Competence In Pain Management Research Articles

Mind the Gaps: A Qualitative Study Combining Patients' and Nurses' Reflections on Pain Care.

Chronic noncancer pain is a serious health problem, one that is often associated with physical debility and emotional suffering. Although chronic noncancer pain is one of the primary reasons that people seek medical care, a significant body of evidence indicates that chronic pain is underdiagnosed and undertreated. There is a consensus among professional stakeholders in pain care that there is a need to strengthen quality, capacity, and competence in pain management at all levels of health care. Thus, there is a need for more in-depth knowledge of both the recipients and the providers of pain care, and qualitative studies can contribute to this. The aim is to explore and combine the perspectives of patients receiving pain care and registered nurses providing care at pain clinics. A multimethod design was based on two qualitative studies consisting of semistructured interviews with patients receiving pain care (N = 10) and nurses providing pain care at pain clinics (N = 10). Qualitative content analysis was applied to interpret and abstract their experiences. The themes developed from triangulation revealed significant gaps between ideal pain care and actual practice: “Dissonance in reflections on personalized care,” “A corresponding need for improved information flow in all levels,” and “A corresponding need for improved structure in pain care.” We suggest a stronger commitment to efficient information flow and person-centered communication to facilitate the patient involvement and self-management. In addition, more resources, education, and training are necessary to enable nurses and other professionals to act upon guidelines and ensure effective pain care.

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.

Effectiveness of an interprofessional workshop on pain management for medical and nursing students

ABSTRACTInterprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group’s pain management plans. Findings show that IP mentorship and IP group participation improved medical students’ pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.

Music therapy for pain management: the state of the art

Pain is a common clinical issue in medical populations, and music therapy is widely used as a treatment. The purpose of this presentation is to provide a comprehensive overview of this topic to include the theories underlying the use of music therapy for pain, a categorization of levels of music therapy practice, and clinical considerations based upon type of pain, therapist skill, patient need, and patient preference for coping. A description of the music therapy methods typically used according to levels of practice will be presented. In addition, the most recent meta-analytic evidence for the effects of music therapy will be discussed and compared to other types of music interventions (i.e. music medicine). A brief description of entrainment will be included as well as evidence for its effectiveness. Specific recommendations will be made regarding the future of clinical practice, research needs, and also the training of music therapists for competence in pain management.

Transfer of learning: Radiographers' perceptions of simulation-based educational intervention

AimThe aims of this qualitative descriptive study were to 1) explore and define radiographers' competence in intravenous pharmacotherapy before and after a simulation-based education, 2) examine radiographer's perceptions of transfer of learning into clinical practice. MethodSixteen diagnostic radiographers in one hospitals' Clinical Radiology Unit were individually interviewed before a multidisciplinary simulation-based pharmacotherapy education intervention in 2012 and fourteen were re-interviewed after the intervention 6–7 months later. Data were analyzed using qualitative content analysis. ResultsBefore education the participants reported uncertain competence in pain management during imaging procedures and acute situations. These weak competence areas identified were strengthened and self-confidence grew. The intervention improved the domains of pharmacotherapy-related patient safety; teamwork development and communication skills. In addition, the radiographers indicated that the iv. pharmacotherapy knowledge from simulation learning was transferred to routine work. ConclusionThe results of this study suggest simulation-based education is suitable for radiographers' pharmacotherapy learning. Adequate pain measurement and management are essential during invasive procedures and these skills can be realistically learned in simulations and transferred to clinical practice.

Nurses' competence in pain management in patients with opioid addiction: A cross-sectional survey study

There may be up to 21 million opioid abusers in the world. Drug abuse and associated health-related problems are increasing. Opioid addiction can cause serious bacterial infection, injury and trauma, conditions that can trigger pain. Opioid abusers experience pain differently from non-addicts. There is limited research on nurses' competence to provide pain treatment to patients with opioid addiction. To report on a Norwegian pilot study examining nurses' knowledge about pain and competence in treating pain in patients who abuse opioids. A descriptive cross-sectional survey design was employed. Nurses at medical (n=64) and orthopaedic (n=34) units at two urban, public Norwegian hospitals. Data were collected in January 2010 using a self-administered questionnaire. Sample selection was determined by purposive sampling. The response rate was 54%. Eighty-eight percent of nurses did not have sufficient knowledge about pain treatment in patients with opioid addiction. Eight-eight percent and seventy-seven percent regarded work-place experience and colleagues as the primary contributors to their knowledge about pain treatment, respectively. Work-place experience contributed most to nurses' competence. Ninety percent, 70% and 84% of nurses responded that education, literature and information technology, respectively, played a minor role in obtaining knowledge about pain management. Sixty-five percent of the respondents had basic skills for evaluating pain, although 54% could not evaluate the degree of pain. Almost 62% of nurses did not trust the pain experience self-reported by patients who were opioid abusers. Our study shows shortcomings in the nurses' competence to evaluate and treat pain, suggesting that patients with opioid addiction may not receive adequate pain management. Nurses' competence to offer pain treatment to opioid abusers could be characterized as experience-based rather than evidence-based.

