Psychometric Evaluation of the Revised Iowa Pain Thermometer (IPT-R) in a Sample of Diverse Cognitively Intact and Impaired Older Adults: A Pilot Study.

Self-report pain assessment tools are commonly used in clinical settings to determine patients' pain intensity. The Iowa Pain Thermometer (IPT) is a tool that was developed for research, but also can be used in clinical settings. However, its utility in clinical settings is challenging because it uses a 13-point scale (0-12 scale) that does not align with common electronic pain scoring metrics. Therefore, this study evaluated the psychometric properties of an 11-point (0-10 scale) adaptation of the Iowa Pain Thermometer (IPT-R) to evaluate the psychometric properties of the IPT-R and to determine patient preference for a self-report pain assessment tool. A descriptive, correlational design was employed. The IPT-R was compared with the original IPT and a numeric rating scale (NRS). This study was conducted in the southeastern United States with 75 adults ranging in age from 65-95 years with varying levels of cognition. Participants were primarily representative of black and white backgrounds. Participants were asked to rate current pain, worst pain during the past week, and reassessment of current pain after 10-minute intervals using three scales (IPT-R, IPT, and NRS) presented in random order. Participants were asked to identify the tool preferred (the easiest to use and that best represented their pain intensity). Spearman-rank correlations were performed to determine convergent validity and test-retest reliability. Based on the results of this preliminary study, the IPT-R has good validity and reliability. The participants in this sample preferred the IPT-R over the original IPT (0-12 scale) and the traditional NRS (0-10 scale). Clinicians may consider using this tool with diverse older patients to assess pain intensity.

Do ethnic differences still exist in pain assessment and treatment in the emergency department?

Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated and some evidence supports the existence of pain treatment disparities. Despite strong incentives from accreditation organizations, pain management in the ED may still be inconsistent and problematic. The purpose of this research study was to conduct a retrospective chart review to investigate pain assessment and treatment for 200 adults (≥18 years old) admitted to the ED suffering from long-bone fractures. An additional purpose was to investigate demographic variables, including ethnicity, to determine if they influenced pain assessment, pain treatment, and wait times in the ED. Although assessment and treatment of pain is universally recognized as being important and necessary to provide optimal patient care, only 52% of patients in this study were assessed using a pain intensity scale, with 43% of those assessed reporting pain as ≥5 on a 0-10 pain intensity instrument. Pain medication was administered to 75% of the patients, but 25% of the patients received no medication. Only 24% of those receiving a pain medication were reassessed to determine pain relief. Compounding these problems were wait times for analgesia of >1 hour. Although the influence on pain management related to ethnicity was not a factor in this study, other findings revealed that undertreatment of pain, inadequate assessment, lack of documentation of pain, and lengthy wait times persist in the ED.

Factors that influence patient advocacy by pain management nurses: results of the American society for pain management nursing survey.

What is the meaning of advocacy, and how does it relate to the nurse who wants patients to experience optimum pain management? This question and the lack of empirical data provided the stimulus for the American Society for Pain Management Nursing (ASPMN) Research Committee to explore ASPMN members' beliefs, knowledge, and skills regarding pain management advocacy activities. The specific aim of the study was to determine the educational needs for and barriers of advocacy for nurses working with patients experiencing pain. An ASPMN Advocacy Survey Instrument was developed to gather data about advocacy activities and interventions. The sample consisted of 188 ASPMN nurses (20% of the membership) who responded via the internet. Study findings revealed that the majority of nurse respondents were active in personal advocacy, serving as guardians of the patient. They confronted physicians as necessary and assisted patients to evaluate their pain management. Regarding making the public aware of pain management-related issues (i.e., public awareness advocacy), the respondents were not as active. Respondents were knowledgeable about pain management and best practices/best evidence, with the exceptions of legislative issues and media training. These two areas need support and educational intervention. Additional areas in need of education and training, as identified by respondents, are social and political advocacy interventions. "Lack of time" was identified as the barrier to advocacy experienced by the greatest number of nurses.

Ethnic wait time differences in analgesic administration in the emergency department.

Although many studies have documented ethnic disparities in analgesia administration, few have dealt with the wait time for analgesia in the emergency department, despite the fact that the provision of timely and appropriate analgesia should be a primary goal in caring for patients. Inadequate analgesia has been reported for patients presenting with long bone fractures, and a body of evidence exists indicating that ethnic and minority patients may be receiving inadequate pain care when presenting to the emergency department for treatment of long bone fractures. The purpose of the present research was to determine whether wait time differences in pain treatment existed for ethnic and minority adults (18 years old or older) who were admitted to the emergency department suffering from long bone fractures using a quantitative retrospective design. Purposive sampling of medical records of 234 European-American, African-American, and Hispanic patients presenting with long bone fractures from two small Georgia hospitals were analyzed. Although Hispanic, European-American, and African-American patients in this study all reported substantial pain, a significant (p = .005) overall wait time difference was found between Hispanic and European-American patients, with Hispanic patients waiting an average of 102 minutes for the first dose of analgesia, and the European-Americans waiting an average of 67 minutes. Significant (p = .011) wait time differences were also found between Hispanics and European Americans when opioids were ordered and when there was a nurse notation of pain in the record (p = .029).

Evaluation of the Revised Faces Pain Scale, Verbal Descriptor Scale, Numeric Rating Scale, and Iowa Pain Thermometer in older minority adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale Revised (FPS-R), Verbal Descriptor Scale (VDS), Numeric Rating Scale (NRS), and Iowa Pain Thermometer (IPT) with a cognitively impaired minority sample. A descriptive correlational design was used, and a convenience sample of 68 participants, admitted to acute care facilities in the South, with an average Mini Mental Status Exam score of 23 comprised the sample. Thirty-two percent of the participants were males, and 68% were females. The majority (74%) of the sample consisted of African-American participants with the exception that 16% were Hispanic and 10% were Asian. An overwhelming majority of participants were able to use all of the tools. Concurrent validity was supported with correlations ranging from 0.56 to 0.90. The lowest correlations were found between the FPS-R and the other scales, suggesting that the FPS-R may be measuring a broader construct incorporating pain. Test-retest reliability was supported with coefficients ranging from 0.77 to 0.89. In terms of pain scale preference, the Numeric Rating Scale (33%) was the preferred scale in the cognitively intact group and the FPS-R (54%) was the preferred scale in the cognitively impaired group. When race and cognitive status were considered, African-Americans and Hispanics preferred the FPS-R. Severely, moderately, and mildly impaired participants also preferred the FPS-R. The findings of this study support the use of these scales with older cognitively impaired minority adults.