Non-pharmaceutical Interventions for Chronic Pain

Non-pharmaceutical Interventions for Chronic Pain

Guidelines for Annotated Bibliography

An annotated bibliography is a paper that contains the review of articles related to a specific topic. You need the full text of the article in order to write an annotated bibliography – do not use an abstract. If you need to request a copy of article that is not available in full text online, go to Troy Libraries Interlibrary Load page listed under Services on the libraries’ home page: http://trojan.troy.edu/library/ You will need to create an account and enter the required information for the article. Graduate students are allowed up to 25 articles at no charge.

You are required to include 12-15 articles in this assignment.

An annotated bibliography is not an abstract and is more than a summary of the article. The writer summarizes the main points of the article. If the article describes a research study, the writer discusses the purpose, methodology, and findings of the study. After summarizing the article, the writer then briefly critiques the article and relevance to advanced nursing practice.

Begin the paper with a title page. Use running head and page numbers.

Use double spacing throughout the paper, including citation of article, and start each article at the top of a new page.

At the top of the second page, cite the first article in 7^th APA format.

On the first line below the citation, begin the annotated bibliography.
- Summarize the article
- Briefly critique the article and relevance to advanced nursing practice.

Each annotated bib should contain at least 250-300 words (not including citation), or roughly 1-1.5 pages in length.

Begin each annotated bib with citation at the top of a new page.

Unless an exception is approved by your mentor, you should include 12-15 articles in your annotated bibliography paper.

Include a reference list at the end of the paper in APA format.

Exceptions to these guidelines should be approved in advance by your faculty mentor.

Submit your paper by deadline agreed upon with mentor in Module 5 of the NSG 6696 Canvas course.

Things to remember!

Your annotated bibliography made need some additional work based on your faculty mentor’s review. Students are expected to take feedback from their faculty mentor to make corrections in their assignments before the semester is over. Communicate with your faculty mentor regarding their expectations of each assignment.

Faculty mentors will require students to correct assignments until they meet the mentor’s level of expectancy for graduate work.

Format Summary (all in APA format):

Title page

Annotated bibliography for each article, 1-1.5 pages in length, insert page break at end.

Each article bibliography begins at top of new page.

Reference list.

Include running head and page numbers.

Diagnosis and Management of Postpartum Depression

Annotated Bibliography

Submitted by

Student Name

NSG 6696, Fall 2015

Needs running head and page numbers

da Rocha, C. M., & Kac, G. (2012). High dietary ratio of omega-6 to omega-3 polyunsaturated acids during pregnancy and prevalence of post-partum depression. Maternal & Child Nutrition, 8(1), 36-48. doi:10.1111/j.1740-8709.2010.00256.x

Few studies have been conducted examining dietary consumption as it relates to post-partum depression (PPD). The main objective of this study is to evaluate the association between an unbalanced dietary ratio intake among omega-6 and omega-3 fatty acids above 9 in the first trimester of pregnancy, and the prevalence of PPD. The study was conducted during five waves: wave 1– 8^th-13^th weeks; wave 2 -19^th-21^st weeks; wave 3 -26^th-28^th weeks; wave 4-36^th – 40^th weeks; and wave 5 – after thirty days post-partum. During the waves, interviews were conducted and information regarding socio-economic, food consumption, obstetric, lifestyle and anthropometric data were obtained.

Only women who met the following criteria were enrolled in the study: (1) being between the 8^th and 13^th week gestation; (2) between the age of 18 and 40; (3) being free of any chronic diseases; (4) not having a twin gestation. PPD was used as the dependent variable, while food consumption was the independent variable. PPD was evaluated using the Edinburgh Post-partum Depression Scale (EPDS), while food consumption was measured using a Food Frequency Questionnaire (FFQ). Analyses were conducted using STATA version 9.2.

The results indicate that the prevalence of PPD was 2.5 times greater among women whose dietary ratio of omega-6/omega3 fatty acids in the first trimester of pregnancy was greater than 9:1. The study concludes by noting the importance of omega-6 and omega-3 fatty acids in the regulation of mental health. It also adds that an omega-6/omega-3 ration greater than 9.1 has an association with PPD. This study can be utilized within my current study to examine how the consumption of certain items may cause postpartum depression and can be used as an identifying factor for the possible development of PPD.

