Medicine and Health Sciences Commons^™

Implementing Pain Management Policies And Procedures At A Rural Pain Clinic, Jamie Swearingen

Doctor of Nursing Practice Projects

The United States is facing an uprising in opioid use disorder and a rise in overdoses due to the disorder. Due to the high addiction potential of opioids and the potential for overdose, providers must be cautious and conservative in their opioid prescribing practices. In 2022, the Centers for Disease Control (CDC) updated the Clinical Practice Guidelines for Prescribing Opioids for Pain to help in prevention of developing opioid use disorder and unintentional overdoses. The lack of an opioid use disorder risk screening tool, random urine drug screens, and clear pain management contracts were identified as issues at one rural …

Doula Support For Hispanic Women, Marilyn Cervantes-Munoz, Daisy Arango-Hernandez

Nursing | Senior Theses

Purpose

This quantitative study will seek to provide valuable insight into the needs and preferences of Hispanic women during labor with the potential benefit of doula support in minimizing their pain.

Methods

A quasi-experimental design study will be conducted, randomizing a convenient sample into two groups consisting of one experimental and one control group, with the objective of evaluating the efficacy of doula presence as a source for pain management in Hispanic women. One hundred Hispanic women will be recruited under the following criteria: 18 years or older, a single fetus pregnancy, gestational age 37 weeks and above, and no …

Unveiling New Realities: An In-Depth Analysis Of Virtual Reality's Impact On Postoperative Adolescents, Julia Tolentino

Nursing | Senior Theses

The traditional approach to postoperative pain management heavily relies on opioids, but there’s been a surge in their misuse and adverse effects, leading to a significant public health concern. This has led healthcare providers to incorporate a multimodal approach aimed at reducing opioid dependence. This proposal introduces an immersive component, virtual reality (VR), not as a replacement for opioids but as a complementary tool offering distinct advantages for enhancing postoperative pain management. By immersing patients in a virtual environment, VR effectively distracts them from pain and discomfort, allowing for reduced opioid dosages and mitigating the risk of opioid misuse. Additionally, …

The Influence Of Psychosocial Factors On Opioid Decision-Making For Cancer-Related Pain Among Breast Cancer Survivors: A Mixed Method Study, Melody Nichole Chavez

USF Tampa Graduate Theses and Dissertations

Introduction: Breast cancer is the most frequently reported malignancy among women in the United States. Cancer-related pain is highly prevalent occurrence and is often the most fearful side effect following curative intent treatment. Opioid pain management is considered a standard of care and can be of great benefit to treat moderate to severe pain. However, undertreatment of pain remains a significant issue affecting the patient’s physical function, psychological well-being, and overall quality of life. Barriers to adequate pain management are multifactorial and often attributed to patients’ beliefs and attitudes revolving around opioid pain management. In addition, the opioid epidemic has …

The Influence Of Psychosocial Factors On Opioid Decision-Making For Cancer-Related Pain Among Breast Cancer Survivors: A Mixed Method Study, Melody Nichole Chavez

USF Tampa Graduate Theses and Dissertations

Introduction: Breast cancer is the most frequently reported malignancy among women in the United States. Cancer-related pain is highly prevalent occurrence and is often the most fearful side effect following curative intent treatment. Opioid pain management is considered a standard of care and can be of great benefit to treat moderate to severe pain. However, undertreatment of pain remains a significant issue affecting the patient’s physical function, psychological well-being, and overall quality of life. Barriers to adequate pain management are multifactorial and often attributed to patients’ beliefs and attitudes revolving around opioid pain management. In addition, the opioid epidemic has …

Nonpharmacological Pain Management Of Adult Patients In The Burn Unit: An Interdisciplinary Toolkit Through The Occupational Therapy Lens, Taylor Harrison-Merrill

UNLV Theses, Dissertations, Professional Papers, and Capstones

Interdisciplinary care is the standard for individuals admitted to a burn unit, yet there is a lack of uniform education among different professionals regarding pain management (Kuhlmann & Tallman, 2022). Occupational therapists offer a unique and holistic lens to pain management by using nonpharmacological interventions to reduce patients’ perception of pain (American Burn Association, 2017; Nielson et al., 2022). The purpose of this quality improvement doctoral capstone was to apply this occupational lens in an educational toolkit designed for the interdisciplinary team that addressed nonpharmacological pain management for adults in the burn unit; effectively closing the knowledge gap across disciplines …

