Pain management nursing : official journal of the American Society of Pain Management Nurses
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Methadone treatment in chronic pain patients is still limited owing to misconceptions about addiction, safety, and its unique pharmacokinetic and pharmacodynamic properties. Nevertheless, patients with chronic noncancer pain are frequently treated with methadone at our Pain Centre either as the first opioid of choice, for specific pain conditions, or as a second-line opioid in patients developing tolerance or intractable side effects with other opioids. The aim of this study was to examine whether a nurse case management program of chronic pain patients treated with methadone is feasible and safe in trying to improve patients' care in an ambulatory setting. ⋯ No patients developed serious morbidity or mortality. Fifty-seven percent of patients were either satisfied or very satisfied with their treatment. A nurse-led case management program of methadone in chronic pain patients can improve patient care in an ambulatory setting.
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Comparative Study Clinical Trial
Improving patient and nurse outcomes: a comparison of nurse tasks and time associated with two patient-controlled analgesia modalities using delphi panels.
Increased demand on nursing time may adversely affect nurse satisfaction and patient outcomes. Technologies to reduce nursing time and burden may improve patient care. Two Delphi panels assessed the perceived nursing time of fentanyl iontophoretic transdermal system (ITS) and intravenous patient-controlled analgesia (IV PCA) for postoperative pain management. ⋯ Thirteen extra tasks were identified by the Clinical Trial panel to be associated only with IV PCA, and these eliminated steps primarily explained the estimated total nursing time difference between IV PCA and fentanyl ITS. According to the two Delphi panels, the perceived nursing time consumed was less and the number of tasks was lower for fentanyl ITS than for IV PCA. This benefit associated with fentanyl ITS may lead to other positive outcomes, such as improved nurse satisfaction and improved patient outcomes.
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Practice Guideline
Registered nurse management and monitoring of analgesia by catheter techniques: position statement.
The American Society for Pain Management Nursing believes that the administration of analgesia and the management of the associated effects are fundamental nursing responsibilities. This position statement will address the registered nurse's responsibilities for the management and monitoring of analgesia by catheter techniques in all patients of all ages and in all care settings. It will provide recommendations for the health care institution, licensed independent practitioner, and registered nurse to ensure the safe and effective implementation of these pain control methods. The position statement reinforces the American Society for Pain Management Nursing's belief that the administration of analgesia by catheter techniques is within the registered nurse scope of practice.
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The primary purpose of this study is to compare parental-global-impression of children's level of acute pain at home with parental assessment of children's pain using a structured instrument and with children's self-reports of pain. We recruited 32 parents of children aged 5 to 10 years who were diagnosed with a fractured limb and treated in a tertiary emergency department. After discharge, parents were asked to complete three home-based assessments relating to their child's acute pain: the parental-global-impression of pain, child's reported pain, and structured Parental Postoperative Pain Measure. ⋯ When compared with child report of pain, the sensitivity of Parental Postoperative Pain Measure was 71% on day 1 and 66% on day 2, whereas specificity was 82% on day 1 and 83% on day 2. On the basis of acceptable statistical criteria, parental-global-impression has good sensitivity and specificity compared with the child self-report measure. We do not suggest, however, that parental-global-impression can or should replace child report, but rather suggest that it can be used as an adjunct assessment measure as needed.
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Pain is a common problem for many older adults, with up to 50% of community-dwelling and 70% to 80% of nursing home residents experiencing pain regularly. Effective pain management requires thorough assessment, appropriate intervention, and systematic reassessment. Pain assessment, however, is complicated by dementia, which impairs memory, reasoning, recognition, and communication, and affects elders' ability to verbally report pain. ⋯ The tapes, all previously scored using microanalytic observational coding, were rated again by naïve raters using the NOPPAIN measure. Results indicated (1) high inter- and intrarater reliability of the NOPPAIN and (2) significant correlations of the NOPPAIN with self-reported pain and detailed behavioral coding. Findings support the reliability and validity of the NOPPAIN measurement tool and suggest this easy-to-use tool may be adequate for measuring pain indicators in older adults.