Pain Management Nursing最新文献

Purpose: There is a paucity of research about the nature of the support parents need when their hospitalized child experiences pain. This study builds on previous research, which identified the need for a collaborative approach to managing children's acute pain, focused on empowering parents to be effectively involved.

Design: This study used a participatory qualitative approach.

Methods: Semi-structured online interviews were carried out by two researchers using four practice-based vignettes created with an expert pain nurse. The interviews elicited the views of eight parents on best practice in engaging parents in the management of their child's pain. The child patients ranged in age from 7 to 16 years. Each child enrolled in this study had the experience of pain while being hospitalized. The study had full ethical approval from the Open University, United Kingdom, and the National Health Service Health Research Authority. Interviews with parents ranged from 20 to 40 minutes.

Results: Eight parents (six mothers and two fathers) of children who had experienced pain while hospitalized participated in this study. Interview data highlighted the importance of open and clear communication between parents and nurses, the need for parents to build a relationship with nurses in which they feel confident to seek help when their child experiences pain, and the need for parents to build a relationship with nurses who would provide pain management for their child.

Conclusions: This study revealed that there is still a need for better communication between parents and nurses at the study site. The parents in this study reported a need for better communication between parents and nurses regarding their child's pain management.

Clinical implications: A 3-minute animation (computer-generated video) with key messages from eight experienced parents to other parents about how to be confident and seek help when their child experiences pain has the potential to increase parent involvement in the management of their child's pain.

Background and purpose: This study aimed to investigate the effects of a Portative glass waterfall (PGW), which is an artificial natural waterfall device, and a white noise (WN) mobile application on patient pain, anxiety, and physiological parameters during a gastroscopy procedure.

Design: This study was a randomized, controlled, clinical trial.

Methods: The study was conducted with 135 participants (45 in the PGW group, 45 in the WN group, and 45 in the control group. Data were collected using a Patient Information Form, a Physiological Parameters Record Form, and a Visual Analog Scale to assess pain, and the State-Trait Anxiety Inventory.

Results: The study results showed significant decreases in pain, anxiety, heart rate, and systolic and diastolic blood pressure and significant increases in respiratory rate and oxygen saturation levels in both the PGW and WN groups (p < .05). In the control group, no significant difference was found between the means of the variables before and after the procedure (p > .05).

Conclusion: According to the results of the study, PGW and WN applied during gastroscopy procedures decreased pain and anxiety in patients and had positive effects on physiological parameters.

Trial and protocol registration: ClinicalTrials.gov Identifier NCT06333431 Registration date: 13.03.2024.

Purpose: Pain reduction and the associated reduction in activities of daily living (ADL) should be achieved through targeted pain management and the promotion of patient self-management. We investigated whether a short, structured nursing patient education to promote self-management of pain therapy reduces pain-related limitations in ADL in patients with cancer.

Design: Exploratory before-after study.

Methods: Brief Pain Inventory total scores were compared between a control group and an intervention group receiving patient education. These scores reflect functional capacity in ADL and serve as a validated measure for assessing daily functioning, thereby enabling comparisons of limitations. Data were collected at baseline and follow-up (after four to eight weeks). Controlgroup data were used to adjust for caregiver-related effects. For this exploratory study, an a priori sample size of at least 30 patients per group was determined. Changes in pain scores were analyzed using multivariable linear regression, accounting for patient satisfaction with pain control and attitude toward pain management.

Results: A total of 31 controls and 31 exposed patients were assessed. Baseline characteristics were similar except for differences in satisfaction with pain control and attitude toward pain management. The education intervention significantly reduced painrelated ADL limitations compared to controls (-3.56 points; 95% CI: -7.11 to -0.01; p=0.049). Female patients showed greater benefits, though not statistically significant (p=0.293).

Conclusions: The patient education intervention was effective in enhancing pain self-management and overcoming limitations in ADL. While the results indicate only marginal statistical significance, it is important to consider that the control group received a conversation addressing patient questions. In typical clinical practice such specific communication between nursing staff and patients about pain management is uncommon. Therefore, the observed effect may underestimate the true impact in real-world settings.

Clinical implications: Nurses should be encouraged to offer structured pain self-management instruction - such as the nurse-led patient education evaluated in this study - to improve daily living of oncology patients. The results should be confirmed in further controlled clinical trials.

Background: Mechanically ventilated patients in intensive care units (ICUs) often require sedation to tolerate life-sustaining interventions. However, sedation management can be complex, and improper dosing can lead to adverse outcomes. Nurse-led sedation protocols have emerged as a promising strategy to optimize sedation care, but the evidence base remains fragmented.