Chronic Pain Assessment And Documentation Protocol Implementation In Home Health Care, Lannese Purtell

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background/Purpose: Chronic pain management protocols are necessary in all aspects of health care to reduce negative perceptions and improve knowledge and comfort when caring for patients with chronic pain.
Methods: A pre-implementation Simplified Knowledge and Attitude Survey Regarding Pain (KASRP) and Comfort Survey were administered to rural Midwest home health nursing staff followed by implementation of a chronic pain management protocol. The protocol included an educational session on understanding and managing chronic pain, the use of the OPQRST handout to guide proper documentation, Pain Risk Factors Assessment Form, and a Managing Chronic Pain handout. The Simplified KASRP and Comfort Surveys …

Prescription Opioid Misuse And Addiction: Healthcare’S Contribution To The Opioid Epidemic And What Can Be Done About It, Emily Larsen, Katrina Ecke

Nursing | Senior Theses

Up to one in four patients undergoing prolonged opioid therapy in a primary care setting battle opioid addiction. In 2020, the CDC found that more than 16,000 deaths involving prescription opioids (limited to natural and semi-synthetic opioids and methadone) had occurred, which is equivalent to about 45 deaths per day. Opioid overdose death can be identified through three distinct waves; increased prescribing of opioids in the 1990’s began the first wave, the beginning of the second wave came in 2010 with a rapid increase in heroin related overdose deaths, and in 2013 the third wave began with a significant increase …

Reducing Opioid Prescribing By Using The Center For Disease Control Guidelines, Christina Marie Peters

Walden Dissertations and Doctoral Studies

Opioid abuse is a serious national health crisis resulting in overdose and increased mortality in chronic pain patients. The purpose of this evidenced-based, quality improvement (QI) project was to improve primary care provider’s (PCP) awareness of The Center for Disease Control and Prevention’s (CDC) opioid prescribing guidelines to reduce opioid prescribing at this project site. The Donabedian model of structure, process, and outcome was used as the framework for this QI project. Lewin’s change management model of unfreezing and freezing was used as a guide to implement organization change by creating problem awareness, seeking alternative methods, and integrating the new …

Reducing Opioid Prescribing By Using The Center For Disease Control Guidelines, Christina Marie Peters

Walden Dissertations and Doctoral Studies

Opioid abuse is a serious national health crisis resulting in overdose and increased mortality in chronic pain patients. The purpose of this evidenced-based, quality improvement (QI) project was to improve primary care provider’s (PCP) awareness of The Center for Disease Control and Prevention’s (CDC) opioid prescribing guidelines to reduce opioid prescribing at this project site. The Donabedian model of structure, process, and outcome was used as the framework for this QI project. Lewin’s change management model of unfreezing and freezing was used as a guide to implement organization change by creating problem awareness, seeking alternative methods, and integrating the new …

The Impact Of Psychological Interventions Given To Icu Patients To Help With Pain Management, Kelly Liu

Nursing | Senior Theses

Pain management among the critically ill population is a significant issue in the intensive care setting. Whether the pain is acute or chronic, nurses tend to be the first-hand responders to help with pain management in the intensive care unit (ICU). With barriers ranging from patients’ inability to verbalize pain to nurses’ experience with obstacles to assessment such as sedation, confusion, or other concerns, pain management is a serious issue. Although pharmacological interventions such as opioids and analgesics help with pain control, in this thesis, we will focus on the impact of nonpharmacological and psychological nursing interventions and how it …

Non-Pharmacologic And Alternative Management Of Chronic Pain In Multiple Sclerosis, Kylie Patian

Physician Assistant Scholarly Project Papers

Chronic pain associated with multiple sclerosis (MS) is prevalent in many phenotypes. Pharmacologic therapy of this pain often fails to provide analgesia. This research is intended to determine which nonpharmacological interventions may be recommended for treatment of chronic extremity pain in individuals with MS. This research was primarily conducted through a comprehensive literature review of publications within the past five years on three databases, PubMed, EMBase, and CINAHL. Additional resources were added from “similar” sections of the databases, directly from included studies, and when used to inform background information, for a total of 26 resources. Studies were excluded if not …

