Global Health Problems: Pain Management

Abstract

Pain is a global health problem. It is severe among older adults (65 years and over) and may go unattended. Guidelines exist but nurses fail to implement them or lack skills and knowledge in pain management. It is therefore necessary for nurses to adopt pain management guidelines, assess pain and treat them. They also require education and mandatory review of practices.

Pain in older adult (65 years old and over) is a global health problem. In the US, the clinical guideline considers patient pain as unique, but subjective experience, which results from chronic and acute conditions (American Geriatrics Society Panel on Persistent Pain in Older Persons, 2002). In the UK, pain has been associated with frailty, chronic diseases and other conditions associated with pain (Abdulla et al., 2013).

These guidelines recognize that pain in older adults is often poorly assessed, under-recognized and under-treated despite its high prevalence (Abdulla et al., 2013; American Geriatrics Society Panel on Persistent Pain in Older Persons, 2002). Attitudes and belief of older adults and misconceptions of nurses have negatively affected pain management. These articles provide ways of assessing pain, significance of pain, nursing care strategies, treatment guidelines and expected outcomes. They have shown that pain management among older adults still requirement improvements, particularly among healthcare professionals’ knowledge and skills and patients belief systems.

Study #1; Nursing research Study in the USA

Al-Shaer, D., Hill, P., & Anderson, M. A. (2011). Nurses’ Knowledge and Attitudes Regarding Pain Assessment and Intervention. MEDSURG Nursing, 20(1), 7-11.

Purpose

To determine nurse knowledge and attitude toward pain management

How sample was obtained

A convenience sample was used

Inclusion or exclusion criteria

Only RNs were considered for the study. The demographic characteristics included type of education, age, work full time, experience and department.

Sample

A sample of 129 registered nurses was used.

Methods used to collect data

Data were collected using a modified NKAS model.

Data were analyzed by SPSS. Descriptive statistics and were used

Interventions tests

No information was provided.

Main findings

The average knowledge score was 25.9 (SD=2.5) from the possible 32 points. The major finding showed that “knowledge of pain management principles and interventions was insufficient” (p. 7).

Credibility

Peer-reviewed journal

The article was obtained from peer-reviewed journal.

Design appropriateness

The design was appropriate for the study to explore the relationship between nurse attitude and knowledge on pain management.

Data obtained and research questions

Data obtained involved nurse knowledge and attitudes and therefore were suitable for the study. Descriptive statistics was used to determine normality and describe variables while Chi-square test was used to examine differences among categorical variables.

Instrument validity and reliability

Instrument validity was done through construct validity, while test-retest reliability was r > 0.80, and internal consistency reliability, r = 0.70.

Bias

Any potential bias was eliminated by modifying the tool to omit irrelevant items and items had definite correct/ incorrect response.

Randomly chosen

Only nurses who were in the room completed the instruments.

Consistency of findings with previous studies

The researchers cited previous studies with similar findings in the discussion section.

Findings credibility

Findings were credible.

Clinical significance

Target population

Nurses and their demographic characteristics were identified by no further details were provided.

Findings clinically significant

The findings showed the need for knowledge and attitude on pain management among nurses, but convenience sample and sample size restricted their generalization.

Clinical significance

The findings had important implications for nurses. It showed the need to review pain competencies annually and pain education. A review of nursing curricula is required.

Study #2-Nursing Research Study Non-USA

Corbett, S., & Williams, F. (2014). Striking a professional balance: interactions between nurses and their older rural patients. British Journal of Community Nursing, 19(4), 162-167.

Purpose

TOPS study investigated the nature and value of the link between older adults in chronic pain living in rural areas, and their health and social care providers.

How sample was obtained

Home-based observations and semi-structured interviews were conducted in remote and rural Scotland and Wales.

Inclusion or exclusion criteria

Participants were aged between 60 and 79, lived in rural areas, and suffered chronic pains (persisted for over three months continuously).

Health and social care providers were engaged in care provision to older adults.

Sample

Purposive sampling was used to select two cohorts: 10 older adults and 6 health and social care providers (4 community nurses and 2 care providers).

Methods used to collect data

Data were collected through interviews and observations. Ethical approval was obtained. The Interviews lasted between 30 and 70 minutes and were digitally recorded and transcribed verbatim. Data were analyzed with Nvivo 9. Analytic hierarchy was used to analyze qualitative data to allow an iterative analytical process to generate new themes and sustain link with the study context and data.

Main findings

Three interrelated themes were identified: the development of the relationship between the health and social care provider and older adult; home-visit based interactions; and the professional boundary issues.

Credibility

Peer-reviewed journal

The article was published in peer-reviewed journal.

Design appropriateness

The design was appropriate because the study was exploratory and new themes were considered as they emerged during interviews and data analysis.

Data obtained and research questions

Data obtained answered research questions and there were verbatim to support findings.

Instrument validity and reliability

There was no information provided on instrument reliability and validity. Hence, others cannot adopt the research design.

Bias

Data were ‘anonymised’ and managed. No further information was provided on how the researchers managed any possible bias, including personal influences.

Randomly chosen

Purposive sampling was used in this study.

Consistency of findings with previous studies

The researchers showed that other previous studies had established similar outcomes in social connectedness and psychological wellbeing.

There was a need for nurses to develop close relationships and social connectedness with their older patients.

Findings credibility

While the study researchers found similar results as some of the past studies, the two sample cohort sizes were small, taken in isolated settings and therefore may not be generalized.

Clinical significance

Target population

Older adults with chronic pain, living in socially isolated areas were identified as the target populations and it was critical for nurses to develop close long-term relationship with them during care provision.