Denis, A. A., Ponsin, M. M., & Callahan, S. S. (2012). The relationship between maternal self-esteem, maternal competence, infant temperament and post-partum blues. Journal Of Reproductive & Infant Psychology, 30(4), 388-397. doi:10.1080/02646838.2012.718751

While pregnancy and birth are physiological experiences, they are also a time of psychological stress that can lead to vulnerability in the mother. The authors note that a previous study indicates that a large number of women experience post-partum blues, characterized by crying with or without sadness, mood swings, and moderate cognitive difficulties. The study implied that experiencing post-partum blues immediately after birth was linked to developing post-partum depression up to two months post-delivery.

The authors describe another study that implied that the intensity of the depressive mood on the third day post-partum was predictive of post-partum depression. The purpose of this study was to evaluate the link between infant temperament, maternal cognitions and post-partum blues. The study was conducted two days post-partum on 69 women ranging in age from 19-41; among which 25 (37.68%) women were having their first baby. The participants completed three questionnaires measuring post-partum blues symptoms, maternal self-esteem, feelings of competence and infant temperament. Post-partum blues symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). Maternal self-esteem was evaluated by the Maternal Self-Report Inventory, (MSI) short version. Feelings of maternal competency and infant temperament were evaluated using the Mother Baby Scale. Analyses were computed using Statistica, version 9.0. The results revealed that baby blues symptoms were inversely correlated to maternal self-esteem (p<0.05), meaning the higher score on the EDPS (post partum blues symptons), the lower the score on the Mother Baby Scale (maternal self esteem) and vice versa.

The study conclusions imply that above all the temperament of the infant affects the development of depressive symptoms, independent of maternal self-esteem and feelings of competency in caretaking and feeding abilities. This article can be used within my current study to imply that the diagnosis of postpartum depression may be caused by the temperament of the infant.

References

List all articles alphabetically here.

Non-pharmaceutical Interventions for Chronic Pain

Student’s Name

Institutional Affiliations

Adams, A., Eschman, J., & Ge, W. (2017). Acupressure for chronic low back pain: a single system study. Journal of Physical Therapy Science, 29(8), 1416–1420. https://doi.org/10.1589/jpts.29.1416

Chronic low-back pain negatively affects the overall quality of life, which calls for the need for effective management. Acupressure is a non-pharmacological pain management intervention that can be used to manage chronic pain. However, there is limited literature to support the effectiveness of acupressure in managing chronic low-back pain. Adams et al. (2017) conducted a study to examine the effectiveness of acupressure in improving chronic low-back pain.

The site for the study was an outpatient physical therapy clinic. The researchers used a single system study design conducted in Phase A and phase B. They applied the convenience sampling approach to recruit the participant (n=1) into the study. The inclusion criteria were an adult aged between 18 and 65 who has been experiencing symptoms of low-back pain in the past 3 months. Patients with low-back pain with a known cause were excluded from the study. Traditional physical therapy interventions were implemented during phase A and a combination of physical therapy and acupressure was implemented during phase B. The instruments that were used to assess changes in pain levels include the Oswestry Disability Index (ODI), the Patient Specific Functional Scale (PSFS), and the Visual Analog Scale (VAS). The outcomes being evaluated were the subject’s function, level of pain, and degree of disability.

The study revealed that the pain level at baseline, after phase A, and after phase B were 38.8 mm, 11.3 mm, and 2.5 mm respectively as recorded in the VAS. The subject’s function at baseline, after phase A, and after phase B was 5/10, remained the same, and increased to 9/10 respectively as recorded in the PSFS. The participant’s disability changed from moderate (30%) to minimal (14%), to complete resolution (0%) at baseline, phase A, and phase B respectively as recorded in the ODI. The researchers concluded that the integration of acupressure into traditional physical therapy is associated with pain reduction, an improvement in function, and a reduction in disability in adult patients with chronic low-back pain. This article is relevant to advanced nursing practice in that it provides evidence that can guide the nurse practitioner to utilize acupressure together with traditional physical therapy interventions to treat patients with chronic pain.

