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Background: The Nurses' Cancer Pain Management Competency Scale (NCPMCS) is a tool to explore nurses' competencies and subjective experiences in cancer pain management, and to help nurses understand their current shortcomings in cancer pain management. The scale, currently available only in English and translated into Chinese for wider adoption abroad, provides a tool for Chinese nurses to assess their level of cancer pain management. Furthermore, based on the scale's specific score, they can evaluate their lack of understanding about cancer pain management, advance research into this area, and enhance their capacity to control cancer pain while providing patient care., Objective: The purpose of this study was to translate and localize the new scale, and to measure its reliability and validity. The study was also to provide a way to quickly and accurately measure the competency of cancer pain management among nursing staff in China., Methods: The Bristling translation approach was used to translate, translate back, and culturally modify the English version of the cancer pain management competency scale for nurses to create the Chinese version. A convenience sample was used for the study, 220 clinical nurses from three Grade III hospitals in Zhengzhou, Henan Province, China, were chosen by convenience sampling. The Chinese version of the scale was used for this investigation., Results: The Cancer Pain Management Competency Scale for Nurses has 14 items over 4 dimensions in its Chinese form. From the exploratory factor analysis, four common components were recovered; the cumulative variance rate was 81.994%, the scale's Cronbach's α coefficient was 0.902, and the Cronbach's α coefficient for each dimension ranged from 0.800 to 0.938. Retest reliability was 0.915, scale content validity was 0.865, and Spearman-Brown's broken half reliability was 0.808., Conclusion: Nurses' cancer pain management competency in clinics can be assessed using the Chinese version of the Nurses' Cancer Pain Management Competency Scale, which has strong validity and reliability., (Copyright © 2024. Published by Elsevier Inc.)

Background: Research reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses' pain assessment practices in Saudi Arabia., Aim: To assess the nurses' pain assessment practices in the NICU in Saudi Arabia., Design: This study used a descriptive cross-sectional design., Settings: Research was conducted using an online survey., Participants/subjects: This study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia., Methods: Data on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages., Results: The majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%)., Conclusions: NICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the matching and content validity of a pain quality pictogram tool with a Hmong community., Design: A Qualtrics survey was administered to two groups of participants., Methods: Sixty Hmong participants (n = 49 limited English proficiency and bilingual Hmong community members in group 1; n = 11 bilingual Hmong healthcare practitioners in group 2) participated in this study. Hmong community members in group 1 were asked to identify the pain pictogram that best matched a pre-recorded Hmong pain quality phrase. The practitioners in group 2 were asked to evaluate how well each pain pictogram represented the pre-recorded Hmong pain quality phrase it intended to measure. To assess the matching, we assessed agreement between the pain concept in the phrase and the pictogram intended to represent it, using group 1. A content validity index (CVI) was calculated to assess the content validity of the tool using group 2., Results: Among the community participants, 8 of the 15 pictograms were matched with the intended phrase almost perfectly, and 3 were matched by a substantial majority. There were no differences in matching by patient gender and language proficiency. Among practitioners, 11 of 15 pain pictograms met the CVI threshold of 0.70 for all three dimensions (i.e., representativeness, relevance, and comprehension)., Conclusion: Findings support including most of the pain pictograms in the tool but suggest specific areas for improvement., Clinical Implications: Findings provide insights for redesigning the selected pain pictogram tool to be used in clinical settings with LEP Hmong patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Anxiety is common in hospitalized patients and can worsen pain or lead to unsuccessful pain relief., Aims: The purpose of this study was to evaluate the usefulness of measuring anxiety with a visual analog scale (VAS) in the hospitalized patient experiencing pain., Design: We conducted a multiple-center cross-sectional study., Participants/subjects: Adult inpatients experiencing moderate to severe pain defined by a pain VAS score ≥40 of 100 were included., Methods: Pain and anxiety data were collected using the following instruments: pain VAS, anxiety VAS, State Anxiety Scale of the Spielberger State-Trait Anxiety Inventory (STAI-YA) and Anxiety Subscale of the Hospital Anxiety and Depression Scale (HAD-A)., Results: Data were collected from 394 patients. Of those patients, 43.6% (171 of 392) and 36.6% (143 of 391) had significant anxiety according to STAI-Ya and HAD-A, respectively. Correlation was good between anxiety-VAS and STAI-YA (ρ = 0.67 [95% confidence interval 0.61-0.72]) and moderate between anxiety VAS and HAD-D (ρ = 0.48 [0.39-0.56]). The main factor predictive of situational anxiety was history of anxiety-depression symptoms (odds ratio = 2.95 [1.93-4.56]). For anxiety VAS score ≥ 40 of 100, the sensitivity for detecting anxiety was 81% with 70% specificity., Conclusion: This study confirmed the high prevalence of anxiety among inpatients experiencing pain, demonstrated the capacity of a VAS to assess this anxiety, determined an anxiety VAS cutoff level to screen for significant anxiety, and identified risk factors of anxiety in this population. Anxiety VAS has been found to be an easy-to-use method familiar to caregivers, with all the advantages needed for an effective screening instrument. An anxiety VAS score ≥40 of 100 would thus warrant particular attention to adapt care to the patient's anxiety-related pain and initiate specific therapeutic interventions., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: There is currently no gold standard instrument for assessing pain in severely cognitively impaired adults who are unable to provide self-report., Aims: To determine interrater reliability of the PACSLAC and PAINAD in assessing pain behaviors in patients with the same pain stimulus, determine the consistency of the reliable changes between and within the instruments and assess nurse preference for either instrument., Design: A single-group, within-subjects repeated-measures design was implemented., Setting: The study took place in a small suburban hospital., Participants/subjects: Pain levels were observed at 24, 48, and 72 hours postsurgery using two instruments: Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). These instruments were selected because they are among the most commonly recommended tools for clinical use. Interrater reliability was analyzed along with reliable changes in pain for each period, and the study concluded with the nurse raters completing a preference survey., Methods: A convenience sample of 30 patients was used with a diagnosis of severe dementia rendering the patient unable to reliably express pain, 60+ years of age, recovering from hip fracture surgery., Results: Greater interrater reliability was found for the PACSLAC, with reliable change potentially affected by the type and level of pain medication. The nurses' preference for the tool was split., Conclusions: The results of this study indicate that the PACSLAC may be the more reliable tool over the PAINAD; however, rater training and familiarity with the tool is critical., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: One of the critical components in pain management is the assessment of pain. Multidimensional measurement tools capture multiple aspects of a patient's pain experience but can be cumbersome to administer in busy clinical settings., Aim: We conducted a systematic review to