Use Of Pain Assessment Scales Research Articles

A UTILIZAÇÃO DAS ESCALAS DE AVALIAÇÃO DA DOR EM PEDIATRIA

An important part of pediatric treatment is assessing pain in children, as they often cannot communicate the intensity of pain verbally. The objective, therefore, was to analyze the effectiveness of the use of pain assessment scales in pediatrics by the nursing team. Methodologically, the integrative literature review was carried out according to Whittemore and Knafl’s guidelines, with searches in the PubMed, Google Scholar and Scielo databases, using the descriptors “pain assessment”, “nursing” and “pediatrics”. Studies on the use of pain scales in pediatric patients were included, regardless of the type (validation, clinical use, systematic reviews), published in the last 10 years and written in Portuguese, English or Spanish. Review articles, theses, monographs, repeated or paid articles, and those that did not specifically focus on pain scales for pediatrics were excluded. As a result, the review of studies indicates that, although these scales are widely recognized and used by the nursing team, there is an evident need for greater training and awareness among professionals to ensure their correct and effective application. Therefore, it is concluded that, to maximize the effectiveness of pain assessment scales in pediatrics, it is essential to invest in continuous training, develop protocols adapted to the individual needs of children and explore new technologies that complement traditional approaches. These steps will improve the quality of care provided as they also contribute to a more welcoming and compassionate environment for children and their families.

Attitudes to acute pain and the use of pain assessment scales among Spanish small animal veterinarians.

This study aimed to characterize the level of concern among Spanish veterinarians regarding acute pain in companion animals. Additionally, it sought to determine whether this concern correlates with the utilization of optimal assessment tools. A survey was conducted to explore Spanish veterinarians' attitudes toward pain and its assessment. The survey was distributed through two most prominent small animal veterinary associations, the Spanish association for veterinary anesthesia and analgesia, as well as key industry players committed to proactive pain management. Descriptive analysis of the collected data was performed using Excel and SPSS. A total of 292 veterinarians participated in the study. A high level of concern regarding pain in dogs and cats was determined where 44% of surveyed veterinarians assessed pain in all patients. Despite an awareness of validated pain scales, only 28% used them. The preferred scales were the Glasgow CMPS for dogs (94%) and the Feline Grimace Scale for cats (93%). Among respondents who do not use these validated tools, there was a considerable interest in incorporating these scales into practice (85%) and considered lack of training was the most relevant issue (32%). Other challenges to scale utilization were identified, including constraints related to time, staffing, and the need to establish a habit. Spanish small animal veterinarians demonstrated a strong awareness to pain in their patients and employed various methods for pain assessment. However, a limited use of validated tools was identified and likely attributed to challenges such as a lack of established routine, time constraints, insufficient personnel, and, notably, a knowledge gap among veterinarians who do not employ pain assessment scales. The most commonly used scales were the Glasgow CMPS for dogs and the FGS for cats. Overall, these results suggest a window of opportunity for the implementation of training programs in small animal pain assessment at a national level.

Implementation of a knowledge translation and exchange intervention for pain management in neonates

Objective To describe the implementation process of a multifaceted knowledge translation and exchange intervention to improve pain management practices, and to evaluate the adoption of this intervention by health professionals during painful procedures in neonates. Methods A quasi-experimental before-and-after study developed in a neonatal unit. The Evidence-Based Practice for Improving Quality intervention guided by the conceptual framework The Promoting Action on Research Implementation in Health Services was implemented in two stages (preparation and implementation). Its adoption was measured by clinical indicators related to pain management presented through descriptive statistics. Results After discussion on existing practices in the unit that needed to be changed, synthesis of current scientific evidence and local context data, members of the unit’s Research and Practice Council developed and implemented coherent and achievable goals for the change of practice in pain management, selected knowledge translation and exchange strategies, determined the target audience and indicators, and implemented the interventions. There was a 32.8% reduction in the number of painful procedures performed, an increase of 26.6-50.7% in the use of pain assessment scales and of 25.1% in the administration of oral glucose. Conclusion The multifaceted Evidence-Based Practice for Improving Quality intervention is complex, and has processes that demand knowledge and skills, commitment from the various actors involved, availability of time and financial investment. The analyzed indicators showed that the intervention resulted in positive changes in clinical practice in the management of pain in neonates.

Nurses’ Assessments Versus Patients’ Self-Assessments of Postoperative Pain: Knowledge and Skills of Nurses for Effective Pain Management

Postoperative pain is the most common form of acute pain. Nurses contribute to effective pain management with their knowledge and skills. The aims of this research were to examine differences between nurses' assessments and patients' self-assessments of postoperative pain, differences in the mentioned (self) assessments with respect to characteristics of both groups of respondents, and the correlation between the NRS and the VRS scale. The study included 103 nurses employed at a hospital and 103 patients treated in the surgical departments after the surgical procedures. Data were collected using the standardized Numerical rating scale (NRS) and Verbal rating score (VRS). The median of patients' self-assessments of pain intensity on the NRS scale was 4, while the nursing assessment of patients' pain was 3, with no significant difference (p = 0.083). No significant differences were found on the VRS scale between nurse assessments and patient self-assessments of current pain intensity. The pain was described as moderate by 35% of participants, including 35.9% nurses and 35% patients. Significant positive correlations were recorded between values on the VRS and NRS scales for nurses (Rho = 0.812; p < 0.001) and patients (Rho = 0.830; p < 0.001). The results of this study may have implications for the improvement of postoperative pain management protocols, with regular use of pain assessment scales and individualization of analgesic prescriptions.

