Pain Management Nursing RSS feed: Current Issue. This peer-reviewed journal offers a unique focus on the realm of pain management as it applies to nursing. Original and review articles from experts in the field offer key insights in the areas of clinical practice, advocacy, education, administration, and research. Additional features include practice guidelines and pharmacology updates.http://www.painmanagementnursing.org/?rss=yesElsevier Inc.en © 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved. Pain Management Nursing1524-9042112June 2010 © 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.painmanagementnursing.org/article/PIIS1524904210000421/abstract?rss=yesThe National Community of Pharmacists Association (NCPA) submitted a written statement for the United States Special Committee on Aging hearing on March 24, 2010 (). The NCPA recommended that the Drug Enforcement Agency (DEA) cease enforcement of its current interpretation of the Controlled Substance Act (CSA). Since the enactment of the CSA 40 years ago, federal law has mandated that a controlled substance may be prescribed or dispensed only by a DEA-registered practitioner. This closed system of distribution was to provide security and accountability for the controlled substance supply.The War on Drugs on Pain: Nursing Home Patients Caught in the CrossfireJoyce S. Willens10.1016/j.pmn.2010.04.001Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0Editorial6767http://www.painmanagementnursing.org/article/PIIS152490421000041X/abstract?rss=yesAbstract: 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. In the first phase, the content expert panel discussed performance domains that exist in pain management nursing. The six domains developed were: 1) assessment, monitoring, and evaluation of pain; 2) pharmacologic pain management; 3) nonpharmacologic pain management; 4) therapeutic communication and counseling; 5) patient and family teaching; and 6) collaborative and organizational activities. The panel then produced a list of 70 task statements to develop an online survey which was sent to independent reviewers with expertise in pain management nursing. After the panel reviewed the results of the pilot test, it was decided to clarify a few items that did not perform as expected. After the questionnaire was finalized it was distributed to 1,500 pain management nurses. The final yield was 585 usable returns, for a response rate of 39%. Thirty-three percent of the respondents reported a bachelor's degree in nursing as the highest degree awarded. Over 80% indicated that they were certified in pain management. Over 35% reported working in a staff position, 14% as a nurse practitioner, and 13% as a clinical nurse specialist. Part of the questionnaire asked the participants to rate performance expectation, consequence or the likelihood that the newly certified pain management nurse could cause harm, and the frequency of how often that nurse performs in each of the performance domains. The performance expectation was rated from 0 (the newly certified pain management nurse was not at all expected to perform the domain task) to 2 (after 6 months the newly certified pain management nurse would be expected to perform the domain task). The consequences of the degree would be the inability of the newly certified pain management nurse to perform duties or tasks in each domain was rated from 0 (no harm) to 4 (extreme harm). The first domain received the highest average frequency rating. 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.Role Delineation Study for the American Society for Pain Management NursingJoyce S. Willens, Christine DePascale, James Penny10.1016/j.pmn.2010.03.010Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0Original Articles6875http://www.painmanagementnursing.org/article/PIIS1524904209000228/abstract?rss=yesAbstract: Postoperative pain is a subjective concept that can only be defined by the individual experiencing it. This research was planned as a descriptive study to make postoperative pain assessments of patients who have undergone major orthopedic surgery. The study sample consisted of 150 patients who met the inclusion criteria and agreed to participate in the study. Data were collected using a questionnaire form that included sociodemographic, postoperative pain characteristics, and the McGill Pain Questionnaire. The data obtained were assessed using the SPSS 10.0 program. The mean age of the patients was 54.13 ± 18.12 years, 67.3% were female, 72.7% of the patients had a history of previous surgery, 43.3% had had hip prosthesis surgery, and 70.7% when their analgesic medications were taken on PRN basis. They experienced “external” pain at the surgical site and in pressure areas according to type of surgery and verbalized their pain at the highest percentages as “throbbing,” “tiring,” “troublesome,” and “nagging.” In addition the majority of the patients (95.3%) stated that their pain was decreased with analgesic medication administration, and 78.7% stated that position change and physical therapy (69.3%) increased their pain. In the assessment of pain severity on the third postoperative day, the Present Pain Intensity was determined to be a mean of 1.75 ± 1.02 (on a scale of 0 to 5), and 78.7% had “intermittent” pain. In addition, worst/severe pain severity was determined to be a mean of 4.55 ± 0.70 on the