Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research study

The study of nurses' knowledge and attitudes regarding pain management and control in emergency departments

BACKGROUND

Given the importance and pivotal role of nurses in pain management and control, this study was conducted to determine the nurses' knowledge and attitudes toward in emergency departments.

METHODS

This study was designed and conducted as a descriptive-analytical cross-sectional study. Nurses' attitude and knowledge towards pain management and control and relationship between their demographic characteristics have been assessed. Nurse Attitude Survey (NAS) and Pain management and control principles assessment Test (PMPAT) questionnaires were used.

RESULTS

Totally 400 volunteers, including 148 (37.2%) male and 250 (62.8%) female nurses recruited from 23 hospitals in East Azerbaijan, Iran, with a mean age of 30.88 years (± 6.04 SD) and age range between 22 and 53 years old. The crude mean score of participants' knowledge of pain management and control was 12.51 (± 2.77 SD), and standardized mean score was 40.34 (± 8.92 SD), which was low at 84.8% and moderate in 15.3% of the participants. Older nurses and nurses who previously participated in pain retraining courses had significantly less knowledge about pain management and control (r= -0.104, P = 0.038), and (r= -0.148, P = 0.003) respectively. The crude mean score of participants' attitudes toward pain control and management was 15.22 (± 2.56 SD), and standardized mean score was 60.87 (± 10.26 SD). Nurses' attitudes have become more negative with the increase of their work experience (r = -0.168, P = 0.001), and previously participation in pain retraining courses (r =-0.207, P < 0.001). Older nurses and highly educated nurses had significantly more negative attitudes towards pain control and management (r = -0.153, P = 0.002), and (r= -0.126, P = 0.005), respectively.

CONCLUSIONS

The current study revealed that pain management and control knowledge in most emergency nurses was low, and most of them had a moderate attitude. We need more scientific and comprehensive pain management and control training courses to improve knowledge and attitude among health workers and nurses.

Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea

Background

Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals.

Methods

This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses’ utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05.

Results

The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p = 0.013), level of education (p = 0.012), work experience (p = 0.001) and place of work (p = 0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p < 0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified.

Conclusion

The use of non-pharmacological methods in the studied hospitals varied greatly due to knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12912-020-00492-0.

The athletic gut microbiota

The microorganisms in the gastrointestinal tract play a significant role in nutrient uptake, vitamin synthesis, energy harvest, inflammatory modulation, and host immune response, collectively contributing to human health. Important factors such as age, birth method, antibiotic use, and diet have been established as formative factors that shape the gut microbiota. Yet, less described is the role that exercise plays, particularly how associated factors and stressors, such as sport/exercise-specific diet, environment, and their interactions, may influence the gut microbiota. In particular, high-level athletes offer remarkable physiology and metabolism (including muscular strength/power, aerobic capacity, energy expenditure, and heat production) compared to sedentary individuals, and provide unique insight in gut microbiota research. In addition, the gut microbiota with its ability to harvest energy, modulate the immune system, and influence gastrointestinal health, likely plays an important role in athlete health, wellbeing, and sports performance. Therefore, understanding the mechanisms in which the gut microbiota could play in the role of influencing athletic performance is of considerable interest to athletes who work to improve their results in competition as well as reduce recovery time during training. Ultimately this research is expected to extend beyond athletics as understanding optimal fitness has applications for overall health and wellness in larger communities. Therefore, the purpose of this narrative review is to summarize current knowledge of the athletic gut microbiota and the factors that shape it. Exercise, associated dietary factors, and the athletic classification promote a more “health-associated” gut microbiota. Such features include a higher abundance of health-promoting bacterial species, increased microbial diversity, functional metabolic capacity, and microbial-associated metabolites, stimulation of bacterial abundance that can modulate mucosal immunity, and improved gastrointestinal barrier function.

The views of patients, healthcare professionals and hospital officials on barriers to and facilitators of quality pain management in Ethiopian hospitals: A qualitative study

BACKGROUND

Postoperative pain remains a challenge in the developed world, but the consequences of inadequately treated postoperative pain are particularly severe in low- and middle-income countries. Since 2011, reports have drawn attention to the poor quality of postoperative pain management in Ethiopia; however, our multicenter qualitative study was the first to attempt to understand the factors that are barriers to and facilitators of quality pain managment in the country. To this aim, the study explored the perspectives of patients, healthcare professionals, and hospital officials. We expected that the results of this study would inform strategies to improve the provision of quality pain management in Ethiopia and perhaps even in other low- and middle-income countries.

METHODS

This study used a qualitative, descriptive approach in which nine healthcare professionals, nine patients, and six hospital officials (i.e. executives in a managerial or leadership position in administration, nursing, or education) participated in face-to-face, semi-structured interviews. Thematic data analysis was conducted, and patterns were explained with the help of a theoretical framework.

