Nurses’ perceptions of pain management in non-communicative critically ill patients: A phenomenological study

Little is known about pain and pain management in older adults who experience open reduction and internal fixation (ORIF) surgery. This qualitative descriptive phenomenological study explored two research questions: (a) What are the perceptions of pain and pain management in patients between 65 and 75 years of age, 48 hours after ORIF surgery in a community hospital? (b) What are the perceptions of adaptation after ORIF? A pilot study included four patients in two units of a Southern California hospital, followed by open ended, semi-structured interviews with 10 participants. Four themes emerged: (a) elderly patients experience different patterns of pain and coping mechanisms; (b) elderly patients experience pain after gaining consciousness from ORIF surgery; (c) effective pain management requires patients’ empowerment and opportunity to participate in pain management decisions; (d) elderly patients perceive adaptation as a process of change and acceptance. Multimodal pain management strategies, including regional opioids and systemic anti-inflammatories, could reduce post-operative, generalized bio-physiological stress experienced by elderly patients.

Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.

To explore healthcare providers' and community-level stakeholders' perceptions of opioid pain management among cancer survivors with a history of opioid use disorder living with cancer-related pain. Using a qualitative methodological approach, healthcare providers and community-level stakeholders providing care to cancer survivors with an opioid use disorder (OUD) were recruited by purposive sampling methods. Data was collected through semi-structured interviews that was subsequently transcribed verbatim and analyzed using thematic analysis. Participants were healthcare providers (n = 24) and community-level stakeholders (n = 6). Four themes emerged from the data: (1) cancer survivors with an OUD deserve the right to adequate pain management, (2) healthcare professionals are uncomfortable providing pain management for cancer patients with OUD, (3) cancer survivors with cancer-related pain may suffer unnecessary pain for fear of violating their sobriety, and (4) perspectives on aberrant opioid-related behaviors among cancer survivors. As opioid use disorder is becoming an increasing and co-present condition among patients with cancer, this study contributes important implications for improving care by understanding the views of healthcare providers and community-level stakeholders.

Nursing students as a group of people who were going to be nurses in the future, their perceptions of pain management had closed connection with the achievements of the pain management. This review provided a summary of the nursing students' perceptions of pain management and its influencing factors, in order to make some suggestions about improving nursing education and offer effective way to improve the nurses' perceptions of pain management. Key words: Students, nursing; Pain management; Perceptions; Influencing factors; Review

Legislation Limiting Postoperative Opioid Prescribing Does Not Impact Patients' Perception of Pain Management After Total Joint Arthroplasty.

Adult patients' perceptions of pain management at triage: a small exploratory study

Untrained family caregivers struggle with complicated medical management regimens for hospice patients. An intervention was tested to improve caregiver's perception of pain management and patient's pain. The intervention was tested with a 2-group (usual care vs intervention) randomized controlled trial using parallel mixed-methods analysis of 446 caregivers in 3 Midwestern hospice programs representing rural and urban settings. Web conferencing or telephones were used to connect caregivers with the hospice care team during care plan meetings. Caregiver's perceptions of pain management were the primary outcome. Secondary outcomes included caregiver quality of life, patient's pain, and anxiety. Video recordings, field notes, and caregiver and staff interviews provided qualitative data. The overall perception of pain management was not changed by the participation in hospice team meetings. Perceptions of fatalism improved for intervention participants, and the intervention participants perceived their patients' pain was better controlled than those in the control group. The intervention was found to be feasible to deliver in rural areas. Caregiver's anxiety and patient's pain were correlated ( r = .18; P = .003), and subanalysis indicated that caregivers of patients with cancer may benefit more from the intervention than other hospice caregivers. Qualitative analyses provided understanding of caregiver's perceptions of pain, cost, and facilitators and barriers to routine involvement of family in care plan meetings. Limitations and Conclusion: The hospice philosophy is supportive of caregiver involvement in care planning, and technology makes this feasible; the intervention needs modification to become translational as well as additional measurement to assess effectiveness. Caregiver education and emotional support should occur outside the meeting, and a strong leader should facilitate the meeting to control efficiency. Finally, the intervention may benefit caregivers of patients with cancer more than others.

