Nurses' Knowledge and Barriers Regarding Pain Management

Pain management education needs for nurses caring for older adults undergoing total knee replacement

INTRODUCTION

Effective postoperative pain management is necessary to improve the outcomes of older adults undergoing total knee replacement (TKR). Discovering what registered nurses (RNs) need to know about pain management may be beneficial to improving the quality of care.

AIM

The study aimed to identify the information needed to develop pain management education for RNs caring for older adults undergoing TKR.

METHODS

A qualitative descriptive design was used in this study. Three focus groups were conducted with 22 staff RNs with experience caring for older adults undergoing TKR at a supra-tertiary care hospital in Bangkok, Thailand; one focus group was conducted with five members of the hospital's nursing pain management committee. Data were analyzed using content analysis.

RESULTS

Two themes relevant to pain assessment education were pain assessment and pain management. Subthemes of pain assessment included challenges in cognitively impaired older adults, inadequate knowledge and misconceptions, and re-assessing pain. Three subthemes of pain management were created, including knowledge of pain medication, new trends in pharmacological pain management and devices, and non-pharmacological pain management using cold compression.

CONCLUSIONS

RNs require current information about pain management to provide effective postoperative care for older adults undergoing TKR. The findings may be used in pain management education to update RNs' knowledge of pain management.

Development, Feasibility, and Preliminary Effects of a Hybrid-Mode Multicomponent Music Intervention for Women Undergoing Mastectomy

BACKGROUND

Music listening interventions have been used to manage preoperative anxiety and postoperative pain in women undergoing breast cancer (BC) using face-to-face mode and music that was relevant to the patients' culture; however, the interventions were not underpinned by any theories.

OBJECTIVE

To assess the feasibility and preliminary effects of a theory-driven multicomponent music intervention on preoperative and postoperative patient outcomes in African women with BC undergoing mastectomy.

METHODS

This study was a multicenter, single-blind randomized controlled trial with qualitative interview. A total of 36 women scheduled to undergo mastectomy were recruited from Nigeria and Malawi and randomly assigned to either the intervention group or the control group. Quantitative data were analyzed using the Mann-Whitney U and Wilcoxon signed rank tests, whereas qualitative data were analyzed using the inductive approach.

RESULTS

The multicomponent music intervention was effective in reducing participants' preoperative anxiety and enhancing satisfaction with care on the day of surgery, reducing postoperative pain at 24 and 48 hours after surgery, and reducing systolic and diastolic blood pressure at 48 hours after surgery. The qualitative data corroborated these findings.

CONCLUSION

The study's findings indicated that the theory-driven multicomponent music intervention was feasible, acceptable, and effective in reducing preoperative anxiety and postoperative pain, optimizing vital signs, and enhancing satisfaction with care among African women with BC undergoing mastectomy.

IMPLICATION FOR PRACTICE

The study's findings indicate that nurses in clinical settings can integrate the intervention into the plan of care of women with BC beginning with their surgery booking visit.

Critical care nurses' perceived barriers and enablers of pain assessment and management

Aim: To examine critical care nurses' perceived barriers and enablers of pain assessment and management. Materials/methods: This descriptive correlational study recruited a convenience sample of 200 Jordanian nurses. Pain Assessment and Management for the Critically Ill questionnaire was used to measure the study variables. Results: The most common barriers to pain assessment and management were patient inability to communicate (57.5%), patient instability (56.5%), and the lack of protocols/guidelines for pain assessment (55.0%). Whereas the most common enablers for effective pain management practices were the ongoing education on pain for nurses (60.5%) and physicians who prescribe adequate doses of analgesia (60.0%). Conclusion: Addressing nurses' perceived barriers and the enablers of pain assessment and management is crucial for optimal pain practice.

A cross-sectional study of factors associated with nurses' postoperative pain management practices for older patients

AIM

The aim of the study was to identify factors associated with nurses' pain management practices in older patients undergoing surgery.

DESIGN

A cross-sectional study.

METHODS

The study sample was 85 Registered nurses working in inpatient surgical units in a tertiary care hospital, Thailand. Data were analysed using descriptive statistics, Pearson's and point biserial correlation coefficients, and stepwise multiple regression analysis.

RESULTS

A positive correlation was found between practices and (a) pain management training and (b) perceptions related to collaboration with physicians. However, practices were negatively related to (a) the nurses' perception of their workload and (b) the number of years of nursing experience. The recent pain management training, the nurses' perceptions of both collaboration with physicians and their workload explained 24.40% of the variance in practices. Appropriate nursing workloads, regular pain management training and promoting collaboration among the healthcare team could all improve the quality of nurses' postoperative pain management.

Nurses' Perspectives on Postpartum Pain Management

Introduction:

There is variation in postpartum opioid use by prescriber characteristics that cannot be explained by patient or birth factors. Thus, our objective was to evaluate nursing training, clinical practices, and perspectives on opioid use for postpartum pain management.