FINDINGS

The barriers identified ranged from healthcare professionals' lack of empathy to a positive social appraisal of patients' ability to cope with pain. They also included a lack of emphasis on pain and its management during early medical education, together with the absence of available resources. Enhancing the ability of healthcare professionals to create favorable rapport with patients and increasing the cultural competence of professionals are essential ingredients of future pain education interventions.

CONCLUSIONS

Barriers to and facilitators of postoperative pain management do not exist independently but are reciprocally linked. This finding calls for holistic and inclusive interventions targeting healthcare professionals, patients, and hospital officials. The current situation is unlikely to improve if only healthcare professionals are educated about pain physiology, pharmacology, and management. Patients should also be educated, and the hospital environment should be modified to provide high-quality postoperative pain management.

Engagement and availability in shaping nurses' management of postoperative pain: a qualitative study

Background

Studies reporting inadequate nursing care for patients indicate that nurses are negatively affected in such situations, and research is needed to study nursing care in postoperative situations.

Objective

To describe situations of postoperative pain management in a surgical ward in Thailand.

Methods

A qualitative approach using the Critical Incident Technique was chosen to investigate situations of postoperative pain management from the perspective of surgical nurses in Thailand. Data were collected through multiple semi-structured interviews with nine nurses over a five-week period.

Results

The situations of surgical nurses described three elements that heavily influenced the quality of postoperative pain management: engagement in a trustful nurse-patient relationship, availability of pain medication and nursing care when needed, and imbalance between meeting the patient’s needs and completing routine nursing duties.

Conclusion

The results help to expand our understanding of how Thai nurses manage pain in postoperative situations and indicate areas that could be improved in terms of how nurses respond to patients’ pain. Nurses challenge existing guidelines and facilitate development of new nursing guidelines and/or policies in pain management.

An Analysis of Italian Nurses' Approach to Patients' Pain: A Nationwide Online Survey

Healthcare providers play a fundamental role in evaluating pain. Several issues about how nurses are educated remain unsolved. The aim of our study was to address how Italian nurses manage patients suffering from pain in daily practice. A cross-sectional survey was administered among Italian registered nurses. Data were collected using a 34-item questionnaire that had been previously validated during a pilot study. The lowest level of participation/education/information events was observed in the South (p=0.0001). A significant difference among the four areas was found in the department affiliation of responders (p=0.0001). Pain assessment at patients' admission was most frequent in the Northeast (32.9%), whereas the lowest frequency was found in the South (15.1%) (p=0.0001). The prevalence of nurses' knowledge of pain scales and their distribution in usual applications was similar in the Northwest and -east, and Central Italy, but lower in the South (p=0.0001). This study underlines the need for change in the clinical approach to pain treatment in healthcare. Pain assessment is a fundamental step for preparing individualized therapeutic plans, and nurses play a crucial role in improving the quality of life of suffering patients.

Healthcare professionals' descriptions of care experiences and actions when assessing postoperative pain - a critical incident technique analysis

BACKGROUND

Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments.

OBJECTIVES

The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain.

METHODS

An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience.

FINDINGS

In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain.

CONCLUSIONS

Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain.

Systematic review of the predisposing, enabling, and reinforcing factors which influence nursing administration of opioids in the postoperative period

AIM

To provide an overview of the administration of opioid analgesics by nurses when prescription is on an "as-needed" basis for postoperative pain, and to identify the important factors that determine the decisions of nurses, by using the framework of predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation.

METHODS

Multiple databases were searched for the period from 2000-2012. Out of a total of 1755 citations and 148 abstracts retrieved, 39 studies met the criteria for inclusion. Studies were considered eligible for review if they focused on situations or factors influencing a nurse's performance in pain assessment and the administration of opioid analgesics in postoperative pain management.

RESULTS

The topics of the descriptive and qualitative studies presented four themes: (i) nurses' knowledge and attitudes about pain management; (ii) the situation of nurses' work practices in administrating range orders for opioid analgesics; (iii) factors that influenced nurses' work practices; and (iv) perceived barriers to effective pain management from the nurse's perspective. The experimental studies investigated the effects of different approaches in nurses' pain management practices in postoperative settings and their outcomes for patients.

CONCLUSION

A knowledge deficit was observed to be the reason in most cases for a nurse's failure to administrate adequate analgesics for postoperative pain relief. Pain-related education for nurses is the cornerstone to improve pain management. The integration of enabling and reinforcing factors will help nurses to develop the ability to make the decision to engage in a comprehensive intervention to improve pain management and patient outcomes.

Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery

Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control.