Pain management nursing : official journal of the American Society of Pain Management Nurses
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Effective pain management has been shown to promote earlier mobilization, adequate rest, reduced hospital stays, postoperative complications, and costs. A multidisciplinary quality improvement team worked together to develop and implement a comprehensive evidence-based program for postoperative pain management. The purpose of this study was to assess surgical patients' pain status, satisfaction, and beliefs with regard to pain management prior to (Phase 1) and following the implementation of the program (Phase II). ⋯ Patients in Phase II had lower pain scores and experienced fewer disturbances in sleep, walking, and general activities. Patients in Phase II were less likely to believe that good patients avoid talking about pain. The results suggest that addressing pain management through a variety of strategies targeted at the level of the institution, the clinician, and the patient may lead to desired changes in practice and better outcomes for patients.
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Controlled Clinical Trial
Effects of a quality improvement program in acute care evaluated by patients, nurses, and physicians.
Hospitalized patients have a right to be assessed for pain and receive optimal pain management, but inadequate pain management is still widely prevalent. Different quality improvement (QI) approaches have been used to improve patients' experience of pain, with varied results. The aim of this study was to implement a QI program and evaluate its effects on pain management routines in acute care, experienced by patients, nurses, and physicians. ⋯ The number of patients assessed with pain rating scales increased (p = .011), but no difference was seen in patients' experience of pain severity, interference with function, or use of nonpharmacologic methods. Younger and higher-educated patients seemed to prefer a more active participation role in their pain management than did older and low-educated patients. In future research it would be valuable to illuminate patients' possibilities to participate in pain management further and test different implementation methods with varied length of educational programs including follow-ups for the whole team and the patients in acute care.
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Comparative Study
Evaluation of the Revised Faces Pain Scale, Verbal Descriptor Scale, Numeric Rating Scale, and Iowa Pain Thermometer in older minority adults.
The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale Revised (FPS-R), Verbal Descriptor Scale (VDS), Numeric Rating Scale (NRS), and Iowa Pain Thermometer (IPT) with a cognitively impaired minority sample. A descriptive correlational design was used, and a convenience sample of 68 participants, admitted to acute care facilities in the South, with an average Mini Mental Status Exam score of 23 comprised the sample. Thirty-two percent of the participants were males, and 68% were females. ⋯ When race and cognitive status were considered, African-Americans and Hispanics preferred the FPS-R. Severely, moderately, and mildly impaired participants also preferred the FPS-R. The findings of this study support the use of these scales with older cognitively impaired minority adults.
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Self-rated health (SRH) is an important outcome measure that has been found to accurately predict mortality, morbidity, function, and psychologic well-being. Chronic nonmalignant pain presents with a pattern that includes low levels of power and high levels of pain, depression, and disability. Differences in SRH may be related to variations within this pattern. ⋯ Multivariate analysis of variance revealed significant differences (p = .001) between SRH categories on the combined dependent variable. Analysis of variance conducted as a follow-up identified significant differences for power (p < .001) and depression (p = .003), but not for pain or pain-related disability; and discriminant analysis found that power and depression correctly classified patients with 75% accuracy. Findings suggest pain interventions designed to improve mood and provide opportunities for knowing participation may have a greater impact on overall health than those that target only pain and disability.
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The primary concern of surgical patients is the expected experience of pain. Presently, the standard for acute postoperative pain management is intravenous patient-controlled analgesia (PCA). Many authors have reported that patients prefer intravenous PCA to nurse-administered analgesia because it affords them greater control and optimizes their pain relief. ⋯ This article describes the implementation of a successful inpatient program that offers patient-controlled oral analgesia (PCOA). Patient-centered care is "an approach that consciously adopts the patient's perspective...about what matters." Patient-centered care is the practice philosophy of the University Health Network, a large tri-site teaching hospital in downtown Toronto, Ontario, Canada, affiliated with the University of Toronto. This philosophy underpins the concept of PCOA as it has been successfully operationalized in a unique PCOA program at the Toronto Western Hospital, one of the three sites comprising the University Health Network.