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400765 Evidence Based Nursing Assessment
Nurse’s knowledge and attitude towards pain assessment and management in adult health care settings.
Pain is one of the the most common reason patients seek help from health professionals, andinadequate pain management is often raised as an issue in customer surveys and a cause for complaints to most health settings. (Bennets, Brophy, Huckson&Dohert, 2012).Issues of pain assessment and management is very significant in the present day health care settings because of high prevalence of pain, continuous evidence of undertreated pain and the adverse consequences of inadequately managed pain(American Pain Society,2013). Despite the advancement in technology and pharmacology or with availability of published literatures and guidelines,most of the patients experiencing pain expressed inadequate relief and eventually results in poor quality of life, decreased productivity,and increasing health care expenses.(Duke,Haas,Yarbrough&Northam,2012).The annual cost of pain in Australia is estimated $11.7 billionwhich including health care expense,negative productivity, and lost income in addition to psychological and social impacts to patient and families (Chronic Pain Australia, 2011).
Many health care barriers to successful pain management have been identified including inadequate knowledge of nurses regarding pain assessment, management and pain medications, exaggerated risks of opioid addiction and respiratory distress, nurses inadequate knowledge of non-pharmacological interventions for pain, and the perceptual differences of pain between patients and health care providers (McNamara, Harmon&Saunders,2012). According to Mercedes and Deborah (2013)since nurses are the health professionals who spend most of the time in contact with patients, pain management is an important aspect of nursing care and nurse’s knowledge and attitudes impact the effectiveness of pain management strategies.The aim of this study is to assess the current knowledge and attitudesregarding pain assessment and management of nurses within the target population.
A preliminary literature review was carried out in order to get more information about nurses knowledge on pain assessment and management and to identify any gap in the literature. Databases utilized in the literature search were Medline (Index medicine online), CINAHL (Cumulative Index to Nursing and Allied health), PUBMED, & UWS library e-resources. TheKeywords used in the search were pain assessment, effective pain management, nurse’sknowledge & barriers .These terms were combined in various combinations to refine the search. . Using these key words 103 articles were found. The search was limited to research articles and to the English language. After reviewing the remaining 26 papers, only 6 were recent and relevant research articles and therefore selected for review.
In a study by Moceri and Drevadahl(2012) ,where 365 nurses from emergency departments of 5 hospitals in pacific northwest region of United States wereparticipated, most of the nurses achieved high scores in general questions about pain assessment and management, but relatively low outcome with regards to medication ,dosage or treatment especially opioid pharmacology.Moreover, results from this study indicated that thereare no significant difference in mean total scores either by age and years of nursing experience or nurses with a bachelor and masters degree.The author concluded with statement on the need for research and education interventions on effective analgesic practices.Lewthwaite, Jabush, Wheeler, Hoehn,Mills,Holder and Federowicz(2011) conducted descriptive study in urban tertiary care hospital in Midwestern Canada where the study surveyed 761 fulltime or part time nurses from a variety of clinical settings.Unlike the findings of Moceri and Drevadahl (2012) this studyshowed younger nurses and those with fewer experience scored higher than the older nurses with more years of experience. This findingis an indication that the more recent formal education of nurses with fewer experience made them stronger performers. The author concluded that lack of knowledge among care providers are one of the main reasons for inadequate pain management,however, the need for inter professional collaboration with colleagues from medicine and pharmacy is essential to ensure effective, individualised pain management.
Al-shear,Hill and Anderson (2011) conducted a studysurveying 129 registered nurses from 10 different units about their knowledge and attitudes regarding pain management. Findings from this study indicated that nurses answered questions at an acceptable level, but areas of concern included pain assessment and the correct usage of opioids. However, it was interesting to note that experience of nurses made difference in their knowledge and attitude regarding pain.Nurses who had less than 1 year experience or more than 16 years of experience achieved the highest knowledgeable scores. The more recent structured education of nurses and the effect of clinical practice influenced these results respectively.Furthermore, the study reveals the nature of the nursing unit or speciality is also appeared to be important becauseoncology nurses showed significantly higher level of more knowledgein comparison to nurses from other units. The author concluded that a high level of knowledge with its application on pain management principles are essential to clinical practice which include pain assessment,pain intensity, and correct dosing of narcotics.
