Pain Management Nursing最新文献

Purpose: The purpose of this study was to qualitatively examine the experiences and perspectives of CRNAs surrounding the utilization of regional anesthesia in outpatient orthopedic surgery.

Design: A descriptive qualitative design was utilized.

Methods: Study participants described their current practices and experiences with regional anesthesia utilization in the outpatient orthopedic surgery setting in individual interviews using a semi-structured interview guide.

Results: Among the study participants (N=14), four key themes describing factors that promote CRNAs' utilization of regional anesthesia for outpatient orthopedic surgery emerged: (1) employment selection, (2) institutional factors, (3) practice variation, and (4) policy change.

Conclusions: Overall, CRNAs felt strongly about implementing regional anesthesia techniques in this patient population due to consistent experiences with its positive impact on patient outcomes. CRNAs expressed the desire to perform regional anesthesia, allowing them to practice to the full scope of their education and training, which ultimately impacted their choice of employment. However, there are several barriers on an institutional, organizational, and systemic level that prevent the universal administration of regional anesthesia by CRNAs, leading to practice variations that inhibit equitable, efficient care delivery.

Clinical implications: This study highlights the importance of the universal utilization of regional anesthesia by CRNAs and the necessity for advocacy efforts to alter unnecessary restrictive policies and barriers, ultimately improving equity in healthcare.

Purpose: To examine pain experiences, coping mechanisms, and treatment approaches among postmenopausal women living with osteoarthritis in a resource-limited healthcare setting in Pakistan, and to explore how different coping styles relate to symptom burden.

Design: Cross-sectional analytical study.

Methods: Between November 2024 and April 2025, 196 postmenopausal women aged 45 years and above, each with a clinical diagnosis of osteoarthritis lasting at least 6 months, were enrolled through convenience sampling at outpatient clinics and community health centers in Lahore. Structured interviews captured demographic and clinical data, pain severity (WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) Index), and coping strategies (Pain Coping Inventory). Descriptive statistics summarized participant characteristics; the Mann-Whitney U test between Osteoarthritis duration and coping score; and the Pearson correlation assessed relationships between coping and WOMAC scores.

Results: The average age of participants was 59.8 ± 9.8 years; most were married (91.3%) and primarily homemakers (80.1%). The mean WOMAC score of 61.4 ± 18.6 reflected moderate to severe symptomatology. Scores for passive coping strategies (53.3 ± 10.0) were markedly higher than those for active strategies (27.4 ± 7.4; t = 31.2, p < .001), and greater use of active coping was linked to lower WOMAC scores (r = -0.214, p = .003). Nearly all women (91.3%) reported using analgesics-chiefly paracetamol and Non-Steroidal Anti-Inflammatory Drugs while 60% engaged in nondrug interventions such as physiotherapy, exercise, or yoga. Prolonged NSAID consumption was frequently noted despite potential adverse effects.

Conclusions: In this cross-sectional sample, passive coping predominates and corresponds with heightened pain and functional limitation. Despite heavy reliance on medication, engagement in nonpharmacologic and active coping strategies is suboptimal.

Clinical implications: Integrating culturally sensitive, psychosocial interventions-such as coping-skills training, community-based exercise programs, and patient education-and expanding access to nonpharmacologic therapies may promote active coping, reduce symptom burden, and improve quality of life in postmenopausal women with osteoarthritis in resource-limited settings.

Background: Pain is the most common and distressing symptom for children at the end of life, with management challenges causing significant distress for patients and caregivers. Patient-controlled analgesia allows self-administration of preset medication doses for breakthrough pain and has shown benefits in postoperative and chronic pain management. However, its use and effectiveness in pediatric palliative care remain unclear.

Objectives: To review and synthesize the evidence pertaining to patient-controlled analgesia use for children at the end of life.

Review methods: A scoping review used the Arksey and O'Malley Framework to identify: (1) utilization of patient-controlled analgesia, including patient groups, advantages, and proxy use; (2) implications, safety, side effects, and impact on pain; and (3) child and parental perspectives.

