BS, Kent State University, 2011, College of Nursing

Pain is a multidimensional phenomenon that affects each patient in a unique way. It is essential for nurses in the post anesthesia care unit to be knowledgeable about this multidimensional phenomenon, including the various aspects of pain management, in order to safely care for those patients who are in pain. If nurses lack the necessary knowledge and skills to provide exceptional pain management, then nursing care will be suboptimal. Although there is much literature on this topic, a lack of adequate knowledge on the part of nursing professionals persists. In fact, pain is typically undertreated. The primary purpose of this paper was to explore pain management in the post anesthesia phase of nursing care. This has been accomplished through a comprehensive and systematic review of the available literature. A large amount of information was synthesized from sixty-five peer reviewed, scholarly sources. This paper includes discussion regarding patient preferences and consequences of uncontrolled pain, as well as factors related to assessment, documentation, and pain control methods. Various pain management methods were reviewed, including pharmacologic and non-pharmacologic techniques. This systematic review yielded findings that demonstrated the need for various changes that should be implemented related to pain management in the post operative phase of nursing care. Furthermore, it is important that nursing care evolves as an evidence-based practice profession and that nurses incorporate these recommendations into their day-to-day nursing care of patients.

Committee: Catherine Snelson (Advisor); Barbara Yoost (Committee Member); Lynne Crawford (Committee Member); John Updegraff (Committee Member) Subjects: Nursing

Doctor of Nursing Practice , Case Western Reserve University, 2024, School of Nursing

Background. Total knee arthroplasty (TKA) is one of the most performed elective procedures in the U.S. and carries a significant risk for post-operative pain. Current analgesia techniques for TKA vary based on provider and institution. Anesthesia providers utilize peripheral nerve blockade (PNB) techniques to treat post-operative pain to reduce or avoid patient reliance on opioids following TKA. Providers can administer an adductor canal block either via a single shot injection (single shot adductor canal block [SACB]) or place a continuous infusion catheter through which a local anesthetic is continuously delivered (continuous adductor canal block [CACB]) for post-operative analgesia. Purpose. The aim of this quality improvement (QI) project was to compare SACB to CACB in post-operative opioid consumption and functional knee mobility (degree of flexion/extension). Methods. A non-interventional retrospective chart analysis was conducted to address the aims of this QI project. Quantitative chart data was collected from a non-randomized convenience sample of 50 patients that underwent TKA at a hospital specializing in orthopedic care in northeast Ohio from January 2023 to September 2023. Descriptive statistics were evaluated and independent t tests were performed to compare for outcomes of interest. Pertinent Findings. Consistent with current literature, findings indicated no significant difference exists between SACB and CACB in opioid consumption or functional knee mobility in the first 24 hours post TKA. Conclusions. Effective management of acute pain may be the key in eliminating significant risk for development of chronic pain and opioid use disorders- potentially alleviating some social and economic implications of the opioid epidemic. Utilizing PNB can help negate some of this risk. More research needs to be conducted to determine which method is most effective in these endeavors.

Committee: Christopher Bibro (Committee Chair) Subjects: Nursing

DNP, Kent State University, 2020, College of Nursing

As a result of pulmonary complications, thoracic trauma is associated with high morbidity and mortality rates. Uncontrolled pain, poor inspiratory effort, and nonproductive cough contribute to pulmonary complications without early intervention. Pulmonary complications are responsible for high hospital and intensive care unit (ICU) readmission rates and lengths of stay (LOS). The implementation of a clinical pathway can reduce these variables through standardization of care. A study was conducted over six months to measure the effects of implementing a rib fracture management clinical pathway in a rural Level II trauma hospital on incidence rates of acute respiratory failure, ICU readmission, and total hospital and ICU length of stay. Results were compared six months pre- and post-clinical pathway. Patient data were obtained from TQIP (Trauma Quality Improvement Program) reports prior to the clinical pathway intervention in 2017 (n = 40) and after the intervention in 2018 (n = 53). Patients were predominantly White (92.5%, 86.6%) males (67.5%, 69.8%) ranging in age from 18 to 88 (mean age = 56). The ICU LOS was also statistically comparable across the categories, t(91)=.11, p=.92. The mean LOS in the hospital was slightly higher among the 2017 (M=6.8 SD=6.0) sample than among the 2018 sample (M=6.3 SD=5.1), the difference did not reach statistical significance, t(91)=.12, p=.25. Similarly, there were no significant differences between the samples in terms of readmission to ICU rates, χ2 (1) =1.46, p=.23, or respiratory failure rates, χ2 (1) =1.64, p=.20. This project identified significant gaps in rib fracture management, in addition to a need to achieve organization-wide goal alignment in order to promote positive patient outcomes.

