Effects of Auricular Point Acupressure on Pain Relief: A Systematic Review.

OBJECTIVES: This systematic review aimed to summarize and provide an update on clinical studies investigating the effects of auricular point acupressure (APA) on pain relief, in addition to the APA methods of delivery and operation. DESIGN: A systematic review. DATA SOURCES: A systematic review on literatures published on five English (PubMed, Web of Science, Embase, EBSCO, and Cochrane databases) and four major Chinese databases (China National Knowledge Infrastructure, Wan Fang Data, Chinese Scientific Journals Database [VIP], and SinoMed) was conducted. METHOD: We screened nine electronic databases from the time of their respective establishment until December 20, 2019. Randomized controlled trials and studies that defined an APA intervention measure and evaluated pain intensity were considered. We individually categorized and analyzed 46 studies considering the following: (1) acute or chronic pain and (2) whether the outcomes positively or negatively support the effectiveness of APA on pain intensity. We also summarized the methods of delivery used (including the acupoint selection, stimulator selection, method of taping seeds on the ears, frequency of replacing seeds, suitability of acupressure intensity, acupressure frequency, and pressing time) and APA operator. RESULTS: Regardless of pain intensity, APA effectively treated most acute pain when combined with other interventions. Although it was used alone to treat low back pain and dysmenorrhea, other chronic diseases typically underwent a combination of APA with other interventions. The 43 positive studies revealed that acute pain required shorter APA intervention periods than chronic pain. Corresponding acupoints and nervous system acupoints were chosen. Vaccaria seeds, the single-ear method (including the alternate-ear method), and daily seed replacement were commonly adopted. Deqi was considered an effective signal for appropriate acupressure intensity. Additionally, the patients could effectively apply acupressure. CONCLUSION: This systematic review revealed important trends in APA treatments, which could be essential in determining treatment efficacy.

Establishment and Empirical Evaluation of a Quality Indicator System for Postoperative Pain Management.

OBJECTIVES: This study aimed to establish a quality indicator system for postoperative pain management and test its reliability, validity, and discrimination in China. METHODS: We established a quality indicator system using the Delphi method. Further, we designed and administered a survey questionnaire in the orthopedic departments of nine hospitals, located in the Zhejiang and Jiangsu Provinces, through purposive and convenience sampling methods to examine the reliability, validity, and discrimination of the quality indicator system. RESULTS: We established a quality indicator system to assess structure, process, and outcome measures of postoperative pain management using three first-level, eight subordinate second-level, and 32 subordinate third-level quality indicators. The scale-level content validity indexes of the three sections of the questionnaire, assessing structure, process, and outcomes measures, were 0.99, 0.98, and 0.98, respectively. We identified two common factors from the third section that demonstrated a cumulative variance contribution rate of 80.38% and a Cronbach's α coefficient of 0.95. The total scores and scores of the structure, process, and outcome quality indicators demonstrated statistically significant differences (P < 0.05) between the wards (N = 4) that participated in the "Painless Orthopedics Ward" quality improvement program and those (N = 5) that did not. CONCLUSIONS: This quality indicator system highlights the need for multidisciplinary cooperation and process characteristics of postoperative pain management, along with interdepartmental quality comparisons. And it demonstrates acceptable reliability, validity, and discrimination; thus it may be completely or partially employed in Chinese hospitals.

Evaluation of the Reliability and Validity of the Behavioral Indicators of Infant Pain Scale in Chinese Neonates.

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.

Pain Management by Nurses in Level 2 and Level 3 Hospitals in China.

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.

Current State of Pain Resource Nurse (PRN) Programs and Experiences of PRNs in China.