Findings clinically significant

Yes. Nurses need support and education rather than recriminations to develop close relationships with their patients.

Clinical significance

The current literature has failed to capture factors that inhibit nurses’ interactions with their patients.

Study #3; Nursing research Study in the USA

Dulko, D., Hertz, E., Julien, J., Beck, S., & Mooney, K. (2010). Implementation of cancer pain guidelines by acute care nurse practitioners using an audit and feedback strategy. Journal of the American Academy of Nurse Practitioners 22(2010), 45– 55.

Purpose

The researchers examined the effect of an audit and feedback (A/F) intervention on nurse practitioner (NP) implementation of cancer pain CPGs and hospitalized patients’ self-report on pain and satisfaction with pain relief.

How sample was obtained

Eight nurses and two groups of 96 patients provided data for the study.

Inclusion or exclusion criteria

The setting was an urban comprehensive cancer center. Nurses came from thoracic medicine and four from the neurology departments. NPs were full time employees for at least 3 months and worked 13 and 16 shifts per month. They had prescription privileges.

The patients were nonrandomized but blinded on group choices. They were 18 years and over, could read and write English and were admitted electively for chemotherapy, radiation, or via the Urgent Care. They had pain scale of pain >3 and

Participants who could not read, were participating in other studies and admitted through the Pain and Palliative Care service were excluded.

Sample

Eights nurses and 96 patients participated in the research.

Sample size was determined to detect a medium effect size of 0.40.

Methods used to collect data

Baseline clinical practice and guideline adherence data were collected. Data were analyzed using SAS version 9.1 and SPSS version 12.0.

Data were collected on an audit and feedback (A/F) intervention and the Brief Pain Inventory-Short Form (BPI-SF) within 24 hours and every 48 hours until discharge.

Interventions tests

Intervention group patients reported significantly less overall pain interference (p <.0001), interference with general activity (p = .0003), and sleep (p = .006).

Main findings

Nurse practitioner adherence to CPGs increased during A/F. Pain intensity did not significantly differ between groups.

Credibility

Peer-reviewed journal

The article was published in peer-reviewed journal.

Design appropriateness

The researchers collected intended data for the study on A/F and BPI-SF.

Instrument validity and reliability

Internal consistency and reliability of the BPI-SF was assessed using coefficient alpha.

Bias

Data collection was controlled between phases to avoid bias.

Randomly chosen

Patient participants were nonrandomized but blinded on group choices.

Interventions definitions

Pre-intervention phase were not eligible to provide data during the intervention phase.

Consistency of findings with previous studies

The discussion section confirmed that the study was consistent with previous findings.

Findings credibility

The research outcomes were credible, but services were NP managed and could have caused bias. The researchers avoided concurrently occurring symptoms.

Clinical significance

Target population

Cancer patients with pain were identified in the study.

Findings clinically significant

It is imperative to adopt clinical guidelines and understand how they are applied in clinical settings.

Clinical significance

Further evaluations are required to understand applications of pain guidelines in hospitals and effects on patients.

Study #4; Nursing research Study in the USA

Russell, T., Madsen, R., Flesner, M., & Rantz, M. (2010). Pain Management in Nursing Homes: What Do Quality Measure Scores Tell Us? Journal of Gerontological Nursing, 36(12), 49-56.

Purpose

The study evaluated pain management among nurse staff and patient outcomes.

How sample was obtained

It targeted all levels of staff with change in quality measure (QM)/quality indicator (QI).

Sample

A total of 29 homes completed the study.

Methods used to collect data

A randomized, two-group, repeated measures design was used, accompanied by an exploratory observation and interview qualitative process

Main findings

Pain management is complex, requires multifaceted approach and QM/QI scores to improve quality of care.

Credibility

This was a peer-reviewed journal with appropriate study design for the questions.

Instrument validity and reliability

Findings were consistence with previous studies as shown in the discussion section. They were also credible and showed that pain management requires multifaceted approach.

Clinical significance

Clinicians and nursing homes can adopt pain management scores to improve quality of care.

Conclusion

The study focused on pain management as a global health problem. It showed that clinical guidelines for best practices exist, but failure to implement them and insufficient knowledge, skills and relationships hampered any positive outcomes. Therefore, nurse practitioners need to understand pain management through education and mandatory hospital practices.

References

Abdulla, A., Bone, M., Adams, N., Elliott, A., Jones, D., Knaggs, R.,… Schofield, P. (2013). Evidence-based clinical practice guidelines on management of pain in older people. Age Ageing, 42(2), 151-153. Web.

Al-Shaer, D., Hill, P., & Anderson, M. A. (2011). Nurses’ Knowledge and Attitudes Regarding Pain Assessment and Intervention. MEDSURG Nursing, 20(1), 7-11.

American Geriatrics Society Panel on Persistent Pain in Older Persons. (2002). The management of persistent pain in older persons. Journal of the American Geriatrics Society, 50(6), S205–S224.

Corbett, S., & Williams, F. (2014). Striking a professional balance: interactions between nurses and their older rural patients. British Journal of Community Nursing, 19(4), 162-167.

Dulko, D., Hertz, E., Julien, J., Beck, S., & Mooney, K. (2010). Implementation of cancer pain guidelines by acute care nurse practitioners using an audit and feedback strategy. Journal of the American Academy of Nurse Practitioners 22(2010), 45– 55. Web.

Russell, T., Madsen, R., Flesner, M., & Rantz, M. (2010). Pain Management in Nursing Homes: What Do Quality Measure Scores Tell Us? Journal of Gerontological Nursing, 36(12), 49-56.