Materials and Methods:

In this survey study, postpartum bedside nurses at a single, large academic center were asked about training, factors influencing clinical decisions, and viewpoints regarding pain management and opioid use. Findings were summarized using descriptive analyses.

Results:

A total of 92 nurses completed the survey. A majority (77%) reported having received some formal training on opioid use for pain management. About a quarter (25.7%) felt their training was not adequate. Regarding clinical practices, the majority (71% and 70%, respectively) reported that “routine habit” and “patient preference” most influenced the type and amount of pain medication they administered. Finally, nurses' perspectives on pain management demonstrated a wide range of beliefs. Most nurses strongly agreed with the importance of maximizing nonopioid pain medication before opioid administration. The majority agreed that patient-reported pain score is important to consider when deciding to administer opioids. Conversely, most nurses disagreed that patients should be encouraged to endure as much pain as possible before using an opioid. Similarly, beliefs about the reliability of use of vital signs in assessing pain intensity varied widely.

Conclusions:

Bedside nurses rely on routine habits, patient preference, and patient-reported pain score when administering opioids for postpartum pain management. Increased training opportunities to improve consistency and standardization of opioid administration may be beneficial.

Perception of music and its cultural elements on acute post-mastectomy pain management among Nigerian women: an exploratory qualitative study

PURPOSE

This study aimed to explore the cultural elements of music in relation to pain management among women who have undergone mastectomy.

METHOD

An exploratory qualitative study with in-depth interviews. Using the purposive sampling technique, 20 participants were recruited for the study. The interviews were conducted face to face at the surgical out-patient clinic and female surgical ward. Data collection continued until data saturation was reached. The inductive approach was used to analyse the data, and the concepts were organised into themes. The consolidated criteria for reporting qualitative research guidelines (COREQ) were used to report this study.

RESULTS

The participants were between 28 and 83 years old and mostly diagnosed with stage III breast cancer. Three main themes emerged from the data analysis, including pain experienced after mastectomy, culture and music, and the perception of music for postoperative pain management after mastectomy.

CONCLUSION

In this study, the knowledge of participants and the utilisation of music for pain management remains inadequate, but the participants perceived that music could be useful for pain control after mastectomy when the language and religion of the patient and the meaningfulness of the music were considered when introducing and selecting the music. This study will help open and extend the conversation about the utilisation and cultural elements of music that can be used clinically for pain management after mastectomy.

Knowledge and Attitude of Saudi Emergency Medical Services Students Regarding Pain Management: A Cross-Sectional Study

The most common reason people seek emergency medical services is pain, either from a severe injury or a life-threatening illness emergency medical services (EMS). Few studies on analgesic administration and pain management assessments are available for EMS students to read (as potential EMS professionals). Therefore, the goal of this study is to find out the knowledge and attitude of EMS students about pain management. Saudi EMS students were asked to complete a survey on their knowledge and attitudes about pain management. As a result, the KASRP scale was used. A t-test was performed to assess the statistical descriptive and independent sampling findings. Data collection started in October 2020 and lasted for one month. EMS students completed 79 questionnaires (response rate of 53%). According to the findings, EMS students demonstrate inadequate fundamental knowledge and attitudes in pain management. The mean correct count for the entire scale was 47% (SD=.09). The findings showed that no major variations were observed in the scores of students associated with demographic features. There are potential opportunities in the program to improve the content and student competencies in pain management.

Barriers and Solutions for Improving Pain Management Practices in Acute Hospital Settings: Perspectives of Healthcare Practitioners for a Pain-Free Hospital Initiative

Background

Effective pain management is a fundamental human right. However, global disparities in pain management practices exist across health settings. This study explored healthcare practitioners’ views on pain management in the acute care hospital setting.

Methods

The focus groups included clinical specialties most likely to encounter patients with ‘difficult to manage pain’, namely those in the Geriatrics and Palliative Care Unit (2 doctors and 3 nurses), Critical Care Unit (7 doctors), and the Pain Management Team (3 doctors and 2 nurses). The transcripts were analyzed using a qualitative thematic analysis.

Results

The data analysis revealed four themes. Theme 1, ‘Being too safe’ described the presence of apprehensive attitudes among patients and healthcare practitioners that limits the appropriate use of diverse and tailored pain medications in acute care hospital settings. Theme 2, ‘Working as a team’ described the need for collaborative approaches to achieve hospital-wide evidence-based pain management. Theme 3, ‘Adaptation for local and cultural preferences’ explored how pain was perceived through cultural lenses and suggested strategies to tailor pain management to local and cultural preferences. Finally, Theme 4, ‘Driving acute pain management forward’ listed clinician solutions for improving pain management in acute care hospital settings toward a pain-free hospital initiative.

Conclusion

Despite advances in pain medicine and pain teaching strategies, effective pain management is proportionate to both clinical and cultural preferences. Future studies should investigate the standardization of global pain management tools and guidelines to fit the local culture and context.