Parents' perceptions of their child's pain assessment in hospital care: A cross-sectional study

PurposeA prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents' perceptions of their child's pain assessment in hospital care. Design and methodsThis study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis. ResultsParents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child's pain assessment. Parents were satisfied with their child's pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child's pain and that the parents' and child's views on pain would be taken into account. ConclusionsMost children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales. Practice implicationsChild's pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.

Current attitudes and self-rated abilities of Bosnia and Herzegovina veterinarians toward pain recognition and quantification in domestic animals.

In previous years interest has grown in investigating the attitudes and capabilities of veterinarians regarding the recognition, quantification and treatment of animal pain throughout different parts of the world and encompassing various species. This is the first report exploring the attitudes and self-rated abilities of veterinarians in Bosnia and Herzegovina (B&H) concerning recognition and quantification of pain in domestic animals. A study questionnaire was made available to 535 general practice veterinarians throughout B&H and 73 (14%) responded in full. The questionnaire contained polar, multiple choice, ordinal and interval scale questions and consisted of sections asking about demographic data, attitudes to pain recognition and quantification, use and availability of analgesics, estimates of pain intensity during specific surgical procedures, and the perceived need for pain assessment and continuing education programmes for analgesia. Half of the respondents considered the recognition and quantification of pain to be difficult while 89% did not make use of pain assessment scales. Of the respondents, (33/73; 45%) felt a certain level of pain to be advantageous since it reduces the activity of the healing animal, whereas 52% (38/73) did not agreed with this concept. Cost was a consideration when deciding whether or not to use analgesics for 58% (42/73) of the respondents with the most commonly used types being NSAIDs (72/73;99%) and opioids (60/73; 82%). Practitioners in B&H displayed awareness of the importance of pain assessment and management however a significant proportion were unaware of pain scales and relied upon physiological indicators of pain.

Обезболивание пациентов с сочетанной и множественной травмой: проблемы и перспективы

Anesthesia for patients with concomitant and multiple trauma requires increased attention fromthe anesthesiologist and intensive care doctors. Problems of insufficient analgesia (oligoanalgesia),monoanalgesia with opioids, insufficient use of pain assessment scales in the doctors practice, excessiveuse of narcotic analgetics, and as f consequence, the occurrence of secondary hyperalgesia and opioiddependence require the development of personalized schemes of pain relief for combined and multiplewith an emphasis on the damaged area using ultrasound visualization.

Nurses' perceptions of infants’ procedural pain assessment and alleviation with non-pharmacological methods in Estonia

PurposeThe purpose of this study was to describe nurses perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs). Design and methodsA descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods. ResultsMore than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants' pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year. ConclusionsThere is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them. Practice implicationsNurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

A survey of procedural pain assessment and non-pharmacologic analgesic interventions in neonates in Spanish public maternity units.

To qualify and quantify clinical practices related to pain assessment and non-pharmacologic analgesia (NPA) in newborns in Spanish public maternity hospitals STUDY DESIGN: We surveyed providers online regarding their use of pain assessment scales, NPA interventions in neonates undergoing procedures, as well parents' presence or absence during interventions. The number of painful procedures and the subjective grading of pain from the responding physicians were similar in all hospitals. Only 12.5% of hospitals used pain scales. No NPA was employed in 37.7% of procedures, with less NPA used in the lower complexity hospitals for venous extraction (p < 0.001) and gastric lavage (p = 0.001). Respondents reported parents' absence during 56.1% of procedures. Available pain assessment scales and NPA interventions to mitigate pain are being underused. The presence of the parents during painful interventions is low despite the evidence that this may help to reduce newborns' perception of pain.

Nursing considerations for the ulna and radial osteotomy patient

ABSTRACT:The patient suffering from limb deformities requires palliative and supportive care postoperatively as well as assistance regaining mobility. The veterinary nurse's primary role is to provide this care, and the use of pain assessment scales upon recovery are a critical tool in aiding return to normal function.

Assessment and expression of pain

This article, the second in a series of articles on pain, describes the importance of pain assessment. It explores the individuality of patients' pain expression and the effect of healthcare professionals' reactions to people experiencing pain. The role of the nurse is analysed, focusing on multidimensional pain assessment and the use of pain assessment scales.