identify brief multidimensional pain assessment tools that nurses can use in both ambulatory and acute care settings., Methods: We searched PUBMED/MEDLINE, PsychInfo, and CINAHL databases from January 1977 through December 2019. Eligible English-language articles were systematically screened and data were extracted independently by two raters. Main outcomes included the number and types of domains captured by each instrument (e.g., sensory, impact on function, temporal components) and tool characteristics (e.g., administration time, validity) that may affect instrument uptake in practice., Results: Our search identified eight multidimensional assessment tools, all of which measured sensory or affective qualities of pain and its impact on functioning. Most tools measured impact of pain on affective functioning, mood, or enjoyment of life. One tool used ecological momentary assessment via a web-based app to assess pain symptoms. Time to administer the varying tools ranged from less than 2 minutes to 10 minutes, and evidence of validity was reported for seven of the eight tools., Conclusions: Our review identified eight multidimensional pain measurement tools that nurses can use in ambulatory or acute care settings to capture patients' experience of pain. The most important element in selecting a multidimensional pain measure, though, is that one tool is selected that best fits the practice and is used consistently over time., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Behavioral Indicators of Infant Pain scale (BIIP) has been shown to be a good tool to assess pain in infants., Aims: This paper aimed to translate BIIP into Chinese and evaluate its reliability and validity for neonates in China., Design: A prospective observational study. SETTING AND PARTICIPANTS: A convenience sample of 396 neonates (preterm and term infants) were recruited from neonatal intensive care units in China from July to October 2016., Methods: The BIIP was translated and adjusted for semantic adaption.396 neonates were assessed during 3 phases of blood collection from an artery/vein. A video camera was positioned for a close-up view of the face and body. The neonates' pain was rated independently by 2 nurses who were trained and familiar with the Chinese version of BIIP (C-BIIP)and FLACC (Facial expression, Legs, Activity, Crying and Consolability)., Results: The internal consistency were 0.904 (preterm) and 0.895 (term). The test-retest reliability were 0.947 (preterm) and 0.938 (term) and the interclass correlation coefficients were 0.921 to 0.959 (preterm) and 0.921 to 0.959 (term). The correlations between the C-BIIP and FLACC were high (preterm: r = 0.948, term: r = 0.896). Using the C-BIIP, the 3 phases of blood collection were found to be statistically different (preterm: F = 635.76, term: F = 675.54; P < 0.001), which showed that the construct validity of C-BIIP was good., Conclusion: The BIIP is a reliable and valid tool to assess pain in term and preterm neonates in China., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: A variety of valid pediatric pain assessment tools are used in clinical practice globally; however, none have been validated for use in the Pediatric Intensive Care Unit (PICU) in Greece. Furthermore, the association between pain behavioral responses and clinical status is unclear., Aims: To assess the reliability and validity of the Greek version of FLACC, Comfort B, and BPS pain scales in critically ill children and to explore their association with clinical severity (Denver MOF, PMODS) and levels of sedation and analgesia., Methods: A methodological and descriptive correlational study was performed in a 6-bed PICU. A total of 60 observations in a sample of 30 children (mean age 4.1 years; 63.3% male) were obtained by 2 independent nurses during rest and painful procedures. At the same time, the bedside nurse assessed the child's pain intensity using the VASobs., Results: High internal consistency and strong interrater reliability were detected (Cronbach's alpha ≥ .85; ICC > .95, p < .001). The agreement between observers was satisfactory (0.71 ≤ Kappa ≤ 0.96, p < .001). Strong correlations were found among the scales (0.65 ≤ rho ≤0 .98, p < .05). Increased pain scores (≥moderate pain) were observed during painful procedures regardless the administration of analgesia. Statistically significant correlations were found between clinical severity and the FLACC and Comfort B scores (-0.577 ≤ rho ≤ -0.384, p < .05)., Conclusions: These pain tools were found to be suitable for this sample of children in Greece. Wider application of these tools in Greek PICUs and further research regarding their association with the clinical severity and the pain responses is required for the improvement of pain management in critically ill children., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: Pain assessment at the end of life remains a problem for patients who are unable to self-report their pain when transitioning across care settings. This study therefore tested the internal consistency and discriminant, concurrent, and convergent validity of the Critical-Care Pain Observational Tool (French version) when used with end-of-life patients in a palliative care setting., Design: This was a descriptive correlational study that used a repeated-measures within-subjects prospective design., Methods: The pain of 13 patients was assessed when at rest and during turning., Results: The internal consistency reliability coefficient alphas were .64 at rest and .70 during turning. Discriminant validity was shown by a decrease in the total Critical-Care Pain Observation Tool score. Concurrent validity was demonstrated by the association between the patients' self-report of pain and the Critical-Care Pain Observation Tool score at rest (0.65, p < .016) and during turning (0.77, p = .002). Finally, the convergent validity between the Critical-Care Pain Observation Tool score and the Algoplus scale score was demonstrated with a Spearman's correlation coefficient of 0.76 at rest and 0.84 during turning., Conclusions: The results suggest that the Critical-Care Pain Observation Tool can be used with end-of-life patients in French-speaking countries., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Aims: To investigate registered nurses' (RNs') and physicians' knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden., Design: Descriptive and explorative study using an online questionnaire., Methods: A researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden., Results: Most NICUs had pain assessment guidelines, but there was a discrepancy regarding interprofessional discussions of pain assessments. A total of seven different pain assessment instruments were reported from the included NICUs and RNs were reportedly those who usually performed the pain assessments. Most respondents expressed a positive attitude toward pain assessment but recognized a lack of intervention after the assessment. Forty-six percent (n = 11) of the physicians said they had sufficient knowledge of assessing pain using pain assessment instruments, versus 75% (n = 110) of the RNs. Difficulties assessing pain in certain populations of infants, such as the most premature infants and infants receiving sedative medicines, were recognized., Conclusions: RNs in this study reported that their pain assessments did not lead to appropriate pain management interventions. They were thus discouraged from further pain assessments or advocating for ethical pain management. An interprofessional team effort is needed to effectively assess and manage pain in neonates., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Previous studies support the role of both auditory and visual stimuli in the evocation of empathy, but no research to date has explored the relative effectiveness of each on any type of empathy., Aims: The present study compared how auditory and visual presentation influence somatic empathic arousal and perceived pain level., Design: Exposure to auditory and/or visual information about an individual in pain was manipulated between groups of participants., Methods: Students (N = 125) in several classes were randomly assigned in groups to one of three conditions-audio-only, video-only, or audio-video-each portraying an elderly man suffering