Pain Management Nursing最新文献

Background: Low back pain (LBP) in patients with spinal diseases significantly reduces quality of life by causing not only physical disability but also psychological issues. LBP has a high prevalence worldwide and imposes substantial economic and social burdens, making its management critically important.

Purpose: This study aimed to develop and validate a model explaining LBP management behavior in patients with spinal diseases based on Self-Determination Theory (SDT).

Design: The hypothetical model of this study was developed based on Deci and Ryan's SDT and a literature review.

Methods: A cross-sectional online survey was conducted with 220 patients diagnosed with spinal diseases, such as herniated intervertebral disc and spinal stenosis, who were members of a self-help group in South Korea. The survey included a total of 95 items, covering general characteristics, LBP management behavior, healthcare provider's autonomy support (support for making decisions and acting independently), social support, internal health locus of control (belief in one's ability to manage health independently), basic psychological needs (autonomy, competence, relatedness), and autonomous motivation (motivation based on intrinsic values). Data were analyzed using structural equation modeling.

Results: Autonomous motivation showed a significant direct and total effect on LBP management behavior (β = 0.60, p < .001). Healthcare provider's autonomy support also had a significant direct (β = 0.20, p = .042) and total effect (β = 0.35, p = .003). Internal health locus of control and basic psychological needs had indirect effects on LBP management behavior (β = 0.18, p = .042; β = 0.33, p = .019), while social support did not show significant direct (β = 0.06, p = .840), indirect (β = 0.07, p = .733), or total effects (β = 0.12, p = .406) on LBP management behavior. These variables collectively explained 52.2% of the variance in LBP management behavior among patients with spinal diseases.

Conclusions: This study confirmed that autonomous motivation and healthcare provider's autonomy support significantly influence LBP management behaviors in patients with spinal disease. Additionally, internal health locus of control and basic psychological needs indirectly impacted these behaviors through autonomous motivation.

Clinical implications: The findings underscore the importance of developing programs that enhance patients' autonomous motivation and providing autonomy-supportive interventions by healthcare providers. By identifying patients' internal health locus of control tendencies and tailoring interventions to meet their psychological needs, healthcare professionals can provide effective support for sustained LBP management behavior in patients with spinal disease.

Registration: None.

Purpose: The purpose of this pilot study was to examine the preliminary efficacy of an 8-week qigong intervention in managing biopsychosocial outcomes in veterans with chronic low back pain (CLBP).

Design: The study design was a longitudinal randomized controlled trial (RCT).

Methods: Multimodal assessments (e.g., biomarkers and psychological and social measures) over multiple time points to assess the preliminary efficacy of an 8-week qigong intervention versus wait-list control group in veterans with CLBP.

Results: Participants in the qigong intervention group showed greater improvement in pain intensity (p = .047), pain interference (p = .040), pain-related disability (p = .027), and sleep disturbance (p = .002). Other psychosocial outcomes were nonsignificant. A statistically significant relationship between biological outcomes (pro-inflammatory cytokines) and psychosocial outcomes was identified (e.g., tumor necrosis factor [TNF] and physical function [p < .001], pain-related disability and IL 8 [p = .049], and posttraumatic stress disorder symptoms and IL 8 [p = .043]).

Conclusions: The results indicated that all pain-related outcomes (pain intensity, low back pain-related disability, and pain interference) and sleep disturbance decreased significantly in the qigong group compared to the control group.

Clinical implications: The combination of gentle, slow-paced movements, along with the focused mindfulness of qigong, may improve physiological and psychosocial health. Charged with this information, healthcare providers (e.g., nurses, physical therapists) should consider non-pharmacological interventions such as qigong for veterans with CLBP.

Purpose: To examine the effect of a self-efficacy-promoting program on pain management among patients with cancer.

Methods: A quasi-experimental design was carried out. Fifty-eight participants were recruited by using consecutive sampling and then divided, according to time period, into either the control group or the experimental group, 29 people for each group. Data collection was completed in the control group before starting it in the experimental group to prevent contamination of the experiment. The control group received standard care, whereas the experimental group received a self-efficacy-promoting program. The pain self-efficacy questionnaire was employed to examine patients' self-efficacy, while a numeric rating scale was utilized to evaluate pain levels.

Results: Compared to the control group, the participants in the experimental group had higher pain self-efficacy scores (p < .05) and lower pain levels (p < .05).

Conclusions: The self-efficacy-promoting program effectively improved patients' self-efficacy scores and pain levels. Therefore, the program should be applied in nursing to assist cancer patients with pain management.

Clinical implications: Pain is high prevalence among patients with cancer. Self-efficacy program can be used as a guide and framework for pain management among adult cancer patients in clinical care.