Bao, Z., & Landers, M. (2022). Non-pharmacological interventions for pain management in patients with dementia: A mixed-methods systematic review. Journal of Clinical Nursing, 31(7-8), 1030–1040. https://doi.org/10.1111/jocn.15963.

Dementia-associated pain can be managed using both pharmacological and nonpharmacological approaches. However, the effectiveness of non-pharmacological interventions in improving chronic pain caused by dementia is not well understood. The purpose of a study by Bao and Landers (2022) was to investigate the effectiveness of non-pharmacological approaches in improving pain experienced by dementia patients.

The researchers utilized a systematic review of the literature to gather data to address the study problem. They obtained articles from major electronic databases including PsycINFO, CINAHL, and MEDLINE. The inclusion criteria that were used to select articles for the review include addressing the effects of a non-pharmacological intervention on dementia-associated pain with a date of publication falling between January 2009 and February 2009. Articles that met the inclusion criteria were synthesized using a table. JBI and CASP checklists were used to appraise the articles. The review captured 8 studies which were a mixture of a qualitative descriptive study (1), randomized controlled trials (6), and a quasi-experimental study (1).

Study findings revealed that non-pharmacological interventions are effective in reducing dementia-associated pain. The specific interventions identified by the review include “singing, painting, massage, ear acupressure, play activities program and robot (p. 1030).” Massage therapy was the most commonly used intervention while the play activities program was found to be the most effective when compared with the other approaches. The researchers concluded that non-interactive non-pharmacological interventions are less effective in improving dementia-related pain when compared with interactive pharmacological approaches. This article is relevant to advanced nursing practice in that it contains evidence that can inform clinical decision-making when nurses are choosing non-pharmacological pain management interventions for patients with dementia.

Feeney, C., Bruns, E., LeCompte, G., Forati, A., Chen, T., & Matecki, A. (2017). Acupuncture for pain and nausea in the intensive care unit: a feasibility study in a public safety net hospital. Journal of Alternative and Complementary Medicine, 23(12), 996–1004. https://doi.org/10.1089/acm.2016.0323.

Healthcare professionals need to understand the effects of various therapeutic interventions before they recommend or use them to treat patients. The objective of this study was to assess how acceptable and feasible acupuncture was in treating pain among patients admitted to the intensive care unit. The researchers used a prospective study design and the study was based in a public hospital with a capacity of 20 beds. A prospective study design was appropriate for the study because it allowed the researchers to assess how study subjects were responding to the interventions over time. The researchers used convenience sampling. The inclusion criteria were all patients hospitalized at the ICU of the public hospital between November 14, 2014, and April 2015.

Subjects who met the inclusion criteria received 20 min acupuncture treatments offered in three sessions. These interventions were added to the usual care protocols. During data collection, the researchers measured the proportion of patients that received acupuncture treatment including those who accepted to use of the intervention. The investigators also recorded subjects’ perceived impacts of acupuncture on nausea and pain and rates of adverse reactions that developed after treatment. The researchers found that patients received an improvement in pain after receiving acupuncture treatment. In addition to pain symptoms, patients reported an improvement in anxiety symptoms after receiving acupuncture. Patients did not report serious adverse effects following the implementation of the intervention. The study confirmed the feasibility, safety, and acceptability of acupuncture among patients in the intensive care unit of the facility.

Golino, A. J., Leone, R., Gollenberg, A., Christopher, C., Stanger, D., Davis, T. M., Friesen, M. A. (2019). Impact of an active music therapy intervention on intensive care patients. American Journal of Critical Care, 28(1), 48–55. https://doi.org/10.4037/ajcc2019792.

Although non-pharmacological pain management interventions are known to have fewer side effects than pharmacological approaches, the benefits of some of these strategies in improving pain are unknown. The purpose of this study was to explore the benefits of active music therapy in improving pain in critical care patients. The outcomes of the study were evaluated by measuring the physiological parameters of patients and subjective data obtained after gathering self-reports from patients. The researchers monitored both the pain and anxiety levels of patients during the study period.