Music As A Treatment For Perceived Postoperative Pain In Adults: A Critically Appraised Topic, Savannah G. Mcdaniel

Honors College Theses

Clinical Question: In postoperative patients, how does listening to music affect perceived pain levels? Clinical Bottom Line: There is consistent evidence to suggest music decreases perceived pain in postoperative patients undergoing nasal septal surgery, open heart surgery, total knee replacement surgery, and general orthopedic surgeries requiring hospitalization. Athletic trainers can confidently implement music during patients’ post-operative care sessions to help reduce pain.

Improving The Process Of Pain Management By Implementing Best Practices In A Nursing Home, Sukhjit Dhillon

Doctoral Projects

Pain is often untreated or undertreated among older adults living in nursing homes. The lack of standardized pain management protocols makes it difficult to address pain in this population. Deficiencies in pain management and documentation were identified in a nursing home and a performance improvement project was implemented with the aim to improve pain management, pain documentation, and staff knowledge of pain management. A pre-and post-intervention study design was used, and data analysis included descriptive statistics and a paired samples t-test. Participants (n=12) included seven registered nurses and five licensed vocational nurses who provide direct care to the residents in …

Telehealth Delivery Of Acceptance And Commitment Therapy And Recreational Therapy: Supporting People With Chronic Pain During The Covid-19 Pandemic, Grace L. Roy

Honors Theses and Capstones

Chronic pain is a significant public health problem that requires person-centered and comprehensive care to address the many socioecological factors that contribute to pain. Within the context of the COVID-19 pandemic, telehealth options for chronic pain management can help more people access the care that they need. The purpose of the current pilot study was to investigate the efficacy and feasibility of delivering a 6-week Acceptance and Commitment Therapy (ACT) and recreational therapy intervention via telehealth for a group of seven participants with chronic pain. It was found that TeleACT-RT was associated with positive behavioral outcomes including increased psychological flexibility, …

Mindfulness And Pain Regulation: The Role Of Acceptance And Commitment Therapy For Individuals With Chronic Pain, Ariana C. White

Honors Theses and Capstones

Chronic pain is a significant and widely prevalent health condition which requires comprehensive care to address the many facets contributing to symptomatology. In 2016, 20% of American adults (about 50 million) reported experiencing chronic pain, of which 7.4% indicated that chronic pain frequently limited their life and participation in activities within the past 3 months (CDC, 2018). As a result, many individuals with chronic pain turn to opioid-based medication for pain relief, but long-term use of opioids actually increases pain sensation (Tobin, 2019). Moreover, opioid medication is unable to target underlying mental health components which emerge as part of chronic …

Pain Assessment In The Emergency Department, Lynnette Huddle

Master of Science in Nursing Final Projects

Aim: The aim of this integrative review was to synthesize studies that explore barriers to pain management in the Emergency Department.

Background: Pain remains one of the main reasons a person seeks help from the Emergency Department. However, patient's pain levels continue to be under-assessed and under-treated in Emergency Departments.

Design: Integrative Review Data Sources: A systematic review of Medline, PubMed, CINAHL, and Google Scholar electronic databases was performed. The articles were searched using the keywords, and the inclusion/exclusion criteria. Eleven studies published between 2011 and 2021 were found.

Review Methods: Studies were appraised using the John Hopkins Nursing Evidence-Based …

Increased Use Of Opioids Perioperatively Leads To Unmanaged Postoperative Pain, Halida Sehic

Nursing | Senior Theses

Background: Total knee and total hip joint arthroplasty are two frequently preformed surgeries, with 5.2 million total knee arthroplasties performed the United States between the year 2000 and 2010 (Williams et al., 2015). Opioids are widely used to manage pain for patients undergoing total joint arthroplasty. However, use of opioids is associated with undesirable adverse effects, such as nausea and respiratory depression, (Johnson et al., 2011). In postoperative patients following total joint replacement, 75 % of the patients complain of inadequately controlled moderate to severe pain (De Luca et al., 2018). Increased use and overprescribing increase tolerance to opioids …

