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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).

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.

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.

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.

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.

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.

Clinicians in chronic pain services are facing the need to develop meaningful and methodologically adequate measures, not only to evaluate the effectiveness of interventions and to assure quality, but also to support the continued funding and future development of such services. Explores the problems inherent in assessing outcomes in chronic pain. These include the complexity of the chronic pain syndrome itself, the multidimensional nature of interventions and the challenges of defining outcomes in the chronic illness syndrome. The complexity and challenges of assessing outcomes may lead to some reticence in facing the challenges but it is the responsibility of the clinicians to continue developing measures and to communicate to purchasers and other stakeholders the complexity of assessing outcomes in chronic pain.

The number of adolescents experiencing pain is increasing. Pain has a major impact on several areas of daily living, such as function at school and school absenteeism, loss of appetite and socializing. One out of ten pupils in Norwegian schools is immigrants, and surveys have shown that immigrants suffer from poor health more often than the general population. The purpose of this study was to explore how school nurses and teachers experience pain in young immigrants in the school setting.

A qualitative design using focus group interviews was chosen for data collection. A total of 11 focus groups (17 school nurses and 25 teachers) consisting of school nurses and teachers in junior high schools (age: 13-16 years) in Southern Norway were conducted. Data were analyzed using a qualitative content analysis.

School nurses and teachers experienced communication of pain with young immigrants as characterized by cultural differences and language problems. Immigrants waiting for residency permits experienced pain more often than others. They also experienced that young immigrants often were absent from school and used pain as an excuse for not participating in classes, but this was not the case at the special school for immigrants. During Ramadan, they experienced that immigrant pupils had an increase of pain, especially headaches.

Culture affects the assessment and management of pain and different strategies may assist school nurses and teachers in their encounter with young immigrants with pain. There is a need for education in cultural competence among teachers and school nurses.

Diagnosing pain in neonates is difficult but critical. Although approximately thirty manual pain instruments have been developed for neonatal pain diagnosis, most are complex, multifactorial, and geared toward research. The goals of this work are twofold: 1) to develop a new video dataset for automatic neonatal pain detection called iCOPEvid (infant Classification Of Pain Expressions videos), and 2) to present a classification system that sets a challenging comparison performance on this dataset. The iCOPEvid dataset contains 234 videos of 49 neonates experiencing a set of noxious stimuli, a period of rest, and an acute pain stimulus. From these videos 20 s segments are extracted and grouped into two classes: pain (49) and nopain (185), with the nopain video segments handpicked to produce a highly challenging dataset. An ensemble of twelve global and local descriptors with a Bag-of-Features approach is utilized to improve the performance of some new descriptors based on Gaussian of Local Descriptors (GOLD). The basic classifier used in the ensembles is the Support Vector Machine, and decisions are combined by sum rule. These results are compared with standard methods, some deep learning approaches, and 185 human assessments. Our best machine learning methods are shown to outperform the human judges.

The purpose of this study is to understand the activities in nurses’ work practices in relation to the design process of a self-monitoring application.

A design ethnographic approach was applied in this study.

To solve the problem of translating highly qualitative phenomena, such as pain, into the particular abstract features of a self-monitoring application, design participants had to balance these two aspects by managing complexity. In turn, the nurses’ work practices have changed because it now involves a new activity based on a different logic than the nurses’ traditional work practices.

This study describes a new activity included in nurses’ work practices when the nurses became part of a design process. This study introduces a novel way on how to gain a deeper understanding of existing professional practice through a detailed study of activities taking place in a design process. This study explores the possible implications for nurses’ professional practices when they participate in a self-monitoring application design process.

Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. The purpose of this paper is to present individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy.

Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to 2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated.

Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care.

Clinical effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs.

A number of recommendations concerning data collection and future service evaluations are made.

Returning to paid or unpaid activities has a high public health impact.

This paper contributes towards the evidence base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e. practice-based evidence).