The investigators used a pretest-posttest, within-subject, single-group design to collect data for the study. They applied the convenience sampling technique to recruit participants in the study. A total of 52 patients met the inclusion criteria and were used as the sample for the study. The intervention involved a 30-minute music therapy session. The subjects received either a “song choice” intervention or a relaxation intervention. Subjects’ pain levels and vital signs were recorded before and after the administration of the music therapy.

Key findings of the study indicate that there was a significant reduction in self-reported pain and levels of anxiety after the intervention despite the increased ease of falling asleep evidenced in the relaxation group. This study supports the idea that music therapy is an effective non-pharmacological strategy for reducing pain in patients admitted to the intensive care unit. The researchers recommend the use of larger and more diverse samples in future studies to examine the differences. Advanced practice nurses can use the evidence documented in this article to design music therapy to enhance the reduction of pain symptoms in patients admitted to intensive care units.

Munkombwe, W. M., Petersson, K., & Elgán, C. (2020). Nurses’ experiences of providing nonpharmacological pain management in palliative care: A qualitative study. Journal of Clinical Nursing, 29(9-10), 1643–1652. https://doi.org/10.1111/jocn.15232

The primary aim of this research study was to explore the views and experiences of nurses who provide non-pharmacological treatment to patients experiencing chronic pain in palliative care. This was a qualitative exploratory descriptive design using narrative interviews and qualitative content analysis. This study was conducted in Livingstone, Zambia in a palliative care facility. The study participants included nurses involved in palliative care at the Livingstone Central Hospital, St Joseph’s Hospice, and those who had retired but who provided palliative care in the community and had at least two years of experience working at a hospital or hospice in Africa. All the nurses were approached and informed about the study; 15 nurses were purposively included in the study. Data collection was conducted through individual interviews among all 15 nurses.

The study results indicated that interpersonal relationships are essential for the success of non-pharmacological pain management in palliative care. Maximum benefits of non-pharmacological pain management can be achieved through the four categories that represented the interrelationships and interactions that affected pain management. These categories include building and sustaining favorable therapeutic relationships, recognizing the diversity of patients’ needs, incorporating significant others, and recognizing the existence of barriers. This was a multi-center study; hence, it had high generalizability. This study is important to advanced nursing practice because it informs best nursing practices to achieve non-pharmacological pain management in palliative care patients. Therefore, advanced practice nurses can improve patient care by adopting the study findings.

Oberoi, D., Reed, E. N., Piedalue, K. A., Landmann, J., & Carlson, L. E. (2022). Exploring patient experiences and acceptability of group vs. individual acupuncture for Cancer-related pain: a qualitative study. BMC Complementary Medicine and Therapies, 22(1), 155. https://doi.org/10.1186/s12906-022-03600-6

The purpose of this study was to compare patient experiences and acceptability of individual versus group acupuncture (AP) in patients diagnosed with cancer to alleviate pain. This was a qualitative inquiry using thematic inductive analysis. The patients were enrolled in a randomized non-inferiority trial comparing group versus individual acupuncture (AP) to relieve pain in cancer patients. The Health Research Ethics Board of Alberta (IRB approved the research study. The study participants included male and female cancer patients who are 18 years and above. Participants in both individual and group arms engaged in a face-to-face intake session. The patients received treatment twice a week for 6 weeks for a total of 12 sessions. A female interviewer carried out all the interviews. Semi-structured, open-ended, in-depth interviews were conducted with a subset of 11 cancer patients. n. Participants for this study were recruited via purposive sampling, aiming for diversity in age, sex, education, employment, cancer types, and treatment arms. Data were analyzed using inductive thematic analysis.

The study results identified two themes: overall experience of AP treatment and the value of AP. The study result showed that patients from both arms of the study reported significant improvement in cancer pain, mood, quality of sleep, and fatigue. Patients in the group AP arm reported a major increase in perceived social support while those in the individual arm valued privacy and one on one interaction with the therapist. Participants in both arms experienced a cordial relationship with the therapist. The authors concluded that both individual and group AP are effective non-pharmacological strategies for pain management. This study used credible, reliable, and valid study methodologies. It will help advanced practice nurses to understand the importance of individual and group AP in pain management.