Objective: Managing pain continues to be a difficult issue worldwide. Pain management has ethical connotations, with the potential to result in moral distress in nurses. The aim of this concept analysis is to analyze moral distress in pain management.

Design: Walker and Avant's method of concept analysis was utilized to determine attributes, antecedents, and consequences of moral distress in pain management.

Methods: Literature searches in The Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, and Pub Med were performed. The search identified and utilized 16 articles in the concept analysis.

Results: Four major attributes of moral distress in pain management are discussed: (1) feeling of ownership of patient pain, (2) perceived powerlessness, (3) frustration, and (4) feelings of conflict between pain management situation, personal values, and professional values of nursing. Antecedents were patients experiencing pain, barriers, and having knowledge of the right thing to do. Consequences included nurse burnout, turnover and exit from the profession, compromised patient care, emotional withdrawal from patients, depersonalization of patients, and feelings of complicity and wrongdoing.

Conclusions: This concept analysis provides a foundation for future research examining moral distress in pain management.

Purpose: Recovery following cardiac surgery via sternotomy involves weaning from invasive mechanical ventilation, maintaining hemodynamic stability, and preventing complications. In the early postoperative period, a key priority is adequate pain control to allow patients to actively participate in exercise. The purpose of this study was to (i) describe analgesic prescribing and administration practices following cardiac surgery via sternotomy and (ii) explore patients' pain experience and how this impacted participation in early postoperative care.

Methods: This research project was a pilot descriptive exploratory study using multiple methods and conducted within a single site. A medical record chart audit was performed to obtain details of prescribed and administered multimodal analgesics and pain intensity scores over the first 3 days following surgery. Semi-structured interviews and responses to validated questionnaires were obtained from 20 postoperative patients on days 3-4 following cardiac surgery to determine pain experience and the impact of pain on participation in recovery.

Results: Patients had a varied experience of pain intensity during their recovery. A total of 19 patients (95%) received 100% of their fixed daily dose of analgesics, but only 22% of available as needed opioids were administered on day 1 and only 12% were administered on day 2. Many patients experienced higher levels of pain at both rest and movement in the 24 hours prior to interview than were recorded in their medical records.

Conclusions: Patients can experience significant pain following major cardiac surgery, and this pain can hinder their ability to participate in important activities, such as deep breathing and coughing and mobilizing, that are central to their recovery. Gaps in the management of breakthrough pain in the early postoperative period were identified. To promote optimal recovery following cardiac surgery, nurses need to assess pain at both rest and movement and administer effective doses of as needed analgesia to manage the occurrence of breakthrough pain. Additionally, patients need to be more informed to understand the link between well controlled pain and their ability to participate in their recovery.

Clinical implications: To promote optimal recovery following cardiac surgery, nurses need to assess pain at both rest and movement and administer effective doses of as needed analgesia to manage the occurrence of breakthrough pain. Additionally, patients need to be more informed to understand the link between well controlled pain and their ability to participate in their recovery.

Background: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive, safe electrophysical pain relief method during childbirth.

Aim: This study was carried out to reveal information about the effectiveness of TENS, which is used to relieve labor pain.

Methods: Inspired by Whittemore and Knafl, we conducted an integrative literature review, including the five key stages of problem identification, literature search, data evaluation, data analysis, and presentation of results. This integrative review was performed between February 27 and March 30, 2023, using the Google Scholar, PubMed, and ScienceDirect databases. The search was made over Istanbul University-Cerrahpaşa internet access network using the English keywords such as (birth OR labor OR labor pain OR birth pain) AND (women OR pregnant women OR pregnancy) AND (transcutaneous electrical nerve stimulation OR TENS OR nonpharmacological). The checklist developed by Joanna Briggs Institute was used to examine the methodological quality of studies.

Results: Eleven articles were included in this study. The total number of samples included in the research is 1,576. The Visual Analog Scale was used to assess labor pain in 9 of the 11 studies included in the research. In all studies, high-frequency TENS (at frequencies of 15-100 Hz) was used in the active phase of labor. It is seen that the TENS intervention was more effective in studies comparing it with control, placebo, lavender, and water immersion at cervical dilatation at 6 cm groups.

Conclusion: In studies evaluating the effectiveness of TENS, it has been found to be an effective method in relieving labor pain.

Disparities, inequities, and injustices in populations with pain are historically pervasive and lead to deleterious patient outcomes and perpetuate systemic barriers to achieving equitable pain management. The American Society for Pain Management Nursing (ASPMN) upholds the principle that all persons with pain have equal rights to evidence-based, high quality pain assessment, management, and treatment. Intervening at multilevels (i.e., individual, interpersonal, community, societal) is necessary to ascertain that just and equitable pain care is provided to all populations.

Purpose: Subjective methods should be used to evaluate pain. It is important to know how pain affects vital signs and brain oxygenation. This study aimed to determine the effects of expressive touch and music applied after lumbar disc herniation surgery on pain, vital signs, and brain oxygenation.