from a painful kidney stone. Participants indicated his perceived pain and level of danger and relevant physical sensations and completed an empathy status scale., Results: Consistent with the hypothesis, the results indicated that participants who were presented with an auditory stimulus (audio-only and audio-video conditions) estimated higher and more accurate pain and danger level for the patient compared with those in the visual-only group. Participants in the audio groups also reported experiencing physical sensations, whereas the visual-only group had no such report., Conclusions: The study found that auditory information is more impactful in eliciting perceptions of pain in others compared with visual information. Experiences of clinical empathy and patient care may be improved by focusing on patients' auditory pain communications., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: The Pediatric Critical-Care Observation Tool (P-CPOT) is an adaption of the Critical-Care Pain Observation Tool (CPOT) originally designed to assess pain in nonverbal critically-ill adults., Aim: The study validated the P-CPOT in assessing nociceptive procedure pain in pediatric intensive care unit (PICU) children who are unable to verbalize pain., Methods: Content validity was tested using a two-round expert panel review with 8 experts. With a sample of 78 PICU patients, prospective repeated measures were designed to detect the change over time at pre- (T1), during (T2), and post- (T3) for routinely scheduled nociceptive procedures. Each measure was independently completed by two raters using two scales, the P-CPOT and the FLACC (Faces, Legs, Activity, Cry and Consolability)., Results: All categories had Item-level content validity indices of 0.88 to 1.00. A one-factor structure containing 5 items was established and accounted for 85% variance in P-CPOT scores. Inter-rater reliability was substantial with correlation coefficient of 0.996 and Kappa value of 0.90. A threshold value of 4 resulted in excellent balance between sensitivity (98.6%) and specificity (97.6%). Both tools detected the score changes over time (p = .025). P-CPOT had a larger effect size (Cohen's d = 4.1) as well as a higher score than FLACC at T2 (p = .039). Linear regression revealed that patients being ventilated tended to have a P-CPOT score of 1.1 higher than the FLACC score while controlling for heart rates (p < .001), meaning that P-CPOT is more sensitive than FLACC for detecting pain increase during nociceptive procedures in ventilated patients., Conclusion: The P-CPOT is a valid scale for assessing pain in PICU patients with very good psychometric performance. It is especially adept in detecting pain in ventilated patients., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: People with dementia experience a decline in language skills required to self-report pain; researchers thus recommend the use of nonverbal behaviors to assess pain. Although multiple instruments exist for assessing nonverbal pain behaviors, psychometric data are lacking for African American nursing home residents with dementia., Aims and Design: The purpose of this methodological study was to describe the development and testing of the Pain Assessment Tool in Cognitively Impaired Elders (PATCIE) in African American and Caucasian nursing home residents with dementia., Settings/participants: The convenience sample included 56 African American and 69 Caucasian residents with dementia in multiple nursing homes from three states. The research staff completed the pain assessments when the nursing home staff transferred the residents., Results/conclusions: Initially, 15 nonverbal pain behaviors were evaluated. Based on the alpha scores and additional literature review, the 15 nonverbal pain behaviors were expanded to 28 behaviors. The PATCIE had a Cronbach's alpha of .73 during movement. Construct validity for the pain behaviors was demonstrated because higher scores were noted during movement, and scores before movement were significantly higher than those obtained after movement. For movement over time, there was a significant difference in the PATCIE score, regardless of ethnicity or time (p < .0001). There were no significant differences found between ethnic groups, either overall or in change over time between movements or between the categories of cognitive function. African Americans were more likely to display frowning, and Caucasians to display irritability. The PATCIE demonstrates preliminary reliability and validity in assessing pain in African American and Caucasian nursing home residents with dementia., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: The Nociception Coma Scale-Revised (NCS-R) is a rating scale developed and validated for measurement of nociception and pain among patients with brain injuries in unresponsive wakefulness syndrome or minimally conscious state. However, little is known about its use in daily clinical practice., Aims: The aim of this study was to explore clinical experience with the NCS-R by means of focus group interviews with nurses and nurse assistants in a subacute rehabilitation ward for patients with severe brain injuries., Design: Qualitative focus group interview study., Settings: Department for highly specialized neurorehabilitation for patients with severe brain injuries., Participants/subjects: Nurses and nurse assistants., Methods: In total, 12 experienced registered nurses and nurse assistants participated in two recorded focus group interviews. The participants were selected from the subacute neurorehabilitation ward on the following criteria: Employed at the ward for at least 11 months and being introduced to and having experience with using the NCS-R in own patients for a minimum period of 6 months. An inductive qualitative analysis was conducted by reading the interview text through several times, and meaning units were defined first separately and later jointly between the authors. Then meaning units were coded and categorized into subthemes and themes., Results: We found three themes, general relevance of the NCS-R, NCS-R versus level of consciousness, and overall assessment of pain in patients with disorders of consciousness, with a total of eight subthemes., Conclusions: The content and subscales of the NCS-R are relevant for pain assessment in patients with severe brain injury in subacute rehabilitation. However, with the present cutoff value at 4 points, challenges are associated with using NCS-R, especially in patients with unresponsive wakefulness syndrome because they are at risk of not being assessed with respect to pain., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Pain is subjective and multidimensional in nature. Its assessment is very challenging especially in the pediatric population. Adequate assessment of pain in children is the keystone for effective management. Accurate and comprehensive evaluation of the child's pain experience requires the use of multidimensional pain assessment tools such as the Adolescent Pediatric Pain Tool (APPT) which measures the intensity, location and quality of pain., Aims: The aim of this study was to translate and culturally validate the APPT for use in Lebanese children and adolescents with cancer., Methods: The instrument was translated and culturally adapted following the WHO four steps; 1) forward translation and back-translation, 2) expert panel, 3) pre-testing and 4) cognitive interviewing. The semantic validation of the pain quality descriptors was performed by healthy children and children with cancer aged 8-17 years, using the Q-sort method., Results: A final Arabic version with 31 pain descriptors equivalent to the original tool was produced based on the results from the pilot study and the children's interviews. Children were able to differentiate between the different words they use to describe their pain., Conclusion: Our results showed that the Lebanese version of the APPT is a culturally sensitive tool to assess the location, intensity and quality of pain in Lebanese children with cancer. Health professionals are encouraged to use this tool to assess the pain characteristics in Lebanese children with cancer, hence leading to effective pain management., (Copyright © 2019 American Society for Pain Management Nursing. All rights reserved.)

