Original ArticleBarriers and Enablers to Emergency Department Nurses' Management of Patients' Pain
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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2022, Annals of Medicine and SurgeryCitation Excerpt :Review done in Dublin, Ireland in 2008 revealed that lack of time, low level of education, inadequate policy or standard, inadequate knowledge, staff attitudes, poor pain assessment, and fear of complication were possible factors related to poor pain management [12]. A studies done on pain management stated that reluctance to prescribe analgesia, insufficient time, nurses workload, and inadequate knowledge about opioids were perceived barriers to inadequate pain management [13,14]. Beside, studies found that reluctant to accept self-report pain, level of understanding of patient suffering, personal opinion regarding opioids choice, fear of opioid side effects, and passive participation in pain assessment as well as management were among the most common barriers of pain management at emergency settings [15–22].
Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records
2020, Pain Management NursingCitation Excerpt :Because physicians rely on the documentation of pain assessments by the nursing staff, lack of documentation leaves the physician with insufficient information to evaluate effectiveness of pain management. This failure to record pain assessments could be related to the tendency to prioritize others factors perceived as more urgent, such as hemodynamics or mechanical ventilation (Manias et al., 2005; Payen et al., 2007; Pretorius et al., 2015). These results match those of an investigation carried out in the United States (Chanques et al., 2006), where the average frequency of assessment was 1.2 times per shift.
Pain Management Knowledge and Attitudes of Healthcare Professionals in Primary Medical Centers
2020, Pain Management NursingCitation Excerpt :Although nurses had good knowledge regarding the definition of addiction and opioid dose adjustment, they had negative attitudes toward addiction, wrongly believing that opioids should not be administered for patients with a history of drug abuse or that patients should be encouraged to tolerate their pain and delay opioid prescription and administration; only half recognized that addiction develops at a very low rate. Fear of addiction is one of the main barriers to appropriate pain management (Dorflinger et al., 2014; Nasser et al., 2016; Pretorius et al., 2015; Razeq, 2016). These myths about addiction are probably due to lack of knowledge about opioids and their uses.
Agencies that supported this work: College of Emergency Nurses New Zealand (CENNZ).