The usability of an AAC pain description system for patients with acquired expressive communication disorders.

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.

Determination of prevalence, characteristics, management and related factors for pain in the older adults: pain among nursing home residents

This study aimed to determine pain assessment approaches and pain management strategies in elderly people in a nursing home.The cross-sectional-descriptive study sample consisted of 147 older adults living in a nursing home in Turkey in 2019. They all agreed to participate in the study (n = 147); however, as our research was about older adultswith pain problems, the study was completed with a total of 108 older adultsexperiencing pain problems. The participants' average age was 73.60 ± 6.97 years. Geriatric pain scale scores were higher for women aged 75 years and over, those who had a chronic disease and those who received analgesics, and there was a statistically significant difference between the mean scores (p < 0.05). Nurses must pay attention to pain assessment and management in nursing homes because of the adverse effects of pain on older adults' health status, vital functions, and well-being.

Pain as an Early Indicator of Pressure Ulcer Risk.

Pain may be an important factor to consider when assessing patients for the development of pressure ulcers, but more research is needed to assess the characteristics associated with pain as a symptom preceding these injuries.

Time from Pain Assessment to Pain Intervention.

OBJECTIVE: The purpose of this study was to describe factors that influence nurses' time from pain assessment to intervention for acute postsurgical pain. BACKGROUND: Nurses' time is a limited resource that must be optimized to manage patients' pain within budget constraints. Little is known about processes and activities nurses negotiate to manage pain. METHODS: Human factors engineering and ethnography were used to quantify factors influencing time from pain assessment to intervention. RESULTS: On the basis of 175.5 observation hours, nurses spent 11% of shifts (mean, 83 minutes) on pain care activities. Time from alert to intervention with PRN analgesics or biobehavioral strategies for 58 cases ranged from 0 to 48 minutes (mean, <11 minutes). Five factors influenced timeliness. CONCLUSIONS: Nurses most efficiently managed postsurgical pain by giving analgesics ordered PRN on a scheduled basis. Nurse leaders can empower prompt responses to patients' pain through delegation, process improvements, real-time monitoring, and prescriber engagement.

Abordaje no farmacológico del dolor en pediatría desde la perspectiva de enfermería: Aplicación de materiales audiovisuales y buzzy® / Non-pharmacological approach to pain in pediatrics from the nursing perspective: Application of audiovisual materials and buzzy®

Objetivo: Evaluacion del abordaje multidisciplinario del dolor pediátrico.Metodo: Revisión sistemática de la bibliografía más actualizada acerca del tema en los buscadores médicos Pubmed, Cuiden, Scielo, Cochrane Library y Cinahl. Aplicando en los motores de búsqueda los términos: “Pain Assessment”, “Pain Measurement” “Pain Management” “Nonpharmacologic treatment”, realizando una acotación a aquellos artículos escritos en castellano e inglés y con fecha de publicación posterior a enero de 2015.Resultados y Discusión: Se ha tratado la identificación de la intensidad del dolor que requiere de un abordaje complejo y no existe un método de evaluación que se muestre superior a otro. Parece por tanto adecuado la aplicación de la combinación del autoregistro por parte del paciente siempre que sea posible, la familia y la aplicación de escalas de aplicación sistematizada por parte de personal cualificado para ello. Para la aplicación de las escalas parece conveniente la utilización según la validación de estas en determinados grupos de pacientes y lo familiarizado que este el personal encargado de registrarlas. El tratamiento farmacológico está siendo desarrollado amplia y eficazmente como medida complementaria a las formas habituales de tratamiento del dolor. Estas medidas en su mayoría de las veces por su fácil aplicación, escaso coste y casi nulo riesgo de iatrogenia se están implementando en la mayoría de las unidades de atención pediátrica. Esta aplicación de medidas exige de la creatividad y capacitación continua del personal que las lleve a cabo y de una correcta evaluación del dolor en cada momento de la asistencia.Conclusión: El control del dolor y la ansiedad que asocia son un desafío de abordaje multidisciplinar en el que la enfermería cumple un gran papel, desde su posición tanto de realizadora de la gran mayoría de procedimientos que pueden desencadenarlo como desde la aplicación de las medidas no farmacológicas.(AU)

