pain management essay nursing

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• v.9; Jan-Dec 2023

Non-Pharmacological Pain Management Practice and Associated Factors Among Nurses Working at Comprehensive Specialized Hospitals

Dejen tsegaye.

1 Department of Nursing, College of Health Sciences, Debre Markos University, Debremarkos, Ethiopia

Asrat Yazew

2 Department of Adult Health Nursing, Agew Gimjabet Primary Hospital, Amhara, Ethiopia

Mihretie Gedfew

Gizachew yilak.

3 School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia

Zemen Mengesha Yalew

4 Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia

Introduction

Non-pharmacological pain management practices are very important for the successful treatment of pain. It has an impact on the patient’s quality of life and the family’s financial situation owing to missed workdays, direct medical expenses, and incapacity from pain.

Therefore, this study is intended to assess non-pharmacological pain management practice and associated factors among nurses working at comprehensive specialized hospitals in northwest, Ethiopia.

Institution-based cross-sectional study design was employed from May 30 to June 30, 2022. A stratified random sampling technique was used to select 322 study participants. A binary logistic regression model was used to identify factors associated with non-pharmacological pain management practice. Variables with a P -value less than .25 in the bi-variable analysis were entered into the multivariable logistic regression analysis and a P -value of less than .05 was considered as having a statistically significant association.

A total of 322 nurses participated, with a response rate of 98.8%. It was found that 48.1% (95% CI: 42.65, 53.62) of nurses had good practice in non-pharmacological pain management. Pain assessment tool availability (AOR = 1.68 [95% CI: 1.02, 2.75]) ( P = .04), good pain assessment practice (AOR = 1.74 [95% CI: 1.03, 2.84]) ( P = .03), favorable attitude (AOR = 1.71 [95% CI: 1.03, 2.95]) ( P = .03), and age (26–35) (AOR = 4.46 [95% CI: 1.24, 16.18]) ( P = .02) were factors significantly related to non-pharmacological pain management practice.

According to this work, the prevalence of non-pharmacological pain management practices was found to be low. Good pain assessment practices, availability of pain assessment tools, favorable attitude, and age (26–35) years were significant factors of non-pharmacological pain management practice. Hospitals are better give training on non-pharmacological pain management methods for nurses as they are important to treat pain holistically, increase patient satisfaction, and are cost-effective.

According to the International Association for the Study of Pain (IASP), pain is unpleasant sensory and emotional experiences associated with actual or potential tissue damage ( Aydede, 2019 ). Pain is the most common health problem leading to seeking health care. About 4 out of 10 hospitalized adult patients suffer from pain. Pain management is a nursing activity comprising basic components of the nursing process; assessment, diagnosis, planning, intervention, and evaluation for patients in pain. The American Pain Society (APS) introduced the “pain as the 5th vital sign” concept in 1996 to lessen the burden of underassessing and treating pain ( Araujo & Romero, 2015 ; Levy et al., 2018 ; Liyew et al., 2020 ). Various nursing tasks, including the application of efficient pain-relieving techniques, are involved in the treatment of pain. It has been indicated that pain management includes proper assessment and provision of relief for patients who suffer from pain ( Association, 2011 ). Nurses are professionals who are closer to the patients than other professionals and devote most of their time to caring for patients. They play a crucial role and have the responsibility of assessing and managing patients’ pain ( Awad & Hashem, 2019 ; Benimana, 2017 ).

Pain management involves pharmacological and non-pharmacological treatment approaches. Non-pharmacological pain management (NPPM) is an intervention without the use of medications ( Conway, 2020 ). Non-pharmacological methods do not replace pharmacological treatments but are complementary to medication treatments. These strategies are worthwhile especially for managing mild to moderate pain ( Mohamed Bayoumi et al., 2021 ). They are used along with medication for moderate to high-intensity pain control and alone for treatment of low-intensity pain. There are various NPPM practices that nurses can apply in nursing care. Physical methods such as massage, movement restriction/rest, repositioning, and cold and hot application have important pain-relieving effects ( Demir, 2012 ). Cognitive behavioral and psychological therapies which include relaxations, patient education, breathing techniques, and attention distraction are important NPPM practices. Other NPPM practices include emotional support/reassurance, touching, and creating a comfortable environment ( He et al., 2011 ; Kidanemariam et al., 2020 ).

Nurses can apply these methods easily with little resources ( Funda Büyükyýlmaz, 2014 ; Gelinas et al., 2013 ).

NPPM practices are essential in that they promote comfort and patients can use to control their pain if they are provided appropriate information or education ( Marie, 2013 ; Mohiuddin, 2019 ). Moreover, these methods have advantages over the conventional drug treatments that they treat cognitive, affective and socio-cultural aspects of pain. They increase feeling of control, diminish pain intensity, improve quality of life, lower required dosage of pain killers, and minimize cost ( Demir, 2012 ; El Geziry et al., 2018 ).

Pain is a common health problem globally affecting many patients but often left undertreated ( Tercan, 2017 ). More than 80% of surgical patients were affected by inadequately managed pain in the U.S. Evidence from the literature showed that unrelieved pain is associated with several detrimental consequences. It affects the quality of life, and economic status of the patient and families from work days lost, direct health costs, and disability due to pain ( Mohiuddin, 2019 ). Among hospitalized patients, unrelieved pain lengthens the duration of recovery, and results in longer hospital stays leading to more cost and decreased patient satisfaction ( Benimana, 2017 ; Swartzentruber, 2021 ). Due to this, incorporating NPPM practices into nursing care contributes to the effective management of patient’s pain ( Nwaneri et al., 2018 ; Swartzentruber, 2021 ).

It has been identified that inadequate pain assessment, lack of knowledge, negative attitude, workload and absent/insufficient guidelines regarding NPPM ( Seldon, 2017 ) are among several contributory factors to the low usage of NPPM practices that have been mentioned in the literature. Despite health professionals receiving training on pain assessment and management, patients are still suffering from poorly controlled pain. So, further training should be provided, along with training on nursing attitudes towards NPPM practice ( Benimana, 2017 ). Educational program can improve knowledge and attitude of nurses regarding pain management ( Germossa et al., 2018 ). In Ethiopia, despite the initiation of training on pain management and the development of national guidelines on the assessment and management of pain given high priority ever before, patients still suffer from undertreated pain. Nurses working at comprehensive specialized hospitals in Ethiopia, specifically in the study area did not take training regarding pain assessment, management and practice ( Association, 2011 ; FMOH, 2014 ).

Review of Literature

Various studies had determined usage of different NPPM approaches for pain management in different countries. A study undertaken in Philippines to determine extent of nurses’ NPPM application for pain treatment showed that good number of nurses often use this practice ( Antwi et al., 2019 ). Another study conducted in Turkey to examine knowledge and practice of nurses regarding NPPM practice had demonstrated that 62.4% of nurses apply NPPM practice ( Tercan, 2017 ). In addition, a research was conducted in Iran to investigate extent of utilization in ICU nurses and found that 55.8% of nurses use NPPM practices. Another descriptive cross-sectional study undertaken in Nigeria and Cameroon to investigate nurses’ utilization of NPPM practice found that 65.2% and 56% of nurses use NPPM practice, respectively ( Abimbola, 2021 ; Kimbi et al., 2016 ). Furthermore, descriptive exploratory study done in Egypt to determine critical nurses’ application of NPPM measures revealed that 67.3% of nurses’ practice was unsatisfactory ( Khalil, 2018 ).

In Ethiopia, studies carried out at Tikur Anbessa and Debre Tabor hospitals and indicated that only 52.8% and 26% of nurses have good NPPM practice ( Sisay, 2017 ; Zeleke et al., 2021 ).