Objective: This systematic review and meta-analysis aim to synthesize the available evidence on the impact of nurse-led sedation protocols on clinical outcomes in mechanically ventilated patients.

Methods: We conducted a comprehensive search of multiple electronic databases, including PubMed, EMBASE, Scopus, CINAHL, and the Cochrane Library, to identify relevant publications in peer-reviewed journals. To quantify the effects of nurse-led sedation protocols, we calculated the mean difference (MD) and risk ratio (RR) with corresponding 95% confidence intervals. Heterogeneity across studies was evaluated using the Cochrane Q statistic, I2 statistic, and associated p-value. All analyses were performed using RevMan 5.4 software.

Results: This meta-analysis of 16 RCTs, involving 1887 patients, demonstrated the substantial effectiveness of nurse-led sedation protocols in improving clinical outcomes. Specifically, nurse-led sedation protocols significantly reduced: ICU mortality: RR 0.32 (95% CI 0.26-0.38), I2 = 26%, p < .001, incidence of delirium: RR 0.42 (95% CI 0.35-0.49), I2 = 20%, p < .001, length of ICU stay: SMD -3.54 (95% CI -4.20 to -2.88), I2 = 68%, p < .001, length of hospital stay: SMD -1.88 (95% CI -2.31 to -1.45), I2 = 50%, p < .001 and duration of mechanical ventilation: SMD -2.73 (95% CI -3.24 to -2.21), I2 = 65%, p < .001. However, no significant difference was observed in the incidence of self-extubation between nurse-led sedation protocols and usual care: RR 1.09 (95% CI 0.97-1.23), I2 = 0%, p = .15.

Conclusion: Implementing nurse-led sedation protocols in ICUs is a safe and effective approach, yielding significant benefits, including reduced mortality rates, shorter ICU and hospital stays, decreased mechanical ventilation duration, and lower incidence of delirium, although they do not impact self-extubation rates.

Background: Patient-reported outcome measures are essential for clinical practice and can also be utilized for auditing purposes to assess the effectiveness of symptom management. Identifying breakthrough pain (BTP) is crucial for managing cancer pain; however, no suitable tool exists in Chinese to evaluate the severity and analgesic reactions associated with BTP.

Purpose: This study aimed to translate the Breakthrough Pain Assessment Tool (BAT) into a Chinese version (BAT-C) and to conduct reliability and validity tests.

Methods: A prospective, descriptive, cross-sectional design was used. Participants were recruited from the oncology departments in Taiwan (N = 160). Instruments included the BAT-C, the Chinese version of the Brief Pain Inventory, and demographic and disease information. Reliability was established by calculating Cronbach's and test-retest reliability. Validity was estimated using construct validity, convergent validity, and known group validity.

Results: The internal consistency was 0.75. The construct validity of the BAT-C was estimated by exploratory factor analysis, the cumulative explained variance of which was 52.93%. Convergent validity showed a significant correlation with pain severity (r = -0.60, p < .01) and pain interference (r = -0.60, p < .01). There was a significant difference among concurrent empirical validity, analgesics (PRN) (t (160) = -5.74, p < .001). Known group validity demonstrated that inpatients had more pain interference than did outpatients (p < .01).

Conclusions: The BAT-C demonstrates good reliability and validity. It can comprehensively assess the severity, analgesic response, and side effects of cancer BTP and could potentially improve BTP management.

Purpose: The Activity-Based Checks of Pain (ABCs) is a pain assessment tool incorporating activities of daily living and instrumental activities of daily living. This instrument is designed to focus on functional capabilities and limitations due to pain. This study was designed to validate the factorial structure of the ABCs and assess its use in participants with chronic pain.

Methods: Participants were recruited in two phases. Phase one optimized the design of the ABCs, with 297 subjects selecting their preferred icon for each function and rating its understandability. The most preferred and understandable icons were then used in phase two, where 304 participants with chronic pain completed the ABCs, the Patient-Reported Outcomes Measurement Information System (PROMIS) with additional PROMIS items that were analogous to the ABCs functions but not represented in the PROMIS-29, and the Brief Pain Inventory (BPI). Data were analyzed using exploratory factor analysis and confirmatory factor analysis.

Results: Four factor loadings resulted in: multiplanar activities, sitting and/or hip flexor pain, walking and/or ambulation, and pain interference with lightweight unilateral activities. High internal consistency was demonstrated for all four factor loadings (0.623-0.879, 0.577-0.824, 0.512-0.841, 0.519-0.817, respectively). Correlations between items in the ABCs, PROMIS, and BPI resulted in moderate to strong correlations. Test-retest reliability was moderate to strong (intraclass correlation coefficient: 0.74).