Background: The use of reliable pain assessment measures is essential for scoring and managing pain in infants. The Premature Infant Pain Profile (PIPP) is reliable and valid and has been recently revised. To adapt and validate the PIPP-R into Portuguese and to evaluate its psychometric properties are required to ensure maintenance of meaning and content., Aims: The aim of this study was to culturally adapt to Brazilian Portuguese and explore content validity and construct validity of the Premature Infant Pain Profile-Revised., Design: This is a methodological study., Participants/settings: Two existing data sets of randomized clinical trials previously conducted were used to examine initial construct validity of the prefinal version of the Premature Infant Pain Profile-Revised., Methods: Cross-cultural adaptation and validation occurred in four steps. Independent versions of the Premature Infant Pain Profile-Revised were produced, followed by the preparation of a synthetic version. Two back-translated versions were realized by professional translators. An expert committee evaluated idiomatic and semantic equivalence and clarity and relevance of the items. A content validity index was calculated. Finally, a consolidated prefinal version in Portuguese was then produced., Results: No difficulties in producing the material were reported. Semantic and idiomatic aspects were considered adequate, and content validity index was 1.0. Premature Infant Pain Profile and Premature Infant Pain Profile-Revised scores were highly correlated for pain after heel lancing and venipuncture (R 2  = 0.986, p < .001) and for pain associated with analgesic strategies (R 2  = 0.966-1.00, p < .001)., Conclusions: The Premature Infant Pain Profile-Revised was culturally adapted into Brazilian Portuguese. Appropriate content validity index was determined. Evidence of construct validity was also found. Future studies are warranted to explore the feasibility and other psychometric properties of using the Premature Infant Pain Profile-Revised translated and adapted into Brazilian Portuguese in the clinical setting., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Managing pain in those vulnerable populations who are unable to self-report or communicate is challenging due to difficulty recognizing pain presence and severity. As no valid and reliable objective measure of pain exists, the ASPMN supports assessment practice recommendations that gather relevant information to infer presence of pain and evaluate response to intervention. Nurses and other healthcare professionals must be advocates for those who are unable to speak for themselves regarding their pain experience., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Background: Enhancing pain patient's ability to function and cope is important, but assessing only intensity ignores those aspects of pain. The Functional Pain Scale (FPS), addresses these dimensions but lacked validation in hospitalized adults with chronic pain., Aims: This research was conducted to establish the FPS psychometric properties in hospitalized adults., Design: A prospective pilot study examined the reliability and validity of the FPS in two acute care hospitals., Settings: Adult inpatients from medical/surgical units at two hospitals., Participants/subjects: A convenience sample of 93 subjects from an Academic Medical Center and 51 from a tertiary care hospital who were 21-81 years old and primarily Caucasian., Methods: Hospitalized adults with chronic pain at two facilities provided pain scores from the FPS, Numeric Rating Scale, Pain, Enjoyment of Life, and General Activities Scale, and Quality of Pain Care Scale. Test-retest reliability and construct validity were evaluated using standard correlation methods., Results: Hospitalized adults aged 21-88 years with chronic pain (N = 144) were evaluated. Data supported test-retest reliability of the FPS (r = .84; p < .001), which had strong, statistically significant correlations with the Numeric Rating Scale at different study sites (r = 0.75 and r = 0.45, respectively), indicating acceptable construct validity. Significant weak correlations between the FPS and other measures of mood and functioning failed to support discriminant validity., Conclusions: Although statistically significant, the reliability and validity of FPS were not as strong in hospitalized chronic pain patients as reported for older adults in other settings., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Despite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs)., Aims: To evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay., Design: A secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review., Settings: Tertiary level neonatal intensive care unit., Participants/subjects: 242 stable preterm neonates born at less than 37 weeks gestational age., Methods: Data were analyzed quantitatively using R for statistics., Results: The 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 non-tissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions., Conclusions: Increased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates., (Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Pain is one of the most common symptoms experienced by patients in acute care hospitals and acutely ill patients experience both acute and chronic pain. Unrelieved pain can have a profound negative impact on individuals' functional status, well-being, quality of life, and satisfaction with care. For providers, managing pain can be challenging. While the numeric rating scale is widely accepted and used, it measures only pain intensity. CAPA® pain assessment offers an alternative approach in which providers have a conversation with patients about pain and how it impacts five key areas., Aims: The purpose of this pilot project was to evaluate provider and patient satisfaction with the CAPA® measure as compared to a numeric rating scale when evaluating patients' experience with pain., Design: A mixed methods qualitative design was employed., Setting: This study was conducted at a 247-bed community teaching hospital in Providence, RI., Participants: The target sample included patients admitted to the study units and providers who delivered care to patients on the study units and used the numeric rating scale and the CAPA® method of assessment., Methods: In focus groups, nurses and physicians were asked about satisfaction with evaluating patients' pain with the numeric rating scale as compared to CAPA®. During a one-to-one interview, patients were asked to describe their impressions of the two assessment measures., Results: Nurses, physicians, and patients were satisfied that CAPA® effectively evaluated pain and provided more information about pain than the numeric rating scale., Conclusions: CAPA® is recommended as a supporting assessment to evaluate patients' pain experience in acute care., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Public hospitals in Catalonia (Spain) recommend using the Spanish version of the Pain Assessment in Advanced Dementia (PAINAD-Sp) scale for assessing pain in adult patients unable to self-report. However, since its inclusion in Catalonian nursing care plans in 2010, there have been no training programs for nurses, contributing to its current underuse., Aims: The aim of this study was to assess the impact of a nurse training intervention on the PAINAD-Sp scale in noncommunicative inpatients unable to self-report., Design: Before-after study., Settings: Two public hospitals in Catalonia (Spain)., Participants/subjects: Four hundred and one nurses participated in the training course and 219 patients received PAINAD-Sp assessments., Methods: We used a before-after study design, evaluating the use of the PAINAD-Sp scale over two 6-month periods before and after an online training intervention for nurses in February 2017, in two public hospitals. Data were collected from patient records in each center. The primary outcome was the number of patients receiving PAINAD-Sp assessments during admission. Secondary outcomes were the number of assessments undertaken per patient during admission, the total (0-10) and item-specific (0-2) PAINAD-Sp score, and pharmacologic treatment administered., Results: There were 401 nurses who took part in the training program. Over the study period, 219 patients received PAINAD-Sp assessments: 29 in the preintervention period and 190 in the postintervention period (p < .001). Administration of analgesics and antipyretics decreased (p < .001) after the intervention, whereas use of hypnotic drugs and sedatives increased., Conclusions: Theoretical and practical training may be an effective way to improve nurses' approach to identifying, assessing, and managing pain in patients unable to self-report., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Pain has a significant impact on hospitalized patients and is a quality indicator for nursing care. The Pain Assessment in Advanced Dementia (PAINAD) scale measures pain in people with communication disorders and advanced dementia, but it has not been validated in any other population., Aims: The aim of this study was to validate the Spanish version (PAINAD-Sp) in hospitalized patients with neurologic disorders and in end-of-life cancer patients with difficulty self-reporting., Design: The study had two phases: (1) analysis of the content by a committee of experts and (2) a cross-sectional study., Settings: We collected phase 2 data from January 2017 to December 2017 in four hospitals in Barcelona: Hospital Germans Trias i Pujol, Institut Català d'Oncologia, Hospital Vall d'Hebron, and Hospital de Bellvitge., Participants/subjects: We included all adults who had either a neurological disorder affecting language or an oncological disease with an end-of-life prognosis and difficulty self-reporting pain. We excluded patients with a diagnosis of dementia., Methods: The cross-sectional study included 325 patients who were simultaneously evaluated by two observers both at rest and in movement. We analyzed psychometric properties in terms of construct validity, reliability, and sensitivity to change., Results: We obtained Cronbach α > .70 in both situations and an inter-rater reliability of 0.80. Confirmatory factor analysis indicated that the model adjusted adequately to a unidimensional structure. In terms of sensitivity to change, the mean difference was greater in movement than at rest (difference in means was 1.15)., Conclusions: The PAINAD-Sp&#95;Hosp scale had good psychometric qualities in terms of validity and reliability in neurology and oncology patients unable to self-report pain., (Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Preverbal children are at increased risk for underassessment of pain. Pain is a social transaction involving the child in pain and the nurse assessor. However, our understanding of the nurse's part in this transaction is limited., Aims: The aim of this study was to explore nurses' assessment of pain in hospitalized preverbal children based on self-selected clinical examples., Design: Qualitative, descriptive design., Settings: Five different hospital units in Canada and Norway. All units had an observational pain scale for preverbal children available for use., Participants/subjects: Nurses (N = 22) with ≥1 year experience caring for preverbal children., Methods: Individual, semistructured interviews. Data were analyzed using inductive thematic analysis., Results: Nurses' assessment of pain in hospitalized preverbal children emerged as a nonlinear complex process incorporating different actions and reflections in response to the child's situation and expression of distress. Information from parents was routinely included in the assessment, although further parental involvement varied considerably. Although each assessment was personalized to the individual child, the nurse used previous experiences to interpret observations of and information from the child and the parents. Few nurses described using structured pain scales, but when used, these scales were included as only one aspect of their overall assessment., Conclusions: Nurses preferred pain assessment based on clinical judgment and tailored to the individual child. Implementation strategies that aim to integrate structured pain scales with clinical judgment to assess pain may be more likely to succed. Further examination of this approach is warranted., (Copyright © 2018 American Society for Pain Management Nursing. All rights reserved.)