Various studies carried out to examine practice of nurses on NPPM found that age, level of education and working experience were determinants of nurses’ NPPM practice ( Ali et al., 2013 ; Mohamed et al., 2021 ; Seldon, 2017 ). Similarly, studies in Nigeria ( Abimbola, 2021 ; Nwaneri et al., 2018 ), Egypt ( Mohamed et al., 2021 ), Eritrea ( Kidanemariam et al., 2020 ), and Ethiopia ( Kerie et al., 2020 ; Sisay, 2017 ) demonstrated that increase in age, higher level of education and more working experience were associated with good practice on NPPM practices among nurses.

A research was conducted at Walden University and Turkey on nurses knowledge of NPPM practices and provision of holistic patient care for postoperative pain management. These studies demonstrated that nurses possess poor knowledge regarding NPPM practices which had led to low utilization of these practices in pain management ( Arbuah, 2019 ; Şimşek & Gözen, 2021 ; Yaban, 2019 ). On the other hand, study in Makkah Al-Mukaramah had determined that nurses’ satisfactory knowledge on NPPM practices has contributed to satisfactory practice ( Ali et al., 2013 ). Studies in Egypt (67.3%) ( Mohamed et al., 2021 ) and Sudan (66%) ( Elhusein et al., 2020 ) revealed that nurses had poor knowledge on NPPM practices. In Ethiopia, studies demonstrated that 52% of nurses had good knowledge regarding NPPM ( Sisay, 2017 ).

A study in Philippines had proven that nurses’ good attitude towards NPPM and good pain assessment practice positively affects application of these practices ( Antwi et al., 2019 ). Another research in Nigeria demonstrated that 65.7% of nurses’ attitude was positive towards these practices of pain treatment and has significant association with utilization of NPPM ( Abimbola, 2021 ). Similarly, studies in Ethiopia had also indicated that attitude had significant difference on NPPM practice of nurses positively associated with good practice ( Sisay, 2017 ; Zeleke et al., 2021 ).

Studies had proven that it is difficult to adequately alleviate pain without adequate assessment ( Benimana, 2017 ). A study conducted in Egypt found that only 50.9% nurses had satisfactory pain assessment practice and most of them (56.4%) didn’t have education about pain assessment ( Mohamed et al., 2022 ).

Multiple institutional-related factors invariably affect NPPM practice of nurses. Cross-sectional studies in Turkey ( Gumus et al., 2020 ), Cameroon ( Kimbi et al., 2016 ), Sudan ( Elhusein et al., 2020 ), and Debre Tabor, Ethiopia ( Zeleke et al., 2021 ) pointed out that in-service training was significant factor associated with NPPM practice. Lack of NPPM equipment's (e.g., special mattress, pillow) was also one of the significant factors with NPPM practice ( Abimbola, 2021 ; Khalil, 2018 ; Nwaneri et al., 2018 ). Another cross-sectional study conducted in Eritrea showed that availability of pain measurement tools in the working unit had determined significant difference among nurses regarding their practice of NPPM ( Kidanemariam et al., 2020 ). Studies had identified that workload was one of the reasons for low NPPM practice ( Khalil, 2018 ; Kia et al., 2021 ; Kimbi et al., 2016 ).

A study in Ethiopia revealed that 70.3% of nurses said that patients’ preference to drugs was one of the reasons not to use NPPM practices for pain alleviation. But, absence of patients’ preference to drugs had positive effect on nurses’ NPPM practice ( Sisay, 2017 ). It had also been identified that about 46.8% ( Nwaneri et al., 2018 ) and 92.9% ( Abimbola, 2021 ) nurses said patients’ severity of pain was one of the reasons in order not to apply NPPM practices. The aim of this study is intended to assess NPPM practice and associated factors among nurses working at comprehensive specialized hospitals in the northwest Ethiopia, 2022.

Conceptual Framework

The nurse’s socio-demographic characteristics, institution-related factors, nurses-related factors, and patient-related factors directly affect NPPM practice ( Abimbola, 2021 ; Ali et al., 2013 ; Antwi et al., 2019 ; Gumus et al., 2020 ; Kerie et al., 2020 ; Khalil, 2018 ; Kia et al., 2021 ; Sisay, 2017 ; Zeleke et al., 2021 ) ( Figure 1 ).

Schematic representation developed to show interactions between the dependent and the independent variables.

Study Design

Institution-based cross-sectional study design was employed.

Study Area and Period

The study was conducted in X, Y, and Z comprehensive specialty hospitals in northwest Ethiopia from May 30 to June 30, 2022. X Comprehensive Specialized Hospital is located in X Town, approximately 250 km from A, and 265 km from B, the capital city of the Amhara Regional State and Ethiopia, respectively. Two-hundred thirty-eight nurses were working in this hospital ( Endawoke et al., 2021 ). Y and Z comprehensive specialty hospitals are located in A which is approximately 565 km away from Addis Ababa. These two university hospitals are public hospitals that provide care to more than five million residents in the catchment region. There were 430 and 310 nurses, respectively, in these hospitals ( Belachew et al., 2021 ).

The source populations were all nurses working at comprehensive specialty hospitals in the Northwest Ethiopia, and the study populations were all nurses working at the hospitals who were available during data collection period.

Eligibility Criteria

All nurses with more than 6 months of work experience at selected comprehensive specialty hospitals in Northwest Ethiopia were included. However, severely ill nurses and those on yearly or maternity leave at that time were excluded.

Variables of the Study

Dependent variable.

NPPM practice.

Independent Variables

Independent variables of the study were socio-demographic characteristics; age, sex, marital status, work experience, educational level, and working unit, institution-related factors; availability of pain assessment tools, availability of NPPM guidelines, availability of NPPM equipment, workload and in-service training on non-pharmacological methods, nurses-related factors; knowledge, attitude, nurses’ pain assessment practice and previous education on non-pharmacological methods and patient-related factors; patients’ preference and severity of pain.

Operational Definitions and Data Collection Tools and Procedures

Data were collected by using structured pretested self-administered questionnaires. The questionnaire has six parts. Part Ι: Socio-demographic variable questions developed by the researcher which include: age, sex, marital status, work experience, educational level, and working unit. Part ΙΙ: Knowledge-related questionnaire (NKASRP) assessing nurses’ knowledge regarding NPPM. It was adapted from previous studies after a literature review ( Jira et al., 2020 ; Tekletsadik et al., 2021 ) and consists of 12 items of Yes or No type questions. Part ΙΙΙ: Attitude-related questionnaire (NKASRP) to assess nurses’ attitudes toward NPPM. It was adapted from previous studies after a literature review and consists of 12 items of Likert type ranging from 1 to 5 ( Jira et al., 2020 ; Tekletsadik et al., 2021 ). Part ΙV: NPPM practice questionnaires. It was adapted from the validated tools after the literature review ( Gumus et al., 2020 ; Khalil, 2018 ; Kia et al., 2021 ; Zeleke et al., 2021 ).

Part V: Pain assessment practice-related questionnaire, which was adopted from previous studies after the literature review and consists of 9 items with closed-ended Yes or No questions ( Melile Mengesha et al., 2022 ). Part VI: contains questions to assess factors related to NPPM practice adapted after the literature review with closed-ended Yes or No questions ( Ali et al., 2013 ; Mohamed Bayoumi et al., 2021 ; Nwaneri et al., 2018 ; Sisay, 2017 ).