third postoperative day. Statistically significant differences were found between patients’ pain severity scores (p ≤ .001). This study determined pain characteristics on the third postoperative day in Turkish orthopedic patients. After an evaluation of the conclusions, nurses must learn the postoperative pain characteristics of orthopedic patients to implement safe and effective postoperative pain management.Postoperative Pain Characteristics in Turkish Orthopedic PatientsFunda Esen Büyükyilmaz, Türkinaz Aştı10.1016/j.pmn.2009.01.003Pain Management Nursing 11, 2 (2010)2009-04-20Pain Management Nursing2009-04-20112S1524-9042(10)X0003-0Original Articles7684http://www.painmanagementnursing.org/article/PIIS1524904209000356/abstract?rss=yesAbstract: 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. The purpose of this quasi-experimental study was to test the effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis. All of the pediatric hemodialysis centers in Tehran (three centers) were assigned to case group (one center with 21 patients) and control groups (two centers with a total of 21 patients) randomly. The Wong-Baker face pain scale was used to assess pain caused by venipuncture. Assessing of pain was done in 12 sessions in both case and control groups. Three first sessions were held without intervention (pretest) and the next nine sessions were held with distraction intervention (posttest). To cause distraction, the adolescents were asked to look at two similar pictures and tell the number of differences between them during venipuncture. Results showed that case and control groups matched in demographic variables and pain intensity. 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.The Effect of Programmed Distraction on the Pain Caused by Venipuncture among Adolescents on HemodialysisFatemah Alhani10.1016/j.pmn.2009.03.005Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0Original Articles8591http://www.painmanagementnursing.org/article/PIIS1524904209000381/abstract?rss=yesAbstract: Fear of engendering addiction is frequently reported as both a provider and a patient barrier to effective pain management. In this study, a clinical scenario ascertained nursing staff members' usual practice in addressing addiction fears for patients with concerns about the addictive potential of pain medication. One hundred forty-five Veterans Health Administration nursing staff members from eight ambulatory care sites were queried to identify variables associated with proclivity to address patient fears about addiction risks in a population where pain is prevalent and the risk for substance abuse is high. Regarding addressing addiction concerns, 66% of nursing staff were very likely, 16% somewhat likely, 9% unsure, 6% somewhat unlikely, and 2% very unlikely to take action. Health technicians were less likely to address addiction concerns than registered or licensed vocational nurses (odds ratio [OR] 0.116; p=.004). Nursing staff with more years' experience (OR 1.070; p=.005) and higher levels of self-efficacy/confidence (OR 1.380; p=.001) were more likely to engage in discussions related to addiction risks. Targeted efforts to improve pain management activities should focus on retaining experienced nursing staff in initial assessment positions and improving the skills and confidence of less experienced and less skilled staff.Addressing Patients' Concerns about Pain Management and Addiction RisksJoy R. Goebel, Cathy D. Sherbourne, Steven M. Asch, Lisa Meredith, Angela B. Cohen, Emily Hagenmaier, Andy B. Lanto, Barbara Simon, Lisa V. Rubenstein, Lisa R. Shugarman, Karl A. Lorenz10.1016/j.pmn.2009.03.009Pain Management Nursing 11, 2 (2010)2009-09-14Pain Management Nursing2009-09-14112S1524-9042(10)X0003-0Original Articles9298http://www.painmanagementnursing.org/article/PIIS1524904209000502/abstract?rss=yesAbstract: Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory–Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important.Interference of Postoperative Pain on Women's Daily Life after Early Discharge from Cardiac SurgeryMarit Leegaard, Tone Rustøen, May Solveig Fagermoen10.1016/j.pmn.2009.04.001Pain Management Nursing 11, 2 (2010)2009-09-10Pain Management Nursing2009-09-10112S1524-9042(10)X0003-0Original Articles99107http://www.painmanagementnursing.org/article/PIIS1524904209000708/abstract?rss=yesAbstract: Pain is the leading reason individuals seek emergency care. Studies have concluded that acute pain conditions are underevaluated and undertreated in the emergency department (ED). There is a paucity of information about how the severity of pain influences the time spent in the ED before being seen by a physician. Therefore, this study focuses on what role pain plays regarding time to treatment in the ED, i.e., to examine the effects of patients' perceived level of pain on wait time in the ED. The CDC's National Hospital Ambulatory Medical Survey 2003 data were used in this study. The sample consisted of 12,860 caucasians and African Americans with a mean age of 44.52 years. Analysis of covariance was used to explore differences in length of waiting time in ED based on race, triage nurses rating of the immediacy of the need to be seen by a physician, and the level of pain the patient reported. The findings showed that patients' reports of pain had very little effect on the length of waiting