Pain Management Nursing最新文献

Background: Pain management in people with dementia is challenging, and there is a knowledge-practice gap in this area.

Objective: The purpose of this study was to comprehensively analyze and synthesize the current evidence on healthcare personnel's knowledge, attitudes, and practices regarding pain management for people with dementia.

Methods: An integrative review was conducted. Six electronic databases, including PubMed, CINAHL, Web of Science, PsycINFO, Cochrane Library, and EMBASE, were searched to identify qualified articles. After removing the duplicates, the search results underwent title screening, abstract screening, and full-text review. The 2018 Mixed-Methods Appraisal Tool was used to evaluate the quality of the included articles. Data analysis incorporated data reduction, display, comparison, conclusion drawing, and verification.

Results: A total of 32 full-text articles were included, and five themes were summarized based on the knowledge-attitude-practice (KAP) model as (1) inadequate knowledge; (2) mixed negative and positive attitudes towards pain management; (3) challenges in pain identification; (4) challenges and barriers to comprehensive pain assessment; and (5) undertreated and poorly documented pain.

Conclusion: Initiatives that prioritize improving healthcare personnel's knowledge, fostering positive attitudes, and promoting the adoption of effective assessment and management methods in pain management for individuals with dementia are essential.

Clinical implications: Nurses should participate in comprehensive training and education on dementia-specific pain assessment, proactively collaborate with interdisciplinary healthcare personnel, and ensure timely communication with family caregivers. Additionally, integrating structured pain assessment tools into electronic health records and standardizing documentation protocols could enhance care coordination and quality.

Purpose: To investigate the effectiveness of integrating respiratory exercises with core stability training compared to core stability training alone in improving outcomes for males with chronic non-specific low back pain (CNLBP).

Design: A randomized controlled trial was conducted with 28 male participants aged 35-55 years over an eight-week period.

Methods: Participants with CNLBP were recruited at the Sport Science Laboratory of Bu-Ali Sina University between September 2021 and October 2022. They were randomly assigned to either a combined core stability and respiratory exercise (CCSRE) group (n=14) or a core stability exercise (CSE) group (n=14). Outcome measures included the Visual Analog Scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ) for functional disability, and Y-Balance Test (YBT) for dynamic balance, assessed 1-3 days before and after the intervention. Repeated measures analysis of variance was used to evaluate group-by-time interactions (p<0.05).

Results: Significant group-by-time interactions were observed for pain (F = 22.17, p = 0.001, η² = 0.460), dynamic balance (F = 10.74, p = 0.003, η² = 0.292), and functional disability (F = 18.58, p = 0.001, η² = 0.417). The CCSRE group demonstrated greater reductions in pain and functional disability and larger improvements in dynamic balance compared to the CSE group.

Conclusion: The integration of respiratory exercises with core stability training significantly reduces pain and functional disability while enhancing dynamic balance in males with CNLBP compared to core stability training alone.

Clinical implications: Incorporating respiratory exercises into core stability training can enhance therapeutic outcomes for males with CNLBP, offering a more effective rehabilitation strategy to reduce pain and improve functional capacity.

Purpose: To compare the effects of nonpharmacological interventions on pain, fear, satisfaction, and duration of peripheral intravenous catheterization (PIC) in children.

Design: A randomized controlled trial.

Materials and methods: The study was conducted in a training and research hospital in northwest Türkiye between October 2023 and March 2024 with 90 patients, ages 5-12. Children were divided into three groups using a simple randomization method: (1) palm stimulator (n = 30), (2) cartoon (n = 30), and (3) control (n = 30). The child, parent, and observer assessed the children's pain and fear levels before, during, and after PIC. After PIC, the children's and parents' satisfaction was evaluated.