Severe pain: is pain rating of 7 to 10 in the numerical pain rating scale; moderate pain is a pain rating of 4 to 6 in the numerical pain rating scale and mild pain is a pain rating of 1 to 3 in the numerical pain rating scale ( Besufekad et al., 2021 ).

Workload: Participants who work >39 hours per week were considered as having a workload ( Yazew et al., 2021 ).

Adequate knowledge: Study participants who scored points ≥65% out of prepared knowledge questions. Scoring system: correct answers were coded “1” and incorrectly coded “0.” Scores of each item were summed-up and the total was divided by the number of items (12 items) and changed to percentage. A score≥65% was considered adequate knowledge and ˂65% was considered inadequate knowledge ( Mohamed et al., 2021 ).

Favorable attitude: Participants who scored points ≥60% out of the prepared attitude questions. Scoring system: for attitude items, scores were summed-up, and the total was divided by the possible maximum score (scores range from 12 to 60) and changed to percentage. A score ≥60% (i.e., 36 scores) was considered a favorable attitude and a score of ˂60% was considered an unfavorable attitude ( Ali et al., 2013 ).

Good practice of NPPM: Participants who scored points ≥65% out of prepared NPPM practice questions. Scoring system: For practice items, scores are summed-up and total is divided by maximum (scores range from 13 to 52). Score ≥65% (i.e., 34 scores) was considered as good practice and score ˂65% considered as poor practice ( Mohamed et al., 2021 ).

Good pain assessment practice : Participants who scored ≥70% to the questions assessing pain assessment practice. Scoring system: the correct answer was coded “1” and incorrect “0.” Scores of items were summed-up and the total score is divided by the number of items (9 items). Score ≥70% was considered good practice and ˂70% was considered poor practice ( Melile Mengesha et al., 2022 ).

Sample Size Determination

The sample size was calculated for the first objective use a single population proportion formula, a 95% confidence interval, a 5% margin of error assumption, and a 26% P -value derived from other studies ( Zeleke et al., 2021 ).

where n = desired sample size, p = 26% → 0.26, the proportion of nurses’ good practice in NPPM, d = 5%, margin of error, Z = 1.96 normal standard deviation for 95% confidence level

By adding 10% non-response rate, sample size was (296 * 0.1) + 296 = 326.

The sample size was also calculated for the second objective use double population formula using Epi 7 software for individual factors at 95% confidence level with 5% margin of error, 80% power, and 1:1 ratio of exposed to unexposed has been determined as follows ( Table 1 ).

Determination of Sample Size by Associated Factors on Non-Pharmacological Pain Management Practice Among Nurses at Comprehensive Specialized Hospitals ( N = 322).

AOR = adjusted odd ratio, p1=exposed group, p2 unexposed group.

Therefore, the final sample size used for the study was the highest value n = 326 determined by the first objective.

Sampling Technique and Procedures

The study participants were chosen using a stratified random sampling technique. The human resource management office of the hospitals provided the total number of nurses from comprehensive specialty hospitals in the east and west Gojjam zones. The total sample size was proportionally distributed among the hospitals and nursing units. Finally, study participants were chosen from each unit using simple random sampling technique ( Figure 2 ).

Schematic presentation of sampling procedure on non-pharmacological pain management practice at comprehensive specialized hospitals in the east and west Gojjam zones, Ethiopia, 2022.

Data Quality Control

Before beginning the actual data collection, a pretest on 17 nurses (5% of the sample size) at Injibara General Hospital was conducted to ensure data quality. In previous studies, the tool was validated by a panel of experts. A reliability test was conducted, and the results showed that the knowledge, attitude, non-pharmacological pain treatment practice, and pain assessment practice items had corresponding Cronbach’s alpha values of 0.71, 0.70, 0.89, and 0.75, respectively. Supervisors and data collectors received training. Six nurses with bachelor degree and three supervisors with master’s degrees collected the data. The way that data were collected, the clarity of the questionnaire, the confidentiality of the information, the rights of the participants, and informed permission were all covered. Daily checks were made during data collection to ensure the accuracy. Data were collected using self-administered questionnaire and Epi Data was used for data entry to prevent data entry errors.

Data Processing and Analysis

The data were checked for completeness and consistency. Then it was coded and entered in EPI data version 3.02 Software. After that, data were exported to SPSS version 25 for analysis. Model fitness test (Goodness of fit was checked with Hosmer Lemeshow model of fit [ P = .36] and assumption test for multicollinearity problem [VIF < 3.35] was done). Descriptive analysis using frequencies, proportions, and graphs was performed to describe the number and percentage of socio-demographic characteristics. The binary logistic regression analysis model was used to identify associated factors of NPPM practice. Variables with a P -value less than .25 in the bi-variable logistic regression were entered into the final multivariable logistic regression analysis to control possible confounding factors and to include more potential significant factors of NPPM practice. A P -value of less than .05 in multivariable regression analysis was considered statistically significant with NPPMP. The results were presented in text, tables, and graphs based on the types of data.

Ethical Considerations

Ethical clearance was obtained from X, the college of health sciences, ethical review committee. Then further permission letter was obtained from Amhara Public Health Institute’s research directorate and permission letters obtained from the institute's research directorate were distributed to X, Y, and Z hospitals. After obtaining permission from each hospital for preceding data collection, the purpose of the study, privacy issues, and participants’ right not to participate in the study or can withdraw from the study at any stage were explained to the study participants. Having obtained informed written consent from participants, data were collected and confidentiality was maintained with no name of the respondents written on the questionnaires.

Distribution of Socio-Demographic Characteristics

A total of 322 nurses participated in the study with a response rate of 98.8%. Of the total participants, 188 (55.9%) were male and 178 (55.3%) were married. Participants’ median age was 33 years with an interquartile range of 9 and the median work experience was 8 years with an interquartile range (IQR) of 6 ( Table 2 ) ( Figure 3 ).

Current working unit of nurses’ socio-demographic characteristics at comprehensive specialized hospitals at oncology unit in the east and west Gojjam zones, Ethiopia, 2022 ( N = 322).

Frequency Distribution of Nurses’ Socio-Demographic Characteristics at Comprehensive Specialized Hospitals ( N = 322).

Socio-demographic frequency distribution table.

Non-Pharmacological Pain Management Practices of Nurses

About 51.9% of nurses apply for position change routinely, 34.8% apply therapeutic communication often, and 43.8% of them use it to create a comfortable environment sometimes ( Table 3 ).

Frequency Distribution of Nurses’ Non-Pharmacological Pain Management Practices at Comprehensive Specialized Hospitals ( N = 322).

Frequency distribution table for nurses who practice non-pharmacological pain management.

Nurses-, Patients-, and Institutions-Related Factors

About 58.4%, 50.6%, 59%, and 32.9% of nurses had adequate knowledge, favorable attitude, good pain assessment practice, and received training on NPPM methods, respectively ( Figure 4 ) ( Table 4 ).

Overall nursing practice of non-pharmacological pain management at comprehensive specialized hospitals in east and west Gojjam zones, Ethiopia, 2022 ( N = 322).

Distribution of Factors on Non-Pharmacological Pain Management Practice of Nurses at Comprehensive Specialized Hospitals ( N = 322).

Frequency distribution table for factors of non-pharmacological pain management practice.

Factors Associated with Non-Pharmacological Pain Management Practice

To identify factors associated with NPPM practice, binary logistic regression was done. In bivariate logistic regression analysis, age, educational level, training, nursing work load, attitude, pain assessment, patients’ preference, and availability of pain assessment tool had an association with NPPM practice. All variables that have an association with the outcome variables in bivariate logistic regression analyses were interred in the multivariate logistic regression analysis models by using backward likelihood ratio method. Then in multivariable logistic regression analysis factors that were significantly associated with NPPM practice were age (26–35), favorable attitude, good pain assessment practice and the presence of pain assessment tools.

