Nurses' attitudes and practices in sickle cell pain management

Pack-Mabien, Ardie; Labbé, Elise E.; Herbert, David; Haynes, Johnson

doi:10.1053/apnr.2001.26783

Cited by 102 publications

(73 citation statements)

References 14 publications

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“…[10][11][12][13] It is a common perception of emergency physicians and staff that SCD patients presenting to the ED are opioid dependent, and this belief may lead to inconsistent or inadequate treatment. 14,15 Both physicians and nurses tend to overestimate the prevalence of addiction in the SCD population, which has been documented to range from 0% to 11%. 12,15 Further exploration is required to fully understand the frequent use of the ED, which may represent a higher acuity of illness, lack of access to a sickle cell provider, or other complex psychosocial issues.…”

Section: Discussionmentioning

confidence: 99%

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Tanabe

Artz

Courtney

et al. 2010

Academic Emergency Medicine

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Objectives: The objectives were to report the baseline (prior to quality improvement interventions) patient and visit characteristics and analgesic management practices for each site participating in an emergency department (ED) sickle cell learning collaborative.Methods: A prospective, multisite longitudinal cohort study in the context of a learning-collaborative model was performed in three midwestern EDs. Each site formed a multidisciplinary team charged with improving analgesic management for patients with sickle cell disease (SCD). Each team developed a nurse-initiated analgesic protocol for SCD patients (implemented after a baseline data collection period of 3.5 months at one site and 10 months at the other two sites). All sites prospectively enrolled adults with an acute pain crisis and SCD. All medical records for patients meeting study criteria were reviewed. Demographic, health services, and analgesic management data were abstracted, including ED visit frequency data, ED disposition, arrival and discharge pain score, and name and route of initial analgesic administered. Ten interviews per quarter per site were conducted with patients within 14 days of their ED discharge, and subjects were queried about the highest level of pain acceptable at discharge. The primary outcome variable was the time to initial analgesic administration. Variable data were described as means and standard deviations (SDs) or medians and interquartile ranges (IQR) for nonnormal data.Results: A total of 155 patients met study criteria (median age = 32 years, IQR = 24-40 years) with a total of 701 ED visits. Eighty-six interviews were conducted. Most patients (71.6%) had between one and three visits to the ED during the study period. However, after removing Site 3 from the analysis because of the short data enrollment period (3.5 months), which influenced the mean number of visits for the entire cohort, 52% of patients had between one and three ED visits over 10 months, 21% had four to nine visits, and 27% had between 10 and 67 visits. Fifty-nine percent of patients were discharged home. The median time to initial analgesic for the cohort was 74 minutes . Differences between choice of analgesic agent and route selected were evident between sites. For the cohort, 680 initial analgesic doses were given (morphine sulfate, 42%; hydromorphone, 46%; meperidine, 4%; morphine sulfate and ibuprofen or ketorolac, 7%) using the following routes: oral (2%), intravenous (67%), subcutaneous (3%), and intramuscular (28%). Patients reported a significantly lower targeted discharge pain score (mean ± SD = 4.19 ± 1.18) compared to the actual documented discharge pain score within 45 minutes of discharge (mean ± SD = 5.77 ± 2.45; mean difference = 1.58, 95% confidence interval = .723 to 2.44, n = 43).

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Section: Discussionmentioning

confidence: 99%

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Tanabe

Artz

Courtney

et al. 2010

Academic Emergency Medicine

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“…29 Weighed against this concept is the pervasive and unfounded fear of drug addiction and drug-seeking behavior in acute and chronic pain patients in general and the SCD population in particular. [41][42][43] For example, 26% of hematologists and 53% of ED physicians in one survey believed that at least 20% of SCD patients are addicted. 42 Moreover, health care personnel consistently indicated that SCD patients were almost twice as likely to be opioid dependent as other pain patients presenting to an emergency department.…”

Section: Concerns About Opioid Addiction and Drug Abusementioning

confidence: 99%

Treatment and prevention of pain due to vaso-occlusive crises in adults with sickle cell disease: an educational void

