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Objective: To determine the impacts of pain nursing intervention of patients with craniocerebral trauma combined with ocular trauma after decompressive craniotomy. Method: This was retrospective study. Eighty patients with craniocerebral trauma combined with ocular trauma who underwent unilateral decompressive craniectomy in Baoding No.1 Central Hospital from January 2023 to November 2023 were included and divided into the observation group(n=40) and the control group(n=40) according to different nursing methods. Patients in the control group received conventional nursing intervention, while those in the observation group received pain nursing intervention. The differences in sleep quality, self-care ability, quality of life, psychological state and nursing satisfaction were compared between the two groups. Results: After intervention, the pain degree of both groups was significantly reduced compared with that before intervention, and the reduction degree of the observation group was more than that of the control group, with a statistically significant difference (p<0.05). The SS-QOL scores of both groups were significantly improved compared with before intervention, and the improvement degree of the observation group was significantly better than that of the control group, with a statistically significant difference (p<0.05). The nursing satisfaction score of the observation group was (93.35±3.83) points, which was higher than (83.38±3.59) points of the control group, with a statistically significant difference (t=12.019, P=0.000). Conclusion: Pain nursing intervention shows a variety of benefits in the treatment of patients with craniocerebral trauma combined with ocular trauma after decompressive craniectomy, improving their quality of life, self-care ability and nursing satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To determine the impacts of pain nursing intervention of patients with craniocerebral trauma combined with ocular trauma after decompressive craniotomy., Method: This was retrospective study. Eighty patients with craniocerebral trauma combined with ocular trauma who underwent unilateral decompressive craniectomy in Baoding No.1 Central Hospital from January 2023 to November 2023 were included and divided into the observation group(n=40) and the control group(n=40) according to different nursing methods. Patients in the control group received conventional nursing intervention, while those in the observation group received pain nursing intervention. The differences in sleep quality, self-care ability, quality of life, psychological state and nursing satisfaction were compared between the two groups., Results: After intervention, the pain degree of both groups was significantly reduced compared with that before intervention, and the reduction degree of the observation group was more than that of the control group, with a statistically significant difference ( p< 0.05). The SS-QOL scores of both groups were significantly improved compared with before intervention, and the improvement degree of the observation group was significantly better than that of the control group, with a statistically significant difference ( p< 0.05). The nursing satisfaction score of the observation group was (93.35±3.83) points, which was higher than (83.38±3.59) points of the control group, with a statistically significant difference ( t =12.019, P =0.000)., Conclusion: Pain nursing intervention shows a variety of benefits in the treatment of patients with craniocerebral trauma combined with ocular trauma after decompressive craniectomy, improving their quality of life, self-care ability and nursing satisfaction., Competing Interests: Conflicts of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Nurses have an ethical responsibility to manage pain and the suffering derived from it. Given the complexity of patients in the critical care setting and the high incidence of pain experienced by critically ill patients, critical care nurses may experience moral distress when pain is inadequately managed. To address moral distress associated with pain management, critical care nurses should be provided with education on evidence-based pain management practices and encouraged to evaluate their personal biases and beliefs regarding pain management. Furthermore, organizations should consider the implementation of programs to address moral distress stemming from pain management and other precipitating factors., Competing Interests: Disclosure The author has no disclosures or conflicts of interest to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset, rapid progression, obvious fluctuations, and preventable, reversible, and other characteristics. Patients with delirium in the intensive care unit (ICU) are often missed or misdiagnosed and do not receive adequate attention., Aim: To analyze the risk factors for delirium in ICU patients and explore the application of emotional nursing with pain nursing in the management of delirium., Methods: General data of 301 critically ill patients were retrospectively collected, including histories (cardiovascular and cerebrovascular diseases, hypertension, smoking, alcoholism, and diabetes), age, sex, diagnosis, whether surgery was performed, and patient origin (emergency/clinic). Additionally, the duration of sedation, Richmond Agitation Sedation Scale score, combined emotional and pain care, ventilator use duration, vasoactive drug use, drainage tube retention, ICU stay duration, C-reactive protein, procalcitonin, white blood cell count, body temperature, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission. Patients were assessed for delirium according to confusion assessment method for the ICU, and univariate and multivariate logistic regression analyses were performed to identify the risk factors for delirium in the patients., Results: Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients. The results showed that 16 risk factors were closely related to delirium, including combined emotional and pain care, history of diabetes, and patient origin. Multivariate logistic regression analysis revealed that no combined emotional and pain care, history of diabetes, emergency source, surgery, long stay in the ICU, smoking history, and high APACHE II score were independent risk factors for delirium in ICU patients., Conclusion: Patients with diabetes and/or smoking history, postoperative patients, patients with a high APACHE II score, and those with emergency ICU admission need emotional and pain care, flexible visiting modes, and early intervention to reduce delirium incidence., Competing Interests: Conflict-of-interest statement: The authors declare no conflict of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Early-life pain is associated with adverse neurodevelopmental consequences; and current pain assessment practices are discontinuous, inconsistent, and highly dependent on nurses' availability. Furthermore, facial expressions in commonly used pain assessment tools are not associated with brain-based evidence of pain., Purpose: To develop and validate a machine learning (ML) model to classify pain., Methods: In this retrospective validation study, using a human-centered design for Embedded Machine Learning Solutions approach and the Neonatal Facial Coding System (NFCS), 6 experienced neonatal intensive care unit (NICU) nurses labeled data from randomly assigned iCOPEvid (infant Classification Of Pain Expression video) sequences of 49 neonates undergoing heel lance. NFCS is the only observational pain assessment tool associated with brain-based evidence of pain. A standard 70% training and 30% testing split of the data was used to train and test several ML models. NICU nurses' interrater reliability was evaluated, and NICU nurses' area under the receiver operating characteristic curve (AUC) was compared with the ML models' AUC., Results: Nurses weighted mean interrater reliability was 68% (63%-79%) for NFCS tasks, 77.7% (74%-83%) for pain intensity, and 48.6% (15%-59%) for frame and 78.4% (64%-100%) for video pain classification, with AUC of 0.68. The best performing ML model had 97.7% precision, 98% accuracy, 98.5% recall, and AUC of 0.98., Implications for Practice and Research: The pain classification ML model AUC far exceeded that of NICU nurses for identifying neonatal pain. These findings will inform the development of a continuous, unbiased, brain-based, nurse-in-the-loop Pain Recognition Automated Monitoring System (PRAMS) for neonates and infants., (Copyright © 2024 by The National Association of Neonatal Nurses.)