BACKGROUND: Since the 2010s, the Pain Resource Nurse (PRN) program and similar programs have been introduced in Chinese hospitals. However, the status of the PRN program and nurses' experiences in these programs remain unclear. AIMS: The aim of the study was to identify the factors related to PRN programs and explore PRNs' experiences being part of the program. DESIGN: A combination of descriptive cross-sectional and qualitative methods was used in the study. SETTINGS: Thirty-two hospitals in the eastern, central, and western regions of China. PARTICIPANTS/SUBJECTS: Twenty-four PRNs who had been PRNs for 6 months or more. METHODS: A purposive sample of 32 hospitals from eastern, central, and western regions of China carried out a PRN or similar program for more than 1 year with at least five bedside nurses from different nursing units were enrolled in the descriptive cross-sectional study. The questionnaire was designed by Brown's advanced nursing practice framework theory. A total of 24 PRNs who had been PRNs for 6 months or more participated in the interview by convenience and purposive sampling. RESULTS: The mean number of PRNs in a program was 30.12 ± 17.93 (range 5-74). The role of the PRN was broader compared with that of bedside nurses, and it included pain management, training, and education. The most common reason for hospitals to establish PRN programs was to improve the quality of pain management (n = 28, 87.5%). Administrative support (n = 28, 87.5%) was a major supportive factor for PRN programs and lack of physician support (n = 28, 87.5%) was a barrier. Although all hospitals provided training, those with knowledge assessments after training indicated a significant improvement in the desired PRN functions compared with those that did not (p < .05). Personal interviews revealed that the reasons for becoming a PRN varied and included considering PRN as a career opportunity, personal interest, passively accepting the designation, and being a PRN temporarily. The positive professional experiences of being a PRN included an increased sense of self-worth and accomplishment and growth in a specialty, whereas the negative experiences included frustration with the work environment and resignation because of extra workload. CONCLUSIONS: The hospital survey results indicated that the PRN program in China is still in the early development stage. The PRN interviews suggest that being a PRN involves both positive and negative experiences.

Development and validation of the health literacy environment scale for Chinese hospitals from patients' perspective.

Introduction: While the research on improving individual health literacy by promoting individual skills and abilities is increasing, less attention has been paid to the complexities of the healthcare environment that may influence patients' ability to access, understand, and apply health information and health services to make health decisions. This study aimed to develop and validate a Health Literacy Environment Scale (HLES) that is suitable for Chinese culture. Methods: This study was conducted in two phases. First, using the Person-Centered Care (PCC) framework as a theoretical framework, initial items were developed by using the existing health literacy environment (HLE) related measurement tools, literature review, qualitative interviews, and the researcher's clinical experience. Second, scale development was based on two rounds of Delphi expert consultation and a pre-test conducted with 20 hospitalized patients. Using 697 hospitalized patients from three sample hospitals, the initial scale was developed after item screening and its reliability and validity were evaluated. Results: The HLES comprised 30 items classified into three dimensions as follows: interpersonal (11 items), clinical (9 items), and structural (10 items) dimensions. The Cronbach's α coefficient of the HLES was 0.960 and the intra-class correlation coefficient was 0.844. The confirmatory factor analysis verified the three-factor model after allowing for the correlation of five pairs of error terms. The goodness-of-fit indices signified a good fit for the model (χ2/df = 2.766, RMSEA = 0.069, RMR = 0.053, CFI = 0.902, IFI = 0.903, TLI = 0.893, GFI = 0.826, PNFI = 0.781, PCFI = 0.823, PGFI = 0.705). The item-content validity index ranged from 0.91 to 1.00, and the scale-content validity index was 0.90. Conclusion: The HLES had good reliability and validity and provides a patient perspective tool for evaluating HLE and a new perspective for improving health literacy in China. That is, healthcare organizations make it easier for patients to access, understand, and use health information and service. Further studies about the validity and reliability of HLE should include other districts and different tiers or types of healthcare organizations.

Effects of Tai Chi on Self-Efficacy: A Systematic Review.

The purpose of this systematic review is to summarize and update the readers regarding clinical studies that have investigated the effects of Tai Chi on self-efficacy and to describe their limitations and biases. Nine electronic databases were searched from the establishment of the database until August 10, 2017. All randomized controlled trials (RCTs), nonrandomized controlled studies (NRSs), quasi-experimental studies, or studies with pre-post design were included if they clearly defined a Tai Chi intervention and evaluated self-efficacy outcomes. We categorized these 27 studies into the "disease category" and the "population category," based on the types of participants. This systematic review summarizes the effects of Tai Chi on self-efficacy in various populations and found that Tai Chi appeared to have positive effects on self-efficacy in some populations. Fifteen research studies showed that Tai Chi had significant positive effects on self-efficacy, while 11 studies did not; only one study found a negative outcome at the follow-up. In addition, it is unclear which type, frequency, and duration of Tai Chi intervention most effectively enhanced self-efficacy. Tai Chi appears to be associated with improvements in self-efficacy. Definitive conclusions were limited due to the variation in study designs, type of Tai Chi intervention, and frequency, and further high-quality studies are required.