Objective: Evaluation of the multidisciplinary approach to pediatric pain.Method: Systematic review of the most up-to-date bibliography on the subject in the medical search engines Pubmed, Cuiden, Scielo, Cochrane Library and Cinahl. Applying in the search engines the terms: “Pain Assessment”, “Pain Measurement” “Pain Management” “Nonpharmacologic treatment”, making a limitation to those articles written in Spanish and English and with a publication date after January 2015.Results and Discussion: The identification of the intensity of pain that requires a complex approach has been discussed and there is no evaluation method that is superior to another. Therefore, the application of the combination of self-registration by the patient whenever possible, the family, and the application of systematized application scales by qualified personnel seems appropriate. For the application of the scales, it seems advisable to use them according to their validation in certain groups of patients and how familiar the personnel in charge of registering them are. Pharmacological treatment is being widely and effectively developed as a complementary measure to the usual forms of pain management. These measures, mostly due to their easy application, low cost and almost zero risk of iatrogenesis, are being implemented in most pediatric care units. This application of measures requires the creativity and continuous training of the personnel who carry them out and a correct assessment of pain at each moment of assistance.Conclusion: The control of pain and associated anxiety are a multidisciplinary approach challenge in which nursing plays a great role, both from its position as the director of the vast majority of procedures that can trigger it and from the application of non-functional measures. pharmacological.(AU)

Effect of a theory-driven educational intervention on the level of knowledge, attitudes, and assessment practices regarding breakthrough cancer pain (BTCP) management among medical nurses in Hong Kong.

PURPOSE: To examine the effect of an educational intervention intended to improve medical nurses' adherence to breakthrough cancer pain (BTCP) assessment practices and their level of knowledge, attitudes and perceived assessment practices regarding BTCP management. METHODS: Nurses working in a regional hospital were recruited to this quasi-experimental study. The intervention group received a 3-h educational workshop and one session of individual clinical instruction, whilst the control group did not receive any intervention. Chart audits were performed to examine adherence to BTCP assessment practices as the primary outcome. A self-developed questionnaire was used to measure nurses' knowledge, attitudes and perceived assessment practices regarding BTCP management as the secondary outcomes. The chi-square or Fisher's exact test was used to compare the rate of adherence to BTCP assessment practices between groups. A generalised estimating equation was used to compare changes in knowledge, attitudes, and perceived assessment practices between groups over time. RESULTS: One hundred and five nurses completed the study. The chart audits revealed a significantly higher rate of adherence to BTCP assessment practices in the intervention group after the intervention (p < .05). The intervention group exhibited significant positive changes in scores for knowledge (ß = 25.49, p < .001), attitude (ß = 0.98 to 2.81, p < .01), and their perceived assessment practices (ß = 1.33 to 3.14, p < .002) when compared with the control group. CONCLUSIONS: This theory-driven educational intervention significantly improved the medical nurses' adherence to BTCP assessment practices and their level of knowledge attitudes and perceived assessment practices regarding BTCP management.

Factors associated with the undertriage of patients with abdominal pain in an emergency room.

INTRODUCTION: The triage process lasts for a very short time, which can result in over-triage and under-triage. Studies have explored factors related to under-triage among trauma patients. In Korea, the clinical characteristics and severity of cases of under-triaged patients have been investigated. However, there is limited research on the under-triage of patients experiencing abdominal pain. Therefore, this study aimed to determine the under-triage rate of emergency department (ED) patients with abdominal pain, as well as the factors associated with their under-triage. METHODS: The participants of this retrospective cohort study were 3,030 adult patients at a single tertiary hospital in Korea, who were brought to the ED for abdominal pain as the chief complaint. Participants' general characteristics, pain-related information, and environmental information were obtained from their electronic medical records. RESULTS: The under-triage rate of ED patients with abdominal pain was 31.0%. Factors related to the under-triage of these patients were sex, age, visit route, time from the onset of the pain to the visit, location of pain, and intensity of pain. CONCLUSION: These findings provide a foundation for the understanding and mitigation of under-triage in EDs through the identification of factors associated with under-triage in patients with abdominal pain.

Nursing Assessment of Wound-Related Pain: An Italian Learning Survey.

