Barriers perceived by nurses in the optimal treatment of postoperative pain

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.

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The effectiveness of a nursing staff development Intervention to improve pain management – A randomized controlled trial

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.04.023 ◽

2015 ◽

Vol 8 (1) ◽

pp. 54

Author(s):

S. Zoëga ◽

S.E. Ward ◽

R.C. Serlin ◽

H. Sveinsdottir ◽

E.Th. Gretarsdottir ◽

...

Keyword(s):

Patient Outcome ◽

Randomized Controlled Trial ◽

Pain Management ◽

Pain Assessment ◽

Management Practices ◽

Controlled Trial ◽

University Hospital ◽

Control Group ◽

Randomized Controlled ◽

Knowledge And Attitudes

AbstractAimsTo test the effectiveness of the Pain Resource Nurse (PRN) education program in a university hospital.MethodsThis was a randomized controlled trial. Two nurses from each of the 23 participating surgical and medical units were selected to participate in the PRN program. The program consisted of a three day course in pain management with a structured follow up. After a baseline measurement, the units were randomized to either receive the intervention or to serve as a wait-list control. The control group received the intervention following a second data collection 10 months from baseline. Data regarding knowledge and attitudes regarding pain were collected from nurses, but patient data were collected with the American Pain Society Patient Outcome Questionnaire and from medical records. Patients had to be ≥18 years, hospitalized for ≥24 h, alert and able to participate.ResultsParticipating patients were 308 at T1 (73% response rate (RR)) and 329 at T2 (79% RR). Participating nurses were 224 (48% RR) at T1 and 176 (38% RR) at T2. No difference was found between the intervention and control groups regarding knowledge and attitudes of nurses, or in any of the patient outcome variables. The only significant effect of the intervention was improvement in documented standardized pain assessment, which increased from 12% at T1 to 24% at T2 on the intervention units, compared to a decrease from 12% at T1 to 9% at T2 on the control units, p < 0.05.ConclusionsPatient outcomes remained unchanged after the intervention, as were nurses’ knowledge and attitudes. The intervention was, however, successful in changing pain assessment practices. Multifarious efforts to change nursing practice resulted in modest changes. Further studies are needed to advance pain management practices in clinical settings.

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Pain assessment, documentation, and management in a university hospital

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2013.07.007 ◽

2013 ◽

Vol 4 (4) ◽

pp. 256-257

Author(s):

S. Zoёga ◽

T. Aspelund ◽

G. Sigurdsson ◽

S.E. Ward ◽

H. Sveinsdóttir ◽

...

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Management Practices ◽

University Hospital ◽

Medical Patients ◽

Cross Sectional ◽

Adequate Treatment ◽

Pain Management Index ◽

Pain Medications ◽

Pain Prevalence

AbstractAimsTo determine if pain is assessed, documented, and treated in a university hospital according to recommended practice.MethodsA cross-sectional descriptive study, conducted in 23 medical and surgical wards in a university hospital. Participants were patients hospitalized for at least 24hours, ≥18 years of age, and able to participate. Data were collected from patients with a questionnaire (APS-POQ-R), from their medical records, and from Therapy®, the hospital medication system.ResultsThe response rate was 73%. Participants (N =308) mean age was 67.5 years (SD = 17.4), 50.5% were women. Pain prevalence in the past 24 h was 83.1% and severe pain was experienced by 34.5%. Descriptions of pain were documented for 60.7%. Standardized methods of assessment were used in 11.6% of patients, other forms of documentation included descriptions as “no pain-complaints”, and “patient received 2 Panodil”. The majority of patients (66.8%) were prescribed pain medications and 34.0% of patients used non-pharmacological methods to treat their pain. The pain management index (PMI = prescribed pain medication – worst pain severity) was negative for 38.6% indicating insufficient treatment. The PMI was more favorable in surgical compared to medical patients, x2(6, N = 306) = 17.81, p = 0.007.ConclusionsPain was both prevalent and severe. Although some form of documentation of pain was recorded for the majority of patients, pain was rarely assessed with standardized methods. Many patients did not receive adequate treatment. There is a need to improve the pain management practices in the hospital, with an initial emphasis on pain assessment.

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

Reviews in Clinical Gerontology ◽

10.1017/s0959259806001766 ◽

2005 ◽

Vol 15 (2) ◽

pp. 149-156 ◽

Cited By ~ 1

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.

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

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v30i1230258 ◽

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.

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Pain assessment and procedural pain management practices in neonatal units in Australia

Journal of Paediatrics and Child Health ◽

10.1111/j.1440-1754.2006.00781.x ◽

2006 ◽

Vol 42 (1-2) ◽

pp. 6-9 ◽

Cited By ~ 66

Author(s):

Denise Harrison ◽

Peter Loughnan ◽

Linda Johnston

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Management Practices ◽

Procedural Pain

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

Pain Research and Management ◽

10.1155/2012/586589 ◽

2012 ◽

Vol 17 (3) ◽

pp. 173-179 ◽

Cited By ~ 29

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.

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An Overview of Pain Management

Journal of Medical Regulation ◽

10.30770/2572-1852-91.2.20 ◽

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.

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

10.26686/wgtn.16920322.v1 ◽

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

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. 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. 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.

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