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1 – 10 of over 20000Terri MacDougall, Shawna Cunningham, Leeann Whitney and Monakshi Sawhney
The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional…
Abstract
Purpose
The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC).
Design/methodology/approach
The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project.
Findings
Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form.
Research limitations/implications
This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide.
Practical implications
Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice.
Originality/value
This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.
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Verity Chester and Marie Henriksen
Research investigating the experience and management of pain in people with intellectual disabilities has mainly been carried out in community services. The purpose of this…
Abstract
Purpose
Research investigating the experience and management of pain in people with intellectual disabilities has mainly been carried out in community services. The purpose of this baseline audit aims to examine this area in a forensic intellectual disability setting.
Design/methodology/approach
A baseline audit of pain management was carried out. Audit standards were derived from recent research, and the performance on each measured. Patients and nurses were interviewed. The audit included 82 patients, of which 64 were interviewed. Twelve nurses were interviewed. Health Action Plans and medication files were accessed for information.
Findings
There were interesting differences and similarities in the experience and management of pain between community and forensic intellectual disability patients. Within this sample, most patients were able to communicate their pain, and access appropriate treatment. However, a minority required further support. Nurse decision making about providing pain treatment was affected by fears of manipulation, contributing to addition and disbelieving the patient. Additionally, a number of patients appeared to have insufficient knowledge about how to best manage pain.
Practical implications
Results suggested that a standardised approach to pain management, incorporating policy, staff training, and health promotion and psycho-education for patients, would have benefits for both patients and staff within secure intellectual disability services.
Originality/value
At present, there is little research focusing on pain experience and management in forensic intellectual disability settings.
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Mark Simmonds and Mrs Peggy Edwards
For this study 334 patients during their stay in the recovery room were assigned to the following groups: ‘comfortable’, in ‘pain’ and in ‘severe pain’. Fourteen per cent of…
Abstract
For this study 334 patients during their stay in the recovery room were assigned to the following groups: ‘comfortable’, in ‘pain’ and in ‘severe pain’. Fourteen per cent of patients awoke from anaesthesia in ‘pain’ and 10% were discharged to the ward in ‘pain’. Thirty‐seven per cent of patients using patient‐controlled analgesia (PCA) in the recovery room were discharged in ‘pain’; 63% of these patients had neither been prescribed nor given a ‘loading dose’ in the recovery room. Forty‐eight per cent of patients receiving sole intramuscular opioid analgesia were discharged in ‘pain’. Ninety per cent who received nurse‐administered ‘prn’ intravenous bolus opioids were discharged ‘comfortable’. An algorithm was therefore developed for the administration of loading doses of intravenous opioids in the recovery unit to be used by recovery nursing staff prior to PCA or other analgesic methods. An early re‐audit established that the algorithm became widely adopted by anaesthetists, was safe and produced comparable discharge pain scores.
Chronic pain has important socio‐economic consequences. The reasons for the evolution of a distinct specialty to treat patients with intractable pain are discussed. The users of a…
Abstract
Chronic pain has important socio‐economic consequences. The reasons for the evolution of a distinct specialty to treat patients with intractable pain are discussed. The users of a pain relief service are defined and their needs explained. A multidisciplinary approach to pain management has many advantages and key personnel are identified. Facilities and funding must be adequate for effective functioning of the service. An important role is education of medical and non‐medical personnel. Careful long‐term planning, both at local and regional level, is needed to ensure that the specialty of pain relief meets current patient needs and can also accommodate new advances in therapy.
Ethan W. Gossett and P. D. Harms
Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United…
Abstract
Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United States is $600 billion, and more than half of this cost is due to lost productivity, such as absenteeism, presenteeism, and turnover. In addition, an escalating opioid epidemic in the United States and abroad spurred by a lack of safe and effective pain management has magnified challenges to address pain in the workforce, particularly the military. Thus, it is imperative to investigate the organizational antecedents and consequences of pain and prescription opioid misuse (POM). This chapter provides a brief introduction to pain processing and the biopsychosocial model of pain, emphasizing the relationship between stress, emotional well-being, and pain in the military workforce. We review personal and organizational risk and protective factors for pain, such as post-traumatic stress disorder, optimism, perceived organizational support, and job strain. Further, we discuss the potential adverse impact of pain on organizational outcomes, the rise of POM in military personnel, and risk factors for POM in civilian and military populations. Lastly, we propose potential organizational interventions to mitigate pain and provide the future directions for work, stress, and pain research.
