Nurses' knowledge and barriers regarding pain management in intensive care units.
ABSTRACT To explore nurses' knowledge and barriers regarding pain management in intensive care units.
Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan.
A cross-sectional study.
Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information.
The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category.
Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan.
Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units.
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ABSTRACT: Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p < .001) for the whole tool, with variations from 0.619 to 0.920 (p < .01) between dimensions. The expert panel was satisfied with the content and face validity of the tool. The psychometric qualities of the NOTPaM developed in this study are satisfactory. However, the tool could be improved with slight modifications. Nevertheless, it was useful in assessing intensive care nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose.Pain management nursing: official journal of the American Society of Pain Management Nurses 03/2014; · 1.31 Impact Factor
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ABSTRACT: Background: Uncontrolled pain in intensive care units triggers physical and emotional stress responses, inhibits healing, increases the risk of other complications, and increases the length of ICU stay. Aim: To explore pain management barriers as identified by Jordanian critical care units. Method: This study employed qualitative content analysis with 37 participant nurses from Jordanian critical care units. Data were ob-tained through semi-structured serial interviews. Purpose nonprobability sampling was used for the initial interviews. Results: Several themes emerged to describe barriers to managing pain identified by the critical care nurses. These were grouped into three main themes: (1) Barriers related to patients with subgroups such as patient did not want to bother nurses, patients’ difficulty with completing pain scales, patients’ reluctance to take pain medications because of side-effects, patients reporting their pain to the doctor, but not to the nurse, and fatalistic beliefs. (2) Barriers related to nurses that included patient sedation, frequent complaints from patients, inconsistent practices around administering if necessary medications, time limitations, limited communication, the fear of side effects of pain drugs, physicians' lack of trust in the nursing assessment of pain in critically ill patients, inadequate staff knowledge of pain man-agement, and fear of causing delirium or confusion. and (3) Barriers related to hospital policies includes: policies and rules of hospital, lack proper pain assessment tool, nursing shortages, powerlessness ,interruptions of activities relating to pain, lack of psychosocial sup-port services, lack of alternatives non-pharmacologic therapy , and lack of pain management drugs. Conclusion: The results identify potential pain management barriers which can be considered when developing and disseminating poli-cies and procedures in managing the pain in Jordanian critical care settings.International Journal of Advanced Nursing Studies. 01/2014; 3(1):1-5.
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ABSTRACT: Background Pain assessment in mechanically ventilated patients is challenging, because nurses need to decode pain behaviour, interpret pain scores, and make appropriate decisions. This clinical reasoning process is inherent to advanced nursing practice, but is poorly understood. A better understanding of this process could contribute to improved pain assessment and management. Objective This study aimed to describe the indicators that influence expert nurses’ clinical reasoning when assessing pain in critically ill nonverbal patients. Methods This descriptive observational study was conducted in the adult intensive care unit (ICU) of a tertiary referral hospital in Western Switzerland. A purposive sample of expert nurses, caring for nonverbal ventilated patients who received sedation and analgesia, were invited to participate in the study. Data were collected in “real life” using recorded think-aloud combined with direct non-participant observation and brief interviews. Data were analysed using deductive and inductive content analyses using a theoretical framework related to clinical reasoning and pain. Results Seven expert nurses with an average of 7.85 (±3.1) years of critical care experience participated in the study. The patients had respiratory distress (n = 2), cardiac arrest (n = 2), sub-arachnoid bleeding (n = 1), and multi-trauma (n = 2). A total of 1344 quotes in five categories were identified. Patients’ physiological stability was the principal indicator for making decision in relation to pain management. Results also showed that it is a permanent challenge for nurses to discriminate situations requiring sedation from situations requiring analgesia. Expert nurses mainly used working knowledge and patterns to anticipate and prevent pain. Conclusions Patient's clinical condition is important for making decision about pain in critically ill nonverbal patients. The concept of pain cannot be assessed in isolation and its assessment should take the patient's clinical stability and sedation into account. Further research is warranted to confirm these results.Australian Critical Care. 01/2014;