Original Article
Barriers and Enablers to Emergency Department Nurses' Management of Patients' Pain

https://doi.org/10.1016/j.pmn.2014.08.015Get rights and content

Abstract

Pain is the most common reason for presentation to the emergency department (ED). On presentation patients expect rapid pain relief, yet this is often not met. Despite extensive improvements in analgesia medication there are still barriers to nurses' assessment, management, documentation, and reassessment of pain. The aim of this study is to identify barriers, enablers, and current nursing knowledge regarding pain management. Using an anonymous quantitative web-based survey, members of the College of Emergency Nurses New Zealand were invited to complete a questionnaire on pain assessment and management. The questionnaires were analyzed using descriptive statistics. Enablers to ED nurses' improved management of pain were the provision of nurse-initiated analgesic protocols and pain management champions. Common barriers perceived by the respondents were the responsibility of caring for acutely ill patients as well as a patient with pain. Similar barriers to previous research were identified and included lack of time, workload, reluctance of clinicians to prescribe analgesia, and the lack of nursing knowledge regarding opioid administration. Raising awareness that oligoanalgesia exists in the ED is essential. This research suggested that nurses would benefit from ongoing education on the usage of opioids. Nurses' attitude regarding patients' right to expect total pain relief as a consequence of treatment was also an issue. ED nurses, by virtue of their role, are in a unique position to be leaders in pain assessment and pain management.

Section snippets

Background

Pain is the most common reason for presentation to the emergency department (ED), and it has been established that more than 70% of patients present with pain as their main symptom (Ducharme et al., 2008, Lewén et al., 2010, Motov, 2012, Puntillo et al., 2003). Studies have reported that 60%-80% of patients in pain are often undertreated (Curtis and Morrell, 2006, Decosterd et al., 2007, Pines and Hollander, 2008, Stalnikowicz et al., 2005). Pain is the third most common healthcare problem and

Research Question

Despite the fact that ED nurses are in a frontline position, there are limited data on ED nurses' perceived barriers and enablers to optimal patient pain management both nationally and internationally (Elcigil et al., 2011). Therefore the research question was “What are the barriers or enablers to the ED nurses' ability to provide optimal pain management for their patients?” A secondary aim was to identify existing knowledge among ED nurses regarding pain management principles. By identifying

Results

The NZNO sent a total of 197 emails to their CENNZ members and a total of 172 surveys were returned and analyzed for a response rate of 87%. No SurveyMonkey respondent IDs were duplicated, suggesting no one completed the survey more than once.

Discussion

The findings of this research are a call to action for nurses in the EDs of New Zealand to become proactive in increasing their own knowledge regarding assessment, principles, and management of pain. Nurses play a vital role in the management of patients' pain and need to become active leaders of pain management in the ED.

Respondents have voiced the need for nurse-initiated analgesic protocols because they believe these would enable nurses' ability to improve patients' pain management. This

Conclusions

Our findings support those of other studies that substantial barriers are present for nurses regarding the management of patients' pain in the ED, including workload and other factors limiting the ability to assess, respond to, and monitor pain. The main enablers to ED nurses' improved management of pain were seen to be nurse-initiated analgesic protocols and pain management champions. Although nurse-initiated protocols were identified as the perceived main enabler to improve patients' pain

Acknowledgments

The authors would like to thank all those CENNZ nurses who participated in the survey.

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    Agencies that supported this work: College of Emergency Nurses New Zealand (CENNZ).

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