Saragih, I. D., Suarilah, I., Son, N. T., & Lee, B. O. (2022). Efficacy of non-pharmacological interventions to reduce pain in people with dementia: A systematic review and meta-analysis. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.16444

The primary purpose of this study was to identify the efficacy of non-pharmacological interventions for pain reduction in people diagnosed with dementia. This study was a systematic review and meta-analysis conducted per the PRISMA guidelines and the Cochrane criteria for systematic reviews. To conduct the study, a comprehensive search was carried out using credible databases such as the CINAHL, Cochrane Library, Academic Search Complete, EMBASE, MEDLINE, PubMed, OVID, and Web of Science databases. The researchers used the modified Cochrane risk-of-bias tool (ROB-2) to evaluate the methodological quality of every research article included in the study. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were synthesized using a random-effects model to assess the efficacy of non-pharmacological interventions for reducing pain in people with dementia (using Stata 16.0).

A total of 12 studies (including 989 individuals with dementia) were included to conduct this systematic review and meta-analysis. The study result showed that non-pharmacological interventions significantly reduced pain in 4 to 8 weeks after the interventions (SMD: −0.32; 95% CI: −0.62 to −0.02). However, the authors stated that the effects of intervention frequency and patient age remained unknown. Based on the findings, non-pharmacological interventions are effective in reducing pain in people with dementia. This study the findings of this study can guide healthcare practitioners when considering the use of non-pharmacological pain management methods for people with dementia. Also, this study can be used to improve the implementation of these strategies in clinical practice.

Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2018). Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455–474. https://doi.org/10.1016/j.jpain.2017.11.005

This study aimed to update an individual patient data meta-analysis to determine the effect size of acupuncture for four chronic pain conditions. To conduct this study, the researchers used various valid databases such as MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials. The researchers included randomized controlled trials of acupuncture needling versus sham acupuncture or no acupuncture control for non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. The study outcome measures included pain and function.

A total of 13 trials, which included 20,827 patients, were included in the study. The study findings showed that Acupuncture was superior to both sham and no acupuncture control for each pain condition. The differences between groups were close to 0.50 SD for comparison without acupuncture control and close to 0.20 SD in comparison with sham. The results found that the effects of acupuncture tend to persist over time with only a small decrease. The authors concluded that acupuncture is effective for the treatment of chronic pain and with treatment effects persisting over time. This study is relevant to advanced nursing practice because it can guide the use of acupuncture in healthcare to reduce pain among patients.

Williams, A., Fisher, E., Hearn, L., & Eccleston, C. (2020). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Database of Systematic Reviews, 8(8), CD007407. https://doi.org/10.1002/14651858.CD007407.pub4

This study aimed to determine the clinical efficacy and safety of psychological interventions for the treatment of chronic pain in adults (age > 18 years) compared with active, waiting list, or treatment-as-usual (TAU) controls. This was systematic research conducted using randomized controlled trials (RCTs) focusing on a credible psychological treatment or a compound treatment and comparing it with a placebo, TAU, or waiting list control. Psychological treatment was considered credible if it was based on an extant psychological framework or model and delivered by qualified healthcare providers. Primary outcomes include pain intensity, disability, distress, and adverse events.

A total of 75 studies (including 9401 participants at the end of treatment) were selected for conducting this research study. The majority of the participants suffered from fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. The study results indicated sufficient evidence that cognitive behavioral therapy (CBT) had small to very small benefits in addressing disability, pain, and distress. Acceptance and commitment therapy (ACT) improved adverse events. The findings of this study can help guide advanced practitioners in pain management.

Whale, K., Dennis, J., Wylde, V., Beswick, A., & Gooberman-Hill, R. (2022). The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 23(1), 440. https://doi.org/10.1186/s12891-022-05318-5

Approximately two-thirds of patients with chronic pain also experience problems with sleep. This research study aimed to assess the effectiveness of non-pharmacological sleep interventions to improve sleep in patients with chronic pain. This study was a meta-analysis and systematic review of non-pharmacological and non-invasive interventions to improve the quality and duration of sleep in adults with chronic cancer pain. Randomized controlled trials were used in this study. The researchers used Cochrane Library, MEDLINE, Embase, PsycINFO, and CINAHL to retrieve relevant studies. Only studies that had participants aged 18 years and above were included. Other inclusion criteria include non-pharmacological and non-invasive intervention, the comparator of standard care, no treatment, attentional, or waitlist control, and others.