The odds of NPPM practice is almost five times higher among nurses whose age were 26 to 35 than among nurses whose age were <25 years (AOR = 4.48 [95% CI: 1.24, 16.19]) ( P = .04). Similarly the odds of NPPM practice is almost two times higher among nurses who had favorable attitude than among nurses who had not (AOR = 1.71 [95% CI: 1.03, 2.95]) ( P = .03). Also nurses who had good pain assessment practice were practicing NPPM 1.74 times than who had not (AOR=1.74 [95% CI: 1.03, 2.84]) ( P = .03). Finally nurses who had pain assessment tools in the working unit were practicing NPPM 1.68 times than nurses who had not (AOR = 1.68 [95% CI: 1.03, 2.76]) ( P = .04) ( Table 5 ).

Multivariable Logistic Regression Analysis of Factors Associated with Non-Pharmacological Pain Management Practice at Comprehensive Specialized Hospitals ( N = 322).

*Statistically significant at P < .05, AOR = adjusted odd ratio, COR = crude odd ratio.

Logistic regression table.

According to this study, 48.1% (95% CI: 42.65, 53.62) of nurses had a good practice on NPPM practice. This finding is in line with a study done in Addis Ababa ( Sisay, 2017 ) in which 52.8% of nurses had good practice regarding NPPM. However, this study finding is incongruent with the study in Debre Tabor that only 26% of nurses had a good practice on NPPM ( Zeleke et al., 2021 ). This discrepancy might be due to differences in sample size, training on NPPM methods, and scoring system used/operational definition.

However, the current study finding is higher than studies in Sudan (12%) ( Elhusein et al., 2020 ), Turkey (29.1%) ( Özveren1a et al., 2016 ), Egypt (26.7%) ( Mohamed et al., 2022 ) and a study stated that most nurses did not use NPPM methods for pain management ( Khalil, 2018 ). Possible reasons might be variations in the level of knowledge on NPPM methods, NPPM education, sampling technique, study design, and sample size difference. This means that when nurses are educated on NPPM practices, they become more knowledgeable which provides them confidence for practice. From the literature, it has been stated that evidence-based education on NPPM increases nurses’ knowledge and confidence, which helps nurses to apply these pain intervention methods in clinical practice ( Arbuah, 2019 ). In these studies, convenient sampling was used and this non-probability sampling method might have affected the selection of participants, which in turn reduces accuracy.

On the other hand, this study result is lower than the studies in Nigeria (65.2%) ( Abimbola, 2021 ), Iran (55.8%) ( Kia et al., 2021 ), and Turkey (62.4%) ( Tercan, 2017 ) of nurses used NPPM techniques for treatment of patients’ pain and the study ( Gumus et al., 2020 ) that 92.6% of nurses used NPPM methods for pain management. The possible explanation might be variation in the level of knowledge on NPPM methods, training, sample size, level of education, and study setting. In these studies most of the study participants had received training and had a high level of education as compared to this study and training and a higher level of education are important in acquiring knowledge which is the foundation for practice. As well, in these studies, participants were from specific units (ICU, pediatrics, medical or surgical). From the literature, it has been stated that staying longer duration in specific clinical settings leads to more clinical exposure and more practice.

Nurses who had good pain assessment practice were nearly two times (AOR = 1.74 [95% CI: 1.03, 2.95]) ( P = .03) more likely to practice NPPM than those who had poor practice on pain assessment. This implies that pain assessment has a positive effect on the NPPM practice of nurses. Pain assessment helps to determine the type of pain and effectiveness of pain management methods applied by reassessing after applying the methods and understanding the effectiveness of pain treatment methods helps to practice more. This finding is supported by the study ( Antwi et al., 2019 ), which determined the statistically significant association between pain assessment practice and utilization of NPPM practices by nurses. This finding is also supported by studies done in Ethiopia ( Ayenew et al., 2021 ; Melile Mengesha et al., 2022 ).

Nurses who reported that a pain assessment tool was available in their working unit were nearly two times (AOR = 1.68 [95% CI: 1.03, 2.76]) ( P = .04) better to practice NPPM than those who said there was no pain measurement tool in their working unit. Pain assessment tools are necessary to measure pain before and after applying NPPM methods for patients in pain. Measuring pain helps to identify the type/level of pain which is important to plan appropriate and effective management methods. This may increase clinicians’ practice. This finding is supported by the study in Eritrea ( Kidanemariam et al., 2020 ) that the availability of pain assessment tools showed statistically significant differences among nurses regarding NPPM utilization.

This study finding revealed that nurses with favorable attitudes were two times (AOR=1.71 [95% CI: 1.03, 2.84]) ( P = .03) more likely to practice NPPM as compared to nurses whose attitude was unfavorable towards NPPM. This implies that nurses’ positive perceptions towards NPPM methods are the facilitator for good NPPM practice. This finding is congruent with the studies in Debre Tabor ( Zeleke et al., 2021 ), Nigeria ( Abimbola, 2021 ), and the Philippines ( Antwi et al., 2019 ) that favorable attitude had a significantly positive association with good NPPM practice.

The last but not least, nurses aged 26 to 35 years were four times (AOR = [95% CI: 1.24,16.19]) ( P = .04) more likely to practice NPPM than those whose age was 25 years and below. This finding is congruent with the study in west Gojjam ( Kerie et al., 2020 ) and Egypt ( Mohamed et al., 2022 ) that age had significant association with good NPPM practice of nurses ( Figure 4 ).

Strength and Limitations

Cross-sectional study design makes it difficult to draw causal relationships between dependent and independent variables/factors. Research methodologies also involved self-reported measures that largely depend on individuals’ memory, and recall bias may exist. Nurses who were working in oncology unit are not included in the study.

Recommendations

Hospitals better give more emphasis on NPPM methods for nurses as they are important to treat pain holistically, increase patient satisfaction, and are cost-effective. The hospitals are also better to arrange training for nurses regarding NPPM practices, developing a decision algorithm or teaching which activities can reduce pain and avail pain assessment tool in each working units. It is better for nurses to emphasize and use NPPM methods in their nursing practice to reduce patients’ undesirable suffering from ineffectively treated pain and provide quality nursing care service since nurses have the responsibility to relieve patients’ pain. In addition, nurses better educate patients on NPPM methods to cope with and control their pain.

Implications for Practice

Considering the low practicability of NPPM, it is of great importance to provide in-service training, availing pain management tools, and decreasing work load of nurses to ensure the quality patient care. However, additional studies should be conducted to explore the long-term factor of the NPPM practice needed to improve quality nursing care.

According to the study, the overall NPPM practice of nurses in the study area was found to be poor. Good pain assessment practices, favorable attitude, the presence of pain assessment tools in the working unit, and age (26–35 years) were factors significantly associated with nurses’ NPPM practice. Hospitals are better give training on NPPM methods for nurses as they are important to treat pain holistically, increase patient satisfaction, and are cost-effective.

Abbreviations

Author’s Contribution: All authors made a significant contribution to the work reported, whether to the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work. All authors read and approved the final draft of the manuscript.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs: Dejen Tsegaye https://orcid.org/0000-0002-3285-3855

Zemen Mengesha Yalew https://orcid.org/0000-0001-6341-5172

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Adult pain assessment and management

Claire Ford

Lecturer, Adult Nursing, Northumbria University, Newcastle upon Tyne, explain how to reduce the risk of contamination

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Claire Ford, Lecturer, Adult Nursing, Northumbria University, Newcastle upon Tyne ([email protected]) outlines the skills and tools health professionals use to help patients manage pain

For health professionals, one of the most common patient problems they will encounter is pain. Although this is universally experienced, effective assessment and management is sometimes difficult to achieve, as pain is also extremely complex. Therefore, when a patient states they are in pain it is every health professional's duty to listen to what they say, believe that pain is what they say it is, observe for supporting information using appropriate and varied assessment approaches, and act as soon as possible using suitable management strategies.

