Pain Management Nursing最新文献

Purpose: Little is known about the use of collaborative care models for patients with co-occurring chronic pain and substance use disorders (SUD). This study aimed to pilot test a collaborative care intervention delivered over telehealth to rural patients engaged with SUD treatment who experienced chronic pain.

Design: Single-arm, open-label pilot intervention trial.

Methods: Patients (N=88) were enrolled in SUD treatment at a single VA Medical Center and endorsed moderate-to-severe chronic pain. Patients received a nurse-led collaborative care intervention consisting of a comprehensive pain assessment, up to six follow-up appointments with the nurse care manager (NCM), and an optional 10-session pain education class. All patient encounters occurred remotely via telehealth. Baseline, 1- and 4-month follow up assessments measured outcomes of pain, depression, and substance use. Generalized estimating equations and intent-to-treat procedures modelled changes in outcomes over time.

Results: Patients were predominantly male (85%) and white (85%), with high mental health and substance use disorder comorbidities (92%). The most common substances of use at treatment initiation were alcohol (49%), opioids (17%), cannabis (17%), methamphetamine (11%), and cocaine (6%). By 4-month follow-up, patients who received the pain intervention endorsed significant reductions in pain intensity, pain interference, and depressive symptoms. Among patients using alcohol or cannabis at baseline, significant reductions in days using these substances were also observed.

Conclusions and clinical implications: An NCM-led collaborative care intervention delivered via telehealth may improve both pain and substance use outcomes for rural patients with these comorbidities. Large-scale clinical trials are needed to demonstrate intervention efficacy.

Purpose: The study aimed to determine how pain documentation audits and repeated feedback (REFPAD intervention) affect registered nurses' pain documentation and knowledge, and to discover how background variables relate to such documentation and knowledge.

Design: A cluster randomized trial.

Methods: Thirty work units in a university hospital were randomized into intervention (n = 15) and control (n = 15) groups. The intervention group received monthly pain documentation audits and feedback, while the control group received no feedback. A pain knowledge test was conducted in three phases. Data were collected from February to November 2022. A linear mixed model was used to detect the effects of the REFPAD intervention.

Results: The REFPAD intervention positively affected pain documentation quality, but its statistical significance was lost because of substantial within-unit variation. At baseline, pain documentation quality scores were in intervention 35% and control 38%. After 8 months of feedback, the quality scores were 44% and 43%. The number of pain assessments per patient per day was the only factor that affected pain documentation quality. The REFPAD intervention had no effect on pain knowledge.

Conclusions: The REFPAD intervention may improve pain documentation quality. A more comprehensive analysis of implementation barriers and facilitators is needed to reduce variations between and within work units.

Clinical implications: More focus should be paid to feedback implementation and continuous monitoring of the quality of pain care is recommended.

Trial registration: ClinicalTrials.gov Identifier: NCT05373641. Registration date: February 22, 2022.

Objective: The aim was to establish a competency index system for pain resource nurses (PRNs) in China.

Background: PRNs play a crucial role in enhancing pain management in Chinese hospitals. Their professional competence significantly impacts the quality of pain management in the hospital. However, a clear evaluation system for assessing the abilities of PRNs is lacking. Establishing a scientific and systematic evaluation system for nurse competencies is essential for selection, training, and assessment within hospitals.

Methods: Utilizing the iceberg competency model, a competency index for PRNs was developed through literature analysis and semistructured interviews. Two rounds of Delphi consultations were conducted with 19 experts in pain management and medical psychology from 12 provinces in China to establish competency indicators and weight values.

Results: After the Delphi consultations, the postcompetency index system for PRNs comprised 5 primary indices, 15 secondary indices, and 51 tertiary indices. The primary indices include professional theoretical knowledge, practical skills, job execution ability, professional development, and professional attitudes. The effective response rates for the two Delphi rounds were 100% and 84.2%, respectively. The authority coefficient values were 0.89 and 0.91, respectively. The Kendall harmony coefficients for expert opinions were 0.155, 0.212, and 0.188, and 0.524, 0.267, and 0.302 across levels, with statistical significance (p < .05) after consistency testing.

Conclusions: The postcompetency index system for PRNs developed in this study is reliable and scientifically grounded. It provides an objective quantitative basis for training and evaluating PRNs.

Objectives: This scoping review explores hybrid healthcare models combining telehealth and in-person visits for pain management. It examines their components, effectiveness compared to traditional care, advantages, and disadvantages of telehealth, and the influence of future technologies.

Design: The review followed the JBI scoping review methodology and used the PRISMA-ScR checklist. Studies on hybrid pain management models involving adult patients and clinicians were included.

Data sources: Searches were conducted in PubMed, CINAHL, and Google Scholar, along with gray literature from healthcare organizations.

Review/analysis methods: Studies were screened based on Population, Concept, and Context (PCC) criteria. Data extraction followed a modified JBI tool, with thematic analysis and descriptive statistical summaries of study findings.

Results: Hybrid care models combining telehealth and in-person visits improve access to pain management, particularly in rural areas, and reduce costs. Telehealth provides convenience but faces barriers such as privacy concerns, technological disparities, and patient preference for in-person visits. In-person care remains crucial for diagnostics and patient-provider trust. Future technologies like machine learning show promise for enhancing these models.

Conclusions: Hybrid models offer a flexible, cost-effective approach to chronic pain management. While telehealth expands access, challenges include privacy issues and digital inequities. Future technologies will likely improve these models' personalization and efficiency.

Nursing practice implications: Nurses should be trained in telehealth technologies to facilitate the implementation of hybrid models while continuing to provide essential in-person care to engage patients and build trust.

Purpose: Although nurses frequently are responsible to care for and ensure safety of patients receiving epidural analgesia resources to guide them in this care are difficult to locate and not inclusive of all aspects of such care. The purpose of this manuscript is to provide a comprehensive resource to provide information for nurses when caring for patients receiving analgesia via an epidural catheter.

Methods: Literature and guidelines were reviewed to determine current standards of practice and guidance regarding care of patients receiving epidural analgesia. State boards of nursing were contacted to ascertain positions regarding nursing care of thosepatients.

Results: In 2023 the American Society for Pain Management Nursing (ASPMN) reaffirmed their 2007 position that management of analgesia by catheter techniques is within the registered nurse's scope of practice. Other professional organizations and agencies provide education regarding various aspects and factors involved in the care of patients receiving analgesia via an epidural catheter.

Conclusion: The literature and professional positions were identified and collated to produce a single document with evidence informed information to provide a single resource for nurses in all aspects of care of patients receiving analgesia via an epidural catheter.

Clinical implications: To ensure patient safety, RNs need to have didactic knowledge with annual competencies as well as practical training. Education of nurses who are caring for patients with epidural catheters should include anatomy; indications and contraindications for epidural analgesia; nursing responsibility during placement of the epidural; management of the catheter after placement including monitoring, assessment for side effects, and medications used; and knowledge of potential complications and their treatment. Depending on the nurses' role the practical instruction may include ACLS, administration of anxiolytics or opioids, and/or the treatment of local anesthetic systemic toxicity (LAST). Institutional policies and procedures as well as the state description of nurses' scope of practice must define the education required of the nurses who are taking care of patients with epidural analgesia.