BACKGROUND: Pain is an important symptom in wound management, and the choice of treatment directly affects the patient's quality of life. Pain assessment (PA) is essential for quality wound care and, in Italy, mandatory by law. OBJECTIVE: To administer a dedicated learning survey to obtain a better sense of current PA practices, ensure more training, improve procedures, and reduce malpractice. METHODS: A 16-month learning survey of nurses based on a validated questionnaire developed for this project. RESULTS: The survey sample comprised 512 questionnaires. Of respondents, 78% were female, 56.1% were older than 40 years, 94% were RNs, and 6% were wound care specialist nurses. Participants performed a range of dressing changes per week (1-5, 46.3%; 6-20, 34.4%; >21, 19.3%). Although 93% of respondents considered PA important, only 26% recognized it as a vital parameter, and barely one-quarter (25.4%) were aware of current legislation mandating PA. The majority (95.3%) believed that PA is not consistent with pain perceived by the patient. Further, 87.3% stated that they did not have adequate knowledge to conduct a PA, 91.4% did not consider themselves up-to-date on PA, and 81% did not document PA results. However, specific wound care training leads to significantly better PA (P < .001): 71.9% of wound care specialist nurses recognized pain as a vital parameter, and 59.4% were aware of current legislation regarding PA; further, 81.3% consistently evaluated pain, 59.4% documented PA results, and 50% communicated the outcome to the physician in charge. CONCLUSIONS: The results illustrate the lack of sensitivity, training, and education that Italian RNs have regarding PA in wound care.

Nurse's Evaluation of a Pain Management Algorithm in Intensive Care Units.

BACKGROUND: Many patients have memories of pain during intensive care unit stay. To improve pain management, practice guidelines recommend that pain management should be guided by routine pain assessment and suggest an assessment-driven, protocol-based, stepwise approach. This recommendation prompted the development of a pain-management algorithm. AIM: Evaluate the feasibility and clinical utility of this algorithm. DESIGN: A descriptive survey. SETTINGS: One medical/surgical intensive care unit, one surgical intensive care unit, and one postanesthesia care unit at two hospitals in Norway. PARTICIPANTS/SUBJECTS: Nurses working at the three units. METHODS: A pain-management algorithm, including three pain assessment tools and a guide to pain assessment and pain management, was developed and implemented in three intensive care units. Nurses working at the three units (n = 129) responded to a questionnaire regarding the feasibility and clinical utility of the algorithm used. RESULTS: Our results suggested that nurses considered the new pain-management algorithm to have relatively high feasibility, but somewhat lower clinical utility. Less than half of respondents thought that pain treatment in clinical practice had become more targeted using the tree pain-assessment tools (45%) and the algorithm for pain assessment and pain management (24%). CONCLUSIONS: Pain-management algorithms may be appropriate and useful in clinical practice. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on pain-treatment actions and reassessment of patients' pain is needed. Further focus in clinical practice on how to implement an algorithm and more focus on pain-treatment action and reassessment of patients' pain is needed.

Pain assessment and interventions by nurses in the emergency department: A national survey.

AIM: The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses. BACKGROUND: Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate-to-severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management. DESIGN: This cross-sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses. METHODS: Australian emergency nurses were invited to complete an online survey comprising 91 items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study. RESULTS: Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses' intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients. CONCLUSIONS: Emergency nurses recognise the importance of pain relief. The ability to nurse-initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor. RELEVANCE TO CLINICAL PRACTICE: While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse-initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.

Improving Pain Reassessment and Documentation Rates: A Quality Improvement Project in a Teaching Hospital's Emergency Department.

INTRODUCTION: ED pain score reassessment and documentation rates were drastically low according to sampled data from the St. Margaret Hospital Emergency Department, leading to difficult pain management encounters for clinicians. The purpose of this project was to improve pain score reassessment rates in ED patients who were discharged with extremity pain. METHODS: This project was an 8-month, pre-postinterventional (preintervention: September-November 2018, intervention: December 2018-January 2019, and postintervention: February-April 2019) quality improvement project that took place in a community hospital emergency department. Emergency nurses participated in 6 focus groups, allowing for the creation of focus group-themed interventions at the request of the nursing staff. Daily audits of pain reassessment and documentation rates for individual nurses took place during the month of January 2019. In addition, a weekly newsletter was created and reported the ED pain reassessment and documentation rates. RESULTS: All patient encounters (581) were reviewed over the 8-month period. Baseline pain score reassessment and documentation rates were 36.2% (confidence interval, 30.3%-42.3%) in the emergency department. Pain reassessment and documentation rates increased to 62.3% (confidence interval, 56.8%-67.6%) during the 3-month postintervention period. DISCUSSION: Implementing daily audits and weekly newsletters that created transparency of individual and group performances increased pain score reassessment and documentation rates.

Role of the nurse in the assessment and management of post-operative pain.

