenting why this is an important area to consider. Current available literature and findings from an ethnographic study which was designed to examine peri-operative pain-management practices with older people will then be discussed to highlight the key issues of pain assessment and management. Three overarching themes; (1) pain assessment (2) knowledge/strategies to cope with pain and (3) organization of care (culture and context), will guide the discussion. It is suggested that comprehensive pain assessment, proficient communication and multidisciplinary working, are essential to improve pain-management practices. The paper demonstrates some of the multiple and complex factors that affect the older person's pain experience and identifies possible developmental work in this field.

scholarly journals Barriers perceived by nurses in the optimal treatment of postoperative pain

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 239-246 ◽  
Author(s):  
Wioletta Medrzycka-Dabrowka ◽  
Sebastian Dąbrowski ◽  
Aleksandra Gutysz-Wojnicka ◽  
Aleksandra Gawroska-Krzemińska ◽  
Dorota Ozga
Keyword(s):  
Pain Management ◽  
Elderly Patients ◽  
Pain Assessment ◽  
Management Practices ◽  
National Level ◽  
University Hospital ◽  
Municipal Hospital ◽  
Post Operative Pain ◽  
Polish Version ◽  
The University

AbstractIt is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. On a national level, the greatest burden of inadequate treatment is borne, among others, by elderly patients. The purpose of the paper was to compare the prevalence of barriers to optimum post-operative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. The research project was a multi-center one and took over a year. The study was questionnaire-based. It used the Polish version of the Nurses’ Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1602 nurses working at a clinical, provincial and municipal hospital.In the university hospital, difficulties in pain assessment related to the healthcare system occurred statistically significantly more often.

Dynamics on the field: A focused ethnographic study of pediatric pain management at four Ghanaian hospitals

2020 ◽  
Author(s):  
Abigail Kusi Amponsah ◽  
Evans Oduro ◽  
Victoria Bam ◽  
Joana Kyei-Dompim ◽  
Collins Kwadwo Ahoto ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Participant Observation ◽  
Symbolic Capital ◽  
Ethnographic Study ◽  
Pediatric Care ◽  
Pediatric Pain ◽  
Improvement Programs ◽  
Children's Pain

Abstract BackgroundAs part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings.MethodsGuided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 hours conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records. Results Analysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field). ConclusionsThe habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

scholarly journals Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Abigail Kusi Amponsah ◽  
Evans Oduro ◽  
Victoria Bam ◽  
Joana Kyei-Dompim ◽  
Collins Kwadwo Ahoto ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Participant Observation ◽  
Symbolic Capital ◽  
Ethnographic Study ◽  
Pediatric Care ◽  
Pediatric Pain ◽  
Improvement Programs ◽  
Children's Pain

Abstract Background As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings. Methods Guided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records. Results Analysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field). Conclusions The habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

scholarly journals Improving the Quality of Care for Acute Pain Management in Recovery Room at the Georgetown Public Hospital Corporation

2019 ◽  
pp. 13-14
Author(s):  
Dorette Husbands-Anderson ◽  
Jennifer Szerb ◽  
Alexandra Harvey
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Standards Of Care ◽  
Average Dose ◽  
Management Intervention ◽  
Pain Medications ◽  
Post Operative Pain ◽  
Pain Intervention

Objectives: To observe the method of pain assessment and pain management intervention performed by nurses in the PACU. Methods and Design: A QI prospective observational study was conducted to observe nurse’s pain assessment and management of thirty (30) patients from the time of PACU admission to discharge. The sample size was determined using the sealed envelope power calculator. Data Collection Included: patients demographics, the method and frequency of pain assessments as well as modalities of the pain intervention and the type and average dose of pain medications administered by PACU nurses. Data analysis was done using Microsoft excel. Results: No validated pain assessment tool was used in the PACU.  The majority of patients 67%, n=20) had no pain assessments or pain interventions. When performed, the frequency of pain assessments recorded were low, 70% of patients had 1-2 assessments. The principal pain management intervention was pharmacological with the use of opioids, accounting for 96%. Conclusion: Post-operative pain management in the PACU at GPHC does not meet accepted standards of care. More frequent nursing pain assessment using a validated pain assessment tool is required. Monotherapy with the opioid was the main pain intervention for pain management. Recommendations: Effective pain management begins with the appropriate pain assessment; therefore pain management education programs for health care professionals are essential. Also, the implementation of a standardized pain assessment tool, a standardized post anesthetic order sheet with a multimodal approach to pain management and restructuring the post-anesthetic record to allow for documentation of pain assessment will greatly improve pain management in the PACU.

scholarly journals Improvements in Pain Outcomes in a Canadian Pediatric Teaching Hospital Following Implementation of a Multifaceted, Knowledge Translation Initiative

