Pain management nursing : official journal of the American Society of Pain Management Nurses
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A role delineation study, or job analysis, is a necessary step in the development of a quality credentialing program. The process requires a logical approach and systematic methods to have an examination that is legally defensible. There are three main phases: initial development and evaluation, validation study, and development of test specifications. ⋯ The pharmacologic domain received the highest mean rating on consequence. The reliability of all scales was 0.95 or higher, which indicated that the questionnaire consistently measured what it was intended to measure. The quality of the questionnaire is an indicator that certification is one measure of nursing excellence.
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Opioid therapy has been shown to decrease pain intensity, restore levels of function, and improve quality of life for adults with chronic pain. Even so, opioids are rarely used as a long-term treatment option, and the prescription of opioid analgesics for managing chronic nonmalignant pain has remained a highly debated treatment modality. This ongoing debate has resulted in a stigma being associated with both the treatment modality and those individuals receiving it. ⋯ Overall, the data reflected that these individuals encounter much stigma surrounding their pain management regimen, and that the routine course of maintaining that regimen is fraught with barriers. These barriers arise from family, the health care system, and society at large. Awareness of the life-enhancing benefits of opioid therapy in adults with chronic nonmalignant pain, as well as the stigma and barriers that they encounter, will enable clinicians to intervene appropriately and to act as advocates on behalf of adults using chronic opioid therapy.
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The rapidly expanding number of aged Americans and the increasing prevalence of persistent pain in older adults create an urgent need to unravel the complexities of chronic pain management in this population. This requires health professionals to understand both normal and pathologic changes that occur within the aging body and mind, as well as how those factors affect responses to pain and pain-relieving treatments. The medical management of pharmacologic treatment for pain in older adults is often suboptimal, ranging from failing to use analgesics for patients with considerable pain to exposing older adults to potentially life-threatening toxicities, overdoses, or drug interactions. ⋯ Older adults tend to be more vulnerable to side effects and drug interactions than their younger counterparts, owing to differences in drug distribution, metabolism, and elimination. This review delineates these vulnerabilities and informs clinicians of the strategies needed to promote safe and effective use of medications to treat pain in older adults. The goal of this paper was to review specific considerations for balancing efficacy and safety in the pharmacologic treatment of persistent pain in older adults.
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Randomized Controlled Trial Multicenter Study
The effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis.
Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures and one of the most frequently performed ones, and children and adolescents on hemodialysis are anxious about repeated venipunctures. Distraction is one of the most effective ways to relieve pain, and nurses are responsible for pain control. ⋯ After distraction, pain intensity during venipuncture significantly decreased (p=.003); but this decrease began from the sixth session; at the five first sessions, pain intensity had not changed. This study shows the effect of distraction with a simple, inexpensive, and quick way for decreasing the pain caused by venipuncture. We recommend that the reasons of the intervention's delay in effect be assessed in future studies.
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Across all care settings for older patients, pain is often ineffectively managed. A gap still exists between best-practice recommendations for pain assessment/treatment and current clinical practice, despite the availability of guidelines. Using a validated pain scale is critical to objectively evaluate pain intensity. ⋯ Pain undertreatment is a particularly important phenomenon to address, because unrelieved persistent pain can significantly affect older individuals. Approaches tailored to an individual's needs and supported by the best available evidence should be implemented to improve patient outcomes and to increase the consistency with which care is delivered to the growing population of older Americans. The goal of this paper was to provide current evidence-based strategies and tools for pain assessment in older adults, including those with cognitive impairment.