How do nurses in specialist palliative care assess and manage breakthrough cancer pain? A multicentre study.

OBJECTIVE: To gain a better understanding of how registered nurses working in specialist palliative care assess and manage breakthrough cancer pain. METHODS: A mixed-methodology study was undertaken in two stages-this paper reports findings from stage two. Anonymous postal questionnaires, designed based on themes identified in interviews undertaken during stage one, were sent to trained nurses working in ten specialist palliative care services in England. RESULTS: A total of 104 questionnaires were returned. Respondents were experienced nurses mainly working in inpatient settings. Some 82% of the nurses wanted more training on the assessment of breakthrough cancer pain. Although there were inconsistencies around the use of terminology, pain management appeared to be good. CONCLUSION: The use of terminology in the field of breakthrough cancer pain remains variable. However, this does not appear to have a negative impact on patient management, which was broadly in line with recently published consensus recommendations. There is a desire for more education within this area of practice.

How do nurses assess and manage breakthrough pain in specialist palliative care inpatient units? A multicentre study.

The aim of this qualitative study was to gain a better understanding of how nurses working on inpatient specialist palliative care units assess and manage breakthrough pain. Thematic analysis of semi-structured interviews with fifteen nurses from five different specialist palliative care units in the UK was undertaken. Themes identified have been broadly categorized into four main areas: defining breakthrough pain, assessing breakthrough pain, managing breakthrough pain, and attitudes/teamwork. Nurses had difficulty defining breakthrough pain as a distinct pain subtype and were often unable to differentiate it from poorly controlled background pain. This study highlights significant training needs and suggests that the theoretical work and recently published consensus recommendations around breakthrough pain now need to be translated into day-to-day clinical practice.

An investigation of MRSA infection in a hospice.

This study investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage and infection among patients admitted to a hospice. Under the existing policy at this hospice, only patients admitted from hospital wards where MRSA is known to be present are screened for MRSA prior to transfer. Hence the investigators were keen to study patients transferred from settings other than this. One hundred and twenty patients, all either from the community or from hospital wards without known MRSA, were entered into the study ('study group') and were swabbed for MRSA on admission to the hospice. Swabbing was continued at weekly intervals until discharge or death. Of the 120 patients, seven (5.8%) were MRSA positive on admission. A further four patients who were negative on admission showed MRSA on later swabs. Another two patients developed symptomatic infections during admission that were proven to be due to MRSA, but neither of these had shown MRSA on any swabs taken during the study. During the study period, a separate group of 156 patients was swabbed routinely before transfer from hospital wards where MRSA was known to be present in accordance with hospice policy ('non-study group'). Of these patients, 11 (7.1%) were found to be colonized with MRSA but none developed associated symptomatic infection. It appears that the risk of symptomatic infection with MRSA in hospice patients is low, and the burden placed on this vulnerable group by conventional eradication regimes may be disproportionate to any benefit derived.