Deborah Padfield and Mary Wickenden
Pain is socially and culturally experienced. This chapter builds on previous research into the value of visual images for communicating pain in the UK, which evidenced ways in…
Abstract
Pain is socially and culturally experienced. This chapter builds on previous research into the value of visual images for communicating pain in the UK, which evidenced ways in which images can improve doctor–patient interaction. It discusses ways in which photographs co-created with people living with chronic pain can be catalysts for discussion of pain and suffering in a range of cultural contexts, including higher education and healthcare training. We draw on a pilot project in Delhi, India where images were used as stimuli to dialogue and exploration of shared understanding of pain and current work in UK higher education using visual and other participatory methods. Students have a chance to work with and discuss images which depict qualities and characters of pain. Through seeing and hearing about patients’ experiences of pain, students learn about the commonalities and diversities in people’s experiences of their bodies and minds and how these impact on lives. As future health professionals, their own responses to this are important. Chronic pain can be a disabling condition leaving people vulnerable, with their sense of self and how they are seen by others threatened. People living with pain have to (re)negotiate their identity, with themselves and others, to see who they can be, as well as what they can do in this new state. Exploration of this through visual arts and verbal participatory activities can provide otherwise untapped insights and understandings of the human condition and its diversity. Exploring ways in which this approach could be extended to and adapted to other contexts are part of our future plans.
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Susan W. Hinze, Noah J. Webster, Heidi T. Chirayath and Joshua H. Tamayo-Sarver
Do physician perceptions of patient “deservingness” factor into the decision to prescribe opioid analgesics? Using a data set of 398 physicians randomly selected from the American…
Abstract
Do physician perceptions of patient “deservingness” factor into the decision to prescribe opioid analgesics? Using a data set of 398 physicians randomly selected from the American College of Emergency Physicians (ACEP) membership list, we explore how a range of patient social context variables influence a physician's decision to prescribe opioids for three conditions: ankle fracture, back pain, and migraine headache. Being hurt running from the police, former and current drug or alcohol use, and frequent emergency room (ER) visits reduce the likelihood of opioid prescription. Having a reliable relationship with a primary care provider and being injured in a ladder fall or intramural collegiate basketball game increase the likelihood of opioid prescription. Factor analyses for each of the three conditions reveal two scales: socially stigmatizing characteristics and socially accepted characteristics. Discussion centers on what places people at risk for inadequate pain control. Our work contributes to the expanding literature on social conditions as a fundamental cause of illness.
Pain is demonstrated as a complex, multi-dimensional phenomenon that is interdependent and connected between people. The author proposes that social scientists use a “total model”…
Abstract
Purpose
Pain is demonstrated as a complex, multi-dimensional phenomenon that is interdependent and connected between people. The author proposes that social scientists use a “total model” of pain to better understand pain epistemologically and ontologically and people’s “pain lives.” Through this model, and drawing from the author’s own research on mixed martial artists, new ways to conceptualize, study, and talk about pain within the sporting context have been outlined.
Design/Method/Approach
In the first part of this chapter, pain is discussed with respect to how it has been researched and understood within the fields of medicine, sport psychology, and the sociology of sport. In the second part of this chapter, the total pain model developed by Dame Cicely Saunders is explored as a revolutionary development for the ways in which pain is understood and treated within the health field. Lastly, the author proposes a reconstructed methodology for the study of pain.
Findings
Pain should be studied not from one tradition, but using an amalgamation of the medical, sport psychology, and sociology of sport traditions and perspectives. In this way, the many dimensions of the phenomenon, social, cultural, political, material/physical, spiritual, existential, emotional, and cognitive must be explored from all systems and languages of pain in order to achieve a more robust understanding of pain in sport.
Research Limitations/Implications
The dualistic relationship between theory and method currently present in most qualitative research does not fully account for the complexity of bodies in pain. Therefore, it is critical to adopt an interwoven methodological and theoretical approach that enables scholars to relate to, and feel with, people in pain.
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In this chapter, I explore connections between institutional and personal narratives of treating chronic pain with prescription opioids.
Abstract
Purpose
In this chapter, I explore connections between institutional and personal narratives of treating chronic pain with prescription opioids.
Methods/Approach
I explore how stories told in a Food and Drug Administration public hearing construct moral boundaries around different kinds of pain patients and justify a label change intended to reduce prescribing of opioids to people with chronic pain. I then examine how personal narratives, acquired through interviews with chronic pain patients who rely on opioids, both conform to and challenge the institutional narratives told in the hearing and work as subversive stories. Additionally, I consider how institutional and personal narratives of chronic pain shed light on intersections and conflicts between the medical and social models of disability.
Findings
The “invisible disability” experience of chronic pain highlights the complex entanglement between the struggles associated with impairment emphasized by the medical model, and those stemming from cultural and structural barriers emphasized by the social model.
Implications/Value
I conclude with a discussion of the methodological value of examining narratives such as those of chronic pain and disability at multiple levels of social life. This study contributes to efforts to broaden disability discourse to include experiences such as chronic pain that are poorly represented in disability scholarship.
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