The assessment of pain in older people

Pain is under-recognised and under-treated in older people. It is a subjective, personal experience, only known to the person who suffers. The assessment of pain is particularly challenging in the presence of severe cognitive impairment, communication difficulties or language and cultural barriers. These guidelines set out the key components of assessing pain in older people, together with a variety of practical scales that may be used with different groups, including those with varying levels of cognitive or communication impairment. The purpose is to provide professionals with a set of practical skills to assess pain as the first step towards its effective management. The guidance has implications for all healthcare and social care staff and can be applied in all settings, including the older person’s own home, in care homes, and in hospital

Understanding long-term opioid prescribing for non-cancer pain in primary care: A qualitative study

YesBackground: The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain. Methods: We held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts. Results: Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs’ responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient’s wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust. Conclusions: Problematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients.National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number PB-PG- 1010–23041)

Translation to practice: a randomised controlled study of an evidenced based booklet targeted at breast care nurses in the United Kingdom

BACKGROUND: In the United Kingdom (UK), it was documented that a problem of knowledge transfer existed within the speciality of breast-cancer care, thus depriving patients of receiving optimal care. Despite increasingly robust research evidence indicating recommendation of whole body exercise for people affected by breast cancer, commensurate changes to practice were not noted amongst breast-care nurses (BCNs). AIM: To evaluate the effect of a targeted booklet, Exercise and Breast Cancer: A Booklet for Breast-Care Nurses, on changes in knowledge, reported practice, and attitudes of BCNs in the UK. METHOD: A prospective, experimental approach was used for designing a pre- and post-test randomised controlled study. Comparisons of knowledge, reported practice, and attitudes based on responses to a questionnaire were made at two time-points in two groups of BCNs (control and experimental). The unit of randomisation and analysis was hospital clusters of BCNs. The sample comprised 92 nurses from 62 hospitals. Analysis consisted of descriptive statistics and clustered regression techniques: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items, and clustered multiple regression for paired and multiple variable analysis. RESULTS: A statistically significant increase in knowledge and changes in reported practice and attitudes were found. Robust variables affecting knowledge acquisition were: promotion of health, promotion of exercise, and understanding how exercise can reduce cancer-related fatigue. DISCUSSION: The study has shown that evidence-based printed material, such as an information booklet, can be used as an effective research dissemination method when developed for needs, values, and context of a target audience. CONCLUSIONS: This practical approach to research dissemination could be replicated and applied to other groups of nurses.</p

Clients' perceptions of support received from health visitors during home visits.

NoAims and objectives. The current study sought to identify how many mothers from 149 visits carried out by seven health visitors identified support as a feature of the visit, whether this type of support was unique to the health visitor and what support meant to them. These responses were then compared with the taxonomies of social support from the social support literature. Background. Some studies of client perceptions describe support as an element of home visits by health visitors. However, the importance, relevance and impact on the client of this support are not described in detail. Social support theory suggests that there are tangible benefits to people's well-being and their ability to cope with various challenges that may arise from individuals' perceptions of receiving support. Design. Qualitative study using semistructured interviews. Methods. Seven volunteer health visitors recruited 149 women into the study. These clients were interviewed by the researcher, usually within one week of the home visit by their health visitor. The discussions were audio-taped and the resulting transcripts analysed using content analysis. Findings. Thirty-seven women identified receiving support which they said was only available from the health visitor. The relevance of this support to the mother and the impact on her well-being varied within the group suggesting differing perceptions of support by clients according to their personal situation. There was a correspondence between the descriptions of support given by the women and the taxonomies of social support from the social support literature. Conclusion. For some interactions between clients and their health visitors the existing theory of social support may provide an explanation of how health visitors contribute to clients' perceived ability to cope and well-being. Relevance to clinical practice. Social support may be defined as a possible outcome of health visiting. This concept will have use within educational programmes to demonstrate to students how health visiting can have an impact on clients' well-being. Similarly, the concept could be used to investigate and record health visiting practice

Comment on : Thompson D.R. & Darbyshire P. (2013) Is academic nursing being sabotaged by its own killer elite? Journal of Advanced Nursing 69 (1), 1-3.

Peer reviewe

A nursing study of patients' night-time pain, analgesic provision and sleep following surgery

SIGLEAvailable from British Library Document Supply Centre- DSC:q92/22503(Nursing) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

A study to inform nursing support of patients coping with chemotherapy for breast cancer

SIGLEAvailable from British Library Document Supply Centre- DSC:q91/09443(Study) / BLDSC - British Library Document Supply CentreGBUnited Kingdo