A total of 42 randomized controlled trials (including 3346 people randomized to 94 groups and 56 of them received an intervention targeting sleep) to conduct in the study. The study findings showed that CBT was an effective treatment of insomnia to improve sleep in patients with chronic pain. This paper used a large number of articles; hence, the study findings are valid. This study is relevant to advanced nursing practice because it provides evidence that can guide the use of non-pharmacologic intervention to improve sleep in patients with chronic pain.

Kidanemariam, B. Y., Elsholz, T., Simel, L. L., Tesfamariam, E. H., & Andemeskel, Y. M. (2020). Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea. BMC Nursing, 19, 100. https://doi.org/10.1186/s12912-020-00492-0

The purpose of the article was to examine the usage of non-pharmacological approaches by nurses in postoperative pain and the alleged impediments to their enactment at the National Hospitals. The research utilized a descriptive cross-sectional study method. It was done among 154 nurses employed at Sembel Private Hospital and the National Referral Hospitals. The study used a uniform five-point Likert-scale questionnaire to gather data. The questionnaire examined the usage of the nominated non-pharmacological techniques and the seeming obstacles to the execution by the nurses.

The study determined that assisting with daily undertakings, building a calm atmosphere, and emotional sustenance had the most utilization. Other methods like physical techniques and cognitive-behavioral were barely employed. Furthermore, the research determined that attributes like education level, workplace, job experience, and age considerably correlated to the usage of non-pharmacological approaches at the bivariate level. The following perceived obstacles to enacting non-pharmacological strategies at the National Hospitals were identified: insufficiency in procedures for pain control, the disobliging conduct of the patients, language variance, hefty workload, limited resources, and awareness and experience deficit by the nurses. This study is significant and can be used to further knowledge and train healthcare providers at all levels. Through this study, the caregivers will appreciate the advantages of non-pharmacological techniques in managing postoperative pain

Lin, Z. W., Liu, J. F., Xie, W. P., Chen, Q., & Cao, H. (2021). The effect of music therapy on chronic pain, quality of life and quality of sleep in adolescents after transthoracic occlusion of ventricular septal defect. The Heart Surgery Forum, 24(2), E305–E310. https://doi.org/10.1532/hsf.3513

This article aimed to examine the upshot of music therapy on the value of life, chronic pain, and the value of sleep in teenage patients after transthoracic occlusion of ventricular septal deficiencies. In carrying out this research, the patients got classified into two clusters regarding whether they got music therapy. The two groupings were the control cluster and the music cluster. Patients in the music cluster got thirty minutes of music therapy each day for six months after the operation. The control cluster patients also obtained typical management and had thirty minutes of quiet time each day for six months after the operation. The study utilized the short-form McGill pain questionnaire, the Karolinska Sleep Questionnaire, and the SF-36 scale to appraise the value of sleep, chronic pain, and the value of life.

Based on the results received from the research, in relationship to the magnitude of postoperative chronic pain, the score in the SF-MPQ assessment of the music cluster was considerably lower than that of the control cluster. The Role Emotional scores of the SF-36 in the music cluster were substantially higher than in the control cluster. Besides, KSQ scores were considerably higher in the music cluster than in the control cluster for sleep standing. The study is relevant to advance nursing because it can be used for future research in music therapy. The results show that the therapy is worth bearing in mind in managing postoperative pain patients experience after cardiovascular operation.

References

Adams, A., Eschman, J., & Ge, W. (2017). Acupressure for chronic low back pain: a single system study. Journal of Physical Therapy Science, 29(8), 1416–1420. https://doi.org/10.1589/jpts.29.1416

Bao, Z., & Landers, M. (2022). Non-pharmacological interventions for pain management in patients with dementia: A mixed-methods systematic review. Journal of Clinical Nursing, 31(7-8), 1030–1040. https://doi.org/10.1111/jocn.15963.

Munkombwe, W. M., Petersson, K., & Elgán, C. (2020). Nurses’ experiences of providing nonpharmacological pain management in palliative care: A qualitative study. Journal of Clinical Nursing, 29(9-10), 1643–1652. https://doi.org/10.1111/jocn.15232.

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