Pain Management Nursing最新文献

Background: While neonatal care units (NCUs) are essential for critical neonatal care, they expose neonates to frequent painful procedures. Despite the benefits of non-pharmacological pain management and family-centered care (FCC), Thai parents' perspectives in alleviating their infants' pain remain under-reported.

Aim: To explore Thai parents' perspectives regarding their understanding of and involvement in non-pharmacological pain management strategies.

Methods: A qualitative descriptive study was conducted using face-to-face, semi-structured interviews with 12 parents of neonates admitted to two units of university hospital in Southern Thailand between March and April 2025. Data were analyzed using inductive thematic analysis.

Results: Five major themes emerged: 1) Parents' recognition and interpretation of their baby's pain; 2) Parental coping strategies and involvement in pain alleviation; 3) Gaps in communication and information from healthcare professionals; 4) Preferences for information delivery and suggestions for improvement; and 5) Cultural and religious considerations.

Conclusions: Thai parents demonstrate strong willingness to support their infants' pain relief but face structural, cultural, and informational barriers. Improved communication, culturally sensitive education, and inclusive visitation policies could enhance FCC and empower parents in neonatal pain management.

Clinical implications: Standardized communication and culturally tailored education, including materials both Thai and "Ja-Wi", can better equip parents to support neonatal pain management. Revising visitation policies and enhancing staff training can also promote parental involvement and strengthen FCC in Thai NCUs.

Purpose: Cancer pain significantly affects patients' quality of life, yet facilitators and barriers to patient pain self-management remain poorly understood. This study aimed to quantitatively validate and test the Barriers and Facilitators of Chronic Cancer Pain Self-Management (BFCCPSM) instrument, which identifies barriers and facilitators of chronic pain self-management among people with cancer using Creswell and Clark typology.

Design: Through a quantitative approach, this study evaluated the BFCCPSM instrument, the first tool to assess both facilitators and barriers facing patients in home settings.

Methods: The study sample comprised 200 patients who were recruited using online platforms and from an oncology center. Nine factors (51 items) were identified through principal component analysis and showed acceptable construct validity and internal consistency (65.8% of the variance explained and Cronbach's α = 0.70-0.88, respectively). The tool was composed of two main constructs: barriers (patient-health care provider relationship, fear of side effects, addiction concerns, negative beliefs, psychological stressors, discrimination, transportation) and facilitators (family, friends, and social support and self-efficacy and active role).

Results: Significant differences were observed between groups (i.e., age, marital status, and race), which supported the criterion validity of the instrument. Noteworthy is that transportation and discrimination were reported as novel barriers, whereas social support and self-efficacy were the main facilitators.

Conclusions: Despite the study limitations represented by the length of the survey and the included sample size, the BFCCPSM contributes to filling a gap in the field, as it addresses factors previously unmet in the self-management of chronic cancer pain, providing a basis for person-centered interventions and health equity. Future studies should validate the instrument with other populations and refine its factors.

Clinical implications: Identifying barriers and facilitators to chronic cancer pain self-management can inform targeted strategies to improve health equity and reduce bias in care. Use of the BFCCPSM instrument within quality improvement initiatives may support organizational and provider-level interventions, including addressing transportation barriers and enhancing key facilitators such as social support and self-efficacy, across patient, provider, and health system levels.

Purpose: Disagreements between nurses and doctors regarding the assessment and management of existential suffering in terminally ill patients represent a critical challenge in palliative care, particularly in the context of inpatient adult hospices. This study aimed to explore nurses' decision-making processes for palliative sedation in cases of existential suffering in an inpatient adult hospice, providing a comparison with physicians' approaches.

Design: The study employed Charmaz's constructing grounded theory methodology.

Methods: Case-based guided interviews, incorporating a case vignette, were conducted with nurses in a German inpatient adult hospice. Data were analyzed using MAXQDA 22.8.0 following Charmaz's methodology.

Results: Five categories were identified: (1) enabling quality of life until death, (2) perceiving existential suffering, (3) making a decision, (4) performing palliative sedation, and (5) palliative sedation as a solution for existential suffering. In this article, we focus on the decision-making process.