Implementing a paradigm shift: incorporating pain management competencies into pre-licensure curricula.

The purpose of this article is 1) to present the historical context and rationale for competency-based pain management education; and 2) to suggest learning tools that faculty might apply into their teachings and their institutions' pre-licensure curricula for promoting conceptual learning based on competency-based pain management education. Based on the well-documented need to improve the competency of health care professionals in pain assessment and management, an interprofessional group of health care providers collaborated and then convened in August 2012 to develop core competencies for pain management for the pre-licensure programs of study across health care disciplines. This interprofessional group of pain educators achieved consensus on a common set of pain-related competencies intended to be implemented across a variety of pre-licensure professional programs. A group of the interprofessional faculty, who participated in the development of the core competencies for pain management, provides a follow-up of how to implement learning tools within teaching and curricula, based on competency education in pre-licensure health care. Broad questions about how to incorporate competencies into pre-licensure curricula, for all health provider pre-licensure programs, including how to assess competency across individuals and how to teach in ways that emphasize the demonstration of conceptual learning, remain unanswered. This article reviews how the use of competencies creates historical context for a shift from teaching to learning and concludes with suggestions and exemplars in applying core competencies for pain management in pre-licensure programs.

Influences of experiential year and web-based learning module on student pharmacists’ confidence and competence in pain management

ObjectivesCompare the confidence and competence in pain management skills between student pharmacists at the end of their didactic and experiential years. Examine the potential influence of general medicine faculty preceptors, and a web-based experiential learning module on students’ confidence and competence skills. MethodsTwo cohorts of students were surveyed at the end of the third (P3) and fourth (P4) professional years to assess their self-reported confidence and competence on four pain management skills. During the second year of the study, students were asked to complete a web-based learning module aimed at improving competency in pain management. Confidence and competence measures were compared for each cohort with a Fisher’s exact test. ResultsStudents were more confident than competent on all four pain management skills evaluated, and overall competence between both class years was suboptimal. Competence in pain management declined among P4 students who did not complete the learning module. ConclusionPharmacy students overestimate their pain management skills, particularly prior to their final experiential year. During the experiential year, pain management skills decline without an educational intervention, but having students complete learning modules can improve their competence.

Geriatric pain competencies and knowledge assessment for nurses in long term care settings

Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with a grant from the MayDay Fund to provide a single site for evidenced-based, easy-to-use, downloadable resources on pain management. This paper describes the development of the most recent addition to the website, a set of evidence-based core geriatric pain management competencies and a geriatric pain knowledge assessment, and discusses their potential uses in improving pain care for older adults. Geriatric Pain Competencies and Knowledge Assessment for Nurses in Long Term Care Settings.

Pain in hip and knee osteoarthritis.

Q To what extent does pain play a factor in the rehabilitation & treatment of hip and knee osteoarthritis? Pain is the most common complaint of individuals with osteoarthritis (OA) and is also the usual reason for seeking advice. Effective pain management is of utmost important for patients with hip and knee OA. Because the natural history of OA is still poorly understood and there is currently no cure or treatment proven to slow OA progression, the main goals of OA treatment are the management and alleviation of pain, as well as the maintenance and improvement of functional capacity. The guidelines on hip and knee OA management emphasize the need for individualized multimodal approaches that involve a combination of non-pharmacological, pharmacological and surgical treatment modalities [1–3]. Jari Arokoski*: Jari Arokoski is Adjunct Professor in Physical and Rehabilitation Medicine at the University of Eastern Finland, Kuopio and Consultant at the Department of Physical and Rehabilitation Medicine in Kuopio University Hospital. He received his medical degree from the University of Kuopio in 1990 and completed his specialisation in Physical and Rehabilitation Medicine in 1998 at the University of Kuopio. He finished his PhD thesis titled ‘Altered properties of articular cartilage and subchondral bone after long-term joint loading. An experimental study of young beagles’ in 1996. He became Adjunct Professor (docent) of Physical and Rehabilitation Medicine at the University of Kuopio in 2001. He received his Special Competence in Pain Management in 2001, in Rehabilitation Medicine in 2002, in Insurance Medicine in 2007 and in Medical Education in 2008. He has published over 100 peer-reviewed scientific publications on different aspects of musculoskeletal issues particularly on cartilage structure and function, joint loading, physical function and gait in osteoarthritis and the effects of exercise and rehabilitation in knee and hip osteoarthritis. He is Chairman of the Working group for Current Care Guideline for Treatment of Knee and Hip Osteoarthritis in Finland (Finnish Medical Society Duodecim) and President of Finnish OsteoArthritis Research Society (FOARS).

