Boerlage, A.A.

The COMFORT behavior scale: Is a shorter observation period feasible? (Article)

2012-03-01T00:00:00Z

Objective: The COMFORT behavior scale has been validated for postoperative pain in 0- to 3-yr-old children. Scoring is preceded by a 2-min observation period, which nurses may consider too long. The objective of this study was to test the reliability of a 30-sec observation period. Design: Observational study. Setting: One Level III intensive care unit at a university children’s hospital. Participants: Designated pain specialist and all nursing staff. Interventions: None. Measurements: The pain specialist and caregiver nurse each conducted a bedside COMFORT behavior scale assessment and assigned an additional pain rating on the 11-point Numerical Rating Scale. Main Results: Total COMFORT behavior Scale score for the 2-min observation was 17 or higher in 19% of the patients and 11% for the 30-sec observation. The mean COMFORT behavior scale score for the 2-min observation was 13.5 (SD 3.8) and 12.7 (SD 3.7) for the 30-sec observation. The mean difference therefore was 0.8 (confidence interval 0.6–1.1, paired t test, p < .001). Sensitivity and positive predictive value for the 30-sec observa- tion were 0.44 and 0.80, respectively. Conclusions: A 30-sec COMFORT behavior scale observation increases the risk of underscoring pain. Therefore, the 2-min observation period should be adhered to in the interest of the patients.

Having a Feel for Others’ Pain (Doctoral Thesis)

2011-12-16T00:00:00Z

Pain is a phenomenon so common that almost all individuals become familiar with this sensation at some point in life. Some consider it as unavoidable and others as a challenge that has to be defeated. During the second part of the last century researchers became interested in the neurobiological source and regulation of pain, the use of assessment instruments to “objectify” pain, and treatment options for distinct patient groups and types of pain. Meanwhile we have become aware of the negative impact of pain on quality of life, recovery from surgery and survival, as well as the risk of acute pain turning into chronic pain. Babies and intellectually disabled individuals of all ages have often been excluded from pain studies; for long it was believed that they were unable to experience pain. For infants and young children this belief was not specifically based on a scientific rationale but more on a lack of knowledge about the status of the myelinisation process of the nerves in neonates, the individual variability in drug disposition and fear of harmful side effects of analgesics and narcotics. Intellectually disabled individuals have always been considered to be unable to experience or suffer from pain. This misconception was partly based on absence of visible emotion during potentially painful situations, like continuing to walk with a broken hip or leg. Such observations seemed more important than the knowledge that a condition is known to be (extremely) painful in individuals that are not intellectually disabled. Fortunately enough we have done away with these misconceptions. A landmark publication of Anand and Hickey in 1987 reported huge circulatory and metabolic complications in (prematurely born) neonates after ligation of a patent ductus arteriosus without fentanyl compared to children that received fentanyl. Since then it was acknowledged that babies are capable to feel pain and require treatment just like in older patients.

The COMFORT-Behavior scale is useful to assess pain and distress in 0- to 3-year-old children with Down syndrome (Article)

2011-06-02T00:00:00Z

Many pediatric intensive care units use the COMFORT-Behavior scale (COMFORT-B) to assess pain in 0- to 3-year-old children. The objective of this study was to determine whether this scale is also valid for the assessment of pain in 0- to 3-year-old children with Down syndrome. These children often undergo cardiac or intestinal surgery early in life and therefore admission to a pediatric intensive care unit. Seventy-six patients with Down syndrome were included and 466 without Down syndrome. Pain was regularly assessed with the COMFORT-B scale and the pain Numeric Rating Scale (NRS). For either group, confirmatory factor analyses revealed a 1-factor model. Internal consistency between COMFORT-B items was good (Cronbach's α = 0.84-0.87). Cutoff values for the COMFORT-B set at 17 or higher discriminated between pain (NRS pain of 4 or higher) and no pain (NRS pain below 4) in both groups. We concluded that the COMFORT-B scale is also valid for 0- to 3-year-old children with Down syndrome. This makes it even more useful in the pediatric intensive care unit setting, doing away with the need to apply another instrument for those children younger than 3.

Is Pain Assessment Feasible as a Performance Indicator for Dutch Nursing Homes? A Cross-Sectional Approach (Article)

2010-07-26T00:00:00Z

Quality of care gains transparency with the help of performance indicators. For Dutch nursing homes, the current set of performance indicators does not include pain. To determine the feasibility of pain assessment as performance indicator, information about pain prevalence and analgesic prescription in one nursing home was collected. Within the time span of 3 days, pain intensity was measured in 91% of the residents (201 out of 221), either with a numeric rating scale, a verbal rating scale, or the Rotterdam Elderly Pain Observation Scale (REPOS). Numerical rating was used for 72%, verbal rating for 3%, and REPOS observation for 25% of the residents. Pain was substantial in 65 residents (32%), who received the following analgesic prescription: World Health Organization (WHO) step 1, 45%; WHO step 3, 12%; and neuroactive agents, 5%. Thirty-eight percent of these residents were in pain and received no analgesics. Residents with substantial pain significantly more often received analgesics (p = .007). Results suggest that pain assessment is feasible in a nursing home and would stimulate staff attention to pain. Further investigation is necessary to find out if a pain algorithm is feasible and will lead to improved pain treatment.