Results: The average age of the children was 7.81 ± 2.62. The pain scores recorded for the intervention groups before, during, and one minute after the PIC were significantly lower than those of the control group. The fear scores reported by the children during the PIC were as follows: 1.26 ± 1.50 in the palm stimulator group, 1.33 ± 1.32 in the cartoon group, and 2.76 ± 1.38 in the control group, indicating a statistically significant difference between the groups. However, there was no significant difference in the satisfaction scores of children and parents across the groups. Additionally, the duration of the PIC was the shortest in the control group.

Conclusions: The use of palm stimulators and cartoons as nonpharmacological methods in pain intervention for children significantly reduced pain levels before, during, and after procedures. This study, which included evaluations by children, parents, and observer, found that the palm stimulator impacted pain and fear levels comparable to watching a familiar cartoon. Although there was no difference in overall procedure satisfaction between the groups, the satisfaction score for the palm stimulator was notably higher.

Clinical implications: The palm stimulator and cartoon film methods can reduce pain and fear during PIC in children. These methods significantly reduced the pain and fear of our participants during PIC.

The clinical trial registration number: NCT06772259.

Purpose: To investigate the relationships among shoulder pain, functional disability, perceived stress, and health-related quality of life (HRQOL), as well as to assess the educational needs related to shoulder pain prevention among middle-aged Korean women.

Design: Cross-sectional study.

Methods: This study included middle-aged Korean women recruited between November 27 and December 28, 2022. Data were collected using the Shoulder Pain and Disability Index (SPADI), the 12-item Short-Form Health Survey (SF-12) for HRQOL, the Perceived Stress Scale, and a structured questionnaire assessing educational needs related to shoulder pain prevention. Descriptive and frequency analyses were conducted to examine the general characteristics of participants. Chi-square tests were conducted to compare sociodemographic and behavioral variables by SPADI severity. Differences in HRQOL, shoulder pain, disability, and perceived stress based on educational needs were analyzed. Pearson's correlation analysis was conducted to examine the relationships among variables, and stepwise multiple regression was employed to identify factors influencing HRQOL.

Results: Participants with moderate-to-severe shoulder pain (SPADI ≥30) reported significantly higher levels of work-related physical burden, lower educational attainment, and greater willingness to participate in shoulder pain prevention education than those with milder symptoms. Perceived stress levels were also significantly higher among participants in the moderate-to-severe SPADI group compared to those with lower scores. Additionally, significant differences in physical and mental health were observed based on the educational demand for cause and symptom management of participants. Mental health and perceived stress also differed significantly according to demand for posture education. Stress levels varied significantly by demand in indoor home training and proper desk and chair positioning for shoulder pain prevention. Increased shoulder pain was positively correlated with greater disability and perceived stress, alongside declines in physical and mental HRQOL.

Conclusions: Most participants sought education focused on shoulder pain causes, management, stress relief, and psychological support.

Clinical implications: A mobile app-based educational intervention is recommended to alleviate shoulder pain and stress while offering information on its causes, symptoms, and management.

Background: Pain is a barrier to gynecological procedure completion. Best practices recommend pharmacotherapy and assessment techniques (e.g., trauma-informed history) to manage pain. Non-pharmacological interventions, including distraction techniques (e.g., heat and breathing), demonstrate minor effectiveness, low side effects and low cost. However, there is a paucity of evidence exploring the implementation of pain management interventions into gynecological services. The purpose of this paper is to map a pain management intervention in order to increase our understanding of how to create environments supportive of pain management and patient safety for adults receiving gynecological procedures.

Methods: We applied Intervention Mapping to the development and implementation of a pain management intervention known as the Adult Comfort Promise. We used informant conversations with healthcare providers, identified as pain champions, to complete the six steps of Intervention Mapping. We completed the following Intervention Mapping steps: 1) conduct a needs assessment, 2) create change objectives, 3) select theory-based interventions, 4) design the intervention, 5) plan for adoption and implementation and 6) evaluation. This included a barriers and facilitators assessment, mapped to the Inside out socioecological model by Golden et al. We used member checking to confirm the accuracy of our findings.