time. Given the sample size, we feel there is adequate power to detect the effect of pain in determining the length of waiting time to see a physician if it were present. In addition, African Americans had a statistically significant longer wait (15.29minutes) than Whites. The effect of race might be interpreted as another example of health disparities or could be a hospital-level effect which was not examined within this model.Level of Pain and Waiting Time in the Emergency DepartmentErlinda Wheeler, Thomas Hardie, Paula Klemm, Ibironke Akanji, Erin Schonewolf, Janna Scott, Beth Sterling10.1016/j.pmn.2009.06.005Pain Management Nursing 11, 2 (2010)2009-09-22Pain Management Nursing2009-09-22112S1524-9042(10)X0003-0Original Articles108114http://www.painmanagementnursing.org/article/PIIS1524904209000538/abstract?rss=yesAbstract: Feasibility and clinical utility are essential characteristics to consider when it comes to developing or selecting a pain assessment tool to implement into practice. However, these characteristics have not been widely studied with available pain assessment tools in critically ill adults. The objective of this study was to describe nurses’ evaluations of the feasibility and clinical utility of the Critical-Care Pain Observation Tool (CPOT) in assessing pain in critically ill ventilated adults. A descriptive design was used. Of the 51 nurses who used the CPOT with the enrolled patients (n = 55), 33 returned their completed evaluation form. Overall, the feasibility and clinical utility of the CPOT were positively evaluated by the nurse participants. More than 90% of them supported that the directives about the use of the CPOT were clear and that it was simple to understand and easy to complete. Regarding its clinical utility, a little more than 70% of the nurses mentioned that the CPOT was helpful for nursing practice and recommended its use routinely. They acknowledged that the CPOT provided them with a common language and a standardized way to assess patients’ pain. Half of the nurse participants supported that the CPOT had influenced their practice. On the other hand, six nurses mentioned that they were already sensitive to nonverbal cues of pain before the introduction of the CPOT. In conclusion, the CPOT is a valid behavioral pain scale, which has been suggested by experts in recent critical reviews. So far, the CPOT is being used for research purposes and has been implemented into clinical practice of various health care centers of North America.Nurses’ Evaluations of the Feasibility and the Clinical Utility of the Critical-Care Pain Observation ToolCéline Gélinas10.1016/j.pmn.2009.05.002Pain Management Nursing 11, 2 (2010)2009-09-22Pain Management Nursing2009-09-22112S1524-9042(10)X0003-0Original Articles115125http://www.painmanagementnursing.org/article/PIIS152490421000038X/abstract?rss=yesIn the article “Chronic Neuropathic Pain in Women After Breast Cancer Treatment” by Bokhari and Sawatzky in the December 2009 issue (10(4), 197-205; doi: 10.1016/j.pmn.2008.04.002), under the heading “Personal Risk Factors,” the reference Hack et al. (1999) was erroneously cited. The corrected sentence reads: “Increased body mass index [BMI] (i.e., weight-to-height ratio) has been linked to chronic neuropathic pain development after surgery (Bruce et al., 2003; Poobalan et al., 2001; Smith et al., 1999).” The author regrets the error.Erratum10.1016/j.pmn.2010.03.007Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0Original Articles125125http://www.painmanagementnursing.org/article/PIIS1524904209000368/abstract?rss=yesAbstract: 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. As a result of these stigmas, a multitude of barriers have arisen for those individuals using opioids to control their chronic nonmalignant pain. Limited qualitative research exists that reflects patients’ perspectives regarding the stigmatization and barriers that they encounter when using this treatment option. This paper reports part II of the results of a phenomenologic study that investigated the experience of 22 adults receiving opioid therapy for chronic nonmalignant pain, with a focus on associated stigmas and barriers to treatment. 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.Chronic Opioid Therapy for Nonmalignant Pain: The Patient's Perspective. Part II—Barriers to Chronic Opioid TherapyApril Vallerand, LuAnn Nowak10.1016/j.pmn.2009.03.006Pain Management Nursing 11, 2 (2010)2010-04-23Pain Management Nursing2010-04-23112S1524-9042(10)X0003-0Original Articles126131http://www.painmanagementnursing.org/article/PIIS1524904210000457/abstract?rss=yesEditorial Board10.1016/S1524-9042(10)00045-7Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0FrontmatterA1A1http://www.painmanagementnursing.org/article/PIIS1524904210000469/abstract?rss=yesTable of Contents10.1016/S1524-9042(10)00046-9Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0FrontmatterA2A2http://www.painmanagementnursing.org/article/PIIS1524904210000470/abstract?rss=yesInformation for Readers10.1016/S1524-9042(10)00047-0Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0FrontmatterA3A3http://www.painmanagementnursing.org/article/PIIS1524904210000482/abstract?rss=yesInformation for Authors10.1016/S1524-9042(10)00048-2Pain Management Nursing 11, 2 (2010)2010-06-01Pain Management Nursing2010-06-01112S1524-9042(10)X0003-0FrontmatterA4A6