Pain Management Nursing最新文献

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.

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.

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.