Committee: Louise Knox (Committee Chair); Lisa Onesko (Committee Member); Tracey Motter (Committee Member) Subjects: Nursing

DNP, Otterbein University, 2022, Nursing

Brachial plexus blocks (BPB) are a type of regional anesthesia that inhibits the sensory and motor function of the upper extremity. The efficacy of a BPB depends on the type and dose of local anesthetics (LA), as well as the use of any additive agent. The selection of LA depends on the type, concentration, and volume of LA. Certain additives, such as dexamethasone, when added to BPB, were shown to increase motor and sensory block duration. A chart audit conducted by the pharmacy and anesthesia departments revealed a significant variability of clinical practice in the use of LA and additives in BPB at a large Level 1 trauma center. The audit also revealed that only 46.4% of anesthesia providers used the additive dexamethasone. Further complicating the issue, key stakeholders also reported a lack of standardized evidence-based practice (EBP) guidelines for the choice of LA and additives utilized in BPB, which may have also contributed to the inconsistent practice among providers. The following objectives and methods were framed using the Johns Hopkins Model for EBP and were established to achieve the project's goals: 1) synthesize the evidence around the choice of LA and the additive dexamethasone with BPB, 2) develop a guideline based on the evidence, and 3) present the guideline to the Clinical Process Improvement Team (CPIT). To enhance EBP guideline development, data was compiled through a systematic review and local/national/standard clinical practice guidelines, using the Johns Hopkins Nursing Evidence-Based Practice Synthesis and Recommendations Tool. The project was significant because the incorporation of newly developed EBP guideline into clinical practice may improve patient outcomes. The findings of the scholarly project served as a beginning point for a greater understanding of the importance of EBP, clinical knowledge, and policy. The guideline was communicated to the anesthesia and pharmacy departments for potential implementation.

Committee: Brian Garrett Dr. (Advisor); Kacy Ballard Dr. (Committee Chair); Sara Hyland Dr. (Committee Member) Subjects: Health Sciences; Medicine; Nursing

PhD, University of Cincinnati, 2021, Education, Criminal Justice, and Human Services: Health Education

This dissertation consists of two related studies using the same survey and participants. As such, the studies share some related information. Study One examined perceptions of menstrual changes, menstrual management strategies, relations between select demographic factors and menstrual management strategies, and sources of information for menstrual management strategies. Study Two examined menstrual pain symptoms, strategies to manage menstrual pain, relations between select demographic factors and menstrual pain management strategies, sources of information for menstrual pain relief, and overall success of menstrual pain management. Abstract for Study One Background. A majority of women experience some premenstrual symptoms. This study examined the associations among demographic factors of race, location, age and the three most reported menstrual management strategies for menstruators. Menstrual history, perceptions of menstrual changes, and sources of information regarding strategies were also explored. Methods. A 22-item survey was developed to assess the aforementioned categories. The recruitment information and survey were posted to several Facebook groups and listservs. Results. About 87% of the participants (n = 504) reported cramps with menstruation. The top three menstrual management strategies were rest, pain medication, and heat. Logistic regression models for rest and pain medication were significant, whereas the model for heat was not significant. Menstruators who were in the racial minority group and those without a college degree were more apt to use rest as a strategy. Furthermore, menstruators without a college degree were more likely to use pain medication. Family members, friends, and the internet were cited as primary sources of information. Conclusions. This study provided additional insight into adult menstruators' use of menstrual management strategies. Because differences in the use of popular strategies were found according to (open full item for complete abstract)

Committee: Laura Nabors Ph.D. (Committee Chair); Amy Bernard Ph.D. (Committee Member); Rebecca Vidourek Ph.D. (Committee Member) Subjects: Health Education

Bachelor of Science, Walsh University, 2021, Honors

This research study compared the effectiveness of music therapy in reducing pain levels in the pediatric, adult, and older adult populations. In addition, this study compared different types of music therapy and their effectiveness in reducing pain levels in comparison to pediatric, adult, and older adult populations. The research design is a content analysis to study the relationships between the effectiveness of music therapy in reducing pain levels in various populations with different types of music therapy. This study included peer-reviewed scholarly journals that included human participants that researched the effect of music therapy implemented by a licensed music therapist on pain levels using valid and reliable pain measurement tools in the pediatric, adult, and elderly populations. Music therapy is a growing field and is effective in providing non-pharmacological pain relief in individuals of all ages. The results of this research study can assist in guiding future research by identifying the varying effectiveness of music therapy in different populations.