Adopting Pain Management Competencies

Conflict of Interest/Disclosure Summary: Dr. Herrreceived an honorarium in the amount of $1,000 forher work as an executive committee participant in the“Summit for Interprofessional Consensus on PainManagement Competencies” and for her contributionto the development of the core pain managementcompetencies. This honorarium was made possiblethrough a grant by the Mayday Fund. Mr. Koebnerreceived no support outside of his normal salary as afaculty member in the Department of Anesthesiologyand Pain Medicine at University of California, Davis,School of Medicine.Gaining interprofessional consensus on the core painmanagement competencies for all prelicensure healthprofessional education is a significant achievement, yetthe value of this effort will be diminished if the com-petencies are not translated into practice. Production ofknowledge may be a prerequisite for change inpain management, but it is not sufficient in and of itself[1]. Adoption of the core pain management competen-cies by academic programs and professional groups isan important next step in modifying pain managementpractices to better meet the needs of people in pain. Toassure that the model pain management competenciesadvanced in this issue of

Assessment of Cancer Pain Management Knowledge in Southwest China: A Survey of 259 Physicians from Small City and County Hospitals

Pain management is a critical issue in the care of cancer patients in China, especially in small city and county hospitals in southwest China. The study intended to determine Chinese physicians' competence in cancer pain management and to assess their opinions on barriers to optimal pain management. A questionnaire on pain management was given to 259 fellows after their general orientation meeting at a tertiary teaching hospital. The questionnaire was adapted from an earlier study by the Eastern Cooperative Oncology Group (ECOG). The majority of the fellows believed that 70% of cancer patients suffer pain. Nearly 90% (224/259) indicated that their training in cancer pain management was poor. The fellows stated that concern about morphine addiction was the primary reason they hesitated to prescribe opioids, and they identified inadequate assessment of cancer pain as the most significant barrier to optimal management of cancer pain. The study reflects to some extent the state of pain management in hospitals in southwest China. Medical students and physicians in China need improved pain management education.

Attitudes, beliefs and self‐reported competence about postoperative pain among physicians and nurses working on surgical wards

To investigate attitudes, beliefs and self-reported competence with regard to pain management in nurses and physicians on surgical wards. Interprofessional differences between physicians and nurses were also examined. A total of 795 physicians and nurses from different surgical departments in Norway were invited to complete a questionnaire measuring attitudes, beliefs and self-reported competence about postoperative pain. In total, 128 physicians and 407 nurses completed the questionnaire (response rate 68%). Of these, 77% of physicians and 57% of nurses reported more than 4 years' work experience with postoperative pain. Most of the physicians (95%) and nurses (86%) reported that patients 'often' or 'very often' achieved satisfactory pain relief. Overall, 69% of the sample evaluated themselves as being highly competent or competent in treating nociceptive pain, while only 16% reported they were highly competent or competent in treating neuropathic pain. There were no statistically significant differences between the professions regarding their self-reported competence in pain management, and nurses and physicians only differed on three out of 18 conditions regarding their appraisal of conditions related to postoperative pain management after controlling for years of experience. Only 20% of respondents were satisfied with the annual updates for staff about pain relief for patients with postoperative pain. Even though the majority of physicians and nurses described themselves as competent in management of nociceptive pain, and thought that patients often or very often achieved satisfactory pain relief, the respondents reported dissatisfaction with the annual updates in pain management and poor competence in treatment of neuropathic pain.

