Pain management nursing : official journal of the American Society of Pain Management Nurses
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The purpose of this study was to determine the self-report pain rating scale(s) that can be used to quantify pain in elderly persons across cognitive functioning levels. Randomly selected elderly subjects (N = 100) completed the Short Portable Mental Status Questionnaire to categorize their level of cognitive impairment: intact (n = 36), mild (n = 9), moderate (n = 15), and severe (n = 40). Pain was measured with the Memorial Pain Assessment Card verbal subscale, FACES, COOP pain subscale, a numeric rating scale, and the Present Pain Intensity subscale of the McGill Pain Questionnaire. ⋯ Of the severely impaired, 30% were able to complete 1 or more pain assessment tools. Intraclass correlations showed a high degree of consistency among all pairs of tools (intraclass correlation > 0.74). We conclude that most elderly, with normal to moderately impaired cognitive functioning, as well as some severely impaired elderly, are capable of using self-report tools to rate their pain.
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Randomized Controlled Trial Multicenter Study Clinical Trial
An educational implementation of a cancer pain algorithm for ambulatory care.
Algorithms are proposed as a means of operationalizing guidelines or standards for cancer pain management. Professional education is used as the means to translate knowledge into practice. Outcomes measurement is the gold standard for validating improvement. ⋯ There was a clear deterioration in the impact of the training over time. The most significant effect occurred within the first 140 days after the intervention and was followed by a gradual return to baseline practice. In conclusion, algorithmic interventions can be successfully transferred into community practice, but further work must be performed to develop methods for securing retention of knowledge and maintaining improved outcomes.
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Methods to treat cancer pain effectively have existed for more than 2 decades. However, the effective treatment of cancer pain continues to elude many patients with cancer who suffer from poor management. Although efforts to address the problem of cancer pain in the United States have acknowledged the importance of patient education and advocacy, few endeavors, to date, have attended to the special needs of inner-city, low-literacy, or socioeconomically disadvantaged patients from minority cultural groups. ⋯ The focus group approach was used to develop materials that would empower patients and families to more effectively participate in pain management when working with health care providers from cultures other than their own. Qualitative data analysis methods were used to analyze transcripts of taped focus group sessions. Themes emerged from the data regarding pain and its culturally competent management as well as the group process of booklet development.
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This article provides a descriptive profile of pain in 80 women during the first 2 days after gynecologic surgery in 4 hospitals. Surgical procedures included abdominal hysterectomy, oophorectomy, and laparotomy. Average pain was moderate on both days, but paired t tests indicated that pain increased significantly during ambulation on day 1 (P = .009, sensation; P < .001, distress) and on day 2 (P = .007, sensation; P = .030, distress). ⋯ Although 41% of the women had previously used relaxation techniques for stress or pain, only 9% used it for pain after surgery. Results suggest that postoperative patients have moderate to severe pain that is incompletely relieved with patient-controlled analgesia. Nurses should encourage patients to press the patient-controlled analgesia button more often, report unrelieved pain, and use nonpharmacologic interventions.
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The purpose of this study was to determine the knowledge base of long-term care nurses regarding pain assessment and management in the elderly. Three specific themes related to long-term care nurses were investigated: personal beliefs regarding patients' self-reports of pain, documentation of patients' self-reports of pain, and choice of pain medication and dose. Eighty-nine long-term care nurses, from 6 rural counties in California, responded to a questionnaire that consisted of 2 patient scenarios. ⋯ Older nurses with more experience were less likely to believe or document their patient's self-report of pain than younger nurses with fewer years of experience. Less than half of the nurses would increase the analgesic dose for either patient scenario. Nursing implications include the importance of ongoing pain assessment and management education tailored to the geriatric population and long-term care.