2012 ◽  
Vol 17 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Lisa M Zhu ◽  
Jennifer Stinson ◽  
Lori Palozzi ◽  
Kevin Weingarten ◽  
Mary-Ellen Hogan ◽  
...  
Keyword(s):  
Pain Management ◽  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Pain Assessment ◽  
Management Practices ◽  
Audit And Feedback ◽  
Opioid Administration ◽  
Pain Outcomes ◽  
Pain Prevalence ◽  
The Impact

BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT) initiatives (education, reminders, audit and feedback) were implemented to address identified care gaps; however, the impact is unknown.OBJECTIVES: To determine the impact of KT initiatives on pain outcomes including process outcomes (eg, pain assessment and management practices) and clinical outcomes (eg, pain prevalence and intensity); and to benchmark additional pain practices, particularly opioid administration and painful procedures.METHODS: Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007. Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form. Where possible, pain outcomes were compared with previous audit results.RESULTS: Records of 265 inpatients were audited. Sixty-three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01). Eighty-three per cent of children with documented pain received at least one pain management intervention. Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain-relieving intervention. Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01). Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01). One-third of children received opioids; 19% of these had no recorded pain assessment. Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment. Painful procedures were accompanied by a pain-relieving intervention in 12.5% of cases.CONCLUSIONS: Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.

scholarly journals An Overview of Pain Management

2005 ◽  
Vol 91 (2) ◽  
pp. 20-30
Author(s):  
June L. Dahl
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Public Health Problem ◽  
The United States ◽  
Basic Knowledge ◽  
Rational Approach ◽  
Major Public Health Problem ◽  
Pharmacologic Treatments ◽  
Control Pain

ABSTRACT In spite of major advances in pain management practices, the undertreatment of pain remains a major public health problem in the United States. A basic knowledge of pain assessment and management is critical to removing the barriers that are responsible for poor pain control. Pain assessment is the essential first step in the management of any type of pain as it guides the development of a rational approach to treatment. Pharmacologic therapies are often essential to successful pain management. Three major classes of pain medications are available: non-opioids, opioids, and adjuvant analgesics for special pain problems. This paper provides an overview of the various drugs in each of these classes as well as recommendations to guide their use. The goal of therapy is to reduce pain and improve function. A comprehensive approach to pain management should be based on the use of multimodal therapy, rational combinations of pharmacologic and non-pharmacologic treatments.

scholarly journals Post-Operative Pain Management Knowledge and Attitude of Paediatric Nurses: a New Zealand Regional View

2021 ◽  
Author(s):  
◽  
Sue Smart
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Pain Management ◽  
Children And Adolescents ◽  
Management Practices ◽  
Pain Education ◽  
Knowledge And Attitudes ◽  
Post Operative Pain ◽  
Knowledge And Attitude ◽  
Regional Hospitals

<p><b>Pain and fear of pain are major concerns for many hospitalised patients. Nurses need to understand this pain, and be able to assess and manage it effectively. Despite advances in knowledge and an increased amount of nursing research related to pain management, literature continues to identify that infants, children and adolescents continue to experience unrelieved pain post surgery. Contemporary literature suggests that nurses’ knowledge and attitudes towards pain affects their pain management practices. Nurses in small regional hospitals often don’t have the support of paediatric pain specialists and therefore rely on their own knowledge, education and experience to manage the pain of the infants, children and adolescents in their care.</b></p> <p>This research explored the knowledge and attitudes towards paediatric post-operative pain, within the New Zealand context of small regional hospitals. It established how nurses working in these areas obtain and update their paediatric pain management knowledge, and what is it that influences their paediatric post-operative pain management practices. A questionnaire survey of registered nurses working in three small paediatric units (5 to 12 beds), in regional secondary service hospitals was undertaken. The questionnaire developed was based on the Paediatric Nurses Knowledge and Attitude Survey (PNKAS). The survey had a 79% (n=33) response rate. Findings corroborate many findings in previously published literature including that nurses do well in questions related to assessment. However pharmacological knowledge continues to be lacking. Results also indicated that while nurses have a good understanding about who is the best person to rate pain, this wasn’t carried through in the clinical scenarios provided. Education is clearly an important factor in improving the knowledge and attitudes needed in clinical practice.</p> <p>While this survey was somewhat limited, both in size and in that a clear correlation between the results and actual clinical practice could not be made, results are significant for the areas surveyed and for the development of pain education for nurses. Wider research into both pain education and clinical practice is needed. - II -Some of the first steps could be to survey the knowledge and attitude of those who instruct in undergraduate programs related to pain, and review what is being provided in the course programs, and then examine what is being offered within the clinical environments. Research, incorporating chart review and utilising open written questions and/or interviews, or group discussions would provide far more information on which to base recommendations for practice.</p>

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