Results: From August 2023 onwards, healthcare providers in an Ambulatory Care Clinic, within a tertiary-level healthcare center for women, youth, children and gender diverse individuals in the Maritime Canadian provinces, designed and implemented an intervention to improve the assessment, prevention and treatment of procedural pain for in-office gynecological procedures. Creating supportive environments for comfort and pain management required multiple factors, including policies, pain champions, ongoing monitoring, and support from leadership. Future research will evaluate the intervention's effectiveness, acceptability and fidelity.

Conclusion: Intervention Mapping was a valuable method for identifying opportunities for patient empowerment and implementation strategies for the Adult Comfort Promise. These findings may be transferable to other procedures or settings (e.g., primary care, student health, or community clinics). Intervention Mapping offers a guide to designing and implementing other pain management interventions to improve procedure completion. It may be useful for nurses as they implement pain management interventions into practice.

Purpose: This study aimed to examine the effects of virtual reality and music on pain, anxiety, itching, and vital signs of children during a skin prick test and evaluation.

Methods: This randomized controlled trial was divided into three groups: virtual reality (n = 30), music (n = 30), and control (n = 30). Anxiety, pain, vital signs, and itch were assessed.

Results: There was no significant difference between the groups in terms of sociodemographic characteristics; pain, anxiety levels and vital signs, except pre-procedural heart rate (p > .05). The mean age of the groups was similar (p = .946). The gender ratios were similar amongst the groups (p = .585), with 53% of the children in the VR group as female, 47% of the children in the music group as female, and 60% of the children in the control group as female. The pain scores and respiration rates of the children in the Virtual reality group were lower than those in the music and control groups during the skin prick test (p < .05). Children in the Virtual reality and music group indicated decreased levels of anxiety, respiration rates, and itching at 5, 10, and 15 minutes of the skin prick test evaluation compared to the control group (p < .05).

Conclusions: Virtual reality was found to be highly effective in reducing pain and respiratory rate during skin prick testing and in reducing heart rate after skin prick testing.

Purpose: This study aimed to compare the effect of auditory distraction and virtual reality (VR) on pain severity and physiological indicators during burn dressing changes among adult patients.

Design: A single-center, randomized controlled trial.

Methods: A total of 60 patients were randomly assigned to the auditory distraction (n = 20), VR (n = 20), and control (n = 20) groups. All patients in the three groups received intravenous morphine at a dose of 0.05 mg/kg body weight, 15 minutes prior to the dressing change. The auditory distraction group listened to music during the dressing, while the VR group used a headset to view nature images throughout the dressing procedure. Data collection tools were the numeric pain scale, a checklist form of the physiological Indicators, and a pulse oximetry device.

Result: Statistically significant differences in pain severity were observed among the VR, auditory distraction, and control groups during dressing changes (p < .05). Despite all patients receiving intravenous morphine (0.05 mg/kg), both interventions led to greater pain reduction. Oxygen saturation and respiratory rates also differed significantly across groups (p < .05), with posthoc analysis confirming that both interventions were equally effective and superior to standard care.

Conclusions: This study's findings demonstrated that auditory distraction was as effective as VR techniques in reducing fluctuations in physiological indicators and pain severity during dressing changes in adult patients.

Clinical implications: Nonpharmacological interventions can serve as effective adjuncts alongside pharmacological treatments in pain management nursing.

Objectives: Evaluate the effectiveness of adding health education programs to a fibromyalgia intervention, focusing on pain intensity and the impact of fibromyalgia on quality of life.

Design: Systematic review and meta-analysis of randomized controlled trials.

Data sources: Databases: Web of Science, Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature and PsycINFO.

Review/analysis methods: Literature from 2005-2025 was reviewed. Risk of bias was assessed by two researchers using the Cochrane Collaboration's tool. Quality of evidence was measured using the Grading of Recommendations, Assessment, Development, and Evaluation tool.

