Nurse Intervention Beneficial to Patients Dealing with Chronic Pain

Nurses can help lead efforts to ease psychological distress and reduce suffering for people with chronic pain, according to a new study of U.S. veterans.

Nurse care managers in the study provided support, motivation, and encouragement that “many of the participants really clung to,” lead author Marianne Matthias tells Pain Medicine News. Nurses were also very important in providing cognitive-behavioral therapy (CBT) to the veterans.

Matthias’s paper is one of several being published from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) study, which involved 242 U.S. veterans of the recent Afghanistan and Iraq wars. The study was funded by the Department of Veterans Affairs. In 2010, a U.S. Army Pain Management Task Force made recommendations on the best approach to helping veterans with chronic pain, which included making support available and creating a spectrum of best evidence-based practices for the continuum of care. The ESCAPE studies were conducted in response to those recommendations.

For Matthias’s study, patients were put into randomized groups to either receive “usual care” or “a nurse-led intervention” that included pain medication management and 12 phone conversations. During the conversations nurses provided information on medication management, pain self-management instruction, and CBT. The most recent findings from the study, which explored the pain’s emotional toll on 26 patients and their perceptions of need for support, found that nurses in particular had a positive impact on the patients.

An INQRI funded study: SPEACS 2: Improving Patient Communication and Quality Outcomes in the ICU, examined the value of a nurse-generated and nurse-led innovation on ICU patient care outcomes, including pain symptom management. The study was led by Mary Beth Happ and Amber Barnato.

Detecting and Controlling Significant Pain in the ICU through Assessment Tools

Significant pain is very common in critically-ill adult ICU patients and patient self-assessment is not always the best way for nurses to record, report or treat their patients’ needs, according to an article on Advance Healthcare Network for Nurses.

To address this issue, nurses and other medical professionals need to have the right tools, including validated, standardized pain assessment plans, according to nursing experts quoted in the article. The most common verbal scale tool for adult ICU patients is the Verbal Numerical Rating Scale, where pain is rated on a scale from zero to 10. Non-verbal scales consist of patients pointing to a number on a board or paper, and nurses asking the patient to shake their head yes or no while following their facial expressions and vital signs for indications of pain. Another tool is the mnemonic OLDCART:

•    O = onset
•    L = location
•    D = duration
•    C = characteristics of the pain on a 0-10 scale
•    A = aggravating factors
•    R = relieving factors
•    T = treatment

Tools for patients who are not able to communicate at all are also outlined in the article.

The INQRI funded study: SPEACS 2: Improving Patient Communication and Quality Outcomes in the ICU examined the value of a nurse-generated and nurse-led innovation on ICU patient care outcomes, including pain symptom management.

Webinar: Dissemination and Implementation of Evidence-Based Methods to Measure and Improve Pain Outcomes

Did you miss yesterday's webinar?  If so, here's your chance to catch up...

Thank you to INQRI grantees Susan Beck and Nancy Dunton for their presentation on evidence-based methods to measure and improve pain outcomes and to INQRI National Advisory Committee member Shelley White-Means for facilitating our discussion.

INQRI Research on Pain Management for Oncology Patients

INQRI grantee Susan Beck and her colleagues recently had an article published in Health Services Research regarding their PainCQ tool.  The objective of this study was to examine the reliability and validity and to decrease the battery of items in the Pain Care Quality (PainCQ©) Surveys. Cumulative evidence supports the reliability and validity of the companion surveys in hospitalized patients with pain in the oncology setting. The tools may be relevant in both clinical research and quality improvement. Future research is recommended in other populations, settings, and with more diverse groups.

Click here for more information.

Nurses and Cancer Treatment

The Institute of Medicine (IOM) has issued a report on improving the quality of oncology care through patient-centered treatment planning. Marie Bakitas, APRN, DNSc, AOCN, FAAN, associate professor of anesthesiology at Dartmouth Medical School, noted that a systematic review of 46 studies found that nurses are prominent information providers for cancer patients, especially after the initiation of treatment.

Click here to learn more about the report.