Design: This was a convergent, parallel, mixed-methods study utilizing randomized controlled trials and semi-structured qualitative interviews.

Methods: With power analysis, 132 (44: expressive touch, 44: music, 44: control) patients were included in the study. Thirty-two patients were included in the qualitative research sample. Expressive touch and music interventions were repeated 3 times. Pain, vital signs, and brain oxygenation values were recorded before and after the interventions. Qualitative data were collected after the interventions.

Results: It was determined that expressive touch and music significantly decreased the patients' pain levels compared to the control group (X²: 67.118), (p < .001). It was found that expressive touch and music created a significant difference in respiration (X²: 15.289), blood pressure (X²: 8.754-8.706), saturation (X²: 47.953), and brain oxygenation (X²: 31.473-37.110), (p < .001). Music was found to be more effective than expressive touch on pain and brain oxygenation. The interventions relaxed and distracted the patients.

Conclusions: It was found that expressive touch and music were effective in reducing pain level, keeping vital signs within physiological limits, and increasing brain oxygenation. Further studies are needed to examine the effects of other methods used in postoperative pain management on brain oxygenation.

Purpose: Treatment of localized neuropathic pain continues to represent an unmet need. The primary objective of the present study was to evaluate the efficacy of cryotherapy to reduce the burning pain induced by capsaicin (8%) patches (QUTENZA) in a neuropathic pain cohort. We also investigated subsequent neuropathic pain during an 8-week follow-up.

Design: The present work resulted from a prospective, randomized, two-center, open-label, interventional French trial.

Methods: This study aimed to investigate the effects of cooling of the application area of QUTENZA patches. Visual analog scale (VAS) scores were measured 30 and 60 minutes after patch application. Weekly neuropathic VAS scores were then collated for 2 months. Ninety-nine patients were included and randomized into a cryotherapy group (n = 50 [80% women], median age = 51 years old) and a no cryotherapy group (n = 49 [69% women], median age = 48 years old).

Results: Cooling at the application site of the patch resulted in a reduction by 3.20 in burning pain VAS score at 60 minutes, with no cooling VAS 6.99 (95% CI [6.2, 7.77]) versus 3.78 (95% CI [3, 4.56]) for cryotherapy. Neuropathic VAS pain scores over the follow-up period were not statistically different.

Conclusions: Cryotherapy at the application site significantly reduced the burning pain induced by capsaicin patches but had no effect on neuropathic pain for the 8 weeks following application.

Clinical implications: The use of cooling during capsaicin patch application, by ameliorating the therapeutic alliance, improves the clinical management of neuropathic pain. © 20XX by the American Society for Pain Management Nursing.

Background: Bronchoscopy is a medical procedure that allows imaging of the airways and lungs. With the help of a light and camera at its tip, the bronchoscope device can enter the airway and provide real-time visualization. Since most patients are conscious during the bronchoscopy procedure, they may experience pain and anxiety regarding possible complications and an uncertain outcome.

Aim: This study was conducted to determine the effects of virtual reality (VR) application on pain intensity, anxiety level, physiological symptoms of anxiety (vital signs) and patients' satisfaction level with the use of virtual reality while undergoing a bronchoscopy.

Design: A parallel randomized controlled trial.

Setting: Bronchoscopy unit of the chest diseases service of a 1053 bed university hospital in eastern Turkey.

Sample and methods: The study was conducted with a total of 70 patients, 35 in the intervention group and 35 in the control group. The researcher interviewed patients and approved those who met the research criteria and agreed to participate in the study. The researcher applied relaxation exercises to the patients in the intervention group using virtual reality glasses for 5 minutes before the procedure and 4-5 minutes during the procedure. No interventions were made for the patients in the control group. Data were collected using the Descriptive Information Form, Visual Analog Scale (VAS), Anxiety Assessment Scale (AAS), Physiological Symptoms of Anxiety Follow-up Form, and Virtual Reality Glasses Application Satisfaction Form.

Results: When compared with the control group, the mean scores of VAS, AAS, heart rate, diastolic and systolic blood pressure, and respiratory rate of the intervention group were found to decrease significantly, while the O₂ saturation value increased significantly (p < .05). It was found that 82.5% of the patients in the intervention group want to use virtual reality glasses if they have another intervention, and 70% recommend relaxation exercises with virtual reality glasses to patients who will undergo bronchoscopy.

Conclusion: Study results for this sample revealed that the use of VR decreased pain intensity scores, state anxiety levels, anxiety severity, diastolic blood pressure, systolic blood pressure, heart rate and respiratory rate, and increased O₂ saturation in patients who underwent bronchoscopy. In line with these results, VR should be considered during bronchoscopy procedures.