The widely used and acknowledged universal definition of pain developed by the International Association for the Study of Pain (IASP) in 1979 has been revised in 2020. The 2020 IASP definition states pain is 'an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage'. The 2020 IASP definition of pain reinforces the importance for nurses to have an understanding of the pathophysiology of pain and highlights the crucial role pain assessment plays in overall pain management, which nurses are pivotal in driving and delivering. [ABSTRACT FROM AUTHOR]

Background: Urological calculi often cause renal colic, which is characterized by paroxysmal or persistent severe pain in the upper abdomen or lumbar region. Development of methods to quickly relieve these pain symptoms has garnered clinical attention. Wrist-ankle acupuncture is a type of floating acupuncture therapy administered at selected points in the carpal and ankle areas, and it has good pain-relieving effects. We used wrist-ankle acupuncture combined with pain nursing for pain intervention in patients with renal calculi to confirm its application and safety., Aim: To study the effect of wrist-ankle acupuncture combined with pain nursing in the treatment of urinary calculi with acute pain., Methods: Eighty-two patients with urinary calculi with acute pain as the first symptom followed at our hospital from November 2019 to June 2021 were enrolled in the study and classified into two groups according to the odd and even numbers of the visit sequences, each with 41 cases. The control group received a routine nursing intervention and intramuscular injection of nonsteroidal anti-inflammatory drugs, whereas the observation group received pain management nursing and wrist-ankle acupuncture. Subsequently, the pain-relieving effect was compared between the two groups., Results: The score on the visual analog scale (VAS) at 24, 48, and 72 h postintervention was decreased in both groups compared with the baseline data; moreover, the observation group scored significantly lower than the control group on the VAS at each time point after the intervention ( P < 0.05). The clinical efficacy at 24 h postintervention was not significantly different between the two groups ( P > 0.05). In turn, the pain recurrence rate at 72 h postintervention was lower in the observation group compared with the control group ( P < 0.05). Finally, the nursing satisfaction rate in the observation group was significantly higher than that observed in the control group ( P < 0.05). No serious adverse reactions occurred during the treatment and the safety of treatment was high in both groups., Conclusion: Wrist-ankle acupuncture combined with pain nursing for treating urolithiasis with acute pain effectively alleviated the degree of pain and reduced the recurrence rate, which was worthy of clinical application., Competing Interests: Conflict-of-interest statement: There are no conflicts of interest to report., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Augmentative and alternative communication (AAC) has been used by patients with acquired expressive communication disorders as an alternative to natural speech. The use of symbols to express pain, which is intangible, is challenging because designing a series of comprehensible symbols to represent personal experiences such as pain is not straightforward. This study describes (a) the development of symbols to express pain that were derived from Chinese pain-related similes and metaphors for an AAC mobile application developed specifically for this study known as PainDiary and (b) an assessment of the appropriateness of the app compared to conventional methods of collecting pain information. The symbols depicted headache pain and discomfort, which is prevalent among neurosurgical patients. The participants were 31 patients diagnosed with acquired expressive communication disorders who were receiving treatment in a neurosurgery general ward of Chang Gung Memorial Hospital in Taiwan and 14 nurses who worked on the ward. Pain information was collected by nurses using conventional methods and the PainDiary app. Assessment data, including the accuracy and efficiency of and user satisfaction with PainDiary, are compared. The results show that use of the app was effective in reporting pain and that patients required less time to report a pain event. The results further indicate that the PainDiary app was better received by younger individuals than by their older counterparts.

