Date of Award

2025

Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chair

Kimberly Budisalich

Committee Member

Deva Sharma

Subject(s)

Sickle cell anemia--Complications--Nursing, Chronic diseases--Treatment, Pain--Treatmen

Abstract

Vaso-occlusive pain (VOP) episodes represent a major complication of sickle cell disease (SCD), associated with increased utilization of opioids and emergency room visits. The approach to managing pain is challenging in adults with SCD due to the complexity and uncertainty of the pathophysiology that drives both acute and chronic pain. Opioids are often effective in managing VOP, even though they do not target specific biomarkers of vaso-occlusion. However, there are no specific guidelines on how to utilize opioids for pain management in SCD. Consequently, pain management is often tailored to the personal preferences of individual healthcare professionals, which can lead to inconsistencies in treatment plans and potential mismanagement. A clinical practice change was implemented to improve VOP management by introducing standardized sickle cell pain treatment guidelines that included individualized pain action plans, optimizing disease management therapies to reduce the frequency of acute VOP episodes when used consistently, and incorporating depression screening. Thirty-four participants (male 11 and female 23), who were Hgb SS (n=26), Hgb SC (n=4), Hgb SB0 (n=3), SB+ (n=1), age 18 years or older, participated in this clinical practice change. The Wilcoxon signed-rank test showed a statistically significant difference in the number of ER visits pre- and post-intervention (p< 0.001). The Friedman test showed a statistically significant difference in PHQ-9 scores pre- and post-intervention (p< 0.001). Patients who participated in this clinical practice change had a reduction in ER visits and PHQ-9 scores.

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