Conclusions: The study highlights the limited involvement of nurses in decision-making processes regarding palliative sedation despite their critical insights into patients' existential suffering. The findings emphasize the need for interdisciplinary collaboration and the integration of nurses' perspectives to achieve more holistic and ethically sound care in inpatient hospices.

Clinical implications: The study emphasizes the need to strengthen nurses' role in palliative sedation to foster ethical practice and reduce moral distress. © 20XX by the American Society for Pain Management Nursing.

Purpose: Limited data are available on the validation or use of culturally and language-specific pediatric self-report pain scales in Sub-Saharan Africa despite the high burden of pain affecting children.

Design: An observational study was conducted to determine the discriminant and convergent validity of two self-report pain scales in Tanzania translated into Swahili: Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS).

Methods: Children aged 5-18 years in the outpatient clinic and inpatient wards at Bugando Medical Center in Mwanza, Tanzania, were eligible. The FPS-R and CAS were translated into Tanzanian Swahili. Discriminant validity was assessed before, during, and after venipuncture using analysis of variance. Convergent validity between the two scales and between parental and child reports was assessed using Spearman correlation.

Results: A total of 107 children were enrolled (56% male, median age 8 years, interquartile range = 6.5-11). A majority (73%) had sickle cell disease. Serial assessments around venipuncture were completed in 46 children, and 74 child-parent dyads were assessed for pain burden, caregiver correlation, and scale preference. Median scores before, during, and 5 and 30 minutes after venipuncture documented an expected increase and decrease in pain over time (p < .001) in both the FPS-R and CAS. The correlation between FPS-R and CAS was r = 0.972 and p < .001. The correlation between parent and child was r = 0.849 and p < .001. Most caregivers (85%) and children (92%) preferred the FPS-R.

Conclusions: The FPS-R was preferred and the parent pain report correlated with the child report.

Clinical implications: The Tanzanian Swahili FPS-R and CAS are valid pediatric pain assessment tools.

Purpose: Healthcare education programs often provide limited training in contemporary pain neuroscience, leaving future professionals ill-prepared to address the pervasive and biopsychosocial problem of chronic pain. Exploration of the level of understanding of contemporary pain neuroscience and the attitudes toward people in pain among university students may help educators identify appropriate roles for students in pain-related interprofessional education. This study assessed and compared knowledge of contemporary pain neuroscience and attitudes and beliefs toward individuals experiencing pain among university students.

Design: Cross-sectional observational study.

Methods: 284 undergraduate and graduate, healthcare and non-healthcare students completed the revised Neurophysiology of Pain Questionnaire and the Health Care Providers' Pain and Impairment Relationship Scale.

Results: Findings revealed a widespread lack of contemporary pain neuroscience knowledge and misinformed attitudes and beliefs about individuals in pain across most groups. Physical Therapy students demonstrated significantly greater contemporary pain neuroscience knowledge and more informed attitudes and beliefs compared to all non-physical therapy healthcare and non-healthcare students. Surprisingly, non-healthcare students displayed comparable contemporary pain neuroscience to healthcare undergraduate and non-physical therapy graduate students, further highlighting gaps in healthcare curricula. Attitudes and beliefs toward individuals in pain were deficient among non-physical therapy healthcare majors and non-healthcare students alike.

Conclusions: These results underscore the need for comprehensive, contemporary pain neuroscience education across healthcare disciplines.

Clinical implications: All universities should consider incorporating contemporary Pain Neuroscience Education into healthcare curricula. Improved knowledge and attitudes among physical therapy students highlight the potential for meaningful contributions to interprofessional pain education through leadership, collaboration, and shared learning.

Objectives: To evaluate the correlation between opioid administration, pupillary changes measured by pupillometry, and patient-reported pain levels in nonprocedural settings, and to assess the utility of pupillometry as an objective tool for pain assessment and opioid efficacy.

Design: Systematic review of published literature.

Data sources: A literature search was conducted in February 2022 using PubMed, CINAHL, Web of Science, and EMBASE to identify studies examining the relationship between opioids, pupillary responses, and pain.