The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration., Competing Interests: None declared, (© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Purpose: To determine the impact of music on the physiologic and psychological stress experienced by hospital inpatients., Methods: This pilot study monitored vital signs; utilized pain, anxiety, and agitation rating scales; and gathered verbal feedback from 50 participating inpatients at the authors' healthcare facility as they listened to music via an audiovisual interactive patient engagement technology system., Results: After listening to music for 30 minutes, patients reported significantly lower pain and anxiety., Conclusion: Music offered a helpful tool to reduce pain and anxiety for patients in the ICU and telemetry units at the authors' healthcare facility. Future research may be geared toward incremental expansion and monitoring of this music intervention in other units., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The community respiratory nurse specialist (CRNS) supports patients at different stages of lung disease, witnessing the challenge of living with chronic obstructive pulmonary disease (COPD), a progressive illness for which there is no cure. Breathlessness is the most prominent and debilitating symptom experienced; it is frightening, distressing and very difficult to manage. Little is known about the experience of CRNSs in witnessing the distress of patients, specifically those experiencing breathlessness. The nurse may have cared for such patients over many months or years. In witnessing this distress, CRNSs engage in emotional labour, which is associated with burnout and poor-quality care. This paper seeks to identify bearing witness to suffering and vulnerability as components of emotional labour in the context of the CRNS role. It highlights the need for research to explore the experience of CRNSs and insights into supporting people with long-term breathlessness. It is more likely that well-supported staff can provide sustained, supportive care to patients living with breathlessness.

Objective: To explore the effect of acupoint application combined with virtual reality (VR) technology in relieving pain after circumcision in children., Methods: Using a random number table, we divided 106 children undergoing circumcision into a control and an intervention group of an equal number, the former receiving routine nursing care, and the latter acupoint application combined with VR technology. We compared between the two groups the postoperative pain scores with the Changhai pain ruler, the Hamilton Anxiety Scale (HAMA) scores, and the satisfaction of the patients and their families., Results: Compared with the controls, the patients in the intervention group showed a significantly lower HAMA score (［2.94 ± 0.98］ vs ［1.06 ± 0.92］, P < 0.05) and postoperative pain score (［5.96 ± 1.24］ vs ［3.66 ± 1.18］, P < 0.05), but higher satisfaction in the patients and their families (86.79% vs 98.11%, P < 0.05)., Conclusions: Acupoint application combined with VR technology for children after circumcision has the advantages of effectively relieving the anxiety of the patients, distracting their attention, increasing the pain perception threshold, reducing the perception of pain, improving the satisfaction of the patients and their family members.

Maintaining skin integrity plays a key role in the ongoing care and comfort of patients at the end of life. Unfortunately, patients receiving cancer treatments are at higher risk of altered skin integrity. Cancer treatments involve multiple modalities, all of which impair wound healing. Excess exudate can be distressing to patients, resulting in catastrophic damage to the wound bed and surrounding skin, reducing quality of life and increasing the need for specialist services. This article describes the use of the Kliniderm foam silicone range of dressings, in combination with best practice, in the treatment of wounds in the oncology setting. The case study evidence presented indicates that this range of dressings is useful in the management of radiotherapy and oncology wounds. It had a positive effect on the exudate level, wound-association pain and the peri-wound skin in these patients, aiding the management of the wound bed.

Purpose: To assess the supportive care needs (SC-needs), quality of patient-centered care (PCC), and factors associated with increased SC-needs of patients with lung cancer (LC) in Mexico., Methods: We conducted a cross-sectional survey in the main oncology hospital of the Mexican Institute of Social Security in Mexico City. The study included LC ambulatory patients aged ≥18 years with at least one hospitalization before the survey, ≤five years since diagnosis, and without memory loss. Participants answered SC-needs and quality of PCC questionnaires. We performed a multiple negative binomial regression analysis to evaluate the factors associated with an increased number of SC-needs., Results: One hundred twenty-eight LC patients participated. Most participants had adenocarcinoma (61.7%) and were at an advanced disease stage (92.1%). In the month preceding the survey, 3.9% had undergone surgery and 78.9% had been receiving chemotherapy and/or radiotherapy; 28.9% had symptoms of depression and 21.9% had anxiety. All patients reported one or more SC-needs-predominantly physical, daily living, information, and psychological needs. The significant gaps in PCC-quality were in the domains of care that addressed biopsychosocial needs and information for treatment decision-making. Factors that decreased the probability of SC-needs were respectful and coordinated care, high-school education, and older age. The factors increasing the likelihood of SCneeds were the type of LC (adenocarcinoma, mesenchymal tumors), chemotherapy and/or radiotherapy, and anxiety., Conclusion: PCC improvement initiatives to address SC-needs of LC patients should be prioritized and focus on: (1) information on physical suffering relief and treatment; (2) psychological support; and (3) SC-needs monitoring., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Venous leg ulcers (VLU) respond well to compression, yet many ulcers remain unhealed after 1 year. Practitioners could be reluctant to apply compression to patients with significant ulcer pain. This study aimed to capture the views of practitioners on compression therapy for patients with painful VLU. A survey was conducted at a UK meeting in 2019 using handheld voting pads to capture the anonymous responses to four questions to which a mean of 90 practitioners responded. Nearly 40% of practitioners treat six or more patients a day with painful lower-limb ulcers. Some 80% felt confident in managing patients with painful ulcers; yet, most practitioners suggested they would refer onward for pain management. Some 40% would omit or reduce compression therapy as a pain management strategy. This survey supports the need for technological solutions that reduce VLU pain so that patients receive effective compression therapy.