Solomon

2008

Blood

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Pain due to vaso-occlusive crisis is the major cause of hospital use in sickle cell disease. Although available guidelines provide recommendations for opioid administration in this setting, only 4 (21%) of 19 medical textbooks present treatment regimens that are consistent with them. Moreover, only 7 texts (37%) note that addiction is infrequent in this population, while 11 (92%) of 12 texts provide such reassurance for cancer-related pain (P < .005). Finally, hydroxyurea use to decrease the frequency of vasoocclusive crises is completely defined only in 2 textbooks. Thus, most medical texts provide neither adequate information for the treatment or prevention of pain due to vaso-occlusive crisis in sickle cell disease nor reassurance of the unlikelihood of addiction in this population. In contrast, treatment recommendations for less common hematologic disorders are consistent with current standards in 53% to 84% of appropriate texts (P < .05). Limited knowledge regarding the principles and appropriateness of opioid therapy; a lack of evidence-based research on pain control; and misconceptions and prejudices about drug abuse and addiction contribute to this educational void. Thus, research and training on pain control in sickle cell disease are needed to parallel studies of environmental and genetic factors contributing to the known clinical heterogeneity of this disorder. (Blood. 2008;111:997-1003)

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“…This finding is inconsistent with other studies which reported nurses' identify lack of time to provide psychological support as a common barrier (Pack-Mabien et al, 2001). Meunier-Sham and Ryan (2003) developed developmentally appropriate strategies to decrease the pain associated with routine and emergency pediatric procedures.…”

Section: Non-pharmacological Methodsmentioning

confidence: 68%

“…Workload and lack of time have been identified as barriers to optimal pain management practices (Dalton et al, 2001;Kaasalainen et al, 2007;Pack-Mabien et al, 2001;Schafheutle et al, 2001). Kaasalainen et al (2007) explored the decision-making process of physicians and nurses in pain management for older adults with cognitive impairment.…”

Section: Contextual Influencesmentioning

confidence: 99%

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cummings¹

2013

Journal of Pediatric Health Care

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Rationale for the Study: Despite the exponential growth in pharmacological and nonpharmacological methods for the treatment of pediatric procedural pain there remains a gap between available interventions and actual practice in the emergency department clinical setting. Researchers have recommended the examination of unit culture since culture is proposed to be a major factor that affects the implementation of pain management practices. Method:Ethnography was employed to gain access to the beliefs and practices of healthcare participants in a Northeastern non-pediatric emergency department. Data were collected for 5 months with over 100 hours of observation. Six key informants were interviewed and 44 pediatric procedural interactions with 27 healthcare providers during the treatment of children two to eight years of age undergoing procedures were observed.Other information gathered included documents from the institution, and pain related information from the patient's medical record. All interviews were recorded and transcribed verbatim. Data were managed using the Ethnograph 6.0 and analyzed using the procedure developed by Leininger and McFarland (2006). Results:Seven major themes with categories were discovered that included assessment, ii procedural pain, treatment of pain, communication related to comfort, fragmentation of care in the emergency department, healthcare provider attitudes, and environmental issues and policies. Conclusion:The results of this study suggest that practice environment of the emergency department and organizational culture exerted a significant degree of influence over healthcare providers' pediatric pain management practices. Nurses' did not use pain measurement tools as they were intended to be used and instead improvised measurement by observing the child's behavior. The management of children during painful procedures consisted of an array of behaviors and practices. The use of physical restraint during painful procedures was a common practice. Participants continue to hold many assumptions and misconceptions about pediatric pain assessment and management. The findings of this study provide insight to the everyday practice of emergency department healthcare providers for pediatric pain in a non-pediatric setting.iii Acknowledgments and Dedication

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Nurses' attitudes and practices in sickle cell pain management

Cited by 102 publications

References 14 publications

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Treatment and prevention of pain due to vaso-occlusive crises in adults with sickle cell disease: an educational void

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

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