The holistic assessment and management of pain is important, as pain involves the mind as well as the body, and is activated by a variety of stimuli, including biological, physical, and psychological ( Boore et al, 2016 ). For some patients, the pain they experience can be short-lived and easy to treat, but for others, it can cause significant issues in relation to their overall health and wellbeing ( Flasar and Perry, 2014 ).

Mismanaged pain can affect an individual's mobility, sleep pattern, nutritional and hydration status and can increase their risk of developing depression or becoming socially withdrawn ( Mears, 2018 ). As nurses are the frontline force in healthcare settings, they play a vital role in the treatment of individuals in pain. This article examines and explores some of the holistic nursing assessment and management strategies that can be used by health professionals.

Classifications of pain

Before diving into the assessment process, it is necessary to have a general understanding of the various types of pain that can be experienced, as well as how these are manifested. This understanding will ultimately help to inform management decisions—it is the first step in the assessment process ( Boore et al, 2016 ).

There are several classifications of pain (see Table 1 ); some overlap and patients may present with one or more. Pain can be:

• Acute: pain that is of short duration (less than 3 months) and is reversible
• Chronic: pain that is persistent and has been experienced for more than 3 months
• Nociceptive: pain resulting from stimulation of pain receptors by heat, cold, stretching, vibration or chemicals
• Neuropathic: pain related to sensory abnormalities that can result from damage to the nerves (nerve infection) or neurological dysfunction (a disease in the somatosensory nervous system)
• Inflammation: stimulation of nociceptive processes by chemicals released as part of the inflammatory process
• Somatic: nociceptive processes activated in skin, bones, joints, connective tissues and muscles
• Visceral: nociceptive processes activated in organs (eg stomach, kidneys, gallbladder)
• Referred: pain that is felt a distance from the site of origin. ( Colvin and Carty, 2012 ; Laws and Rudall, 2013 ; Kettyle, 2015 ; Boore et al, 2016 ; Cunningham, 2017 ; Mears, 2018 ).

Individuals react to pain in varying ways; for some, pain is seen as something that should be endured, while for others it can be a debilitating problem, which is impeding their ability to function. Therefore, in order to develop an effective and individually tailored holistic management plan, it is important to understand how the pain is uniquely affecting the individual, from a biopsychosocial perspective ( Flasar and Perry, 2014 ).

To do this, health professionals use a range of tools, such as the skills of observation (the art of noticing), questioning techniques, active listening, measurement and interpretation. No one skill is superior; rather, it is the culmination of information gathered via the various methods that enables a health professional to determine if a patient is in pain, and how this pain is affecting them physically, psychologically, socially, and culturally ( Cunningham, 2017 ) ( Table 2 ).

One of the first skills that can be used is to visually observe the patient, and examine body language, facial expressions, and behaviours, as these provide information about how a person is feeling. For example, an individual in pain may be quiet and withdrawn or very vocal, angry, and irritable. They may display facial grimacing and teeth clenching or exhibit negative body language, guarding and an altered gait.

However, there may be times when an individual may not be able to show behavioural signs of pain, such as when a patient is unconscious. Therefore, physiological response to noxious stimuli can be observed through the measurement of vital signs, such as hypertension, tachycardia, and tachypnoea. Although these observations are routinely used within perioperative and critical care areas, these signs can be present in the absence of pain; consequently, these must be used in conjunction with other assessment strategies ( Laws and Rudall, 2013 ).

Assessment tools

Although vital observations and behavioural manifestations may indicate that a patient is in pain, questioning, measurement and interpretation skills will assist with determining the intensity, severity, and effect of the pain on the patient's wellbeing and quality of life. This process can be aided with the use of specifically designed tools, which act as prompts for health professionals and facilitate the assessment of one or more dimensions.

Unidimensional tools

A visual analogue scale (VAS), numerical rating scale (NRS), or verbal rating scale (VRS) can be quick, easy to use, regularly repeated and do not require complex language. These are limited in terms of the information gained, as examining one specific aspect is not sufficient for adequate and holistic pain management ( Mears, 2018 ). However, for individuals who are unable to communicate or where language barriers exist, unidimensional tools, such as the Wong-Baker FACES tool can be very useful ( Kettyle, 2015 ). The Wong-Baker FACES tool (https://wongbakerfaces.org/), which was originally created for children, has been successfully integrated into the care of older people (with or without cognitive impairment) and is beneficial in facilitating an individual's ability to communicate if they are experiencing pain.

Multidimensional tools

These ask for greater information and measure the quality of pain via affective, evaluative and sensory means. The McGill Pain Questionnaire (MPQ) is one example ( Melzack, 1975 ). This long-established tool is often used to assess individuals who are experiencing chronic pain. However, due to its higher levels of complexity health professionals can sometimes find this tool more difficult to use, especially if unfamiliar with it. The Abbey pain scale ( Abbey et al, 2004 ) is another multidimensional tool that has proven to be beneficial for assessing pain in older adults who are unable to articulate their needs.

OPQRST and SOCRATES are just two examples of mnemonic aids, which can be useful and require no equipment as they use mental assessment processes only. OPQRST stands for onset, provokes, quality, radiates, severity and time. SOCRATES stands for site, onset, character, radiates, associations, timing, exacerbating factors and severity.

However, regardless of which tool or mnemonic is used, because pain presentations are often unique pain assessment will not be successful if the health professional fails to ascertain and interpret the signs and symptoms, uses the tools inappropriately, and does not apply a person-centred approach to the overall assessment process, ie uses the wrong tool for the wrong patient.

Management strategies

The primary goal for all patients is to pre-empt and prevent pain from occurring in the first instance; however, if pain cannot be avoided, optimal analgesic management is vital.

The word analgesia, ‘to be without feeling of pain’, is derived from the Greek language, and in terms of pain management can relate to medication and alternative interventions ( Laws and Rudall, 2013 ). Hence, pain management plans should incorporate a multi-modal approach in order to successfully and holistically treat patients' pain ( Flasar and Perry, 2014 ). Boore et al (2016) argued that this is an effective way to manage pain, but stressed that the decisions about which management strategies to use, also need to take into consideration the context of the clinical situation, the patient's level of acuity, the environment and physical space, and the availability of resources.

Pharmacological

One very effective strategy that health professionals have within their management arsenal is the use of pharmacological treatments. The choice of treatment depends on whether the pain is nociceptive, neuropathic, inflammatory or of mixed origin. There are three main categories: opioids, non-opioids/non-steroidal anti-inflammatories, and adjuvants/co-analgesics ( Table 3 ). The most efficient pharmacological regime, for moderate to severe pain (ie cancer-related pain) often incorporates a combined approach, by administrating a specific drug in conjunction with adjuvants or co-analgesics ( Figure 1 ).

Non-pharmacological

Pharmacological treatments are not the only strategy at health professionals' disposal, and true holistic management cannot be achieved without the incorporation of other non-pharmacological therapies. Some of these interventions are long-standing, are ingrained in some traditional medical practices and, when used correctly, can enhance patients' feelings of empowerment and involvement ( Flasar and Perry, 2014 ). However, due to limited resources, funding, space, time, knowledge of use, and personal beliefs, some therapies are not fully used or embraced ( Cullen and MacPherson, 2012 ).