Results: The systematic review included 7 randomized controlled trials. 6 studies were included in the meta-analysis of the impact of fibromyalgia on quality of life, and five in the pain intensity meta-analysis. Meta-analysis results showed that health education significantly reduced pain intensity (MD=-13.10; 95% CI [-22.06, - 4.14], p=0.004) and improved the impact of fibromyalgia on quality of life (SMD=-0.39; 95% CI [-0.55, -0.23], p<.001). Subgroup analyses showed that adding education to usual care led to clinically relevant reduction in pain intensity (MD=-19.53; 95% CI [-31.68, -7.39], p=0.002) and statistically significant improvement in the impacf of fibromyalgia on quality of life (SMD=-0.46; 95% CI [-0.66, -0.26], p < .001).

Conclusions: Health education programs are effective in improving pain intensity and reducing the impact of fibromyalgia on quality of life. Further research is needed to support findings.

Nursing practice implications: By implementing health education for fibromyalgia patients, nurses can improve outcomes, enhancing the quality of care provided.

Background: A majority of adults undergoing heart surgery involving cardiopulmonary bypass (CPB) will experience acute pain.

Aims: To explore the effects of nursing interventions based on behavior change theory (BCT) on pain severity, pain interference, sleep quality, perceived control, quality of life, and self-care abilities.

Methods: A total of 53 patients undergoing CPB heart surgery in one hospital were enrolled. The patients were divided into Behavior Change Theory (BCT) group (n = 33) and Usual Care (UC) group (n = 20), among whom patients in the UC group received routine nursing intervention, while patients in the BCT group received nursing intervention based on BCT. Patients were evaluated for pain, sleep, perceived control, quality of life, self-care abilities, Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) questionnaires at baseline and after the intervention.

Results: Individuals in the BCT group demonstrated reduced pain levels, improved quality of life, enhanced self-care abilities, and lower scores of the HAMA and HAMD scales compared to those in the UC group (all p < .05). Implementation of BCT resulted in improvements in perceptual control (p < .001), reductions in pain interference (p = .02), and pain severity (p = .03). Group effects remained significant in terms of perceived control and pain interference (both p < .05), with trends observed in pain severity after adjusting baseline difference variables (p < .10). Sleep quality, assessed by PSQI, did not differ significantly between groups (p = .288).

Conclusion: Nursing interventions rooted in BCT holds the potential to augment patients' perception of control, elevate quality of life, enhance self-care abilities, and alleviate pain after CPB heart surgery.

Background: Physicians and nurses experience a high prevalence of non-specific neck-shoulder pain (NNSP) and are exposed to multiple risk factors. However, no targeted tools comprehensively assess these risk factors.

Objective: This study aimed to develop assessment indicators for evaluating risk factors contributing to NNSP among physicians and nurses.

Design: A systematic literature review and Delphi method, guided by a theoretical framework, were employed to develop the index system.

Methods: This study utilized a theoretical framework based on ergonomics and the biopsychosocial pain model to collect multi-source data for developing a risk assessment index system. Initially, candidate indicators were identified through literature reviews, theoretical analysis, expert interviews, and consultations. Three rounds of the e-Delphi technique were conducted to identify indices potentially affecting neck-shoulder pain. Finally, the analytic hierarchy process (AHP) method was employed to calculate the relative weight of each indicator.

Results: After two rounds of expert consultation, the risk assessment index system reached a consensus, comprising six first-level indicators: workload factors, individual factors, work facilities and equipment factors, workspace and environment factors, organization management factors, and psychological factors. These were further divided into 14 second-level indicators and 82 third-level indicators. Among these, workload factors had the highest weight (0.2484), while psychological factors had the lowest (0.1019).

Conclusion: The risk assessment index system achieved expert consensus, confirming its scientific validity and practical applicability. It provides a structured approach to identifying risk factors and high-risk individuals for neck-shoulder pain among physicians and nurses.