Objectives: This study was a randomized, controlled examination of the effect of the Buzzy device (MMJ Labs, LLC, Atlanta, GA, USA) in reducing pain during peripheral intravenous cannulation in children. The device uses a combination of highfrequency vibration and cold to block pain., Methods: The study was conducted with 56 children aged 7-12 years who presented at the pediatric emergency department of Trakya University Health Center for Medical Research and Practice. Data were gathered using a family and child data collection form and the Wong-Baker FACES Pain Rating Scale (Wong-Baker FACES Foundation, Oklahoma City, OK, USA). A vein visualization tool was used in both groups for peripheral intravenous cannulation, and the Buzzy device was also used in the experimental group. The pain of the children was assessed by a nurse and the children. Descriptive statistics, the Wilcoxon t-test, the Mann-Whitney U test, and correlation analysis were used to evaluate the data. The results were evaluated at a 95% confidence interval and p<0.05 was accepted as the level of significance., Results: The mean age of the children was 8.37±1.96 years and 58.9% were male. The mean pain score provided by the children in the experimental group was 3.40±3.56 and it was 3.76±3.06 in the control group. The mean pain score reported by the nurse for the experimental group was 4.53±3.44 and 3.76±2.73 for the control group. There was no significant difference between the pain scores reported by the children and the nurse according to group (p<0.05). However, there was a significant difference between the pain scores recorded by the nurse and the children (p=0.034)., Conclusion: The Buzzy device was not effective in reducing pain during intravenous cannulation. The level of pain reported by the nurse was higher than that described by the children. It is recommended that training on pain assessment and the use of distraction methods should be provided to nurses working in pediatric emergency departments.

Background: The opioid crisis has influenced practice changes to mitigate risks to patients receiving opioids. It is essential that nurses understand contemporary guidelines to provide safe patient care for patients receiving opioids., Purpose: This study was designed to assess general knowledge of opioids among nurses in nonprescribing patient care roles., Methods: A survey was developed, validated, and deployed to 564 nurses in a large hospital system., Results: Nurses had strong knowledge of basic pharmacology, the conjunctive use of nonopioids for pain relief, and differences in analgesia for chronic versus acute pain. Opportunity for education included risk factors for opioid-related adverse events, medication combinations, differences in opioid tolerant and opioid-naïve patients, and recognition and management of overdose., Conclusions: Results of this study can be used to guide continuing education and academic curricula to ensure nurses are equipped with the key knowledge to provide safe quality clinical care and patient education.

Background: Intensive Care Units (ICU) usually treat patients with pain. Being close to patients makes nurses key professionals for guaranteeing an optimal assessment and treatment of pain, which are crucial to ensure quality care. Therefore this study aims to describe the knowledge and attitudes of ICU nurses about pain management in their clinical practice, and its relationship with socio-demographic data., Methods: Cross-sectional study carried out in a third level university teaching hospital ICU. The Knowledge and Attitudes Survey Regarding Pain (KARSP) translated into Spanish was used to obtain information about the knowledge and attitudes towards pain of nurses., Results: All nurses (n?=?37) working at the ICU answered the questionnaire. The mean score of the questionnaire was 5.87 over 10 (SD: 0.98, range: 7.89-3.68). There was not a statistically significant relationship among the questionnaire score and age, professional experience, time worked at the ICU, specialized training or pain training. However, nurses with a master's degree obtained significantly higher mean scores in the questionnaire (6.97; DE: 0.75 vs. 5.73; DE: 0.92; p?=?0.018)., Conclusions: ICU nurses show insufficient knowledge and attitudes towards pain. Having a master's degree improves the results obtained in the questionnaire about knowledge and attitudes towards pain.

Background: The Universal Health Coverage goals call for access to affordable palliative care to reduce inequities in "total pain" and suffering. To achieve this, a patient-centred understanding of these inequities is required., Aim: To assess association of total pain and suffering (i.e. physical, psychological, social, and spiritual health outcomes) and perceived health care quality with financial difficulties among stage IV solid malignancy patients., Design: Using baseline data from the COMPASS cohort study, we assessed total pain and suffering including physical (physical and functional well-being, pain, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual (spiritual well-being, hope) outcomes and perceived health care quality (physician communication, nursing care, and coordination/responsiveness). Financial difficulties were scored by assessing patient perception of the extent to which their resources were meeting expenses for their treatments, daily living, and other obligations. We used multivariable linear/logistic regression to test association between financial difficulties and each patient-reported outcome., Setting/participants: Six hundred stage IV solid malignancy patients in Singapore., Results: Thirty-five percent reported difficulty in meeting expenses. A higher financial difficulties score was associated with worse physical, psychological, social, spiritual outcomes, and lower perceived quality of health care coordination and responsiveness (i.e. greater total pain and suffering) (all p < 0.05). These associations persisted after adjustment for socio-economic indicators., Conclusion: Results identify advanced cancer patients with financial difficulties to be a vulnerable group with greater reported total pain and suffering. A holistic patient-centred approach to care at end-of-life may help meet goals for Universal Health Coverage.

Background: No studies have explored the pain resource nurse curriculum in the hospice setting. This curriculum offers a structured method to teach pain management to nurses., Aims: The purpose of this study was to examine the effect of implementing a modified pain resource nurse curriculum on nursing knowledge in a community hospice agency., Methods: A modified and condensed version of the pain resources nurse curriculum was presented to community hospice nurses during two educational sessions. A pre-test-post-test assessment was conducted using a modified version of the Nursing Knowledge and Attitudes Survey Regarding Pain tool to assess knowledge growth from the educational sessions., Findings: For educational session 1, average correct responses rose slightly from the pre-test to the post-test. However, this increase was not found to be statistically significant. For educational session 2, average correct responses rose an average of 2.6 points. This increase was found to be statistically significant., Conclusions: Based on this pre-experimental study, there is evidence that the pain resources nurse curriculum can provide an instructional framework for teaching hospice nurses. However, further study is needed, including a more rigorous design.