Background: There is an urgent need to prepare a reliable and accurate tool for pain assessment in patients who are unable to self-report. Translating pain assessment scales into foreign languages requires further validation testing., Aim: The aim of the study was to carry out psychometric assessment of behavioral and physiological indicators of pain included in two Polish versions of pain assessment scales, the Behavioral Pain Scale (BPS) and the original Adult Non-Verbal Pain Scale (NVPS)., Design: A prospective repeated-measure descriptive study was conducted., Settings and Participants: Twenty-eight adult non-communicative mechanically ventilated ICU patients were included in the study. The study took place in five hospitals in Poland, one 15-bed general ICU of a university teaching hospital and four 6-bed medical ICUs of district hospitals., Methods: Pain assessment was conducted at rest, during non-painful and painful procedures independently by two observers., Results: Internal consistency of the Polish version of the scales was below the expected 0.7 value (Cronbach's alpha for the BPS 0.6883 and NVPS 0.6697). Principal component analysis showed that for the Polish version of the BPS, all three domains formed one separate factor (63.9%), while in the case of the NVPS two separate factors were found, one covering four domains of the NVPS (47.1%) and the other exclusively covering the category of Vital sign (20.2%). There was a significant difference between the pain scores with the NVPS (χ 2 = 228.95 p < .001) and the BPS (χ 2 = 236.46 p < .001) during three observation phases. There were no significant differences between scores obtained by different raters. The analysis of variance demonstrated a statistically significant difference in the values of physiological indicators of pain (SBP, DBP, MAP) between observation phases., Conclusions: The Polish version of the BPS has better psychometric properties than the Polish version of the NVPS. It is necessary to define precisely the descriptors used in the scales and to implement a staff training program., (Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to describe the incidence, pharmacologic management, and impact of pain on function, agitation, and resistiveness to care among assisted living residents., Design: This was a descriptive study., Data Sources: Baseline data from 260 residents in the second cohort of the study Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle., Review/analysis Methods: Descriptive analyses for the Pain Assessment in Advanced Dementia (PAINAD), Visual Descriptor Scale (VDS), and use of medication for pain management and hypothesis testing using linear regression analyses were performed., Results: The majority of the sample was female (71%) and white (96%) with a mean age of 87 (standard deviation = 7). Fifty-two out of the 260 residents (20%) reported pain based on either the PAINAD or the VDS. Out of the total 260 residents, 75 (29%) received pain medication. Twenty-two out of the 52 individuals (42%) reporting pain were not getting pain medication. Controlling for age, gender, and cognition, the PAINAD was significantly associated with agitation, function, and resistiveness to care and the VDS was only associated with function., Conclusions: The incidence of pain was low among participants based on the PAINAD or the VDS. Pain measured by the PAINAD was significantly associated with function, agitation, and resistiveness to care., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Pain management practice differs among hospitals in China; however, no studies have examined the association between hospital level and nursing practice of pain management., Aims: To evaluate the nursing practice of pain management in orthopedics wards of level 3 and 2 hospitals and compare the differences in pain management regulations, policies, and perceived barriers., Design: This was a cross-sectional descriptive study., Setting: This study was conducted during the 10th International Congress of the Chinese Orthopedic Association, November 19-22, 2015., Participants: Subjects: The sample included 121 nurses from China., Methods: Quantitative research methods were used to assess pain management practice by 121 Chinese nurses as well as barriers to nursing practice., Results: Nurses in level 3 hospitals were more likely to evaluate patients' pain intensity (85.23% vs. 65.38%, p < .05) and quality (77.27% vs. 53.85%, p < .05) than those in level 2 hospitals. Compared with level 2 hospitals, level 3 hospitals were more likely to participate in the Painless Orthopedics Ward program (53.41% vs. 23.08%, p < .01), conduct pain management knowledge training (88.64% vs. 69.23%, p < .05), and establish pain management regulations (68.18% vs. 34.62%, p < .01). Level 2 hospital nurses reported a higher score for barriers than level 3 hospital nurses (3.27 vs. 2.45, p < .05)., Conclusions: Nurses from level 2 hospitals received less education on pain management and also paid less attention to and faced more restrictions for pain management than nurses from level 3 hospitals., (Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: The Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US., Design: Cross-sectional study., Settings: Sixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama., Participants: One hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment., Methods: Validity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician's pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach's alpha., Results: MOBID overall scores were significantly associated with expert clinician's rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (α = 0.83)., Conclusions and Clinical Implications: Result of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff., (Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Pain assessment of patients with traumatic brain injury is a challenge because they are unable to self-report their pain experience., Aims: To investigate the psychometric properties of validity, reliability, and responsiveness of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in patients with traumatic brain injury., Methods: This was an observational, cross-sectional, repeated-measure and analytical study. This study was developed at the medical and surgical ICUs in a high-complexity public hospital at Aracaju, Sergipe, Brazil. Thirty-seven adult patients with moderate or severe TBI were included. This study was completed with 444 independent observations, a pairwise comparison, and was performed simultaneously before, during, and after eye cleaning and endotracheal suctioning of 37 adult patients with moderate to severe traumatic brain injury., Results: The BPS-Br had good internal consistency (.7 ≤ α ≤ .9), good discriminant validity (p < .001), moderate to excellent reliability based on inter-rater agreement (intraclass correlation coefficient = 0.66-1.00; κ = 0.5-1.0), and high responsiveness (0.7-1.7). The upper limbs subscale had the highest score during the nociceptive procedure (1.8 ± 0.9). Deep sedation affected the increase of grading during painful procedures (p < .001)., Conclusions: Our results suggest the BPS-Br is a useful tool for clinical practice to evaluate the pain experienced by patients with traumatic brain injury. Further studies of different samples are needed to evaluate the benefits of systematic pain assessment of critically ill patients., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Preterm infants spend the early days of their lives in neonatal intensive care units, where they undergo many minor painful procedures. There are many nonpharmacologic methods that can effectively reduce the pain response of neonates who undergo routine procedures., Aims: This study aimed to investigate whether oral glucose and listening to lullabies could bring pain relief during the removal and reinsertion of the tracheal tube and also oronasopharyngeal suctioning in premature infants to whom nasal continuous positive airway pressure was applied., Design: A double-blind, randomized controlled trial., Setting: This study was conducted in the neonatal intensive care unit in the tertiary setting between November 2012 and September 2013., Participants/subjects: A total of 106 preterm infants were divided into three groups, including 37 infants in the control group, 35 infants in the lullaby group, and 34 infants in the glucose group., Methods: All preterm infants were randomly assigned to either the intervention groups or the control group. Pain responses were assessed using the Neonatal Infant Pain Scale and the Premature Infant Pain Profile., Results: An assessment of the pain severity of the preterm infants after the