Evidence On Use Of Pams With Lateral Elbow Tendinopathy: An Evidence-Based Practice Project, Natalie Cerchio, Kat Hillstrom, Anna Restemayer, Karla Scherber, Emenet Sime, Grace Smith, Olivia St. Martin, And Kyia Wu

Graduate Occupational Therapy Research and Projects

The overall focus of each of case scenarios are related to assessment or interventions that are related to Choosing Wisely Campaign items 1, 2, 3, 5, 8, 10. Case scenarios were developed related to each initiative with clientele and conditions across the lifespan in various practice settings. Practice settings included school district, outpatient pediatric, primary care, skilled nursing facility, work rehabilitation, and acute care.

Post-Cesarean Section Pain Management Using Pre-Built Computerized Order Entry Sets, Ashleigh Hunkins

Dissertations

Abstract

Problem

Electronic medical records (EMR) have helped decrease common medication errors. However, prescribing errors are still elevated. Creating pre-built order sets can decrease medication errors for post-cesarean section women.

Methods

This project used an evidence-based practice approach to create new order sets. Women undergoing a cesarean section between January 15, 2021 and April 14, 2021 received the new order sets. A retrospective data review was conducted pre and post-implementation between the dates of October 15, 2021 and April 14, 2021 to view medication errors.

Results

Before implementation of the order sets, there were 239 cesarean deliveries and eight errors …

Nurses' Perspectives On Pain Management In The Emergency Department, Elizabeth Fitzgerald

Seton Hall University Dissertations and Theses (ETDs)

Over 130 million people seek care in emergency departments (ED) in the United States annually. Most patients who seek treatment in emergency departments are experiencing a painful condition, and as such, ED nurses should have a deep understanding of pain management in the ED. There is limited qualitative research which explores pain management from the nurses’ perspective. The purpose of this study is to describe pain management from the nurse’s perspective. Thorne’s (2005) method of Interpretive Description guided this qualitative inquiry. New knowledge describing the nature of pain management in the ED provides insight into elements which support and impede …

Biopsychosocial Multidisciplinary Treatment Impact On Risk Of Opioid Misuse, Michael A. Palacio

Doctor of Nursing Practice Scholarly Projects

From 1999 to 2014, over 165,000 persons in the United States died from an overdose related to prescription opioids (Centers for Disease Control and Prevention [CDC], 2016). In response, the CDC released guidelines that propose nonpharmacologic and nonopioid pharmacologic therapy as preferred methods for chronic pain control (Dowell et al., 2016). The purpose of this project was to examine the biopsychosocial multidisciplinary treatment impact on risk of opioid medication misuse among adult chronic opioid-dependent noncancer pain clinic patients with and without a psychiatric disorder. Engel’s (1977) biopsychosocial model was used to evaluate whether multidisciplinary treatment impacted the risk of opioid …

Staff Education To Improve Pain Management In Skilled Nursing Patients, Keitta Evans

Walden Dissertations and Doctoral Studies

One of the key ethical principles in nursing is the promotion of health and wellness and ensuring that patients are free from unnecessary pain and suffering. It is estimated that at least 65% of patients in skilled nursing centers in the United States report the presence of pain, indicating that there are opportunities for improvement with effective pain management within this practice setting. A key factor that has been identified as an opportunity for improvement is education for clinical staff who practice within this setting. This Doctorate of Nursing Practice (DNP) project provided education to a group of clinical team …

Staff Education: Nonpharmacological Interventions For Pain In Older Adults With Osteoarthritis, Rachel 'Seunayo Ilesanmi

Walden Dissertations and Doctoral Studies

Osteoarthritis (OA) pain is a major social problem for older adults and has psychological and physical implications. In the clinic where the project was implemented, the family nurse practitioners (FNPs) are not addressing the OA pain of the older adult patients according to the evidence-based practice (EBP) guidelines. The purpose of this project was to educate FNPs on EBP guidelines regarding nonpharmacological intervention for chronic pain in OA patients. Knowles’ adult learning theory guided the development of the education program specific to the unique learning style of the FNPs. Fourteen FNPs who treat patients with OA in 3 clinic settings …