Patient-Centered Pain Management in Obstetrics Through Use of a Comfort Menu

Introduction: This paper is based on the third Edition of the RNAO "Pain Assessment and Management" guideline applied to total hip arthroplasty (THA) patients and the evaluation of clinical practice guidelines on pain management and patient satisfaction. Objective: To apply the Third Edition Guideline for the Pain Assessment and Management from RNAO to patients after total hip arthroplasty and evaluate its effectiveness. Division of topics covered Evaluate the knowledge, assessment of pain by nursing, and satisfaction in the care of patients with total hip arthroplasty before and after the implementation of the guide, according to the Knowledge to Action Framework. According to 20 recommendations from the Guideline, 6 quality review indicators were formulated: 1. Establish and implement standard assessment processes and forms; 2. Conduct nurse training and patient education; 3. Compare nurses' pain knowledge and attitude levels before and after evidence-based practice; 4. Compare nurses' implementation of various indicators of patient pain assessment and management; 5. Compare pain control satisfaction of total hip arthroplasty patients before and after Best Practice Guideline implementation; and 6. Ensure nurses use the same proven tool to assess pain in patients. Results. After implementing the Guideline, the rate of nurses' knowledge of pain assessment and management has increased from 42.6% to 48%. Nurses' pain screening and evaluation, strategies to encourage patients and if the families participated in pain management were recorded after an assessment, and they were statistically significant (all P<0.05). There were statistically significant differences in patients' perceptions of pain management, active reporting of pain, and patient satisfaction with pain control (all P<0.05). Conclusion: The application of the evidence can improve nurses' knowledge and attitude toward pain assessment and management, standardize their operating system and process, and improve patients' satisfaction with pain control.

Background: chronic and acute pain are extremely common, particularly among hospitalizes surgical patients, cancer patients, and general medical inpatients. More than half of patients report significant pain. The knowledge and attitude of health professionals toward pain management have frequently been described as inadequate. The purpose of this study was to investigate the attitudes and knowledge of nurses working in health care regarding pain management. Methods: The Nurses' Knowledge and Attitudes Regarding Pain Survey was used in a quantitative, descriptive, cross-sectional design to examine nurses' perception (knowledge and attitude) about pain. We focused on the nursing field to assess nurses' perceptions of pain management. This study included a convenience sample of 200 nurses from hospitals. Results: Participants who scored 75% were thought to have poor knowledge and an abnormal attitude. Participants with a score of more than 75% were deemed to have adequate knowledge and a positive attitude. According to the findings of the study, the knowledge and attitude percentage means of correct answers about pain management were 61% (SD: 11.97%; 95% CI 59.33-62.6%). Inadequate knowledge and attitude were present in 89.5% of all participants, while adequate knowledge and attitude were present in 10.5%. Previous experience with pain management education was statistically significant (p 0.05). Conclusion and Recommendation: According to the findings of this study, nurses have insufficient knowledge and attitudes toward pain management. Younger nurses had a more positive attitude toward pain management than older nurses. Pain management education influences both knowledge and attitude. There is a need for innovative training approaches. Pain management education is an important part of the nursing orientation program and should be offered all year to all nurses. The NKASRP should be used as a baseline and follow-up measure to explore and test new evidence-based approaches to pain management among nurses.

Theory of Planned Behavior Constructs Associated with Nurses’ Pain Assessment and Pro Re Nata (PRN) Opioid Analgesic Administration: A Cross-sectional Study