These can be placed into three main groups ( Table 4 ), and the choice of which to use will depend on patients' preferences and existing coping mechanisms. The following strategies have been highlighted as they align with the fundamental core values of care and compassion, and require very little in terms of resources or time.

• Distraction: this can take various forms, such as talking to the patient about their specific hobbies. This basic skill often requires no equipment, can be done anywhere and is a useful way of taking the patient's mind off their pain
• Imagery/meditation: this management technique takes distraction therapy one step further by using a more structured approach
• Therapeutic touch and massage: for centuries, the therapeutic placing of hands has proven to be a useful skill, and has beneficial physiological (stimulation of A-beta fibres, which restrict pain pathways) and psychological properties ( Kettyle, 2015 ).
• Environment: sound, lighting and the temperature of the patient's immediate environment have been shown to heighten or reduce perceptions of pain
• Body positioning and comfort: this can be used to help patients cope with the pain levels they are experiencing and may reduce the pain associated with nociceptive and inflammatory pain signals
• Thermoregulation: for some types of pain, it has been shown that the use of heat or cold packs can help reduce pain experiences. However, care needs to be taken if these treatments are to be used on postoperative sites and areas with skin-related contraindications
• Electrostimulation: this technique is non-invasive and uses pulsed electrical currents to stimulate A-beta fibres, which inhibit the transmission of nociceptive signals in the pain pathway ( Johnson, 2012 ).

Successful pain assessment and management can only be achieved if health professionals adopt a holistic and multimodal approach, incorporating the use of person-centred assessment processes, compassionate communication and a variety of management strategies, chosen in partnership with the patient.

LEARNING OUTCOMES

• Have a basic understanding of some of the classifications of pain
• Improve awareness of the skills required to assess and manage an individual's pain
• Explore some of the tools used to assist with the assessment of pain
• Understand some of the strategies used to manage pain
• Examine some of the barriers to effective pain assessment and management

Pain management essay

The question:

Management of pain in elderly patients is sometimes inadequate. Discuss this statement with reference to recent nursing literature.

• This question was set for first year students in health. Given that it requests 'recent nursing literature', you should use this suggested answer as an essay model only, not as a current nursing resource.
• The question was intended to assess the students' ability to analyse the question, research and plan the essay, and write the essay demonstrating traditional academic writing conventions; that is, write an introduction, body and conclusion, and use the Author-date referencing system.
• In addition, this assessment tested students' ability to demonstrate good paragraph and sentence writing, and their ability to edit and proofread to present a grammatically accurate and error-free essay.

Introduction

• Pain in old people
• Impact of pain on future health
• Communication problems
• Role of nursing staff

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Managing Acute Pain in Hospital Settings: Essay Sample

How can acute pain be effectively managed for adult medical patients in hospitals?

Introduction

Pain is perceived as one of the most common symptoms experienced by hospitalised adults and is viewed as highly prevalent in many patient populations and settings. There is a myriad of guidelines for pain management as outlined by various institutions (Khatib & Razvi, 2018). While these strategies exist, they have not been rigorously evaluated. In particular, institution-wide quality improvement studies that have applied some of the guidelines have met with only modest success in improving pain assessment rates and at the same time have not yet demonstrated improvements in pain intensity (Nunn et al., 2017). However, these studies suffer from small sample sizes, targeted at isolated hospital units or patient populations such as those with cancer, lacked adequate control groups, and in some cases used cross-sectional rather than longitudinal studies (Bhandari & Swiontkowski, 2017).

In an effort to understand acute pain management for adults’ medical patients in hospitals, this study conducts a systematic review of a number of studies to understand strategies and approaches used to effectively management acute pain (Chan et al., 2013). This is in line with the need for evidence-based practice that is a process of problem solving to clinical issues that involves the incorporation of best evidencae from well-designed studies to make decisions that improve patient care (Jager & Ahern, 2004). Hence, along this perspective, the use of evidence-based practice allows for ease of problem solving by aggregating evidence from different studies on how to manage acute pain in hospitalised patients (Macaluso & McNamara, 2012).

To achieve the above aim, the study will be divided into the following sections. These include: the introduction section; search and the approach to identifying the evidence and studies used in this report; the discussion section that presents the evidence that was gathered during the search process; and a conclusion section.

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Search terms/Key words

The search terms refer to the key words that are used to conduct the search process. The key words can be a single term or a combination of words that are used with the intention of helping arrive at the required studies when conducting a systematic review(Marvasti, 2018) . In line with this therefore, the study topic was: how can acute pain be managed for adult medical patients in a hospital. The key words that were used include the following: acute pain, acute pain management, pain management in adults, pain management in hospitals, pain management among medical patients. Some of the key words were combined into numerous search terms in the process of conducting the search in order to help arrive at the required articles. The appendix one shows the search terms and the number of articles that were identified through the search process.

Databases used

There are many databases that are used in the process of conducting any research. Databases refer to an aggregated reservoir of articles and research materials about specific topics. These databases are often categorised on the basis of the different disciplines in order to make it easier to identify the articles for specific use (Rajalingam, 2021). In the context of this study, given that the study involved a health-related issue, the databases that were used were health-related. Some of the common health related databases that can be used in the process of conducting research include: PubMed, CINAHL, EMBASE, Cochrane Library, TOXNET among others. In the context of this review, the focus was on using articles from nursing databases and hence CINAHL was used as the primary database. CINAHL was accessed via EBSCOHOST, using the university’s library. This database was also used because of the multitude of articles that it has on various nursing related issues that effectively helps the study achieve its objectives with ease. No other database was considered in the process of conducting this study.

Inclusion and Exclusion Criteria

Establishing inclusion and exclusion requirements for study participants is a common procedure needed when developing high-quality research protocols. Inclusion requirements are identified as the main features of the target population that the investigators can use to address their study questions (Davidavičienė, 2018). Typical criteria for inclusion include demographic, clinical and regional characteristics. On the other hand, exclusion criteria are characterized as characteristics of prospective research participants that satisfy inclusion criteria but have additional characteristics that may conflict with the effectiveness of the study or increase their likelihood of an unfavourable outcome (Davidavičienė, 2018). Popular exclusion parameters include the attributes of qualifying persons that make them particularly likely to be lost to follow-up, miss planned data collection appointments, have incorrect data, have comorbidities that may impact the outcome of the analysis, or raise their risk of adverse events.

In the context of this study, the inclusion criteria include the following elements

• Studies published between 2015 and 2020.
• Studies on pain management in adults in medical hospitals.
• Primary research studies which include direct patient participation in the study.
• Studies on adults in medical hospitals
• Studies with a sample size of more than 50 patients.

The exclusion criteria include the following.

• Studies published before 2015
• Editorial opinions or other forms of secondary studies.
• Studies with less than 50 patients in a medical setting.
• Studies that do not talk about pain management within the hospital setting

PRISMA Framework

In conducting the search process, the PRISMA framework was used. The PRISMA framework is a procedure developed to help researchers to identify a minimum set of items required for reporting in systematic reviews and meta-analyses (Rajalingam, 2021). The framework focuses on the reporting of reviews, evaluation of randomized trials, but can also be applied as a basis for reporting systematic reviews of different kinds of studies especially in the evaluation of interventions.