Committee: Tammie Davis (Advisor); Britt Cooper (Other) Subjects: Music; Therapy

Master of Science, University of Akron, 2019, Polymer Science

Adequate post-operative pain management has been proven to enhance the healing and recovery of patients following most major procedures.1 However, it remains significantly under managed and is a serious unmet need in the medical field. The mainstay of post-operative pain management is the prescription of oral opioids, which, although effective, have many pitfalls. Most notably, opioids prescriptions are currently based on a “one-size-fits-all” model, providing an imbalance of doses given to patients and leaving the medication at the risk for misuse and abuse. Opioids are still in practice today ultimately due to a lack of a better solution. Herein, we propose a drug-loaded polymer film to control post-operative pain. Poly(ester urea)s were used to load drugs into solvent cast blade-coated films and tested for drug release of non-opioids agents. Specifically, etoricoxib, a selective cyclooxygenase isoform 2 (COX-2) was used to monitor the efficacy of delivery from these films both in vitro and in a rat model. To obtain different release profiles, film thickness, drug-load, and polymer composition was analyzed in order to get desired profile for analgesic release. The polymer analogs that were implemented for this study are copolymers, 10%, 20% and 30% 1-PHE-6 P(1-VAL-8), and homopolymers, P(1-VAL-8), P(1-VAL-10), and P(1-VAL-12). Moreover, a multi-modal analgesia model with bupivacaine (a local anesthetic) has been sought out to show the versatility of this device. The goal of this study was to study a controlled release system that will produce little to no inflammation while providing pain relief for 3-5 days following a surgical procedure. Ultimately, this device's intended purpose is to replace or minimize the need for prescription opioids. We hypothesize that by tuning the multiple factors available with PEUs that a variety of drug release profiles can be obtained to fit a number of different applications (i.e. acute to chronic pain).

Committee: Matthew Becker (Advisor); Andrey Dobrynin (Committee Member) Subjects: Biomedical Research; Polymers

Master of Fine Arts, The Ohio State University, 2017, Design

Voxel Bay is a virtual reality game created in collaboration with Nationwide Children's Hospital to distract pediatric hemophilia patients from the anxiety related to the prophylaxis infusion procedure they must undergo regularly. This paper documents that answers to the question when designing a game to serve as a pain management distraction technique for pediatric patients, what factors should be considered for the overall experience of the patient-player, clinicians and caregivers, and what may be unique or different from conventional approaches to game development? The answers to the research question are presented in context of the development of Voxel Bay. They are a list of factors to be considered and a documentation of my contribution to the project. The game design concepts discussed include spatial level design for virtual reality and ways to world build without cut scenes. This paper also mentions the hardware configuration used to create an entertaining hands-free system without sacrificing the integrity of the player's medical experience. After an exploration of these concepts, the paper describes the novel processes used to realize them. The design choices and process documentation are supported by a review of research precedents regarding virtual reality as a distraction tool for medical settings as well as games designed to be used with breathing peripherals, games that use a networked system with different user roles and games that directly inspired the design of Voxel Bay. The document closes with some observations about the clinical trial data for this project and some reflection on its further development.

Committee: Alan Price (Advisor); Maria Palazzi (Committee Member); Jeremy Patterson (Committee Member) Subjects: Design

Doctor of Nursing Practice , Case Western Reserve University, 2015, School of Nursing

ABSTRACT Pain is a common phenomenon after surgery. Specifically, postoperative pain after total knee arthroplasty remains one of the most important challenges facing patients undergoing this surgery. Pain and comfort management continue to be overlooked and inadequately managed (McCaffery, Herr & Pasero, 2011; Pasero et al., 2009). Despite the availability of numerous effective analgesics and new drug administration technologies, research studies continue to show suboptimal pain management (ASPAN, 2013). A major focus of postoperative nursing care for patients following total joint replacement surgery is pain management. Although education of today's nurse will require some emphasis on technological advances, fundamental caring practices cannot be neglected. Interventions focusing on the comfort needs of patients and families are entirely within the realm of nursing practice, and are proposed to be strongly related to quality of care and patient satisfaction (Kolcaba, 2012). The purpose of this research study was to examine the relationship between pain intensity, comfort level and patient satisfaction of orthopedic patients following knee surgery on postoperative day one (the first day after surgery). The comfort theory was used as the theoretical foundation for this study. This study was conducted as descriptive/correlational study in which the relationship among variables (postoperative pain, comfort and patient satisfaction) was examined. A convenience sample of 40 male and female adult patients admitted to the hospital for elective total knee replacement /arthroplasty surgery beginning October 2014. The 0-10 Numerical Rating Scale (NRS-11) was used to measure pain intensity. The Perianesthesia Comfort Questionnaire was used to measure comfort. Data collection to assess patient satisfaction was based on questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey and Press Ganey Survey. The resul (open full item for complete abstract)