Assessing chronic pain in general practice: Are guidelines relevant? A cluster randomized controlled trial

Objectives: To evaluate the impact of using pain assessment scales on the management of musculoskeletal chronic pain. Methods: Cluster-randomized controlled multicentre trial in French general practice settings. Practices were randomized by region before patient recruitment. The inclusion concerned patients suffering from musculoskeletal chronic pain. General practitioners assigned to the scale group used two validated assessment instruments; those assigned to the control group cared for their patients according to their usual practice. The primary end-point was the level of relief obtained and the secondary changes in prescription of painkilling modalities. Results: A total of 155 general practitioners included 772 successive patients suffering from musculoskeletal chronic pain. The control group reported a mean level of relief of 50.7% compared with one of 41.1% in the scale group (p<0.0001). In the intervention group, physicians decreased significantly their prescription of level two painkillers.Conclusions. In general practice, the use of pain assessment scales is not associated with greater pain relief. The lesser level of pain relief obtained in the scale group does provide evidence that using pain assessment scales does not enhance the relief of chronic pain in patients in primary care. Guidelines which recommend the systematic use of scales for the assessment and monitoring of chronic pain are not tailored to either the context or the patients encountered in the primary care setting.

Factors Affecting Emergency Department Assessment and Management of Pain in Children

To evaluate statewide emergency department assessment and management of pain in pediatric patients as a quality improvement initiative. 2002 Survey of Illinois Hospital emergency department's pediatric pain assessment and management strategies, in conjunction with a retrospective chart review of children, ages 0 to 15 years, treated for an extremity fracture. Survey results were available for 123 (59.4%) hospitals; 933 charts (107 hospitals) were reviewed for pain management. Survey results were compared with practices identified by chart review. Use of a pain assessment scale estimated by the survey was 92%, compared with 59% use by chart review. Use of pain assessment scales for infants was limited. Fifty percent of patients in moderate to severe pain would be offered an analgesic. Six- to 15-year-old children would be offered opioids more often than children aged 0 to 1 and 2 to 5 years. Offering higher potency narcotic analgesics was associated with patient's age, geographic location of the facility, and emergency department volume. Providing an analgesic (odds ratio 4.53, 95% confidence interval 2.89-7.10), offering supportive care (odds ratio 2.37, 95% confidence interval 1.44-3.89), and pediatric-focused annual nurse competencies (odds ratio 1.90, 95% confidence interval 1.18-3.06) correlated with reduction of the patient's pain. Disparity exists between perceived and documented emergency department pain management practices for children. Quality improvement initiatives should focus on improving pain assessment in infants, treating moderate to severe pain in children of all age groups, and education of health care providers in pain management strategies. Resources should target health care processes effective in decreasing pediatric pain.

Community Hospital Physician and Nurse Attitudes About Pain Management

An interdisciplinary committee was established and charged with examining pain management and developing interventions at a 148 bed community hospital. To examine strategies on managing pain from both healthcare provider and patient perspectives, the committee surveyed the attitudes of physicians and nurses toward pain management and patients' opinions about the pain management they received in the hospital. A separate survey instrument was developed for physicians, nursing staff and patients. Physicians and nursing staff from all departments were asked to complete the survey during departmental meetings in Autumn 2000, and all patients for whom pain medication were ordered during the month of May 2000 were asked to participate. A total of 45 physicians, 142 nurses and 169 patients responded. Results showed that the majority of physicians (88.9%, n = 40) and nurses (83.0%, n = 118) were satisfied with the pain management outcomes in their patients, andthat91.1% of physicians and 90.2% of nurses included their patients in the pain management decision-making process. Nearly all patients believed their pain was adequately managed, but the results indicated a need to improve the use of pain assessment scales by the hospital staff and a need to educate and involve all patients in their pain management options. Survey data also showed a desire for staff education on pain management.

Community Hospital Physician and Nurse Attitudes About Pain Management

An interdisciplinary committee was established and charged with examining pain management and developing interventions at a 148 bed community hospital. To examine strategies on managing pain from both healthcare provider and patient perspectives, the committee surveyed the attitudes of physicians and nurses toward pain management and patients' opinions about the pain management they received in the hospital. A separate survey instrument was developed for physicians, nursing staff and patients. Physicians and nursing staff from all departments were asked to complete the survey during departmental meetings in Autumn 2000, and all patients for whom pain medication were ordered during the month of May 2000 were asked to participate. A total of 45 physicians, 142 nurses and 169 patients responded. Results showed that the majority of physicians (88.9%, n = 40) and nurses (83.0%, n = 118) were satisfied with the pain management outcomes in their patients, andthat91.1% of physicians and 90.2% of nurses included their patients in the pain management decision-making process. Nearly all patients believed their pain was adequately managed, but the results indicated a need to improve the use of pain assessment scales by the hospital staff and a need to educate and involve all patients in their pain management options. Survey data also showed a desire for staff education on pain management.

Nurses' attitudes to pain control and the use of pain assessment scales.

The key to effective pain control is accurate assessment and, more importantly, the belief that what patients state about their pain is true. This research study investigates nurses' attitudes to pain and its assessment, and reveals why pain control continues to be an inconsistent affair.