Indicative of the role nurses serve in providing care to cancer patients is the work conducted by an INQRI team at the University of Utah.  Led by Susan Beck, this interdisciplinary team has designed a robust measure to assess adult patients’ opinions about how nurses manage cancer-related pain.  Although nurses are the frontline providers of pain management in hospitals, pain goes unrelieved which affects patient outcomes, length of stay and costs a great deal. Beck and her team developed an instrument using qualitative and quantitative data to elicit patients’ opinions about how their nurses and other members of their care team managed their pain and, ultimately, to help patients select hospitals based on this dimension of their care experience. For example, the surveys asked patients whether nurses believed them when they said they were in pain and evaluated whether the team involved patients in decisions about their pain management. The Pain-CQ survey tools will let patients rate their experiences and help hospital administrators and policymakers who want to improve the care provided by nurses and other health team members. The initial tool was developed with the help of cancer patients. The tool is now being tested at a Veterans Administration hospital with patients who have a number of different diagnoses. The research may eventually spark the creation of a nurse-performance measure related to pain management.

New Grantee Team's Work Highlighted on Kansas Public Radio

This week, Dr. Nancy Dunton of the University of Kansas was featured on Kansas Public Radio to discuss her INQRI funded study, "Dissemination and Implementation of Evidence-Based Methods to Measure and Improve Pain Outcomes." This project, co-led by Dr. Susan Beck of the University of Utah, will disseminate and implement evidence-based approaches to measure and improve pain care and outcomes in a sample of 100 hospitals across the United States. The program is unique in forging a partnership with the National Database of Nursing Quality Indicators® (NDNQI).

Click here to access the audio interview.

Click here to find out more information about other recent INQRI funded projects.

This recent study is based on the work of Dr. Beck's 2006 INQRI study, "Measuring Nursing Care Quality Related to Pain Management."

INQRI Grantee in the Inaugural Class of HPNA Research Scholars

Congratulations to INQRI grantee Gail Towsley, PhD, NHA, who was one of five scholars recently selected by the Hospice and Palliative Nurses Association as the inaugural class of HPNA Research Scholars.

The HPNA Research Scholars Program supports funding to participate in the 4th Annual Kathleen Foley Palliative Care Retreat and Research Symposium of the National Palliative Care Research Center, co-sponsored by AAHPM, American Cancer Society, and HPNA. The Retreat will be held October 12-14, 2010 in Sundance, Utah. The goal of the Retreat is to advance the scientific endeavors of those who are or will become independent investigators actively involved in palliative care research through development of attendees' individual works in progress and improvement of specific competencies and core methodologies essential to conducting palliative care research.

Dr. Towsley was a member of the INQRI team at the University of Utah whose project was entitled, "Measuring Nursing Care Quality Related to Pain Management."  Led by principal investigator Susan Beck, the team developed and tested a questionnaire that can be used to measure opinions of patients about how their nurses manage their pain. The information from this project will provide researchers with an understanding of how patients with pain understand and interpret questions related to the quality of their nursing care. This measure is likely to prove salient to consumers interested in selecting hospitals that can best address their care needs, as well as to hospital administrators and policy makers interested in improving the quality of nursing-related care.


Click here to learn more about the HPNA.

INQRI Team Offers New Tools to Measure Pain Management

Susan Beck and her colleagues at the University of Utah have published the first phase of their INQRI-sponsored work to develop tools to measure the quality of care related to pain management.

Dr. Beck: The purpose of this phase of our research was to establish content validity of the items and to evaluate whether patients understood each item and were able to make a judgment based on the care provided to them by nurses and their interdisciplinary team. We interviewed 39 hospitalized patients with pain at the end of a nursing care shift. The process allowed the team to produce a 44-item version of the tool that could then be tested in the clinical setting.

Copies of the final version of the tools that resulted from this ongoing work are available upon request. The first tool, "Pain Care Quality (PainCQ) Nursing" includes 14 items that measure three factors: Being Treated Right, Comprehensive Nursing Pain Care, and Efficacy of Pain Management. The second tool, "PainCQ-Interdisciplinary" contains six items that measure Partnership with the Healthcare Team and Comprehensive Interdisciplinary Pain Care. Please contact me at susan.beck@nurs.utah.edu to obtain a copy and request permission to use the PainCQ tools.

You can read the article in the March/April issue of Nursing Research, now available online.

Preliminary INQRI Results

Interested in hearing more about the work INQRI funds? We've pulled together some research syntheses featuring preliminary findings from several of our grantee teams. These documents are available in PDF format at our website, www.inqri.org.

Check them out:

Acute Care
Pain Management
Nurse Staffing and Environment
Medication Errors