Pain management nursing : official journal of the American Society of Pain Management Nurses
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Randomized Controlled Trial
Back pain in direct patient care providers: early intervention with cognitive behavioral therapy.
Back pain and injury are a widespread problem for direct care providers and can lead to disability and job loss. Although most intervention studies focus on the number of reported injuries as the outcome variable, pain is a leading indicator of impending injury. More secondary prevention interventions focusing on early detection and treatment of pain are needed to reduce injuries. ⋯ However, stress scores increased. Depression scores accounted for one-third of the variance in hours absent because of back pain. Although there was a high dropout rate in the intervention group, a cognitive-behavioral intervention shows promise as a secondary prevention intervention.
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Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. ⋯ Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.
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This study explored hospitalized substance abusers' perspectives about getting their pain adequately addressed in the hospital setting and their interactions with nurses about pain-management issues. The aim of the study was to generate theory that can contribute to a greater understanding of the problem of pain management with this population. A grounded theory approach was used to interview participants with a substance abuse problem who were hospitalized with a medical/surgical problem. ⋯ All participants were polysubstance abusers and had a painful medical/surgical problem for which they were hospitalized. The Model of "Knowing How to Play the Game" was developed on the basis of participants' descriptions of their experiences and consisted of two core action categories "Feeling Respected/Not Respected" and " Strategizing to Get Pain Relief." Participants had many suggestions about nursing actions that were helpful or not helpful in assisting them to obtain pain relief. Nursing practice, education, research, and policy implications were discussed.
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Comparative Study
Validity of parent ratings as proxy measures of pain in children with cognitive impairment.
Parent-assigned pain scores have been used as proxy measures of pain for children, such as those with cognitive impairment (CI), who cannot self-report. However, the accuracy of parent-assigned pain ratings for children with CI has not been studied. This study evaluated the construct and criterion validity of parental pain scores of children with CI. ⋯ The parent underestimated the child's pain with FLACC ratings in only one case (8%), but overestimated pain in three cases (25%). This study suggests that parents of children with CI provide reasonable estimates of their child's pain, particularly when using a structured pain tool. Parents may, however, tend to overestimate their child's pain during the early postoperative period.
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The cost associated with surgical procedures has been dramatically decreased by the ability to perform these procedures on an outpatient basis. Pain and nausea, two common symptoms after anesthesia and surgical procedures, are among the greatest concerns for patients and their family members. As a result of the distress and sequelae associated with these symptoms, clinicians have attempted to determine the optimal intraoperative and postoperative symptom management for patients. ⋯ Data were collected at three specific time points (i.e., preoperatively, at 24 hours and at 7 days postoperatively). Postoperative pain and nausea were generally well managed, but improvement was needed in preoperative patient teaching, including the topics of drug and nondrug interventions. The methods used in this project have potential application for the measurement of other clinical outcomes after outpatient surgical procedures.