Sickle cell pain management in the emergency department: A two phase quality improvement project

This quality improvement project addressed the gaps in sickle cell pain management at a suburban teaching hospital emergency department. The aims were to: (1) measure baseline pain management practices for patients with sickle cell disease, (2) develop and pilot a questionnaire on knowledge, attitudes and self-reported practice patterns for emergency department nurses, (3) provide a continuing education intervention for emergency department nurses aimed at increasing their overall knowledge and optimizing analgesic and holistic management practices for patients with SCD, and (4) implement an adapted Emergency Department sickle cell pain management clinical pathway. A retrospective chart review was conducted for data abstraction on pain management practices. ED nurses completed a pre and post education questionnaire measuring knowledge attitude and self-reported practice on SCD pain management. The nurse education consisted of the unique characteristics of sickle cell pain such as organ damage, need for timely and adequate pain management as well as the application of Levin\u27s principles of conservation to provide holistic care while preserving vital organs. There was significant learning between the pre and post education questionnaire. Medical record review from 44 patient visits showed a high use of monotherapy, delay in time to medical evaluation, medication order, and time to first and subsequent analgesic and pain reassessments. Results were used by a multidisciplinary team to develop and implement an evidence based clinical pathway to improve SCD pain management.

Stigma in adults with sickle cell disease and family members: Scale development and pilot study in the USA and Nigeria

Background: Sickle cell disease associated stigma impacts health-related quality of life and community participation. Stigma in adults living with sickle cell disease and family members was appraised via a pilot study for paired (adult and family) instrument development, face validity, and psychometrics. Methodology: Likert type stigma scales were adapted from epilepsy and HIV literature with Bronfenbrenner’s Ecology of Human Development Theory as the conceptual framework. Findings: 42 adults from United States and Nigeria participated in the study. Chronbach’s alpha of the 40 item Stigma in SCD Scale(s) = 0.86. Total score 0–120; mean = 40.6, SD = 20.9, range = 4–86. Nigerians report higher stigma (r = .60, p < .01). Adults from both countries “fear that their significant others will reject them” (r = .44, p < .01) and from the US that “service providers do not believe that people with Sickle cell disease have disabilities” (r = .57, p < .01). Factor analysis indicated four interpretable factors: societal impact regarding the disease and isolation; personal feelings of shame, rejection, guilt; treatment when in pain and concerns for the future; and a sense of burden and needing assistance. Conclusion: Tools to assess stigma in adults with sickle cell disease are useful in individuals and family/social supports across cultural populations. The Conceptual model highlights the complexity of systems that can affect stigma. Implementation of the tool can identify issues such as isolation, fear and burden. Further development and analysis is needed to influence education, treatment, and policy. Keywords: Community Based Participatory Research, Ecology of Human Development, Family measures, Instrument development, Sickle cell disease, Social support, Stigm