Pain management nursing : official journal of the American Society of Pain Management Nurses
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Multicenter Study
Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease.
Few studies have provided a detailed characterization of pain in patients with chronic obstructive pulmonary disease (COPD). The aims of this cross-sectional study were to describe the occurrence, intensity, locations, and level of interference associated with pain, as well as pain relief; to identify differences in demographic, clinical, and symptom characteristics between COPD patients with and without pain; and to determine which demographic, clinical, and symptom characteristics were associated with average pain, worst pain, and pain interference. A total of 258 patients with COPD provided information on demographic characteristics; comorbidities; respiratory parameters including dyspnea; body mass index; and symptom characteristics (i.e., anxiety, depression, sleep disturbance, and fatigue). ⋯ In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients.
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Research on nursing students' pain knowledge and attitudes is limited. Although emotions play a role in pain assessment, no study has examined the associations between emotional intelligence and pain knowledge and the attitudes of nursing students. This cross-sectional quantitative study aimed to address this research gap by assessing the pain knowledge and attitudes of nursing students in Hong Kong and examining associations between emotional intelligence and the pain knowledge and attitudes of nursing students. ⋯ For Year 3 students, emotional intelligence, pain knowledge and attitudes were negatively correlated, but the correlation was significant (r = -.31, p = .02). These results suggest that nursing students' pain knowledge and attitudes could be improved. Implications for nurse educators to enhance emotional intelligence and pain education for nursing students are discussed.
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Randomized Controlled Trial
Low-Dose Ketamine Infusions for Highly Opioid-Tolerant Adults Following Spinal Surgery: A Retrospective Before-and-after Study.
Managing acute-on-chronic pain in opioid-tolerant individuals is complex and challenging; exploring new analgesia regimens for this population is essential. Ketamine is an N-methyl D-aspartate antagonist that blocks transmission of painful stimuli and could be a useful medication for this patient population. A new low-dose ketamine protocol as an adjunct to conventional pain therapy was implemented in a major urban Level 1 trauma center in Canada. ⋯ There were no statistically significant differences between conventional therapy and conventional therapy plus ketamine. Ketamine may still be of benefit to patients with acute-on-chronic pain, although this was not evident in this study. Future research using more robust assessment tools to determine effectiveness of ketamine is required.
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Assessing pain in children with special needs presents unique challenges for school nurses, as no evidence-based or clinical standards to guide practices have been established for use in the school setting. Additionally, school nurse staffing has not kept pace with the growth in the population of children with special needs, which has increased by 60% since 2002. The aim of this study was to explore school nurses' pain assessment practices for students with special needs. ⋯ When assessing students with special needs, nurses should utilize objective clinical assessments, teacher consultations, and parent input scales. In addition to continuing education, policies facilitating lower nurse-to-student ratios are needed to improve pain assessment practices in the school setting. Research to understand the perspectives of nurses, teachers, parents, and students is needed to support the creation of evidence-based policies and procedures.
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Patient-controlled analgesia (PCA) administered intravenously is a generally well-accepted therapy by nurses and patients. PCA devices are now available for oral medications, allowing patients to self-administer pain pills without requesting them from the nurse. Successful introduction of new pain medication delivery devices can depend on nurses' knowledge and attitudes. ⋯ Although improvement was not statistically significant (p = .1637), two items showed significant improvement. Knowledge about the effectiveness of NSAIDS was 27.5% pretest compared with 60.0% post-test (p = .0028); and understanding about use of opioids in patients with a history of substance abuse was 50% pretest compared with 70% post-test (p = .0531). Helping nurses overcome the perceived barriers to use of an oral PCA device has potential implications for better pain management as well as enhanced patient satisfaction.