Results: The key finding is a lack of a clearly defined, standardized patient-controlled analgesia policy for use in children at the end of life. Much of the reviewed evidence was organization-dependent, and most related to use for children with a malignant diagnosis.

Conclusions: Further research is required involving patient-controlled analgesia use with children with a nonmalignant diagnosis, including the perspectives of children and parents. Nurses are integral team members and well-positioned to be developers of policies related to patient-controlled analgesia use in children at the end of life. This is a call to action for nurse clinicians, leaders, researchers, and educators to collaborate to identify and implement an evidence-based, effective policy.

Introduction: Chronic pain (CP) is a prevalent condition that significantly affects quality of life, making its optimal management essential in primary care. However, nurses are often not involved, highlighting the need to better understand the conditions necessary for integrating their expertise before deploying implementation strategies.

Objective: This qualitative study aimed to identify barriers and facilitators to implementing nursing activities in CP management and to explore primary care nurses' perceptions of their role in this regard.

Methodology: Twenty-one nurses from primary care practices in Quebec, Canada, participated in four online focus groups. The Integrated Promoting Action on Research Implementation in Health Services framework in implementation science was used to explore the challenges and opportunities in CP nursing management. Data analysis followed both inductive and deductive approaches, guided by this framework.

Results: While nurses were interested in integrating pain assessment into their practice, they faced challenges due to a lack of training about CP. A gap was identified in their understanding of the chronic nature of pain and their ability to provide appropriate follow-up and support. Nurses also expressed concerns about addressing the mental health aspects associated with CP. Additionally, they often relied on primary care managers, whose leadership is pivotal in driving change, even within nursing practices.

Conclusions: This study highlights several challenges while suggesting essential implementation strategies to strengthen nurses' capacities, including additional training and tailored tools. Promoting interdisciplinary collaboration, clarifying nursing roles, and increasing manager awareness are crucial for enhancing primary care nurses' involvement in CP management.

Purpose: Despite increased interest in opioid-free strategies, their clinical uptake remains limited. This study explores Swedish perioperative healthcare professional's (HCPs) knowledge, attitudes, and practices regarding opioid and nonopioid analgesia across intraoperative and postoperative contexts.

Design: A national web-based survey was conducted among perioperative HCPs across Sweden between October 2023 and January 2024.

Methods: The questionnaire, based on the Knowledge, Attitudes, Practices (KAP) model, included closed- and open-ended items addressing intra and postoperative pain management. Quantitative data were analyzed using nonparametric statistics, and qualitative responses were examined using deductive thematic analysis aligned with the KAP model.

Results: Knowledge gaps predominated: 39% of all respondents were unsure of intraoperative opioid-free evidence, and 37% of postoperative anesthesiologists scored lower than nurse anesthetists and critical-care nurses (p < .01). Attitudes were pragmatic but opioid-centric: 89% were satisfied with current practice, and 87% deemed opioids essential, though most favored dose reduction over elimination, citing vague opioid-free anesthesia (OFA) definitions and case-specific risk. Practice mirrored attitudes: 68% did not primarily use opioid-free medications intraoperatively, blocks were common yet rarely audited. Nonpharmacological options were rarely used postoperatively: 23% routinely offered TENS, typically delivered by nurses or physiotherapists, while 59% relied primarily on opioids.

Conclusions: Perioperative pain management remains predominantly opioid-based, yet respondents showed openness toward individualized, opioid-free strategies.

Clinical implications: Key barriers included limited knowledge among HCPs, conceptual ambiguity around OFA, and low routine use of non-pharmacological methods. Targeted education, outcome evaluation, and team-based protocols are needed to bridge the gap between the evidence and practice.

