Nurses' knowledge and barriers regarding pain management in intensive care units

Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan.
Journal of Clinical Nursing (Impact Factor: 1.26). 11/2010; 19(21-22):3188-96. DOI: 10.1111/j.1365-2702.2010.03226.x
Source: PubMed


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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    • "Most bedside nurses are well prepared to deal with the medical needs of their patients but they may find themselves less equipped to understand and treat complex pain issues (Blondal & Halldorsdottir, 2008; Lewthwaite et al., 2011). Even nurses who have some understanding of pain management may run into challenges when trying to meet patients' pain needs in a complex hospital system (Giordano, Engebretson, & Benedikter, 2009; Wang & Tsai, 2010). "
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    ABSTRACT: Bedside nurses care for patients with pain every day but the task is often challenging. A previous qualitative study that investigated nurses' experiences as they treated patients with pain suggested that nurses may suffer from moral distress if they are unsuccessful in providing adequate pain relief. As 20 of the original 48 nurses interviewed described frustration and distress when constrained from doing the right thing to provide pain relief for their patients, the purpose of this secondary qualitative analysis was to answer new research questions on nurse moral distress related to managing pain. Findings indicated that difficulties in nurse/physician communication and lack of pain education were contributors to nurses' frustrations and provided barriers to optimal pain management. Many participants indicated a need for interprofessional pain management education. Further investigation is needed to clarify the impact of moral distress on nurses managing hospitalized patients' pain.
    No preview · Article · May 2014 · Clinical Nursing Research
    • "Furthermore, additional obstacles are found in this context (Haslam, Dale, Knechtel, & Rose, 2011; Subramanian, Allcock, James, & Lathlean, 2012). The fact that ICU patients are frequently intubated or unconscious makes communicating with them and subjectively assessing their pain more difficult (American Association of Critical-Care Nurses, 2006; Wang & Tsai, 2010). Yet regardless of whether they are capable of communicating their current state or not, these patients too should have their sensory, affective, and behavioral dimensions evaluated (G elinas, Viens, Fortier, & Fillion, 2005). "
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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.
    No preview · Article · Mar 2014 · Pain management nursing: official journal of the American Society of Pain Management Nurses
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    • "The reasons for not applying systematic pain assessment may be related to the gap between research evidence and its use by professionals in individual patient care. The lack of an appropriate pain assessment tool might explain the low rate of pain documentation (Wang & Tsai 2010). In the absence of a behavioural pain scale in our study, the application of the NRS was intended to enable the nurses to establish the best drug and non-drug treatment by providing them with a tool to evaluate the effect of analgesia and to adjust pain treatment. "
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    ABSTRACT: AIMS AND OBJECTIVES: To assess the effects of introducing a systematic approach to pain and sedation management in the ICU. BACKGROUND: Identification of ICU patients' analgesic and sedative needs decreases the risk of complications and the hospital length of stay. Several studies have reported a lack of systematic assessment. DESIGN AND METHODS: Three assessment tools were implemented in two Norwegian ICUs in a prospective two-site study (April-July 2009). Frequency of pain and sedation documentation, the number of days when a sedation level was prescribed, and the amount of analgesics and sedatives used were documented for 958 ICU days in 139 mechanically ventilated patients. Fifty-five ICU nurses completed a questionnaire on the effects of the assessment tools before and after implementation. RESULTS: Patients assessed by the tools had a documented pain score 2·5 times daily and a sedation score three times daily. A sedation level was prescribed for 70% of the total patient days. A documented match between prescribed and reported sedation level was achieved for 27% of the days. Combinations of continuous analgesia and sedation were prescribed with wide therapeutic ranges. Significant improvements were seen in the units' assessment and documentation routines scored by the nurses after the implementation of the tools. CONCLUSION: Although the tools were well accepted, they were not used as frequently as recommended. The proportion of missing written prescriptions and documentation of sedation levels most likely reflects the nurses' and physicians' poorly defined intentions for the prescribed treatment. The tools applied helped nurses to focus on significant signs and symptoms. RELEVANCE TO CLINICAL PRACTICE: Without well-organised pain treatment and sedation, the risk of oversedation is always present. Our results show that the implementation of tools contributes to a systematic approach of the assessment and treatment of pain and sedation in intensive care.
    Full-text · Article · Nov 2012 · Journal of Clinical Nursing
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