Committee: Faye Gary (Advisor); Jacquelyn Slomka (Committee Member); Claudia Douglas (Committee Member) Subjects: Health Care; Nursing; Teaching

Master of Science, The Ohio State University, 2014, Comparative and Veterinary Medicine

Abdominal surgery is commonly performed in cattle for both diagnostic and therapeutic purposes. A recent survey of veterinarians in the United States revealed that abdominal surgery is thought to be the most painful of the commonly performed surgical procedures in cattle. Pain is thought to play an important role in post-operative performance in cattle undergoing abdominal surgery. However, pain evaluation in ruminants is difficult, and recent research suggests that assessment of pain in ruminants requires measurement of both physiologic and behavioral parameters. Combination analgesic techniques may be superior to individual techniques in calves following abdominal surgery. Pain and incisional algometry scores were evaluated for a total of 120 hours in calves following routine umbilical herniorrhaphy. Twenty-one calves presenting for umbilical herniorrhaphy were randomly assigned to one of two treatment groups: 1) BAN: Flunixin meglumine 1.1 mg/kg IV following intubation and at 24 hours post-op 2) MLK: Co-infusion of morphine (4.75 mcg/kg/hr), lidocaine (2.11 mg/kg/hr) and ketamine (0.42 mg/kg/hr) for 24 hours beginning immediately following intubation. Co-infusion was discontinued at 24 hours. A modified sheep pain scoring system, as well as an algometer to measure incisional pain were used by one blinded evaluator to assess comfort at 14 timepoints during the 5 day study period. There were no significant differences in heart rate, respiratory rate, or pain score between groups during the study period or during CRI administration. Incisional algometry scores were significantly different between groups during the CRI administration, with cattle in the MLK group having higher nociceptive thresholds than cattle in the BAN group(p=0.019). During the entire study period, there was not a significant difference between groups, however there was a trend towards higher thresholds in the MLK group (p=0.098). In addition to the pain scoring, blood samples were taking (open full item for complete abstract)

Committee: Andrew Niehaus (Advisor); Jeffrey Lakritz (Committee Member); Phillip Lerche (Committee Member); Thomas Wittum (Committee Member) Subjects: Veterinary Services

Master of Arts, The Ohio State University, 2012, Communication

This thesis instantiates an initial foray into understanding the relationship between communication and pain. The central role of communication in the pain experience and pain expression remains relatively unexplored and the few existing attempts are disparate inquiries or from outside the communication discipline. This thesis is comprised of two parts. First a literature review underscores the need to study pain from communication perspective that acknowledges the influences of cognitive, social, cultural, and interpersonal factors and in terms of communication processes. Second, a message perception study was completed to investigate implicit theories of pain communication. Two message dimensions, person centeredness and empowerment-victimization, were manipulated in messages and evaluated by participants who imagined they were saying the messages to a friend in either chronic or acute pain. Results indicated that people rate messages with high person centered message features, empowering message features and a combination of high person centered-empowering message features higher than all other combinations of message features (high, moderate and low person centeredness; empowering, victimizing), in terms of message quality and in perceived pain management (indicated by perceived efficacy and perceived coping). Future work will test these message features with participants that are in pain or are highly familiar with pain experiences to better understand implicit and informed theories of pain communication.

Committee: Susan Kline (Advisor); Janice Raup-Krieger (Committee Member) Subjects: Communication