Background: Pain is a barrier to completing in-office gynecological procedures. Best practice recommendations include pharmacotherapy, assessment techniques (trauma-informed history), environmental (distraction techniques, music), and other nonpharmacological interventions (heat, breathing). Yet, despite these best practices, the gap between evidence and practice persists. The implementation of pain management interventions for gynecological procedures requires further study. This study explores the implementation and impacts of a multicomponent intervention, the Adult Comfort Promise, to improve pain management for women and gender diverse adults.

Methods and analysis: We will complete an explanatory mixed-methods study to explore the implementation and impacts of the Adult Comfort Promise for two procedures: intrauterine device insertion and endometrial biopsy. In this three-phase study, we will first complete the quantitative phase, which includes intervention mapping, chart reviews, and surveys with patients and providers. In the second phase, we will explain the quantitative findings using semi-structured interviews with patients and providers. In the third phase, we will complete data integration and co-design implementation strategies for the intervention. We will analyze the quantitative data using descriptive statistics, including frequencies, mean, median, and mode. We will use an ANOVA to compare the effects of intervention components (distraction techniques to pharmacotherapy) on procedures (intrauterine device and endometrial biopsy) and their impact on pain management. The interview transcripts will be transcribed verbatim and analyzed using directed content analysis. We will include sex and gender in our analysis. The implementation strategy will be co-designed during workshops with providers and patients.

Implications for practice: This research supports nurses and other healthcare professionals in their efforts to provide best practice pain management. These findings can serve as a resource for nurses as they continue to lead efforts in bridging knowledge-to-action gaps and implementing pain management interventions into practice.

Conclusions: This protocol presents an implementation science, explanatory mixed-methods study that explores the implementation and impacts of a pain management intervention at a Canadian tertiary women and children's hospital. This study has been approved by the IWK Research Ethics Board (#1031375). These findings will contribute to the evidence base of pain management interventions for women's health. They will also inform future implementation strategies for pain management at tertiary care centers for women, children, and gender-diverse adults. They may also be transferable to other procedures (hysteroscopes) or settings, such as primary care.

Background: Even though there is clear evidence supporting the use of complementary and integrative health (CIH) interventions for chronic pain, their integration into clinical care is challenging. Thus, the purpose of this study was to understand how the integration of CIH interventions, namely, guided relaxation and acupuncture evaluated in the Hybrid Effectiveness-Implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain (GRACE Trial), would impact clinic workflow at each study site.

Methods: We conducted a qualitative descriptive study using individual interviews with healthcare providers and staff working at GRACE Trial sites. Interview data were analyzed using modified rapid qualitative analysis.

Results: We interviewed 13 healthcare providers from three GRACE Trial sites. Two major themes were identified: (1) the variable impact of CIH integration on clinic operations, and (2) the introduction of CIH interventions into clinical practice.

Conclusion: This study highlights the importance and value of participatory approaches in integrating CIH interventions into healthcare settings. This study contributes to the CIH literature by addressing chronic pain and informing the identification of strategies to target the multi-layered challenges of integrating evidence-based CIH interventions into practice.

Objectives: The purpose of this narrative review was to determine the gaps in the literature on pain management among college students.

Methods: Data Sources: Based on the expectation of limited research on pain management among this population, this review included three search terms: pain management, college students, and the United States. Non-college young adults, student athletes, and studies prior to 2018 were excluded.

Data analysis: The initial search yielded 245 articles. Exclusionary criteria and review reduced the sample to 12 articles.

Results: The results highlight the diverse surveys used to measure various pain outcomes among varying samples with limited perspectives from minority populations. Four themes were noted among the final 12 articles: disrupted social interactions, coinciding anxiety and depression, substance misuse, and pain interventions.

Conclusions: There are significant gaps in the literature on pain among U.S. college students related to access to pain management resources and measuring pain as a health outcome, especially among minority populations.

Nursing practice implications: For nurses, when evaluating a college students' pain, obtaining a thorough and accurate history of their pain and substance use is critical for appropriate pain management treatment.