Abdalrahim,Majali,Stomberg and Bergbom(2010) conducted a study in a surgical ward of a University hospital in Jordan with 65 registered nurses were involved. This study consisted of an educational programme on pain management with a post and pre intervention evaluation. The pre intervention evaluation of the study indicated that more than half of the nurses included in the study were lacking adequate knowledge and hasnegative attitudes towards pain management. This was especially evident in the use of narcotic drugs. This study concluded with the findings that lack of knowledge in nurses are a major barrier to pain management, and education programmes might be effective for a better patient outcome. This is also supported by Machira,Kariuki and Martindale(2013) in astudyinvolving 31 nurses in a Kenyan hospital. The most important findings in this study is a baseline knowledge deficit of the sample of nurses which may be attributed to the limited access to in-service lectures on pain management or continuing educational programmes.A study by McNamara et al. (2012) also supports the above study findings,in whicha questionnaire is used to evaluate 59 nurseson their knowledge, attitude and skills towards acute pain management. In addition,this studyfound that nurses had most difficulty with topics of subjectivity of pain, time of pain assessment and incidence of addiction in patients receiving narcotic analgesics. This finding indicates the negative attitudes of nurses in pain assessment as well as insufficient and inaccurate information about opioids use.
Identifying the gaps
There were many studies available to examine the nurse’s knowledge on painmanagement, andmost of these studies agree with the fact that lack of knowledge of nurses is a major barrier towards effective pain management. Although few studies indicated that educational interventions can enhancenurses’ knowledge regarding pain assessment and management, theneed for continuous evidence based educational programs are not emphasized. Since nurses showed poor knowledge in pharmacology especially narcotic drugs, more research is needed to find more effective ways to influence the practice of the working nurse’sknowledge about the narcotic administration and potential side effects including addiction.Since empirical findings consistently supportthe hypothesis that pain management continuesto be a nursing challenge, acontinuous education in painmanagementto be implemented,that increaseknowledge of pain assessment and management. The need for mandatoryin-service education sessions in pain management for all nursesregardless of the experience they gained, position or educational back ground which mayenhance their knowledgeis not discussed deeply in any of the studies. Further research in pain management is integral to ensuring that continuing education is effective in improving nurse’s knowledge, attitudes, and skill in pain management and patient care (Blondal&Halldorsdottir,2009).
Research questions and hypothesis
What is the effectiveness of a continuous evidenced basedpain management educational intervention designed to improve nurses’ knowledge?
Research question is inferential and it is hypothesized that the educational intervention will improve the nurses’ knowledge and attitudes regarding pain management.
Significance of the study.
Although it is the physician who prescribes the analgesia, nurses have much of the responsibility of the assessment of pain and subsequent comfort measures (Duke et al., 2012).The findings from this study, as well as the previous research findings suggest that despite various strategies formed andavailable in pain management, pain is often undertreated and inadequately managed. Sincecomplete knowledgeable practitioners are the key to excellent patient outcome, nurses need to have the knowledge aboutpathophysiology, myth and misconceptions, assessment, pharmacological and non-pharmacological pain management techniques and ethical considerations in pain management(Tse&Ho, 2012).Acquiring knowledge and its application are key strategies to clinical nursing practice for better positive patient outcome. (Al-shear et al., 2011). The future of pain management lies in incorporating education to nurses and empowering them todeliver safe practices and efficient quality of care by evaluating current standards and promoting the knowledge and attitude towards pain(Abdelrahim et al., 2010). There is a need to formulate health strategies which priorities pain management in the clinical settings and nurses have the moral, ethical, professional, and legal responsibility to assess, and relieve pain with appropriate interventions (Wang &Tsai, 2009).
- Abdulrehim, M.S., Majali,S.A.,Stomberg, M,W., &Barboom, T.(2010).The effect of post-operative pain management programme on improving nurses knowledge and attitude towards pain, Nurse Education in Practice,11 ,20-255 doi:10.1016/j.nepr.2010.11.016.
- Al-Shear, D., Hill, P.D., & Anderson, M,A.,(2011).Nurses knowledge and attitude regarding pain assessment and intervention, Medsurgnursing20/,7-11.
- Bennetts, S.,Brophy, E.C., Huckson, S.,& Doherty, K. (2012). Pain management in Australian emergency departments: Current practice, enablers,barriers and future directionsemm.Emergency medicine Australia,24, 136-143doi: 10.1111/j.1742-6723.2011.01499.x.
- Blondal,K., &Halldorsdottir, S.,(2009).The challenge of caring for patients in pain: from the nurses perspective. Journal of clinical nursing ,18, 2897-2906.doi:10.111?j.1365-2702.2009.02794.x.
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