In the study, the procedures that were used included the following: online search and identification of the articles, evaluation and screening of the articles and lastly is the analysis of the articles to make sense of them based on the PRISMA framework. In the online search and identification step, EBSCOHOST was accessed using the university’s online library which provided the search platform for the articles. The search terms were used to conduct the initial search. This was followed by a narrowing down of the results to include only results from CINAHL. Additional filters were used including the dates as explained in the inclusion and exclusion criteria. Lastly, additional filters on the results were implemented to identify only full-text articles that were peer-reviewed and primary in nature. At this stage, systematic reviews and other opinion articles were eliminated.

After the search was complete to identify those articles that were important for the study, the screening and evaluation process started. The screening and evaluation process focused on reading the study abstracts to ensure that these articles were in line with the inclusion criteria especially when it comes to patients used and the sample size as well as fit with the study topic. A total of 5 articles were identified through the screening process for further analysis and use in the systematic review.

The table below provides an analysis of the 5 studies that were selected for evaluation and review. In analysing the findings, the findings are presented in the form of author, the aims of the studies, the methods that were applied in conducting the studies, and the findings of the studies. This is important in making comparisons to understand what was identified and the methods that were used to achieve the study objectives.

The management of acute pain in hospital settings for adults is an issue that remains of critical importance to patients. Existing evidence from studies seem to point a wide range of choices that are made by physicians in order to effectively manage pain and help patients manage their conditions effectively. This systematic review therefore sought to examine existing studies on how acute pain can be managed effectively among adults’ patients in a medical hospital. An analysis of the findings indicated that the different studies that were identified approached the issue from multiple research perspectives, majorly quantitative studies were used, along with various research designs that included cross sectional studies and retrospective studies. The effectiveness of these methodologies however was not evaluated in the context of this study but can be seen to help the studies achieve their objectives. In summary, the findings of the review showed that there were a number of strategies that were used in the process of pain management. Clearly, the pain management strategies can be categorized into pharmacological and non-pharmacological interventions. Most studies seem to suggest the use of pharmacological interventions as approaches that were effective in managing pain. Hence, these studies identified drugs such as adjunct analgesics, ibuprofen, hydromorphone, and acetaminophen, epidural analgesia and local anaesthetic infusions, gabapentin and intraspinal analgesia among others. However, on the other hand, the nonpharmacological interventions that were proposed in the studies were not clear with only one study proposing the use of music therapy especially amongst cancer patient. The studies reported that these interventions were found to be moderate to highly effective in helping manage pain for adults in medical hospitals. Additionally, the retrospective studies also established similar findings which shows the importance of these strategies in helping patients to manage their conditions. Hence, applying these findings and interventions in hospital settings is perceived as important in helping enhance pain management within the hospital setting.

Implications

There are several implications associated with the findings that were established in this study.

First, from a research point of view, the literature search process yielded very few studies on the issue of acute pain management amongst adults in medical hospitals. This means that, there is need for more studies to be done in this area in order to improve the understanding of acute pain management in hospital settings. Specifically, the lack of primary studies on the issue is a factor that has a negative impact on the ability to identify evidence that can be used to help in developing other studies or improving patient care.

The second implication is that nurses still remain at the centre of pain management for patients in hospital settings and hence there is need for them to understand the role played by pharmacological and non-pharmacological interventions in the process of managing pain. This study has shown that there are different pharmacological interventions with different rates of effectiveness. Various forms of analgesics in particular can be used in hospital settings to help improve acute pain management amongst adults. By combining pharmacological and nonpharmacological interventions, nurses will be in a better position to enhance patient care.

Third, the findings of this study also pointed to other important aspects of the nursing practice that when implemented in hospitals help to not only improve patient care but also help to ensure that patients in hospitals can be assisted to manage pain effectively. Some of the aspects that were identified in the studies include: nurse knowledge and skills through education, organizational factors such as workforce planning and workplace environment, and nurse personal characteristics which include attitudes, and communication. The implication of this is that nurses play a crucial role in ensuring that adult patients manage pain effectively. However, this can only be achieved with the right environment and workforce strategies as well as personal characteristics that shape the process of patient care. It calls for medical settings to ensure that nurses are provided with the right environment, education and training in attitude change and communication to enhance overall patient care.

Bhandari, M., & Swiontkowski, M. (2017). Management of Acute Hip Fracture. New England Journal of Medicine , 377 (21), 2053–2062. https://doi.org/10.1056/NEJMcp1611090

Chan, E. Y., Blyth, F. M., Nairn, L., & Fransen, M. (2013). Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis and Cartilage , 21 (9), 1257–1263. https://doi.org/10.1016/j.joca.2013.06.011

Davidavičienė, V. (2018). Research Methodology: An Introduction (pp. 1–23). Springer New York. https://doi.org/10.1007/978-3-319-74173-4_1

Fitzgerald, S., Tripp, H., & Halksworth-Smith, G. (2017). Assessment and management of acute pain in older people: Barriers and facilitators to nursing practice. Australian Journal of Advanced Nursing , 35 (1), 48–57.

Jager, J. P., & Ahern, M. J. (2004). Improved evidence‐based management of acute musculoskeletal pain. Medical Journal of Australia , 181 (10), 527–528. https://doi.org/10.5694/j.1326-5377.2004.tb06435.x

Khatib, S. K., & Razvi, S. S. (2018). Nurses’ Role in Acute Postoperative Pain Management: A Survey of 16 Tertiary Hospitals of Maharashtra. International Journal of Nursing Education , 10 (1), 49. https://doi.org/10.5958/0974-9357.2018.00011.9

Macaluso, C., & McNamara. (2012). Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine , 12 (1), 789. https://doi.org/10.2147/IJGM.S25936

Marvasti, A. (2018). Research Methods. In The Cambridge Handbook of Social Problems (Vol. 1, pp. 23–38). Cambridge University Press. https://doi.org/10.1017/9781108656184.003

Nunn, M. L., Hayden, J. A., & Magee, K. (2017). Current management practices for patients presenting with low back pain to a large emergency department in Canada. BMC Musculoskeletal Disorders , 18 (1). https://doi.org/10.1186/s12891-017-1452-1

Priano, J., Faley, B., Procopio, G., Hewitt, K., & Feldman, J. (2017). Adjunct analgesic use for acute pain in the emergency department. Hospital Pharmacy , 52 (2), 138–143. https://doi.org/10.1310/hpj5202-138

Rajalingam, M. (2021). Methodology. In EAI/Springer Innovations in Communication and Computing (pp. 43–53). Springer Publishing Company. https://doi.org/10.1007/978-3-030-53047-1_3

Sundaramurthi, T., Gallagher, N., & Sterling, B. (2017). Cancer-related acute pain: A systematic review of evidence-based interventions for putting evidence into practice. In Clinical Journal of Oncology Nursing (Vol. 21, Issue 3, pp. 13–30). Oncology Nursing Society. https://doi.org/10.1188/17.CJON.S3.13-30

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Pain Management Best Practice, Essay Example

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Introduction and Problem Statement

Pain assessment and management represents a significant health concern in many areas throughout the world. Pain is a difficult challenge to address across many age groups and requires a high level understanding of the issues that impact health and wellbeing for this group, particularly when pain is difficult to overcome without clinical and/or pharmacological support (Grantham & Brown, 2012). These issues lay the groundwork for an increased risk of health problems in the adult years and reduced quality of life. Advanced practice nurses at the doctoral level may provide a level of education and guidance to adults to provide direction regarding pain management during this vulnerable period (Klassen, 2009). Pain management is a frightening process for many adults, given their level of pain tolerance; therefore, much of the emphasis should be on these areas and specifically, in areas where resources and knowledge are limited. Nurses at the advanced level are required to communication options regarding pain management during periods when this is a serious concern and how it may create challenges throughout the life span (Klassen, 2009). The following discussion will address the problem of pain management in greater detail and will emphasize the use of an educational intervention as led by advanced practice nurses in order to improve knowledge, expand resources, and promote behavioral change among those who experience pain in order to provide greater opportunities to improve health and wellbeing for many children and adults who experience this set of challenges. This discussion will include theoretical nursing perspectives from King and Swanson in order to demonstrate the importance of achieving goals and objectives, while also supporting a caring and nurturing environment for the designated population who require significant attention and focus during a vulnerable period.