intervention indicated that the preterm infants in the lullaby and glucose groups had lower pain, whereas the preterm infants in the control group experienced more pain (p < .05)., Conclusion: The findings suggest that pain could be reduced significantly in preterm infants after the suggested intervention, although further studies are required to identify the benefits of lullabies or glucose in infants during other painful procedures., (Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Most children experience pain in hospitals; and their parents report dissatisfaction with how well pain was managed. Engaging patients and families in the development and evaluation of pain treatment plans may improve perceptions of pain management and hospital experiences., Objectives: The aim of this performance improvement project was to engage patients and families to address hospitalized pediatric patients' pain using interactive patient care technology. The goal was to stimulate conversations about pain management expectations and perceptions of treatment plan effectiveness among patients, parents, and health care teams., Methods: Plan-Do-Study-Act was used to design, develop, test, and pilot new workflows to integrate the interactive patient care technology system with the automated medication dispensing system and document actions from both systems into the electronic health record., Setting: The pediatric surgical unit and hematology/oncology unit of a free-standing, university-affiliated, urban children's hospital were selected to pilot this performance improvement project because of the high prevalence of pain from surgeries and hematologic and oncologic diseases, treatments, and invasive procedures., Results: Documentation of pain assessments, nonpharmacologic interventions, and evaluation of treatment effectiveness increased. The proportion of positive family satisfaction responses for pain management significantly increased from fiscal year 2014 to fiscal year 2016 (p = .006)., Conclusion: By leveraging interactive patient care technologies, patients and families were engaged to take an active role in pain treatment plans and evaluation of treatment outcomes. Improved active communication and partnership with patients and families can effectively change organizational culture to be more sensitive to patients' pain and patients' and families' hospital experiences., (Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Despite advances in the science of sedation and pain assessment, few studies have examined the impact of various assessment tools on nursing confidence. This study examines how bispectral index monitoring impacts nursing confidence in the assessment and comfort in medication administration based on that assessment. In this prospective observational Quality Improvement project, nurses using bispectral index (BIS) and the Richmond Agitation Sedation Scale (RASS) were randomly selected to complete a self-assessment survey intended to measure their personal confidence and comfort regarding care they were providing for a specific patient on the day the survey was completed. From 110 nurse surveys, nurses had higher confidence assessing pain and sedation when BIS monitor was used in concert with RASS assessments for patients with neuromuscular blockade agents. There was no different in confidence in- nor comfort with- sedation and pain assessments for patients not receiving neuromuscular blockade agents., (Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Previous studies have suggested that pain in older people with dementia is often underestimated and undertreated in acute hospitals. Undermanaged pain negatively affects a person's recovery and prolongs hospital stays. However, the issues related to pain assessment and management by nurses for this group have not been fully understood. (1) To synthesize evidence about pain assessment and management for older people with dementia in hospital settings, and (2) to discuss implications for nurses and their practice. Integrative literature review. A systematic search of evidence-based research from six electronic databases (CINAHL, MEDLINE, ProQuest, Cochrane, JBI, and Scopus) was conducted for the period of 2006-2016. Following Cooper's integrative review framework and a systematic screening process, the articles included were analyzed and synthesized to identify the common issues and relationships. Fourteen empirical research articles were examined and synthesized. Two main categories were identified and include: the nursing practice of pain assessment in older patients with dementia is less than optimal, and the nursing practice of pain management for this group varies. The lack of initiation of pain assessment and use of pain assessment tools may contribute to the inadequate pain management by nurses. Whereas this review uncovered the extent and challenges related to pain assessment and management, previous studies were explorative and descriptive. The findings from the review provide nurses with an opportunity to establish empirical evidence that may improve nursing practice of pain assessment and management for older people with dementia in hospital settings., (Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Behavioral scales allow for the pain assessment of vulnerable critically ill patients who are unable to self-report. However, validity of the use of such scales is limited in traumatic brain injury patients with an altered level of consciousness as a result of the different way that these patients express pain. Family participation is considered as an important component of pain assessment for those unable to self-report, but research in this area is minimal so far. This study aimed to describe what behaviors family caregivers deemed relevant to pain for patients with a traumatic brain injury with an altered level of consciousness in the intensive care unit. Using a mixed-method descriptive design, semistructured interviews were conducted and behaviors' relevance was quantitatively rated by seven family caregivers of nonverbal patients with traumatic brain injury in the intensive care unit of a tertiary trauma center in Montreal, Canada. Family caregivers were able to provide rich descriptions of a number of behaviors they observed in their loved ones that were perceived to be relevant indicators of pain, such as muscle tension and key facial expressions and body movements. Several factors influenced how behaviors were interpreted by family, including personal medical beliefs and intimate knowledge of the patient's history. The pain behaviors determined by family caregivers can be useful in the pain assessment process of traumatic brain injury patients with an altered level of consciousness. Their input could also be helpful in further development of pain assessment tools., (Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co-morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring women's experiences who have co-occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit. Our findings suggest that these women view their pain as complex and often feel powerless within an acute psychiatric setting resorting to coping through self management. The women expressed the importance of therapeutic relationships with clinicians in assessing and managing their pain. The implications of this study suggest that patients have a key role in informing the implementation and applicability of best practice guidelines. Validating the patient's personal pain management experience and particular psychological and physical therapies were suggested as strategies to enhance the patient's quality of life. Many clinicians working in mental health are knowledgeable about these therapies, but may not be aware of the application to managing physical pain., (Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Accurate assessment of pain and its management is a challenging aspect of pediatric care. Nurses, usually the primary caregivers, showed inadequate knowledge and restrictive attitudes toward pain assessment. We evaluated an educational intervention to improve nurses' assessment of pain in a teaching hospital in India. A convenient sample of nurses working in the neonatal intensive care unit, pediatric ward, pediatric intensive care unit, and pediatric cardiac intensive care unit were included in the study. Workshops to improve understanding of pain, its assessment, and management strategies were conducted. A modified and consensually validated Knowledge and Attitudes Survey Regarding Pain questionnaire-2008 consisting of 25 true/false questions, eight multiple choice questions, and two case scenarios was administered before, immediately after, and 3 months after the workshops to evaluate impact of the intervention. Eighty-seven nurses participated. Mean (standard deviation) experience was 4.04 (5.9) years. Thirty-seven percent felt that they could assess pain without pain scales. About half (49.4%) of the nurses had not previously heard of pain scales, while 47.1% reported using a pain scale in their routine practice. Significant improvement was observed between pretest and post-test total scores (15.69 [2.94] vs. 17.51 [3.47], p < .001) as well as the pretest and retention score (15.69 [2.94] vs. 19.40 [4.6], p < .001). Albeit the study site and sampling frame may limit the reliability of the findings, the educational intervention was successful, and better retention test scores suggest a cascading effect. Pain assessment and management education of children should be incorporated in the nursing curriculum and should be reinforced in all pediatric units., (Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers can increase the use of available evidence for pain management., (Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