Aims and Objectives: To investigate the effects of education and counselling on anxiety and pain in women undergoing hysterosalpingography (HSG) as part of infertility treatment., Background: The hysterosalpingography has an important diagnostic role in finding the cause of infertility and making a decision on management of treatment. In addition, it is considered a feared procedure in the infertility process and the one about which very little is known. Women often experience anxiety and pain during the HSG procedure., Design: A randomised controlled trial., Methods: The CONSORT guidelines have been used to describe the methods. Women who were diagnosed with infertility between February-October 2016 were included in the study. The participants were randomised and divided into intervention (52) and control (53) groups. The sociodemographic and obstetric data collection form, the State-Trait Anxiety Inventory and a visual analogue scale were used before the procedure. After the questionnaires were applied to the intervention group, individual learning and counselling sessions were given about the hysterosalpingography process. Brochures were also distributed to the patients for their reference after the learning session. The control group received standard care., Results: When the intervention and control groups were compared, it was found that the education and counselling given before the HSG procedure significantly decreased the level of pain and anxiety felt by women. In addition, a significant positive correlation was found between pain and anxiety after the training in the intervention group., Conclusions: This study indicates that the education and counselling given to women before the HSG procedure are effective interventions for reducing pain and anxiety in women undergoing HSG., Relevance to Clinical Practice: With the application of HSG education and counselling, and the distribution of brochures to each patient, pain and anxiety can be reduced during the HSG procedure., (© 2019 John Wiley & Sons Ltd.)

Aims: To seek consensus on the key characteristics that comprise compassion in a health care setting from pre-defined experts currently researching in the field. Background: Compassion is a vital component in healthcare. There is currently little consensus on how compassion is defined or operationalized in healthcare or research. Design: Modified Delphi Study. Methods: A four phase Delphi process was conducted: (1) Literature review of contemporary research (2) open ended questionnaire ( n  = 9); (3) content analysis results and synthesis with literature; (4) two round Delphi approach (Round 1 n  = 8; Round 2 n  = 6). Results : A total of 31 out of 36 statements reached consensus. Conclusions: Experts came to a consensus that compassion was a virtuous response involving awareness of and participation in the suffering of another conveyed through action intended to reduce the suffering observed. Experts placed less emphasis on compassion as sympathetic concern or pity. Compassion does not involve witnessing of the plight of another nor suffering with the patient.

Chronic kidney disease (CKD) is a major health problem. The purpose of this qualitative study was to describe nephrology nurses' experiences in assessing and managing pain in patients who were receiving maintenance hemodialysis at outpatient units within a tertiary care institution. Semi-structured interviews were conducted with seven nurses, and a thematic analysis was used to analyze data. Themes emerged related to the complexity of pain assessment and management in these patients, who were often elderly. Nurses had to ascertain whether the pain was related to hemodialysis treatment, renal failure, or comorbidities. Nurses described managing pain within the context of the hemodialysis unit, and this required working as a team. Nurses also described the need for a palliative approach in patient care., Competing Interests: The authors reported no actual or potential conflict of interest in relation to this continuing nursing education activity., (Copyright© by the American Nephrology Nurses Association.)

Opioid use disorder and opioid misuse continue to increase rapidly in prevalence in North America. Nurses play a critical role in managing pain in patients who are at risk for opioid use disorder. The interplay of pain and opioid use disorder provides nurses with an opportunity to address urgent needs while treating patients across the continuum of care. This article reviews strategies for assessing risk for opioid use disorder while treating patients with pain. Implementing these approaches into daily nursing practice may improve patient care and help reduce the incidence of opioid use disorder., (©2019 American Association of Critical-Care Nurses.)

Background: Nurses must be highly knowledgeable and skilled regarding pain and its management to ensure optimal pain relief. However, nurses worldwide were found to have knowledge deficits and poor attitudes toward pain. Thus identifying the major areas of knowledge deficit regarding pain and incorporating these areas in nursing undergraduate education and nursing continuing training could improve nurses' knowledge and attitude toward pain., Aims: The purpose of this study was to assess Jordanian nurses' knowledge and attitude toward pain using the Nurses' Knowledge and Attitudes Survey (NKAS) and to identify the areas of deficit in nursing knowledge toward pain among Jordanian nurses., Design: Cross sectional descriptive study., Settings: Four Jordanian hospitals (governmental, private, teaching and royal medical services)., Participants/subjects: Nurses working in intensive care units (ICUs), emergency department, and surgical, medical and oncology wards in., Methods: This descriptive study used data from 417 nurses who completed the NKAS tool. The passing score for the NKAS survey was individually calculated for each nurse. Moreover, we examined each item to identify the percentage of correct answers for each of the 39 questions., Results: The percentage of correct response ranged from 18% to 92%. Only four nurses achieved an overall score of 80% or greater and none of them achieved a 100% correct response. We revealed extensive knowledge deficits among Jordanian nurses, particularly in pain assessment and its pharmacotherapeutics components. Moreover, we found that Jordanian nurses held many negative attitudes and misconceptions about pain., Conclusions: Insufficient knowledge and attitudes among nurses toward pain is a worldwide problem. However, recognizing the areas of knowledge deficit and establishing educational interventions based on these deficits could improve nurses' knowledge and attitudes regarding pain and their clinical practice., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