Does Acupuncture Have A Role As An Analgesic In The Emergency Setting?, Andrew Jan

Theses

Background: Pain is a feature of most emergency department (ED) presentations. Exacerbation of chronic pain comprises 40% of pain presentations, with the remainder being a mix of recurrent or one-off painful conditions. Opioids are the mainstay treatment for moderate to severe pain but have both short- and long-term adverse effects, including recurrent use, abuse and death. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also a concern, especially in older patients with comorbidities. Thus, emergency physicians are highly motivated to seek alternatives for pain management. Acupuncture is frequently used in outpatient settings that offer nonpharmacological treatments and has gained acceptance in postoperative analgesia; …

Is Anybody Listening?: Factors Affecting Pain Management In Veterans Within An Acute Care Rehab Setting, Laura Oseghae

Doctor of Nursing Practice

Background: In the United States, pain is a widely discussed issue due to the opioid epidemic stemming from a history of pain mismanagement. Clinical guidelines for successful pain management techniques are readily available for providers to incorporate into the individualized patient care plan.

Purpose: The purpose of this project is to improve pain management through implementation of the VA pain management guidelines and improved interdisciplinary team communication.

Objectives: This project aims to decrease the number of patients reporting moderate to severe pain, enhance staff/provider communication, and improve the provider’s overall process for managing pain with an individualized treatment plan.

Interventions: …

Nursing Students’ Knowledge And Attitudes About Pain Management And Opioids, Hedieh Hatami Sirjani

Health Services Research Dissertations

Statement of the problem: healthcare professionals’ knowledge of using opioids for pain management safely is critical in preventing opioid abuse and overdose. Undergraduate curricula of health professional schools, including undergraduate nursing programs, need to improve and adopt a comprehensive education regarding this issue.

Method: the first project was a systematic analysis of the literature regarding the educational interventions’ impact on healthcare professional knowledge and practice behavior regarding prescription opioids. The second project was a qualitative study of nursing students to explore their experience, self-efficacy, and knowledge of prescription opioid use for pain management and whether they feel the need for …

An Extensive Literature Review On Neonatal Pain Assessment & Management, Bailey Bishop

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Neonatal pain assessment and management is a field requiring much more research. This literature review outlines the current climate of neonatal pain assessment, compares a variety of neonatal pain scales on validity and clinical utility, and implications for how neonatal pain management can be improved. Neonates experience pain to the same degree, if not more, than everyone else. Unmanaged pain during the neonatal period leads to adverse health outcomes. In order to prevent these atrocities from this vulnerable population, NICU pain assessing needs to become the standard of care.

A Multimodal Analgesic Virtual Reality Program To Reduce Opioid Exposure, Jessica Hovland

Student Scholarly Projects

The opioid crisis continues to be a public health concern. Traditionally, an opioid-centric approach treats postoperative pain.

The following PICOT question guided this project: Will initiating a multimodal analgesic virtual reality quality improvement program (I) compared to current practice (C) decrease opioid requirements (O) in robotic hysterectomy patients (P) during the postoperative period (T)? Several articles promote non-opioid analgesia and non-pharmacological interventions, such as multimodal analgesia and virtual reality (VR) for pain management.

This project reviewed pre- and post-implementation data after implementing new evidence-based multimodal analgesia and VR protocols. The project captured a total of 64 patients in the pre-implementation …

An Intervention To Increase Nurses’ Knowledge Of Non-Opioid Pain Management In Post-Operative Elective Knee And Hip Replacement Patients, Kristen K. Grunerud

UNLV Theses, Dissertations, Professional Papers, and Capstones

Post-operative pain control is an enduring problem in health care. The extensive use of opioids since the 1980s has contributed to the current opioid crisis in the United States. In response, healthcare providers have begun to use a more biopsychosocial model to address pain control needs of patients. There is a demonstrated gap in knowledge for nurses in this area, and recent changes to hospital accreditation standards include a requirement to demonstrate both education provisions to staff and the use of non-opioid methods to control pain. The purpose of this Doctor of Nursing Practice (DNP) project was to assess, and …