The purpose of this paper was to assess undergraduate nursing students' pain knowledge after participation in a simulation scenario. The Knowledge and Attitudes of Survey Regarding Pain (KASRP) was used to assess pain knowledge. In addition, reflective questions related to the simulation were examined. Student preferences for education method and reactions to the simulation (SIM) were described. Undergraduate nursing students' knowledge of pain management is reported as inadequate. An emerging pedagogy used to educate undergraduate nurses in a safe, controlled environment is simulation. Literature reports of simulation to educate students' about pain management are limited. As part of the undergraduate nursing student clinical coursework, a post-operative pain management simulation, the SIM was developed. Students were required to assess pain levels and then manage the pain for a late adolescent male whose mother's fear of addiction was a barrier to pain management. The students completed an anonymous written survey that included selected questions from the KASRP and an evaluation of the SIM experience. The students' mean KASRP percent correct was 70.4% ± 8.6%. Students scored the best on items specific to pain assessment and worst on items specific to opiate equivalents and decisions on PRN orders. The students' overall KASRP score post simulation was slightly better than previous studies of nursing students. These results suggest that educators should consider simulations to educate about pain assessment and patient/family education. Future pain simulations should include more opportunities for students to choose appropriate pain medications when provided PRN orders., (Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Despite available guidelines and efforts to improve pain management, pain remains prevalent in hospitals. The aim of this study was to explore whether pain management practices in a university hospital were in line with guidelines on acute, geriatric, and cancer pain. This was a descriptive, correlational, and point-prevalence study conducted at a university hospital with 282 adults, who were hospitalized for 24 hours and were alert and able to participate. Patient self-report data were collected with the American Pain Society questionnaire and pain management data were collected from medical records. Adequacy of treatment was measured with the Pain Management Index, calculated for prescribed and administered treatments. The mean age of participants was 68.9 years (SD = 17; range 18-100); 49% were women; and 72% were on medical services. Pain assessment was documented for 57% of patients, of those, 27% had pain severity documented with a standardized scale. Most patients (85%) were prescribed analgesics and multimodal therapy was prescribed for 60%. Prescribed treatment was adequate for 78% of patients, whereas 64% were administered adequate treatment. The odds of receiving adequate treatment were higher (odds ratio, 3.44; 95% confidence interval, 1.38-8.60) when pain severity was documented. Nonpharmacologic methods were used by 34% of patients. Although the majority of patients had an analgesic prescription, many did not receive adequate treatment. The use of pain severity scales was associated with the provision of more adequate pain treatment. To provide quality pain management, pain assessment needs to be improved and available treatments used to meet patient needs., (Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Determining patient satisfaction with postoperative pain management is an important intervention to improve strategies for effective pain control. The aim of this study was to validate an English version of the 14-item Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire in Turkish language. The study included 113 patients who underwent elective surgeries at a university hospital in Bursa, Turkey. The data were collected after translation procedures and final adjustments were done on the original instrument. For the total scale, Cronbach's coefficient α was 0.81 and the main score obtained from the scale was 45.8 ± 10.8. Included were three subscales: nursing interventions, pain management, and environments. Of the patients, 40.7% reported more pain than expected in the postoperative period and their satisfaction with pain relief was 7.4 ± 2.5. This instrument is a reliable and valid instrument in Turkish language and can be used to evaluate the effectiveness of postoperative pain management., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

The Nociception Coma Scale (NCS) is a pain observation tool, developed for patients with disorders of consciousness (DOC) due to acquired brain injury (ABI). The aim of this study was to assess the interrater reliability of the NCS and NCS-R among nurses for the assessment of pain in ABI patients with DOC. A secondary aim was further validation of both scales by assessing its discriminating abilities for the presence or absence of pain. Hospitalized patients with ABI (n = 10) were recorded on film during three conditions: baseline, after tactile stimulation, and after noxious stimulation. All stimulations were part of daily treatment for these patients. The 30 recordings were assessed with the NCS and NCS-R by 27 nurses from three university hospitals in the Netherlands. Each nurse viewed 9 to 12 recordings, totaling 270 assessments. Interrater reliability of the NCS/NCS-R items and total scores were estimated by intraclass correlations (ICC), which showed excellent and equal average measures reliability for the NCS and NCR-R total scores (ICC 0.95), and item scores (range 0.87-0.95). Secondary analysis was performed to assess differences in ICCs among nurses' education and experience and to assess the scales discriminating properties for the presence of pain. The NCS and NCS-R are valid and reproducible scales that can be used by nurses with an associate (of science) in nursing degree or baccalaureate (of science) in nursing degree. It seems that more experience with ABI patients is not a predictor for good agreement in the assessment of the NCS(-R)., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Comparing organizational approaches to pain management is warranted to understand best practices and provide decision makers with evidence on which to base resource intensive documentation policy decisions. To provide this evidence, a multilevel modeling (MLM) approach is required to accommodate the interrelatedness and nested nature of pain management factors affecting outcomes. Along with MLM, the widespread adoption of the electronic record provides an ability to capitalize on the repeated measurement benefit of the current pain management documentation output by using pain severity trajectory (PST) as a precise and clinically relevant outcome of interest. Therefore, the purpose of this pilot study was to examine the methodological issues that arise when conducting MLM research aimed to answer the question: what is the impact of assessment and reassessment documentation routines on postoperative pain severity trajectory? Researchers used timed pain management documentation data output to construct a growth model of a patient's PST and performed a two-level analysis from a convenience sample of 3 hospitals and 146 patients. Analyses revealed that the hospital where care occurred, the type of surgical procedure, and the presence of reassessment documentation within one hour of intervention affected the PST. Pilot work showed that pain management documentation output could be reformulated into research variables for hypothesis testing. The presentation of the