An estimated 100,000 obese (OB) and overweight (OW) children undergo tonsillectomy each year in the United States. Pain management in this population is particularly challenging because of weight-based dosing, clinician fears, potential for airway obstruction, and genetic differences. A framework is proposed to explain factors involved in the post-tonsillectomy pain (PTP) experience in OB and OW children. The tonsillectomy, the body's inflammatory state, and mechanical stressors comprise influencing factors in PTP progression. Clinician-delivered medication doses, genetic variants of drug metabolism, and soothing factors serve as mediating factors in the progression of PTP. Postanesthesia care unit (PACU) nurses may use this framework to better understand PTP progression in OB and OW children. PACU nurses may manipulate certain mediating factors discussed in this framework to moderate PTP progression in OB and OW children. Researchers may use this framework to support future research to improve PTP management in OB and OW children., (Copyright © 2019 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

The National Institutes of Nursing Research provides funding via the P20 grant mechanism for research infrastructure and resources to develop nurse scientists with expertise in symptom self-management. The Medical University of South Carolina College of Nursing was awarded a P20 grant in 2016 to build the Symptoms Self-Management Center for technology-enhanced interventions to address pain and fatigue in individuals with chronic health conditions. Resources were derived from three key subcores: bioinformatics, mHealth and eHealth consultative services, and community engagement. This paper describes methods for deriving specific resources within each subcore, the application of subcore resources in two pilot studies, and lessons learned during the early phases of our Symptoms Self-Management Center implementation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Multiple studies have been published on toxic epidermal necrolysis (TEN) and Stevens-Johnsen syndrome (SJS). Nursing care is an important part of the treatment of TEN patients. Unfortunately, limited information on nursing in TEN/SJS patients has been published in the current literature. Nursing research is needed to improve the complex nursing care required for these rare patients. Therefore, the objective was to assess nursing problems in TEN patients in a burn centre setting over a 30-year period., Methods: The data for this study were gathered retrospectively from nursing records of all patients with TEN/SJS admitted to Burn Centre Rotterdam between January 1987 and December 2016. Dutch burn centres were recently accepted as expertise centres for TEN patients. Nursing problems were classified using the classification of nursing problems of the Dutch Nursing Society., Results: A total of 69 patients were admitted with SJS/TEN. Fifty-nine patient files were available. The most frequently reported nursing problems (>20% of the patients) were wounds, threatened or disrupted vital functions, dehydration or fluid imbalance, pain, secretion problems and fever. Furthermore, TEN-specific nursing problems were documented, including oral mucosal lesions and ocular problems. The highest number of concomitant nursing problems occurred during the period between days three and 20 after onset of the disease and varied by nursing problem., Conclusions: The most frequently reported nursing problems involved physical functions, especially on days three to 20 after onset of the disease. With this knowledge, we can start nursing interventions early in the treatment, address problems at the first sign and inform patients and their families or relatives of these issues early in the disease process. A next step to improve nursing care for TEN patients is to acquire knowledge on the optimal interventions for nursing problems., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Aim: This study aims to examine the associations of pain assessment scope, nurses' certainty, patient outcomes, and cognitive and verbal characteristics of nursing home (NH) residents. Methods: This study used a descriptive correlational design and a convenience sample of 78 NH residents with dementia. Results: There are significant associations between the severity of dementia and the ability to self report symptoms in NH residents and nurses' certainty of pain. Also, pain assessment scope does not mediate the relationship between nurses' certainty and patient outcomes. Conclusion: Pain assessment in NH residents with dementia is very challenging for nurses due to multiple complex factors. Improved understanding of pain assessment in those residents and how it relates to certainty of pain and patient outcomes are crucial.

Introduction: Nurses encounter children who report of pain of diverse and unknown causes in their professional work. The current study therefore assessed and compared nursing students and nurses' knowledge and attitudes pertaining to children's pain in the Ghanaian context. The goal of this was to have a baseline information to guide the development and implementation of the content for a sustainable educational programme (short-course) for nursing students and nurses in Ghana., Methods: Between October and December 2018, a cross-sectional study was carried out among 554 final year nursing students and 65 nurses in Ghana. The Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain (PNKAS) was used to collect data from participants who were affiliated to four educational institutions and eight hospitals. Data were descriptively and inferentially analyzed using chi-square test of independence, independent samples t-test and one-way analysis of variance (ANOVA)., Results: Our findings revealed that nursing students and nurses generally had unsatisfactory knowledge and attitudes towards pain management in children. Nursing students however, had significantly higher scores than nurses in the total PNKAS score and in 10 out of the 13 identified item-areas. Greater scores were obtained by nursing students in areas which were related to pain physiology, pharmacokinetics, pharmacology of analgesics and pain perceptions (p < .05). All the participating nurses could not accurately determine: the onset of action of orally administered analgesics, equianalgesia of orally administered morphine, and the right dosage of prescribed morphine for a child who consistently reported of moderate to severe pain., Conclusion: Final year nursing students and nurses have unsatisfactory knowledge and attitudes regarding children's pain; which reiterates the need for urgent and effective educational efforts in this area. Regular in-service training should be offered to post-registration nurses to enhance their pediatric pain knowledge and attitudes for improved pain care in children., Competing Interests: The authors have declared that no competing interests exist.

