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Call to boost nurse training on pain


Nursing care of older patients must be improved, particularly the control of pain, the author of a national report on hospital mortality has told Nursing Times.

The National Confidential Enquiry into Patient Outcome and Death report, published last week, found that two thirds of older patients who died in hospital following surgery had not received “good care”.

The study, which examined the care received by nearly 800 patients aged over 80 who died in hospital within 30 days of undergoing surgery, found one in five did not have their pain assessed.

Report co-author Kathy Wilkinson said that investment should be made to improve the general nursing of older patients and, in particular, the management of their pain.

She urged senior nurses to put pain on observation charts and said more nurses trained in managing acute pain were needed.

“We must ensure that this group of patients is not left in pain, however difficult it might be to communicate with some of them because of hearing and other problems, or how stoical they may appear,” Dr Wilkinson said.

Nurse consultant specialising in care of older people at Ealing and Harrow Community Services Linda Narzarko told Nursing Times: “The important lesson here is that all nurses should be trained to look after older people at pre-registration level.

“Older people have particular needs and are 80 per cent of NHS patients so we must all know how to look after them properly.”

Ms Narzarko added that all trusts should have a specialist nurse consultant.

Royal College of Nursing adviser Ian Hulatt said: “Whilst traditionally older person’s care may have had a difficulty in recruiting nurses, the care of the older client is now everybody’s concern, and health professionals need to be prepared in initial and ongoing training to meet the needs of this client group.”


Readers' comments (10)

  • How many times will it need to be said? I can remember studies in the 1980's that raised concern about pain control with particular reference to older people. I have worked with plenty of nurses and doctors who are too scared to give an older person any meaningful dose of opiate analgesia in case it killed them.

    There should be specialist/ consultant nurses in every trust prowling the wards looking for older people and shouting up for those who can't/ won't do it for themselves. Even as I write that I'm changing my mind, there should be someone doing that for every patient in the NHS regardless of age or anything else.

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  • It seems to be that the healthcare authorities spend all their time and money making enquiries and producing reports but why does nobody ever act on the recommendations made as a result of these and why do we never see any improvements?

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  • We had a large proportion of elderly patients on my general medical ward. They were treated as well as the rest of the patients in our care and we felt we had had adequate pre-registration training to care for them and all our other patients who presented with a very diverse range of disorders. For what we didn't know, there were always other specialist nurses, specialist doctors or professors to consult as well as a fully equipped library. Why isn't this the same everywhere?

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  • What are nurses being taught in the universities these days? Everywhere you turn there are reports of what nurses are unable to do, recognise, treat.
    Who are the people undertaking these studies? Are they nurses? If so then stop investigating and get on and DO SOMETHING. Oh sorry - research is high kudos, care is menial.
    These reports are damning of nurses and nursing.

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  • Having tried to develop a pain management service in my local trust and being blocked at every opportunity, I left and now work in Primary care where I can educate patients prior to planned hospital admissions regarding pain management. I have had good feedback from patients after their procedures I feel as if I am making a bit of a difference albeit a small one.

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  • I am a clinical nurse specialist in acute pain managment. In the Trust i work in we run regular pain management study days for nursing staff and educational sesions aimed at FY1s. Our service like most acute pain services is fundimently a surgical service which will take referrals from any where in the hospital. That said i often wonder how well pain is manageed in the Medical side of the sevice. We routinely visit surgical wards but dont have the capacity to to the same with medical patients on the medical wards. Acute pain teams Have evoled to manage primily surgical parients where pain management as been an issue. I feel its now time to broughten the scope of Pain management teams and offer a similar service for our medical patients and not just to some. Pain Management for all.

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  • I too am surprised to read about all the shortfalls in general nurse training and all the areas where qualified nurses do not seem to have learned and developed the knowledge or skills to provide the care demanded of them. I now wonder what a general medical adult nurse on the register actually is and what ever happened to holistic care of the patient.

    When I trained in a London teaching hospital we received an excellent all round training which englobed all the the systems of the body and the pathologies associated with them which is what I thought nursing was all about. The course was based on the most recent scientifically based evidence and included modules and placements initially focussing on basic nursing care then moving on to pediatrics, obstetrics and gynaecology, psychiatry, care of the elderly, psychogeriatrics, intensive care, cardiology, neurology, oncology, surgery, pharmacology, pain control, palliative and terminal care, as well as ward and case management and medical/nursing law and ethics and the meaning of professionalism, to name some of the main areas. This stood me in good stead after qualification to care from patients in my chosen area of general medicine which included patients with a very wide range of conditions and pathologies and psychopathologies related to all of these specialties, with the exception of obstetrics and pediatrics, and also provided an excellent basis for further learning, training and skill development.

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  • The best pain management & palliative team in the world, you can only find in a world class hospital - The King's College Hospital Foundation NHS Trust. Holistic management is considered into perfection.

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  • all you need is pre-reg. education and training in the mechanisms, psychological aspects, evaluation and treatment of pain in detail and then keep up to date with the latest developments post-reg. if you are responsible for the care of patients with pain. There is no excuse nowadays with the wealth of knowledge and methods available to leave a patient in pain.

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  • The nurses are not being practical, what they have learned in their nursing schools is not emulated in their life long caring profession. This means all the HCP should be re-inforced regarding this serious matter. In poor nations the patients pain is neglected and no one bothers who is suffering or in excruciating pain. It seem that the people enjoy in someones suffering, what a humans!!!!!!!!!!

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