BackgroundThe majority of women experience pain during childbirth. Offering and supporting women to use different methods for coping with pain is an essential competency for maternity care providers globally. Research suggests a gap between what women desire for pain management and what is available and provided in many low-and middle-income settings. The study aimed to understand how pain management is perceived by those involved: women experiencing childbirth and maternity care providers.MethodsIndividual semi-structured interviews with women (n = 23), maternity care providers (n = 17) and focus group discussions (n = 4) with both providers and women were conducted in two hospitals in Southern Tanzania in 2021. Transcribed interviews were analysed using reflexive thematic analysis. Coding and analysis were supported by the software MAXQDA.ResultsThree main themes were generated from the data. The first, ‘pain management is multifaceted’, describes how some providers and women perceived pain management as entailing various methods to manage pain. Providers perceived themselves as having a role in utilization of pain management to varying degree. The second theme ‘pain management is primarily a woman’s task’ highlights a perception of pain management as unnecessary, which appeared to link with some providers’ perceptions of pain as natural and necessary for successful childbirth. Few women explicitly shared this perception. The third theme ‘practice of pain management can be improved’ illustrates how women and maternity care providers perceived current practices of pain management as suboptimal. According to providers, this is primarily due to contextual factors such as shortage of staff and poor ward infrastructure.ConclusionWomen’s and maternity care providers’ perceptions ranged from perceiving pain management as involving a combination of physiological, psychological and social aspects to perceive it as related with limited to no pain relief and/or support. While some women and providers had similar perceptions about pain management, other women also reported a dissonance between what they experienced and what they would have preferred. Efforts should be made to increase women’s access to respectful pain management in Tanzania.

Background: Chronic and acute pain are highly prevalent, especially among hospitalized surgical patients, patients with cancer, and general medical inpatients. More than 50% of patients experience significant pain. Health professionals’ knowledge and attitude concerning pain management have often been referred to as insufficient. This study explored the attitudes and knowledge of nurses working in one of the government hospitals in the UAE, with regard to pain management. Methods: A quantitative, descriptive, cross-sectional design was used to examine nurses’ perception (knowledge and attitude) about pain using the Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP). We targeted the nursing field in order to assess nurses’ perceptions of pain management. A convenience sample of 200 nurses working at one of the government hospitals in the UAE participated in this study. Results: Participants who scored <75% were considered to have poor knowledge and a nonstandard attitude. Participants who scored >75% were considered to have adequate knowledge and a positive attitude. The study revealed that the knowledge and attitude percentage means of correct answers about pain management was 61% (SD: ±11.97%; 95% CI 59.33–62.6%). Inadequate knowledge and attitude featured in 89.5% and adequate knowledge and attitude in 10.5% of all participants. Previous pain management education experience was statistically significant p < 0.05. Conclusion and Recommendation: This study showed that nurses reflected an inadequate knowledge and attitude regarding pain management. Nurses’ perception about pain management was higher among younger staff than those with longer experience. Pain management education has an impact on knowledge and attitude. There is a need to follow innovative approaches in training. Pain management education is an essential part of the nursing orientation program and should be conducted throughout the year to target all nurses. New evidence-based approaches to pain management among nurses should be explored and tested, using the NKASRP as a baseline and follow-up measure.

Pain Management in Patients with Heart Failure: A Survey of Nurses’ Perception

About 11.4 million individuals admitted to misusing an opioid in the past year. The purpose of this study was to determine if nurses' definitions of pain management differed by location, and to assess the challenges treating patients with pain management concerns. This study fills a gap by comparing quantitative and qualitative feedback from nurses on pain management concerns in their practice location. Data were collected using an electronic survey emailed to licensed nurses across the United States. The mixed methods survey used multiple choice, select all that apply, and open-ended responses to gather data on nurses' perceptions of pain management. One hundred and eighty nurses completed the survey and were included in the study. Sixty-six percent practiced in an urban hospital. Rural and urban nurses defined pain management as nonopioids and opioids. Seventy-one percent of urban nurses defined pain management as physical therapy compared to only 61% of rural nurses. Similarly, 62% of urban nurses identified homeopathic medicines and treatments as pain management techniques compared to 52% of rural nurses. From the qualitative data, 32% of rural nurses stated that patients with pain management concerns only want pain medications compared to 14% of urban nurses. Nurses have a critical position in and valuable perspective on the opioid epidemic. Rural communities are relatively disadvantaged in combatting the opioid epidemic. The finding that rural residents only want pain medication instead of alternative pain management options further challenges the country's rural health care workforce.