Background: Systematic pain assessment is necessary to ensure effective pain management. Despite the availability of recommendations, guidelines, and valid tools for pain assessment, the actual implementation in clinical practice is inconsistent., Aims: The purpose of this study was to investigate intensive care nurses' pain assessment practices among critically ill patients in Jordanian hospitals., Design: A descriptive cross sectional design was used in this study., Settings: This study was conducted in 22 intensive care unites located in eight hospitals in Jordan., Participants/subjects: Convenience sampling was used to recruit a sample of 300 nurses working in intensive care units., Methods: The Pain Assessment and Management for the Critically Ill survey was used to collect data. Descriptive statistics, χ 2 , and correlational analysis were used to analyze data., Results: A total of 89.7% of nurses (N = 300) used pain assessment tools with patients able to communicate, and the numeric rating scale was the most commonly used tool. A total of 81.7% of the nurses used a pain assessment tool with patients unable to communicate, and the Adult Nonverbal Pain Scale was the most commonly used tool. Nurses' perceived importance of pain assessment was positively associated with frequent use of pain assessment tools. Nurses perceived the use of pain assessment tools for patients able to communicate as being more important than the use of pain assessment tools for patients unable to communicate., Conclusions: The majority of intensive care unit nurses used pain assessment tools for patients both able and unable to communicate; however, the most valid and reliable tools were not used often. Nurses were not aware of the pain behaviors most indicative of pain among critically ill patients., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

A variety of valid tools are available to assess staff knowledge and attitudes regarding pain, among which is the Knowledge and Attitudes Survey Regarding Pain. Although this instrument has been widely and successfully used, a valid and adapted Spanish version is yet to be developed. The purpose of this study was to validate the Spanish version of the Knowledge and Attitudes Survey Regarding Pain. After translating and back-translating this tool, we conducted a cross-cultural adaptation and construct validation with 102 participants, including nursing professionals (in palliative care, oncology, and intensive care) from five health centers and final-year nursing students. All participants were recruited in the Principality of Asturias, Spain. We also evaluated the internal consistency and test-retest correlations. Cronbach's α was .781, and Pearson's r and the intraclass correlation coefficient between the test and retest scores were .881 and .883, respectively. The mean questionnaire scores in the test and retest phases were 65.8% and 67.6%, respectively. Palliative care nurses had the highest score, 70.8%, which differed significantly from the rest of the groups. The Spanish version of the Knowledge and Attitudes Survey Regarding Pain can effectively differentiate nursing staff in terms of their pain expertise. The results indicate that Spanish nurses have a gap in pharmacologic knowledge that is comparable to that found in other countries, but their foundation in general pain concepts was solid., (Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Evaluating the absolute difference in pain intensity and the percentage difference in pain intensity could facilitate an understanding of pain reduction among cancer patients during repeated hospitalizations. Examinations of the absolute differences in pain intensity and the percentage differences in pain intensity according to the worst pain intensity and last evaluated pain intensity before discharge are lacking. The aim of this study was to evaluate the absolute and percentage difference in pain intensities among cancer patients with moderate or severe pain from their 1st to 18th hospitalizations from 2011-2013. A population-based retrospective cohort study was conducted. Pain intensity was assessed using scales and was recorded in a nursing information system. The absolute and percentage difference in pain intensities were examined via the one-sample Kolmogorov-Smirnov test, and group differences in moderate or severe pain were evaluated with the Mann-Whitney U test. For moderate pain patients, the mean absolute difference in pain intensity was 1.52, and the percentage difference in pain intensity was 29.0%; both these values were significant. More significant changes in the absolute and percentage difference in pain intensities were associated with severe pain patients. Both the average absolute difference in pain intensity (3.09) and the percentage difference in pain intensity (38.5%) in patients with severe pain were significantly higher than the average absolute difference in pain intensity (1.52) and the percentage difference in pain intensity (29.0%) in patients with moderate pain. Cancer patients with moderate and severe pain experienced pain reductions of approximately 30% and 40%, respectively. Early pain management intervention in patients with severe pain is necessary to achieve an obvious analgesic effect, and the formula of the percentage difference in pain intensity should be incorporated into the nursing information system to alert clinicians for early detection of the effectiveness of cancer pain management., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Pain assessment is the first step in managing pain; however, this can be challenging, particularly in settings such as the Pediatric Intensive Care Unit (PICU). This paper reports the current pain assessment practices from a study that was conducted describing the prevalence of pain, pain assessment, painful procedures, interventions, and characteristics of critically-ill children. Specifically, this paper addresses the child's communicative ability, pain scales, and characteristics of pain., Design and Methods: The primary study was a cross-sectional, multi-site, descriptive design. Data from a 24-hour time period were collected from medical records and bedside nurses., Results: Data were collected from the records of 220 children across 15 PICUs. The average number of pain assessments per child was 11.5 (SD 5.8, range 1-28). Seven behavioral scales and five self-report scales were used. There were times when no scale was used, "assume pain present" was recorded, or a sedation scale was documented. Twelve pain scales, including the target population, scoring, psychometric properties, and clinical utility are described., Conclusions: Results of this study indicate that a wide range of pain assessment tools are used, including behavioral scales for children unable to self-report., Implications: Foremost, the appropriate assessment method needs to be chosen for each child to manage pain. Knowledge of the criteria for the use of each pain assessment scale will help the clinician select the appropriate scale to use for each child. The practice of "assume pain present," as well as standardization of pain scales, and clinical support tools needs further investigation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.