Conclusions: The results confirm the ABCs as a valid and reliable tool for assessing the impact of pain on function in patients with chronic pain.

Background: Chronic pain is a global health burden with significant impacts on daily functioning and quality of life. While previous studies have reported higher pain prevalence among females globally, emerging evidence from mainland China suggests a contrasting pattern.

Purpose: This study aimed to explore the sex differences, and interactions with socio-demographic factors, pain perception in predicting pain intensity among adults with chronic pain in mainland China.

Design: This study used a descriptive cross-sectional design.

Methods: A survey was conducted among 1,607 adults in mainland China. The Mann-Whitney U test was employed to compare mean pain intensity between sex groups. Generalized Linear Models and stepwise regression were employed to analyze associations with chronic pain.

Results: The findings revealed that males reported a higher prevalence and intensity of chronic pain compared to females. Lower income was associated with a higher likelihood of chronic pain, while higher income and lower education were significant predictors of greater pain intensity. Significant interaction effects between income, education, and sex on pain intensity were observed. Furthermore, males' pain intensity was more strongly influenced by the perception that exercise exacerbates pain, while females were more likely to view pain as a natural consequence of aging.

Conclusion: These findings challenge traditional assumptions about sex differences in chronic pain and underscore the need for sex-sensitive interventions, such as online pain management programs tailored to address the distinct socio-demographic and perceptual factors influencing men and women.

Clinical implications: Recognizing sex differences in chronic pain, particularly related to socio-demographics and pain perception, can help healthcare providers tailor pain assessment and management strategies to improve outcomes for both men and women.

Purpose: To examine the effect of Kids Pain Care E-Booklet in educating mothers on pain management of hospitalized children.

Methods: A quasi-experimental pretest-posttest design with a control group was implemented at two pediatric hospitals in Indonesia. Ninety mothers of hospitalized children aged 3-12 years were recruited through consecutive sampling (45 per group). The control group received standard care, while the experimental group participated in a two-session educational program using the Kids Pain Care E-Booklet. Knowledge, attitudes, and practices were assessed using validated questionnaires (Cronbach's α: 0.89-0.96).

Results: Baseline characteristics were comparable between groups (p > .05). Post-intervention, the experimental group demonstrated significantly higher knowledge scores (19.93 ± 4.58 vs. 13.87 ± 4.02, p = .002), more positive attitudes (48.28 ± 5.68 vs. 37.06 ± 5.39, p < .001), and improved practices (67.33 ± 5.77 vs. 56.88 ± 5.48, p = .001) compared to the control group. Within the experimental group, significant improvements were observed across all three domains (p < .001), while the control group showed no significant changes. The greatest improvement was observed in mothers' ability to implement non-pharmacological pain management techniques.

Conclusions: The Kids Pain Care E-Booklet effectively enhanced mothers' knowledge, attitudes, and practices regarding pain management in hospitalized children. This digital educational tool represents a practical, accessible intervention that empowers mothers to actively participate in alleviating their children's pain during hospitalization.

Clinical implications: Pain is a complex experience for children and is one of the most common concerns during hospitalization. The kids pain care e-booklet offers an evidence-based, technology-enhanced solution for family education that can be readily integrated into standard nursing practice to improve pediatric pain management outcomes.

Purpose: To explore associations between arthritis-related joint pain and walking duration as a primary physical activity among older adults with arthritis.

Design: Cross-sectional secondary data analysis.

Method: This study used data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), focusing on respondents aged 50 and older who self-reported a physician diagnosis of arthritis (N = 31,067). Weekly walking duration and joint pain level (none, mild, moderate, severe) were self-reported. A multinomial logistic regression model was applied to examine associations between walking duration and joint pain levels, controlling for age, gender education, income, and race/ethnicity.

Results: Walking ≥ 151 min/week was associated with a 15%-28% reduction in the odds of experiencing moderate joint pain and a 23%-30% reduction in the odds of experiencing severe joint pain compared with walking < 150 min/week (all p < .05).

Conclusion: Although causality could not be inferred due to the cross-sectional design, moderate increases in weekly walking were significantly associated with lower levels of joint pain. Walking for 301-450 minutes per week (43-64 minutes per day) was linked to substantial pain reduction.

Clinical implication: These findings support the role of cumulative daily walking as a therapeutic strategy for managing joint pain in older adults with arthritis. Barriers to walking should be addressed in clinical assessments and nursing interventions to enhance effectiveness.