While post-operative pain is a common and unavoidable consequence of surgery, evidence suggests that the levels of pain experienced by patients are unnecessarily high. In the past two decades, evidence has also indicated that nurses' knowledge of the assessment and effective management of pain is suboptimal. This article considers the elements required for an effective post-operative pain assessment, as well as examining the barriers that result in many patients' post-operative pain not being assessed. The article also provides an overview of the main pain management interventions available to nurses.

Experiences of Nephrology Nurses in Assessing and Managing Pain in Patients Receiving Maintenance Hemodialysis.

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.

Congruence between nurses' and patients' assessment of postoperative pain: a literature review.

Postoperative pain remains poorly managed for many patients. Effective pain management begins with accurate pain assessment, with patient self-reporting considered the most accurate measure of pain. This literature review aimed to identify how congruent nurses' assessments of pain were with patients' self-reporting. A search identified six observational studies and one quasi-experimental study that met the inclusion criteria. The findings from these studies were summarised under two themes: nurses' underestimation of patients' pain and nurses' knowledge and understanding of pain assessment. Some nurses' pain management knowledge was deemed inadequate, with evidence of negative attitudes towards managing pain in certain groups of patients. Educational interventions have so far had limited impact on correcting the ethical and professional problem of inadequate pain relief in many patients postoperatively. Randomised controlled trials are required to identify effective education interventions that can contribute to ending this avoidable suffering.

Diagnóstico de Enfermería: dolor crónico. Análisis crítico de sus características definitorias / Nursing diagnosis: chronic pain. Critical analysis of its defining characteristics

OBJETIVO: análisis crítico de las características definitorias propuestas en el Diagnóstico de Enfermería [00133] Dolor Crónico, según la taxonomía NANDA. MÉTODO: revisión narrativa de las características definitorias del diagnóstico y su relación con el mismo. Se llevó a cabo una búsqueda bibliográfica en diferentes bases de datos: Cinahl, Pubmed, Cuiden, Scopus, Dialnet y Scielo. Se usaron los descriptores: "chronic pain", "diagnosis" y "nursing". La búsqueda se limitó a publicaciones de los últimos cinco años, en español e inglés. RESULTADOS: el dolor crónico es un problema de salud pública mundial que persiste durante un periodo superior a tres meses. El dolor crónico se considera no solo como un síntoma sino como una enfermedad asociada a alteraciones en el ámbito físico, psicológico, emocional, laboral, social y sexual. Con respecto al aspecto psicológico y emocional prevalece la depresión, la ansiedad y el miedo, lo que en el plano físico puede conllevar a una discapacidad. Las características definitorias del diagnóstico de Enfermería dolor crónico encontradas fueron: "Alteración en la habilidad para continuar con las actividades previas", "Cambios en el patrón del sueño", "Atención centrada en el yo", "Anorexia", "Informes, autoinformes y listas de verificación como características definitorias del diagnóstico". CONCLUSIONES: es necesario revisar las características definitorias de "alteración en la habilidad para continuar con las actividades previas" y "anorexia" al no haber encontrado evidencias de que estas sean realmente características que identifiquen este diagnóstico. Valorar la inclusión de "miedo al dolor" con el fin de ayudar a identificar más fácilmente este diagnóstico

OBJECTIVE: a critical analysis of the defining characteristics described in the Nursing Diagnosis [00133] Chronic Pain, according to the NANDA taxonomy. METHOD: a narrative review of the defining characteristics of the diagnosis and their relationship with it. A bibliographic search was conducted in different databases: Cinahl, Pubmed, Cuiden, Scopus, Dialnet and Scielo. The following keywords were used: "chronic pain", "diagnosis" and "nursing". The search was limited to publications within the past five years, in Spanish and English. RESULTS: chronic pain is a global public health problem which persists during a period over three months. Chronic pain is not only considered a symptom but a disease, associated with alterations in the physical, psychological, emotional, occupational, social and sexual settings. In terms of the psychological and emotional aspect, there is a prevalence of depression, anxiety and fear, which can lead to disability. The defining characteristics found in the Chronic Pain Nursing Diagnosis were: "Altered ability to continue previous activities", "Changes in Sleep Pattern", "Self-focused", "Anorexia", "Reports, self-reports and check-lists as defining characteristics of diagnosis". CONCLUSIONS: it is necessary to review the characteristics defining "Altered ability to continue previous activities" and "Anorexia", because no evidence was found that these were really characteristics identifying this diagnosis. The inclusion of "Fear of Pain" must be assessed, with the aim to help to identify this diagnosis more easily

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery.

