Pain Management Nursing最新文献

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.

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.