Do ethnic differences still exist in pain assessment and treatment in the emergency department?

Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated and some evidence supports the existence of pain treatment disparities. Despite strong incentives from accreditation organizations, pain management in the ED may still be inconsistent and problematic. The purpose of this research study was to conduct a retrospective chart review to investigate pain assessment and treatment for 200 adults (≥18 years old) admitted to the ED suffering from long-bone fractures. An additional purpose was to investigate demographic variables, including ethnicity, to determine if they influenced pain assessment, pain treatment, and wait times in the ED. Although assessment and treatment of pain is universally recognized as being important and necessary to provide optimal patient care, only 52% of patients in this study were assessed using a pain intensity scale, with 43% of those assessed reporting pain as ≥5 on a 0-10 pain intensity instrument. Pain medication was administered to 75% of the patients, but 25% of the patients received no medication. Only 24% of those receiving a pain medication were reassessed to determine pain relief. Compounding these problems were wait times for analgesia of >1 hour. Although the influence on pain management related to ethnicity was not a factor in this study, other findings revealed that undertreatment of pain, inadequate assessment, lack of documentation of pain, and lengthy wait times persist in the ED.

Ethnic wait time differences in analgesic administration in the emergency department.

Although many studies have documented ethnic disparities in analgesia administration, few have dealt with the wait time for analgesia in the emergency department, despite the fact that the provision of timely and appropriate analgesia should be a primary goal in caring for patients. Inadequate analgesia has been reported for patients presenting with long bone fractures, and a body of evidence exists indicating that ethnic and minority patients may be receiving inadequate pain care when presenting to the emergency department for treatment of long bone fractures. The purpose of the present research was to determine whether wait time differences in pain treatment existed for ethnic and minority adults (18 years old or older) who were admitted to the emergency department suffering from long bone fractures using a quantitative retrospective design. Purposive sampling of medical records of 234 European-American, African-American, and Hispanic patients presenting with long bone fractures from two small Georgia hospitals were analyzed. Although Hispanic, European-American, and African-American patients in this study all reported substantial pain, a significant (p = .005) overall wait time difference was found between Hispanic and European-American patients, with Hispanic patients waiting an average of 102 minutes for the first dose of analgesia, and the European-Americans waiting an average of 67 minutes. Significant (p = .011) wait time differences were also found between Hispanics and European Americans when opioids were ordered and when there was a nurse notation of pain in the record (p = .029).

A Strategy to Ensure Faculty Engagement When Assessing a Concept-Based Curriculum.

BACKGROUND: The faculty of an undergraduate nursing program decided to undertake a major curriculum overhaul, transitioning from a curriculum based on the biomedical model to a concept-based curriculum. However, shortly after the new curriculum was implemented, faculty identified many issues with how and when the concepts were being taught. METHOD: In response to the early implementation issues, a conceptual grid was developed to guide assessment of the new curriculum. RESULTS: The conceptual grid provided a framework for assessment of the new concept-based curriculum. By using this approach, the faculty was able to identify and correct curricular issues that impeded student learning. CONCLUSION: The conceptual grid has been extremely useful in the assessment of a newly implemented concept-based curriculum. [J Nurs Educ. 2016;55(8):467-470.].

Psychometric evaluation of selected pain intensity scales for use with cognitively impaired and cognitively intact older adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales such as the Faces Pain Scale (FPS), the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) to assess pain in cognitively impaired older adults. A descriptive correlational design was used, and a convenience sample of 66 volunteers age 60 and older residing in assisted living facilities in the South was recruited for this study. The sample included 22 (33%) men and 44 (67%) women, with a mean age of 76. Ninety-eight percent (65) of the sample comprised Caucasian participants, with the exception of 1 African-American man. Seventy percent (47) completed high school and/or college. The mean Mini Mental State Exam (MMSE) score was 16, with a range of 1 to 29. Eighty-five percent scored 24 or lower, indicating some degree of cognitive impairment. The remaining 15% were cognitively intact. All but one participant could use each scale to rate their pain. Concurrent validity of the VDS, NRS, and IPT was supported with Spearman rank correlation coefficients ranging from .78 to .86 in the cognitively impaired group. The FPS, however, demonstrated weak correlations with other scales when used with the impaired group, ranging from .48 to .53. In the cognitively intact group, strong correlations ranging from .96 to .97 were found among all of the scales. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from .67 to .85) and unacceptable for most scales in the cognitively impaired group (correlations ranged from .26 to .67). When asked about scale preference, both the cognitively impaired and the intact groups preferred the IPT and the VDS. This study revealed that cognitive impairment did not inhibit participants' ability to use a variety of pain intensity scales, but the stability issue must be considered.

Length stay, discharge disposition, and hospital charge predictors.

THIS STUDY EXPLORED the effect of patient, clinical, and treatment factors on length of stay (LOS), discharge disposition, and total acute care hospital charges for older adults undergoing elective total hip arthroplasty or total knee arthroplasty. A CAUSATIVE RETROSPECTIVE DESIGN was used, and data analysis included descriptive statistics, multiple regression, and logistic regression. SIGNIFICANT DIFFERENCES in predictor variables (ie, age, gender, living arrangement, comorbidities, postoperative complications) were found between patients who were discharged to home and those who were discharged to another facility. Only postoperative complications contributed significantly to LOS. Total surgical time and postoperative complications contributed significantly to hospital charges.

Evaluation of the Revised Faces Pain Scale, Verbal Descriptor Scale, Numeric Rating Scale, and Iowa Pain Thermometer in older minority adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale Revised (FPS-R), Verbal Descriptor Scale (VDS), Numeric Rating Scale (NRS), and Iowa Pain Thermometer (IPT) with a cognitively impaired minority sample. A descriptive correlational design was used, and a convenience sample of 68 participants, admitted to acute care facilities in the South, with an average Mini Mental Status Exam score of 23 comprised the sample. Thirty-two percent of the participants were males, and 68% were females. The majority (74%) of the sample consisted of African-American participants with the exception that 16% were Hispanic and 10% were Asian. An overwhelming majority of participants were able to use all of the tools. Concurrent validity was supported with correlations ranging from 0.56 to 0.90. The lowest correlations were found between the FPS-R and the other scales, suggesting that the FPS-R may be measuring a broader construct incorporating pain. Test-retest reliability was supported with coefficients ranging from 0.77 to 0.89. In terms of pain scale preference, the Numeric Rating Scale (33%) was the preferred scale in the cognitively intact group and the FPS-R (54%) was the preferred scale in the cognitively impaired group. When race and cognitive status were considered, African-Americans and Hispanics preferred the FPS-R. Severely, moderately, and mildly impaired participants also preferred the FPS-R. The findings of this study support the use of these scales with older cognitively impaired minority adults.