Master of Social Work, The Ohio State University, 2012, Social Work

Objective: The purpose of this study was to explore and compare the written and unwritten policies of outpatient pain clinics in the state of Ohio regarding positive toxicology screenings. Specifically, the study aimed to learn about the different approaches to toxicology screening in outpatient pain clinics, explore the procedures that outpatient pain clinics use following positive toxicology screenings, and gauge the extent to which outpatient pain clinics use written or unwritten policies in directing their actions following positive toxicology screenings. The research question was, Is there a consistent manner or policy guiding the way in which positive urine tests are handled in pain management facilities? Methods: Initially, a database was built listing one hundred Pain Management Centers or Departments in the state of Ohio using convenience sampling. This comprehensive list was derived from an Internet search and a variety of online directories. Researchers mailed surveys to the pain facilities listed in this database. Telephone calls were also made to each of these clinics prior to the mailing being sent. As a result, 35 (N=35) of these clinics responded providing insight into their respective clinics. The researchers asked questions in order to better understand the practices and policies existing in the clinics surveyed. Such questions included inquiring about: the types or causes of pain treated in the clinics, frequency and types of toxicology screens utilized, what each clinic considers to be a positive toxicology screen, how these positive screens are handled and if a written policy exists in the clinic describing what to do when a patient produces a positive urine screen. These results were coded into an excel file and frequency distributions were calculated in order to create bar graphs to visually conceptualize these results. Results: The researchers found no consistent manner or policy in which positive urine tests are handled in pain management fa (open full item for complete abstract)

Committee: Keith Anderson Ph.D. (Advisor); Holly Dabelko-Schoeny Ph.D. (Committee Member) Subjects: Social Work

Master of Science, The Ohio State University, 2010, Dentistry

Purpose: The objective of this study was to determine 1) which analgesic medication parents would choose and why that medication was selected and, 2) whether health literacy of parents is related to medicating behaviors. Methods: This IRB-approved cross-sectional design study consisted of a cohort of children 18-72 months examined at the Nationwide Children's Hospital Dental Surgery Center. Parents of qualifying patients completed a survey on pain medication dosage and utilization for their children. Parents were also given the short version of the Test of Functional Health Literacy (s-TOFHLA). Results: Data from 108 caregivers were included in this analysis. The mean age of children was 48.0 months (±13.7). The average s-TOFHLA score was 34.5 ± 3.7; only one parent scored marginal health literacy and two scored inadequate health literacy. Parents with a high school education or less scored significantly lower on the s-TOFHLA than parents with more than a high school education (p=0.024). Parents with lower s-TOFHLA scores were significantly more likely to under dose their child (p=0.020). 90% of subjects who daily overdosed their child chose Motrin, and 14.3% of parents relied solely on Orajel for management of tooth pain. Conclusion: Children in pain had caregivers that were 3 times more likely to choose a dosing frequency of six times per day. Children with dental pain are at higher risk for daily overdosing due to frequency errors.

Committee: Sarat Thikkurissy DDS, MS (Advisor); Homa Amini DDS, MPH, MS (Committee Member); Ashok Kumar DDS, MS (Committee Member); Robert Rashid DDS, MAS (Committee Member) Subjects: Dental Care

Doctor of Philosophy, Case Western Reserve University, 2013, Epidemiology and Biostatistics

This dissertation uses an existing data source from the Cleveland Clinic's Chronic Pain Rehabilitation Program (CPRP) to describe factors predicting attrition and failure in interdisciplinary pain care, as well as to use the evidence basis from interdisciplinary pain care to translate to concrete policy strategies for use in primary care. The dissertation has three aims: build a model describing factors that patient attrition in an interdisciplinary pain rehabilitation program using the patient data registry at the CPRP, build a nomogram to predict program failure in a comprehensive chronic pain rehabilitation program, using the CPRP patient data registry and examine the evidence basis for interdisciplinary pain care interventions to suggest focused near-term strategies for implementation of the primary care recommendations in the Institute of Medicine's report Relieving Pain in America. Four factors predictive of program attrition in the CPRP were identified: marital status, IQ, chemical dependence and clinician assessed depression. After imputation, variable selection using Harrrell's `model approximation' method and bootstrap validation of the model were used to develop a nomogram to predict program failure. The final nomogram contained ten variables: marital status, IQ, hours rest/day, smoking, chemical dependence, University of Alabama Pain Behavior Scale, anxiety diagnosis, Pain Disability Index, pain duration (years), and the depression subscale of the Depression, Anxiety, and Stress Scale. The model validation results showed the pooled C-statistic=.794 (.722-.803), r2=.226, and shrinkage factor=.97. Interdisciplinary pain care strategies can provide the evidence base for primary care providers to respond to the recommendations from the IOM. Primary care providers and health systems can use evidence based practice to implement these recommendations in the near-term by: changing screening and evaluation of chronic pain, partnering with community stakeholde (open full item for complete abstract)

Committee: Kathleen Smyth PhD (Committee Chair); Duncan Neuhauser PhD (Committee Member); Kurt Stange MD/PhD (Committee Member); Michael Kattan PhD (Committee Member); Judith Scheman PhD (Committee Member) Subjects: Epidemiology; Health; Health Care