reassessment data output posed a measurement limitation. An interdisciplinary research team is needed to adequately compare organizational practices. Basing policies on evidence has the potential to improve pain management care., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Very few multidimensional tools are available for measurement of pain in children and adolescents. We critically reviewed the scientific literature to examine the psychometrics and utility of the Adolescent Pediatric Pain Tool (APPT), a multidimensional self-report tool that evaluates the intensity, location, and quality (including affective, evaluative, sensory, and temporal) dimensions of pain. The APPT is available in English and Spanish for children and adolescents, and was modeled after the McGill Pain Questionnaire in adults. We found good evidence for construct validity, reliability, and sensitivity of the APPT for the measurement of pediatric pain. The APPT was used to measure pain in children with different conditions, such as cancer, sickle cell disease, orthopedic, traumatic injuries, and allergy testing. Although the APPT was designed to assess the multiple dimensions of pain, the majority of the reports included results only for the intensity ratings. Unlike the numerical and pediatric faces rating scales, which are widely used in clinical practice and research, the APPT is not limited to the single dimension of pain intensity. It measures multiple dimensions, and may be able to discriminate between nociceptive and neuropathic pain. The APPT is one of a few multidimensional pain measures that can help to advance the science of pediatric pain and its management. When the APPT is used in practice or research, the multiple dimensions of pain may be characterized and compared in different painful conditions. It may guide the use of multimodal interventions in children and adolescents with a variety of pain conditions., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Active usage of observational pain scales in Japanese aged-care facilities has not been previously described. Therefore, to examine the feasibility and clinical utility of the Abbey Pain Scale-Japanese version (APS-J), this study examined the interrater reliability of the APS-J among a researcher, nurses, and care workers in aged-care facilities in Japan. This study also aimed to obtain nurses' and care workers' opinions on use of the scale. The following data were collected from 88 residents of two aged-care facilities: demographics, Barthel Index, Folstein Mini-Mental Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and APS-J for pain. The researchers, nurses, and care workers independently assessed the residents' pain by using the APS-J, and intraclass correlation coefficients (ICC) for interrater reliability and Cronbach alpha for internal consistency were examined. The ICC between researchers and nurses, researchers and care workers, and nurses and care workers were 0.68, 0.74, and 0.76, respectively. Nurses and care workers were invited for focus group interviews to obtain their opinions regarding APS-J use. During these interviews, nurses and care workers stated that the observational points of APS-J subscales were the criteria they normally used to evaluate residents' pain. Several nurses and care workers reported a gap between the estimated pain intensity and APS-J score. Unclear APS-J criteria, difficulties in observing residents, and insufficient practice guidelines were also reported. Our findings indicate that the APS-J has moderate reliability and clinically utility. To facilitate APS-J usage, education and clinical guidelines for pain management may be required for nurses and care workers., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

The validity and reliability of the Abbey Pain Scale-Japanese version (APS-J) have been examined. However, the range of cognitive levels for which the APS-J can be accurately used in older adults has not been investigated. This study aimed to examine the differences between total/item scores of the APS-J and Mini-Mental State Examination (MMSE) scores of residents in aged care facilities who self-reported the presence or absence of pain. This descriptive study included 252 residents in aged care facilities. Self-reported pain, MMSE scores, and item/total APS-J scores for pain intensity were collected. The MMSE scores were used to create four groups on the basis of the cognitive impairment level. Self-reports of pain and the APS-J scores were compared with different MMSE score groups. The total APS-J score for pain intensity as well as scores for individual items such as "vocalization" and "facial expression" were significantly higher in those who reported pain than in those reporting no pain across all MMSE groups. The total APS-J score and item scores for "vocalization," "change in body language," and "behavioral changes" showed significant differences in the four MMSE groups. Pain intensity tended to be overestimated by the APS-J, especially among those with low MMSE scores. The APS-J can be used to assess pain intensity in residents despite their cognitive levels. However, caution is required when using it to compare scores among older adults with different cognitive capacity because of the possibility of overestimation of pain among residents with low cognitive capacity., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Pain management is an important aspect of providing quality health care, and monitoring patient-related outcomes is a recommended quality improvement practice. Valid and reliable tools are needed for this purpose. The American Pain Society Patient Outcome Questionnaire (APS-POQ) is widely used to measure quality of pain management. The APS-POQ was recently revised to reflect advances in pain management. The purpose of this study was to test the psychometric properties of the revised version in Icelandic patients in the hospital setting. The questionnaire was translated according to an adaptation of Brislin's model. Data were collected from 143 patients on 23 wards in a university hospital. Participants were ≥ 18 years old, hospitalized for >24 hours, alert, not too ill to participate, and in pain ≥ 1 on a 0-10 scale in the past 24 hours. Mean (SD) age was 66 (18) years, 51.4% were women, 48.6% men. Principal component analysis with varimax rotation confirmed a five-component structure, but four items lowered reliability and were removed from the scales. The final version consists of four components, with Cronbach α >.70, explaining 64.2% of the variance. Participants had little difficulty in answering the questionnaire, but two additional items about participation in decisions and pain medications were added in response to patients' comments and suggestions. Administering the Icelandic version of the APS-POQ-R was found to be feasible, and the questionnaire has acceptable construct validity and reliability. The results support the use of the APS-POQ-R-I to evaluate the quality of pain management in hospitals in Iceland., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Pain has been promoted as the fifth vital sign for a decade, but there is little empirical evidence to suggest that doing so has affected the care of individuals suffering pain. This was a three-stage audit of pain assessment in one large teaching hospital in the Northwest of England. Stage one measured the baseline pain assessment activity on surgical and medical wards and identified that the pain assessment tool was not visible to nurses. Stage two redesigned the patient observation charts held at the end of the bed and piloted two versions for clinical utility. Version 2 which had pain assessment alongside the early warning score was adopted and introduced throughout the hospital. Stage three audited pain assessment and management 8 months after the introduction of the new charts. Pain was assessed more regularly at the stage three audit than at the baseline audit. On average, pain was assessed alongside other routine observations 70% of the time across surgical and medical wards. Medical wards appeared to improve their pain assessment using the philosophy of pain being the fifth vital sign better than surgical wards, because they assessed pain alongside routine observations in >90% of cases. Stage three identified that where a high pain score was recorded, analgesia was delivered in the majority of cases (88%). Introducing the philosophy of pain as the fifth vital sign and making pain assessment more visible on the patient observation chart improved the uptake of pain assessment. Pain management strategies were stimulated when high pain scores were identified., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)