Review/analysis methods: A total of 160 articles were screened, and 14 studies met inclusion criteria for final analysis. Studies were evaluated for associations between opioid administration, pupillary measurements, and pain levels, as well as for reported confounding factors influencing pupillary response.

Results: Most studies demonstrated a significant association between opioid administration and pupillary constriction or altered pupillary reflexes. Several studies also identified correlations between pupillary responses and reported pain levels. Age, intraoperative medications, and individual physiological variability were found to influence pupillary measurements and may act as confounders.

Conclusions: Pupillometry shows promise as an objective indicator of opioid effect and pain response, particularly in settings where subjective pain reporting may be limited or unreliable. However, its interpretation must account for patient-specific and clinical confounding factors.

Nursing practice implications: Pupillary measurement may serve as a useful adjunct to traditional pain assessment tools in outpatient and postoperative settings. Incorporating pupillometry alongside routine vital signs-such as blood pressure, respiratory rate, and temperature-may enhance pain evaluation and support safer opioid prescribing and monitoring practices. Further research is needed to guide clinical implementation and establish standardized protocols.

Purpose: Chronic pain and cognitive impairment share similar biopsychosocial risk factors; however, little work has directly explored how these factors influence the relationship between chronic pain and cognitive impairment. This review aimed toexamine and integrate available evidence on biopsychosocial factors that influence the relationship between chronic pain and cognitive impairment in adults and develop a framework that will guide future research on this topic.

Design: Integrative review.

Method: Guided by the Whittemore and Knafl (2005) framework, we conducted a search using PubMed, Embase, and CINAHL to identify peer-reviewed, English-language articles published between 2015 and February 2025 with available full text that examined biopsychosocial factors associated with cognitive impairment in adults with chronic pain.

Results: Thirty-one articles were included, revealing four themes: 1) nature and type of chronic pain, 2) biological aging processes, 3) psychological disturbances, and 4) socioenvironmental factors.

Conclusion: Biopsychosocial factors influence the relationship between chronic pain and cognitive impairment through various pathways. Individuals with multifocal chronic pain, which is intense and of long duration, may be at the highest risk for cognitive impairment. Markers of brain aging and epigenetic aging may mediate the relationship between chronic pain and cognitive impairment. Psychological disturbances and the stress response may further mediate cognitive outcomes. Socioenvironmental factors may act as moderators in the relationship such that individuals with low socioeconomic status experience worse cognitive outcomes.

Nursing practice implication: Cognitive assessments should be included in the routine care of individuals with chronic pain.

Purpose: High levels of stigma among patients with chronic pain contribute to negative psychological well-being. Existing measures have not focused on opioid stigma among individuals with chronic pain who may have legitimate need for opioid therapy.

Design: We developed a measure of opioid stigma that captures two constructs: perceived stigma (awareness of others' negative attitudes) and internalized stigma (application of stereotypes to oneself) among individuals with chronic pain.

Methods: We recruited 180 participants with chronic pain via the online platform CloudResearch to modify an existing stigma scale. We developed items related to perceived stigma (8 items) and internalized stigma (5 items). Concurrent and discriminant validity were evaluated using the Center for Epidemiologic Study Depression Scale-10, Rosenberg Self-Esteem and Brief Resilience Scales. Factor structure were based on Iterated principal factor analysis with Promax rotation.

Results: The final sample included 151 participants, primarily Caucasian (80%), between 30-39 years old (40%), with a history of opioid use (81%). A two-factor solution was identified (MSA = .90), representing perceived and internalized stigma (Eigenvalues 7.23, 2.53; inter-factor correlation = .45, alphas = .94, .94). Semi-partial item correlations ranged from .61-.78 for perceived stigma and .73-.82 for internalized stigma. Significant correlations were observed between perceived stigma and CESD-10 (0.19, p = 0.02), and internalized stigma and resilience (-0.26, p = .001).

Conclusion: The adapted 13-item measure demonstrates sound psychometric properties in evaluating awareness and agreement with stigmatizing attitudes, supporting its reliability and validity.

Clinical implications: Nurses are uniquely positioned to identify opioid stigma, develop interventions, and reduce its impact for individuals with chronic pain.