Pain Management in Dutch Nursing Homes Leaves Much to Be Desired (Article)

2009-03-01T00:00:00Z

This cross-sectional multicenter study describes several aspects of pain, pain intensity, and pain treatment in a Dutch nursing home population. A standardized pain questionnaire, including the Numeric Rating Scale (NRS), was used to measure aspects of pain and intensity of present pain, pain experienced in the previous week, and tolerable pain. The eligible sample comprised 320 residents (median age 79 years), of whom 233 residents completed the questionnaire. Sixty-six percent (n = 153) experienced (mostly chronic) pain, either in the previous week (median NRS 6) or at present (median NRS 5). Intolerable pain was recorded in 41% of 100 residents. The higher the pain scores, the more interference with activities of daily living was reported. Of the 153 residents with pain, about one-fourth did not receive any pain medication, and 65 (43%) received step 1, 13 (9%) step 2, and 16 (11%) step 3 analgesics. Most residents (60%) were satisfied with pain treatment, and 21% were not. Considering the high prevalences and intensities of pain, pain management in Dutch nursing homes leaves much to be desired. Apparently, residents do not seem to expect effective pain management. Awareness and knowledge about pain assessment and treatment, however, needs to be raised. Pain measurement tools and treatment protocols should be implemented in daily practice.

Evaluation of a Pilot Project for Implementation of REPOS in Daily Practice (Article)

2009-01-01T00:00:00Z

Abstract: Pain assessment in elderly people with a communication disability is a well-known problem. Objective: To explore the feasibility of a new pain observation scale. Study group: Fifteen nurses employed at eight wards in one nursing home. Methods: We developed the Rotterdam Elderly Pain Observation Scale (REPOS), which includes 10 behavioral items scored as present (1) or absent (0) after a 2-minutes observation. In addition, pain level is rated on the Numeric Rating Scale (NRS). A REPOS score of ≥3 in combination with a NRS of ≥4 indicates pain. Fifteen nurses received a 2-hours theoretical training, and performed paired bedside observations with the trainer. After obtaining a sufficient interrater agreement, nurses were asked to continue REPOS observations. These data were examined after six months. Results: All nurses reached sufficient interrater agreement (kappa ≥ 0.61) within a median of 8 weeks (range 4 to 10), after a median of 12 observations. The next 6 months, in total 52 observations were completed by seven nurses at five different wards. Combined REPOS and NRS scores indicated pain in 22 (42%) of 52 observations. In most of these cases (77%) nurses took action as indicated in the decision tree that comes with the REPOS. Conclusions: The REPOS is feasible in daily nursing practice provided training is given. The decision tree was a useful guide for nurses to reflect on residents’ pain and take appropriate action.

Pain prevalence and characteristics in three Dutch residential homes (Article)

2008-10-01T00:00:00Z

Background: In Anglo-Saxon countries, high prevalence rates of pain have been reported for elderly living in nursing homes, residential homes and for community-dwelling elderly. No information on pain prevalence is available for elderly living in Dutch residential homes. Methods: We performed an explorative study on pain prevalence, characteristics and treatment in three residential homes in Rotterdam, the Netherlands. Residents were interviewed using a standardized pain questionnaire. Results: The overall prevalence of pain was 69%. In case of pain, it was chronic in 93% of residents. Present pain and mean pain during the preceding week were substantial (numeric rating scale ≥4) in 68% and 85% of residents, respectively. Of the residents with pain, 22% did not receive any analgesics and only 3% was prescribed a strong opioid. When analgesics were prescribed, they were given only 'as needed' in 31% of residents. In a majority of residents, pain interfered with daily living and mood. Almost 60% of the elderly was convinced that pain is a part of ageing, 70% indicated that they did not always report their pain to the caregivers. Thirty-seven percent was satisfied with the caregivers' and 39% with the doctors' attention towards pain. Conclusions: The pain prevalence rate in Dutch residential homes is similar to rates found in other Anglo-Saxon countries. Furthermore, they are also comparable to rates reported from European nursing homes. Pain treatment is insufficient and although pain interferes with daily activities and mood, elderly tend to accept pain as an unavoidable part of aging.

Pijnregistratie en pijnbehandeling in verpleeghuizen kunnen nog beter. (Article)

2007-01-01T00:00:00Z

AIM. To assess the effect of implementation of pain registration in nursing homes on the residents’ pain (treatment); a secondary aim was measuring nursing compliance. METHODS. Prior to implementation of pain registration, all relevant aspects of pain (treatment) were recorded through interviews with the residents (pretest). Interviews were repeated after at least three months following implementation of pain registration (posttest). RESULTS. Three fourths of all residents were able to give information about their pain and two thirds could provide a numerical rating. On average, 69% of all residents with recorded pain history experienced pain in the pretest. Pain registration resulted in a significant decrease in the proportion of residents suffering from substantial pain during the previous week. CONCLUSION. Pain registration is feasible in the majority of elderly living in nursing homes and may improve pain treatment and satisfaction with caretakers.