AIMS AND OBJECTIVES: To explore the consistency of pain intensity and pain location assessed by nurses and patients in gynaecology undergoing enhanced recovery after surgery pathway. BACKGROUND: Several studies have shown that clinical nurses' assessment of patients' pain is not always accurate. Little is known about the accuracy of nurses' pain assessments for gynaecological patients. Postoperative pain assessment and management is an essential part of enhanced recovery after surgery. DESIGN: Comparative cross-sectional study. METHODS: A total of 160 patients were recruited and only 85 patients and 17 nurses participated. Patients and nurses recorded pain scores (using an 11-point Numeric Rating Scale) and pain location (incision pain, surgical area pain in the abdominal cavity, other pain or no pain) on Pain Assessment Forms at 4 hr after surgery and on the first and second postoperative days. We used the STROBE guidelines to report our study. RESULTS: The patients' pain score was higher than that of nurses from 4 hr to second day after laparoscopic surgery at rest. The pain scores of both nurses and patients decreased over this period of time. All the intraclass correlation coefficients were between 0.214-0.296. At the three time points, surgical area pain in the abdominal cavity and abdominal incision pain were the main pain areas. All the kappa coefficients were between 0.164-0.255. CONCLUSIONS: The consistency of postoperative pain assessment about pain score and pain location between nurses and patients was not high. We should attach importance to systematic pain assessment, and more detailed enhanced recovery after surgery pathways should be developed about pain assessment. RELEVANCE TO CLINICAL PRACTICE: Continuing education for nurses regarding pain assessment is necessary. Nurses should accept the patient's self-reported pain. There should be a step that gives more time for pain assessment in enhanced recovery after surgery pathways.

Validating a pain assessment tool in heterogeneous ICU patients: Is it possible?

BACKGROUND: Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. AIM: The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. METHODS: The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. RESULTS: The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's α 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. CONCLUSION: This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium. RELEVANCE TO CLINICAL PRACTICE: The German CPOT version can be recommended for ICUs in German-speaking countries.

Ways of Reasoning Used by Nurses in Postoperative Pain Assessment.

BACKGROUND: Postoperative pain is a major concern of patients undergoing surgery. Pain assessment for patients undergoing surgery is a common requirement for surgical nurses and is the most important nursing approach to ensuring patient comfort. AIMS: The purpose of this study was to identify the reasoning used by nurses when assessing postoperative pain in patients. METHODS: Phenomenography was the research approach chosen to analyze the nurses' experiences. This approach is used to acquire qualitative knowledge about the ways individuals experience the world. RESULTS: The reasoning used by nurses in postoperative pain assessment was identified from two perspectives: the frames of reference used to interpret a patient's perception of pain and the strategic efforts used to assess the pain. An outcome space for the various categories of reasoning employed by the nurses with regard to postoperative pain assessment was constructed to determine how these categories were logically related. CONCLUSIONS: These findings have the potential to lead to a diverse range of nursing education modalities related to the adoption of different focuses and actions in postoperative pain assessment.

Pain Management in Patients with Heart Failure: A Survey of Nurses' Perception.

BACKGROUND: Over 50% of patients with heart failure (HF) report suffering from pain and pain-related burdens; however, pain in HF patients has not been recognized or well treated. Few studies have comprehensively examined pain management in patients with HF from nurses' perception. AIMS: To investigate nurses' perception of pain management in HF patients. METHODS: Members of American Association of Heart Failure Nurses (AAHFN) were invited to participate in a cross-sectional online survey. RESULTS: A total of 147 nurses responded and completed the survey. The majority agreed that pain in HF patients was related to anxiety, depression, fatigue, and unplanned hospitalization, and that pain should be individually assessed and managed. More than 80% thought pain management practice in HF patients should be improved, and 78.1% were interested in getting more information and believed an online education module was the most preferable approach. Lack of pain assessment tools, drug addiction, side effect, overuse, underuse, and contraindication with other medications were the main concerns regarding opioid use in pain management in HF. The gaps in pain management in HF patients included lack of knowledge of opioid use, lack of consideration and awareness of pain, no clinical guidelines for pain assessment and treatment, and complicated pain management with multiple chronic conditions. CONCLUSIONS: The impact of pain and need for individual assessment and management of pain in HF patients were perceived by nurses; improvement in pain management practice in HF patients is needed. Concerns regarding opioid use and gaps in pain management of HF patients should be addressed.