Nurse-initiated narcotics: Their role in optimum patient management

pain management strategies. These included chest pain (7/24; 29%) and minor traumatic injuries (7/24; 29%). Eighty-nine percent of EDs (32/36) had policies or guidelines that related to the administration of analgesia. Eighty-six percent (n = 25/29) of these policies enabled nurses to initiate a pharmacological analgesia. Nursing analgesic policies or guidelines included opioids (25/32; 78.1%); nitrous oxide (22/32; 68.8%); paracetamol (17/32; 53.1%); and or non-steroidal medication (11/32; 34.4%). Non-pharmacological intervention policies were only identified in 30% (29) of EDs. In 50% (18/36) of EDs, pain management education was regularly provided to staff. However, ED staff orientation programs (22/36; 61.1%) did not target pain management practices. The majority of departments (19/36; 52.8%) did not have nurse pain management competencies. Only a third of EDs (31.0%; 9/29) provided patients with written pain management information on discharge. The majority of EDs (25/36; 69.4%) did not have written patient pain management pamphlets or waiting room pain management pamphlets (32/36; 88.9%). The majority of EDs (28/36; 77.8%) had no quality improvement processes in place for collecting, reporting or feeding back on pain management practices. Conclusion: The study highlighted that nurse initiated pain management medications reduce inefficiencies in the timely delivery of analgesia. All EDs need to ensure adequate policies are in place to enable nurses to deliver timely analgesia. Further research is needed to be undertaken into the association between triage pain scores, documentation and ED pain management practices.

ASPAN's Delphi Study on National Research: Priorities for Perianesthesia Nurses in the United States

Prudent nursing practice mandates the best, scientific evidence available. The complexity of perianesthesia practice, management, and education, coupled with required competencies within these domains, generate problems demanding answers. ASPAN's financial and human resources, however, are limited. Therefore, ASPAN must be able to articulate research priorities. The purpose of this study was to identify and prioritize the research questions related to perianesthesia practice, management, and education. A three-round Delphi study conducted with perianesthesia nursing experts determined research priorities for perianesthesia nursing practice. Research problems were identified and refined into research questions. Questions were ranked for their priority. Research priorities focused on the following themes: evidence supporting ASPAN standards, staffing ratios, nurse fatigue, adverse patient outcomes, patient care issues related to intensive care unit (ICU) overflow, obstructive sleep apnea, pain management, glycemic control, and clinical critical care competencies. This study advances the mission of ASPAN by identifying the top national perianesthesia research priorities related to practice, management, and education, and should guide researchers in their continued exploration of the science of perianesthesia nursing.

Use of a comprehensive survey as a first step in addressing clinical competence of physicians-in-training in the management of pain

Deficiencies in practice, knowledge, and competence among physicians are important contributing factors to the unsatisfactory level of analgesic care in hospitalized patients. By way of a comprehensive survey, we characterized these deficiencies within an internal medicine residency program as an initial step in designing remedial educational strategies. To do so, an anonymous 43-item survey was administered to residents in an internal medicine program. A total of 61 residents (69 percent) responded. The results indicated that patient-controlled analgesia (PCA), a standardized pain scale, and an opioid equivalence table were underused. Competence in opioid conversion was suboptimal, but completion of an oncology rotation and familiarity with the opioid equivalence table predicted greater competence in this area (p = 0. 00 7 and p = 0.001, respectively). Self-perceptions of adequacy of training and pain-management competence were predictors of knowledge (p = 0.026 andp = 0.038, respectively). Attitudes regarding opioid analgesia were generally satisfactory (i.e., low "opiophobia " score), although the risk of addiction was still overestimated. The characterization of deficiencies in pain management in a residency program is an essential step in the design and implementation of educational interventions. Administration of a comprehensive survey is a simple and effective method of gathering this data and has the additional benefit of promoting awareness of pain management issues. Our experience served to establish, among other findings, the didactic value of experience on an oncology floor; this result substantiates the value of practical experience in the gaining of clinical competence in pain management. Interventions that capitalize on the findings of the survey and the interest in pain management generated by its administration are currently ongoing at our institution.

Assessing Needs for Palliative Care Education of Primary Care Physicians: Results of a Mail Survey

The purpose of this study was to determine continuing education needs in the area of palliative care, as defined by family practice physicians. The methodology consisted of an anonymous questionnaire mailed in October, 1991, to all family practitioners in the city of Regina, Saskatchewan having admission privileges at any of the city's three hospitals. Replies were received from 31.1% of that population; the worst-case estimate is that about half of the city's palliative care caseload in 1991 was under the care of these respondents. In a priority-ranking format, physicians rated pain assessment and management as the patients' greatest need and their greatest continuing education need. Although emotional support and communication were highly ranked among other needs of patients, they were not highly ranked among education needs. Grand rounds was indicated as the educational venue of preference. Longer, more intensive educational formats were not selected. Communication of palliative status, including "Do not resuscitate" status, has reportedly become a routine practice. We have concluded that palliative care education should focus on the felt needs of family practice physicians for technical competence in pain assessment and management, using abbreviated formats. Cautious introduction of content areas and educational methods more likely to address patient needs is warranted. A one- or two-day workshop devoted to bereavement guidance might be a concrete focus for communication-oriented continuing education.