Background: Individuals who are resilient are more likely to engage in functional tasks and exercise post hip fracture. There may be a genetic predisposition to being resilient., Objectives: This study tested the direct and indirect association of 10 candidate genes, age, cognition, gender, comorbidities, pain and social activity on resilience, function and exercise post hip fracture., Method: This was a descriptive study including 172 community dwelling older adults. Measures included: age, gender, cognition (Modified Mini Mental Status Exam), comorbidities, social activities (self-report), DNA (GRM1, NTRK1, NTRK2, GNB3, NPY, SLC6A15. SLC6A4, BDNF, CR1TR1, FKBP5), pain (areas of pain and Numeric Rating Scale), function (Physical and Instrumental Activities of Daily Living; Lower Extremity Gains Score; Short Physical Performance Battery; Grip Strength) and exercise (Yale Physical Activity Scale)., Results: The majority of participants were Caucasian (93%), 50% were women and the average age was 81.09 (SD = 7.42). There were significant associations between resilience and single nucleotide polymorphisms from GRM1, NTRK1, NTRK2, GNB3, NPY and SLC6A15. Resilience, age, cognition, social activity, pain and genetic variability were directly and/or indirectly associated with exercise and/or function., Discussion: This study highlights the importance of resilience for engagement in exercise and function after hip fracture and provides preliminary evidence for a genetic role for resilience., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Pain management is essential for the care of hospitalized children. Although multiple barriers have been identified that interfere with nurses' ability to provide optimal pain management, it is not known how pervasive are these barriers across the United States., Aims: This study is the third in a series of studies examining barriers to pediatric pain management. The aim of this study was to examine barriers in different organizations using the same tool during the same period of time., Settings/participants: A sample of 808 nurses from three pediatric teaching hospitals responded to a survey addressing barriers to optimal pain management for children., Results: Barriers unanimously identified as being most significant included inadequate or insufficient physician medication orders, insufficient time allowed to premedicate before procedures, insufficient premedication orders before procedures, and low priority given to pain management by medical staff., Conclusions: Barriers identified as the most and least significant were similar regardless of hospital location. Revealing similar barriers across multiple pediatric hospitals provides direction for nurses trying to provide solutions to these pain management barriers., (Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: To explore the current evidence of nurses caring for people with intellectual disability and dementia who experience pain., Background: People with intellectual disability are ageing and are experiencing age-related health conditions including dementia and conditions associated with pain, but at an earlier age. Addressing the needs of people with intellectual disability who develop dementia is a new challenge for nurses., Design: An integrative literature review., Methods: A systematic search of databases: CINAHL, MEDLINE, PsycINFO, Cochrane, EMBASE, Academic Search Complete, Scopus and Web of Science between 27 October 2017-7 November 2017. Hand searching and review of secondary references were also undertaken. Quality appraisal (Crowe Critical Appraisal Tool), thematic data analysis (Braun and Clarke, Qualitative Research in Psychology, 3, 2006, 77) and reporting using the PRISMA guidelines., Results: Seven papers met the inclusion criteria, and three themes emerged from this review: nurses knowledge of ageing, dementia and pain; recognising pain in people with intellectual disability and dementia; and the role of nurse education. People with intellectual disability and dementia have difficulty communicating their pain experience compounded by pre-existing communication difficulties., Conclusions: A pain experience can present similar to behavioural and psychological symptoms of dementia, and diagnostic overshadowing often occurs whereby a pain need is misinterpreted as behavioural and psychological symptoms resulting in inappropriate treatment. Nurses need greater knowledge about the presence of pain and potential causes in people with intellectual disability and dementia, and education can be effective in addressing this knowledge deficit., Relevance to Clinical Practice: Pain assessment tools for people with intellectual disability and dementia need to include behavioural elements, and baseline assessments are required to identify changes in presentation. Nurses need to recognise and respond to pain based on the evidence in order to deliver quality care., (© 2019 John Wiley & Sons Ltd.)

The opioid public health crisis necessitates that health care providers seek alternatives to opioid pain control. For patients presenting with dental pain, a dental nerve block provides effective, long-lasting pain relief without the use of opioid pain medications. This article presents the techniques required to safely and effectively administer 3 types of dental nerve blocks, allowing the emergency nurse practitioner to provide effective pain control to patients with dental pain.

Background: Nurses' level of knowledge about pain management directly determines the steps of implementation of clinical pain policies., Method: This study surveyed 2,882 pediatric nurse practitioners from six children's hospitals using demographics and pain management questionnaires, as well as the Chinese version questionnaire of the Pediatric Nurse Practitioners' Knowledge and Attitudes Survey Regarding Pain (PNKAS) via the WeChat application., Results: The total score on the PNKAS was 14.88 ± 3.58 for the pediatric nurse practitioners. Multiple regression results showed the main factors influencing the PNKAS score related to position, the frequency of receiving training pain-related knowledge, and working department, which could account for 35.1% of the total variance., Conclusion: Pediatric nurse practitioners from pediatric hospitals were not found to have sufficient knowledge or an appropriate attitude regarding pain management. A new standardized training project of pain management that is closely related to clinical practice for children should be conducted in the future. [J Contin Educ Nurs. 2019;50(6):275-281.]., (Copyright 2019, SLACK Incorporated.)