Making difficult decisions in major military trauma: a crew resource management perspective.

The purpose of this article is to consider three underappreciated but important features of high performance teams: the trade-off relation between social and technical competence, the relevance of team size on productivity, and the inevitability of tensions that, while often experienced as dysfunctional, are in fact quite useful. It does so by reviewing a series of related studies in aviation and the organisation sciences, and by extrapolating insights for crew resource management in major military trauma along two generic themes: team context and team process.

The implementation of a Pain Monitoring Programme for nurses in daily clinical practice: results of a follow-up study in five hospitals.

AIMS OF THE STUDY: To study the effects of the implementation of a Pain Monitoring Programme (PMP) for nurses in daily clinical practice. In addition, nurses' and physicians' pain knowledge and attitudes were studied, as well as change in nurses' pain knowledge after implementation of the programme. RATIONALE: The rationale for the study was that many hospitalized patients suffer from pain and treatment of pain is often inadequate. BACKGROUND: Reasons for inadequate treatment of pain are the failure of nurses to assess pain on a daily basis and insufficient knowledge about pain and pain management in both nurses and physicians. The PMP tried to overcome these barriers by implementing daily pain assessment and educating nurses about pain and pain management. RESEARCH METHODS: This follow-up study was conducted in five hospitals. In total, 277 nurses and 115 physicians participated. The implementation and long-term effects of the programme were measured with a pretest-post-test design without a control group. RESULTS: Results showed that nurses carried out daily pain assessment in at least 75% of patients during the first 5 months of the intervention period, but in the remaining 2 months professional compliance gradually decreased. Both nurses and physicians are positive about daily pain assessment and want to continue with it. The level of nurses' and physicians' knowledge about pain and pain management is moderate. The programme increased nurses' knowledge and satisfaction regarding the quality of pain treatment. DISCUSSION: Because professional compliance decreased after 5 months, incentives are needed to motivate nurses to continue with daily pain assessment. Continuous Quality Improvement may be a useful method to guide the implementation process. CONCLUSIONS: Based on these results it can be concluded that it is possible to implement the PMP in daily clinical practice. Moreover, the beneficial effects of our programme on nurses' knowledge and attitudes have been demonstrated. Therefore, participating hospitals were advised to continue and extend the programme and other hospitals are encouraged to implement it.

A pain monitoring program for nurses: effects on communication, assessment and documentation of patients' pain.

Nurses need to be informed about the patient's pain to be able to take appropriate measures to alleviate pain. However, communication, assessment, and documentation of pain by nurses is often a problemfor hospitalized patients. In this study we aimed to overcome the main barriers by developing, implementing, and evaluating a Pain Monitoring Program (PMP) for nurses. The PMP consists of two components: educating nurses about pain, pain assessment and pain management; and implementing daily pain assessment by means of a numeric rating scale. We describe the effects of the PMP on communication about pain between nurses and patients and between physicians and patients, agreement between patients 'pain intensity and nurses estimations of patients'pain intensity, and documentation about pain in the nursing records. Factors that might influence communication, assessment, and documentation are also discussed. The effects of the PMP were measured in a quasi-experimental design with a nonequivalent control group. In total, 703 patients participated: 358 patients in the control group and 345 in the intervention group. Results of the control group showed that communication about pain between nurses and patients, agreement between patients' and nurses pain ratings, and documentation about pain in nursing records, remain inadequate. Patients'pain intensity and age were related to communication, assessment, and documentation. Communication and documentation is better in patients with moderate to severe pain than in patients with mild pain, and assessment is better in patients with mild pain. Older patients communicate less with nurses and physicians about pain, and nurses document less about pain in nursing recordsfor older patients compared with younger patients. The PMPproved to be effective in improving nurses'assessment of patients 'pain and documentation about pain in nursing records. Patients' pain intensity and care setting were related to the efficacy of the PMP Communication about pain between patients and nurses, and between patients and physicians did not improve as a result of the PAIP Based on this study it can be concluded that in using a simple method such as the numeric rating scale, together with an education program, attention is focused in a systematic way on patients'pain complaints and creates a common language between patients and nurses. Because the PMP proved effective in a heterogenous population in multiple care settings, it is recommended to implement the PMP in nursing practice.

A pain monitoring program for nurses: effects on nurses' pain knowledge and attitude.

One of the reasons for inadequate pain treatment in hospitalized patients is that nurses have insufficient knowledge about pain and pain management. To address this problem, a Pain Monitoring Program (PMP) for nurses was developed, implemented, and evaluated. The PMP consisted of two components: educating nurses about pain, pain assessment, and pain management, and implementing daily pain assessment by means of a numeric rating scale. The effects of the PMP were measured in a one-group pretest-post-test design. The results show that nurses have knowledge deficits and prejudices with regard to pain and pain management. Age and additional pain courses in pain partly predict nurses' pain knowledge. After nurses were educated, the average score on the Pain Knowledge Questionnaire increased from 69.1% (SD = 13.2) at pretest to 75.8% (SD = 11.5) at post-test (P < 0.001). Nurses' attitudes changed with regard to their level of knowledge and skills in relieving pain, willingness to assess pain on a daily basis, and attention to patients' pain complaints. It can be concluded that the PMP is effective in improving nurses' knowledge of pain management and focusing nurses' attention to patients' pain complaints.

Daily pain assessment: value for nurses and patients.

Current guidelines for pain management recommend systematic assessment of pain. A few standardized tools exist for the daily assessment of pain intensity, for example the numeric rating scale or visual analogue scale, yet these instruments are rarely used by nurses. In the study reported in this paper, a numeric rating scale accompanied by an educational programme for nurses, was implemented in three hospitals. The paper describes the feasibility of daily pain assessment from the nurses' and patients' perspective in multiple settings. The outcomes studied were the professional compliance of nurses with daily pain assessment, and the value of daily pain assessment for both nurses and patients. The results show that nurses' compliance with daily pain assessment is high (73.9%) and that daily pain assessment is feasible and valued by nurses; however, differences between the three hospitals and two specialties (medical vs. surgical wards) were found. Although patients have difficulty with expressing their pain by use of a number, almost all patients are able to give a pain score and a majority is positive about daily pain assessment. From this study it can be concluded that daily pain assessment is practical and appreciated by nurses as well as patients, but attuning the implementation protocol to the needs of the specific setting is necessary.