Satisfaction of Postoperative Patients on Pain Management Program its Relationship to the Knowledge and Attitudes of Chinese Nurses: A Cross-Sectional Survey

This study is a cross-sectional survey of the satisfaction of postoperative patients its relationship to the knowledge and attitudes of Chinese nurses on pain management. Data were sourced out from two groups of respondents participated in the study, 75 post-operative patients and 97 in-service nurses from the health institutions China. The study was conducted for five-months. Ethics protocols were observed before and after the conduct of the study. Findings showed that post-operative pain management program among the participating medical institutions in China were assessed to have moderate level of satiation by the patients. All the components namely pain relief experience, care provided by the nurses, education provided as to pain management, and therapeutic dialogue provided by the nurses were all assessed by postoperative Chinese patients at a fair level. Meanwhile, gender and education of post-operative patients can be considered as factors in the planning and implementation of pain management program. Consequently, similar to studies conducted worldwide, Chinese nurses do not establish yet an optimal level of knowledge and attitude towards pain management. Meanwhile age, experience, education are factors on the knowledge and attitude on pain management among nurses. Finally, positive moderate relationship is established between patient satisfaction and knowledge and attitudes of nursing staff towards pain management. The findings of these study call for action and reform in the implementation of pain management program focusing on the major role and development of 21st century nurses. Practical implications of the study are discussed.

What does low psychological distress mean in patients with no mental disorders and different pains of the musculoskeletal system?

Objectives The aim of this study is to define the different levels of psychological distress in patients suffering from pain and functional disorders of the musculoskeletal system. Methods This investigation was conducted as a retrospective study of 60 patients randomly selected of a German specialized orthopaedic hospital within the year 2016, whose therapeutic approaches are based on a non-surgical orthopaedic multimodal approach of manual therapy. All patients were suffering from pain and functional disorders of the musculoskeletal system. Two groups were formed: one without and one with additional mental disorders according to ICD-10. The impairment score (ISS) according to Schepank was determined. Results The somatic sub score of the ISS was the highest sub score in both patient groups. The cumulative value of the ISS score of patients with both a mental disorder and pain in the musculoskeletal system was higher than for patients without concomitant mental disorder. For patients without concomitant mental disorder, the cumulative ISS exceeded the test criteria for mentally healthy individuals. Conclusions Patients without mental disorder but with chronic pain of the locomotoric system receive a psychological pain management program, as it is part of the billing code OPS 8-977 to the health insurance companies in Germany. However, the data show that these patients also have a substantial somatic subscore and a cumulative ISS above the level of healthy individuals. The absence of psychological disorders (according to ICD-10) in patients with pain of the musculoskeletal system should not lead to the assumption that these patients are psychologically inconspicuous. Subsyndromal mental findings (below ICD-10) can be one aspect of a mental disorder presenting with primarily somatic symptoms. In this case, patients would benefit from a psychotherapeutic program in a similar way as the patients with mental disorders according to ICD-10.

Assessing the fidelity of a peer-led chronic pain management program (PAP)

Background Intervention fidelity is the core component of a well-designed clinical trial and processes that are used to ensure that the study intervention is delivered as planned. It affects the design and implementation of a study as well as the analysis of the results and interpretation of the findings. The objectives of this study are (a) to describe the methods of assessing the intervention fidelity used in the peer-led chronic pain management program (PAP) and (b) to report the findings on the PAP’s intervention fidelity. Methods To optimize fidelity to the intervention, we used various strategies and measured them in a continuous process using several different approaches: (a) peer volunteer (PV) training workshop, (b) biweekly meetings with the research team, (c) a detailed teaching manual, (d) a fidelity checklist, (e) on-site visits and direct observations, and (f) semi-structured interview. Results The PVs’ attendance was high, and most of them achieved a high level of implementation in following the fidelity checklist. As part of a large clustered RCT, the fidelity assessment was carried out to help determine the effectiveness of the intervention. Conclusions Overall, the PVs successfully delivered the intervention, and the results of the study indicate the effectiveness of the PAP. Trial registration ClinicalTrials.govNCT03823495. Registered on 30 January 2019.

Effectiveness of a Peer-Led Pain Management Program in Relieving Chronic Pain and Enhancing Pain Self-Efficacy Among Older Adults: A Clustered Randomized Controlled Trial

Chronic pain is common in nursing home residents, who may have difficulty seeking out pain management strategies. Peer support model show promise as a strategy for managing chronic conditions. This was a clustered randomized controlled trial. A peer-led pain management program was provided for the experimental group. Pain situation, depression, quality of life, non-drug strategies used, and pain knowledge were measured. A total of 262 participants joined the study (146 were allocated as experimental group and 116 as control group). Before our intervention, the mean pain score reported was as high as 6.36 on a 10-point Likert Scale. The high intensity of their pain very much interfered with the daily activities of the participants. Pain interference was high and the participants had poor coping as indicated by the low pain self-efficacy. Depression and a low quality of life score was found. Upon completion of our PAP, there was a significant increase in pain self-efficacy, pain interference as well as quality of life for the participants in the experimental group and not in the control group, and this improvement sustained in 3-month follow up. The present study used a peer support models and proven to be effective in managing pain and pain related situations for nursing home residents with chronic pain. The peer volunteers involved in the pain management program taught relevant pain knowledge and pain management strategies to help our participants.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03823495, NCT03823495.

Barriers of Neonatal Pain Management in the Intensive Care Unit: A Qualitative Study

Background: Recognizing and managing neonates' pain in the intensive care unit is challenging. Evidence shows that guidelines available in this area are not utilized effectively in practice. Purpose: To explore barriers to neonatal pain management in a neonatal intensive care unit.Methods: This was a qualitative study. Thirty-one nurses and physicians participated in the study. Data was collected through individual and focus group interviews. Data analysis was performed using conventional content analysis.Results: The barriers consisted of lack of holistic views towards neonates (exclusive concentration on treating the diseases, the neonate's inability to demand and protest verbally), subjective and arbitrary working (unorganized teamwork, lack of unified approach in pain-relieving, limited supervision for pain management), work overload (workload, physical and psychological strain on the caregivers), insufficient professional knowledge (Insufficient expertise in using pain assessment tools, Low importance of controlling environmental stimuli, Insufficient knowledge about pain management medication, and Considering patient's pain as expected).Conclusion: According to the professionals, the barriers to effective management of pain in neonates admitted to the intensive care unit in a developing country, are comprised of the individual, interpersonal, and organizational factors.Practice Implications: Investigation the barriers of optimal pain management in NICU can help to take the proper steps to improve the quality of service provided. Education of care providers, designing and implementation of a unified neonatal-based pain management program, and proper organizational supervision could improve neonatal pain management. Also, physical and emotional support of care workers is essential for more quality performance.