Almost 40 years after Zborowski in People in Pain demonstrated that cultural orientations underlie reactions to pain and willingness to accept treatment, and despite documented high US prevalence rates for acute and chronic pain, little is known about health beliefs regarding pain. The purpose of this paper is to investigate how health beliefs toward pain may influence willingness to approve pain treatment with potentially addictive drugs.

Using 633 randomly sampled, general population telephone interviewed respondents from the southern region of the USA, this paper used difference of means and multiple regression analyses to investigate 11 health beliefs toward pain and their relationship to willingness to accept medical treatment with potentially addictive drugs.

The paper demonstrates that six of the 11 health beliefs about pain have statistically significant relationships to willingness to approve medical treatment for oneself with potentially addictive pain medications.

These health beliefs may prove useful in social marketing programs and in practitioner‐patient communications in clinical settings with the objective of enhancing patients' receptivity to approved medical treatment regimes that involve the use of potentially addictive medications for pain relief.

The purpose of this study was to determine whether combining a structured stretching program with functional movement/body position training would yield additive effects on flexibility, ergonomic practices, and subjective pain levels for employees at high risk for work-related musculoskeletal disorders.

Nine control and 13 experimental university cleaning staff participated in a 10-week full-body stretching intervention led by undergraduate students. Experimental participants also engaged in functional movement/body position training once per week. Joint range of motion, task ergonomic form, pain level, and stretching motivation results were compared pre- and post-intervention.

Overall flexibility (+25.75 ± 3.33%) and task ergonomic form (+26.3 ± 10.5%) significantly improved and were negatively correlated with pain levels (r = −0.541 and r = −0.317, respectively). Experimental participants experienced greater improvements in shoulder (control: +16.8 ± 9.0%; experimental: +64.2 ± 11.5%) and hip (control: +31.4 ± 9.9%; experimental: +91.2 ± 19.9%) flexibility as well as in task-specific ergonomic form for vertical (control: +0.0 ± 5.3%; experimental: +35.2 ± 10.1%) and horizontal wiping (control: −4.7 ± 4.7%; experimental: +29.0 ± 7.8%). Intrinsic motivation was increased for both groups (+26.2 ± 15.4%).

Supplementing a workplace stretching program with functional movement/body position training has the potential to improve flexibility and decrease pain while simultaneously increasing the likelihood that cleaning staff will participate in self-directed stretching in the future. The intervention serves as a model for workplace health management and wellness-focused community building on university campuses who insource cleaning staff.

Multiple pathologies and age-related physiological changes lead to acute respiratory failure. This necessitates mechanical ventilation among elderly patients. Mechanically ventilated critically ill elderly patients may confront various problems, including physical and psychological issues. Therefore, the purpose of this paper is to present the frequent problems encountered by critically ill elderly patients and management of such problems.

This paper reviews relevant literatures.

Physical problems include pain and respiratory infections. Additionally, psychological problems include anxiety and stress. Such problems should be managed by physicians, nurses and family members. Pharmacological and non-pharmacological approaches can be used to manage these problems. Pharmacological management involves use of medications, while non-pharmacological interventions include use of music therapy, acupuncture and sensory stimulation.

The paper indicates physical and psychological problems of mechanically ventilated critically ill elderly patients. To ensure effective management of complications encountered by mechanically ventilated elderly patients, health-care professionals ought to be aware of physical and psychological age-related changes.

The objective of the project was to achieve enhanced quality and efficiency of care to patients with hip fracture in an orthopaedic department at a county hospital in southern Sweden. A further aim was to create better use of resources by identifying and dealing with problems and no‐value‐added activities. The project adopted an approach based on the stages of Business Process Improvement, with the main outcome measures including flow charting overview and block diagram, process‐walking‐through, effectiveness, efficiency, and adaptability measurements and targets, observations and interviews with patients, relatives and professionals, and examination of care plans. Results showed that the care of patients with hip fracture can be improved, but that this would involve better collaboration among different professions and disciplines, standard care plans, and improved status for the patients.