Pain of the acute and chronic variations may have lasting complications; therefore, the scope of this problem must be addressed in the context of existing research and literature. To be specific, pain management requires a high level understanding of the different types of pain that exist and how this impacts patient health and wellbeing in different ways. The utilization of existing clinical practice guidelines represents an opportunity to convey new ideas and approaches to pain management and assessment that will aim to preserve patient health and wellbeing more effectively (Grantham & Brown, 2012). Clinical practice guidelines offer different types of resources that have a significant impact on patient care and treatment in order to minimize pain and suffering and support improved quality of life for patients (Grantham & Brown, 2012). Most importantly, education for patients with chronic pain must be established, using the following recommendations: “Institute educational and psycho-educational interventions as part of the overall plan of treatment for pain management; Implement educational and psychosocial interventions that facilitate coping of the patient and family early in the course of treatment” (Grantham & Brown, 2012, p. 19). In this context, cognitive-behavioral therapy must be considered as part of the treatment plan in situations where this might be a useful approach to manage patient outcomes more effectively than pharmacological treatments (Grantham & Brown, 2012).

Pain management is very difficult for many patients, particularly older adults, as it represents a challenge that is difficult to overcome with respect to their needs if they face cognitive or other behavioral deficits that impact their quality of life (Hadjistavropoulos et.al, 2009). These factors require a greater understanding of the different elements that are recognized as important to the pain management process, including those that impact patients in different ways and support long-term approaches to working with the older adult population (Hadjistavropoulos et.al, 2009). These factors require nurses and other healthcare providers to be cognizant of the challenges of working with older adults who possess deficits and to aim to improve outcomes through a variety of options that are designed to facilitate change and progress within this population (Hadjistavropoulos et.al, 2009).

Pain management in older adults requires an effective understanding of the different scenarios in which pain is experienced, including those involving the abdominal area, which may be very difficult to control (Samaree, 2010). Therefore, patients must be provided with an understanding of their pain and how to address it effectively so that they are provided with the best possible means of recovery and management of this pain if and when it persists (Samaree, 2010). These factors require the development of new ideas and directions that will facilitate effective pain management from the patient’s perspective, including understanding the nature of the abdominal pain and if other factors have exacerbated this condition (Samaree, 2010). For this population, it is often the case that patients do not receive the best possible treatments to address their condition; therefore, they must be provided with advanced practice tools and resources to improve their pain as best as possible (McLiesh et.al, 2009; Tracy, 2013). Education is critical to this process and provides a basis for exploring new ideas and directives to support patients in need of different pain management therapies, using prior research and knowledge to meet these needs (Michaels et.al, 2007; Reid et.al, 2011).

Pain in patients in the intensive care unit requires a high level understanding of the different elements that contribute to the improvement of the practice environment, as well as other factors that support the treatment of pain within this patient population (Barr et.al, 2013). In particular, pain management within the older adult population requires an understanding of the different elements that enable patients to understand their own situations and to work with nurses and other healthcare providers to manage their pain as effectively as possible (Klassen, 2009; Gropelli & Sharer, 2013). Pain management must be addressed with the older adult in mind and must reflect opportunities to examine the treatments that are available, and this must include an examination of behaviors associated with pain assessments and their impact on the treatment decisions that are made (Topolovec-Vranic et.al, 2010).

One of the most relevant nursing theories for pain management is the Goal Attainment Theory of Nursing, created by Imogene King in 1981 (Raingruber, 2013). This theory supports the belief that human beings react to different events that impact their health using their rationale, their ability to act, and their ability to perceive different events and experiences (Raingruber, 2013). For adults, it is necessary to consider a variety of factors that impact patients, such as non-pharmacological treatments, as these may have a significant impact on patient outcomes over time (Raingruber, 2013). Patients who require pain management must be apprised of their condition and the methods that are available to address it effectively so that the appropriate treatment choices are made (Raingruber, 2013).Concepts associated with this theory include transaction, communication, and goal setting, all of which contribute to goal attainment and an opportunity to improve health through these efforts (Raingruber, 2013).

Description of the Case

For older adults, generally considered to be a vulnerable population, there is a potentially greater risk of pain associated with chronic disease, cancer, and other conditions. Therefore, it is believed that older adults will largely benefit from an educational program that supports an understanding of pain and the treatments that are available to address this pain effectively (Tracy 2013).  The proposed case involves a group of older adults who require pain management therapy due to different forms of cancer. This group of adults ranges in age from 65-76 and is comprised of 15 members. For the proposed intervention, King’s Theory of Goal Attainment and Swanson’s Theory of Caring will be addressed in order to determine how they influence an education program taught by an advanced practice nurse in the clinic setting where these patients are treated. The proposed program would provide an environment in which adults would receive targeted information and guidance regarding pain management therapies, such as social and cognitive therapy, in order to address their pain management needs. It is important to address this adult population because with the appropriate knowledge and education, they will be able to make a valid contribution in enhancing their decision-making potential regarding pain and what is involved in addressing this condition to alleviate pain and facilitate greater quality of life, in spite of the cancer diagnosis (Tracy, 2013).

In this case, there are two advanced practice nurses who will provide instruction for the program. The educational program will enable an advanced practice nurse to provide valuable information and guidance to this group of adults so that they are able to make positive decisions regarding their pain management and their overall condition that will benefit their health and wellbeing. This group of individuals requires a high level understanding of the challenges and opportunities that are available through advanced practice nursing in order to make a difference in their own lives, particularly since they face a difficult diagnosis of cancer to begin with. Since pain management is a challenging condition in some communities, it requires an understanding of the issues and challenges that many communities face, including their lack of understanding of the issues that have a significant impact on managing pain under the direction of an experienced set of individuals to treat the pain in different ways (Hadjistavropoulos et.al, 2009). It is anticipated that there will be significant potential to develop new strategies to encourage members of the older adult community to be receptive to education and knowledge regarding their social and cognitive needs and expectations that will have a significant impact on their wellbeing, using established theoretical frameworks as a guide in this learning curve.

The development of the proposed educational framework for older adults requires significant backing from existing theoretical perspectives in order to accomplish the desired objectives. For example, Swanson’s Caring Theory is comprised of a number of key components, including the following: 1) believing and having faith that change will occur; 2) knowing how to address specific experiences and how they demonstrate a high level of meaning and support with the chosen objectives; 3) recognizing the importance of an emotional connection to the issue; 4) treating others the same as one would like to be treated; and 5) supporting others and enabling them to be able to recognize how to provide self-care (Swanson, 2011). This theory represents an opportunity to examine the different constructs of caring and to be cognizant of the issues that impact older adults who face the risk of pain. For older adults, recognizing that those around them care about their wellbeing is an important step towards the discovery of self-awareness and the ability to care for oneself effectively towards the primary goal of improved health and wellbeing (Swanson, 2011).  Therefore, Swanson’s Caring Theory is applicable to the case in question because it engages adults in an environment that enables older adults to be receptive to learning about behaviors that will have positive results in their lives, even if they do not fully understand their significance.

Another theory to consider in evaluating pain management and related education for adults is Imogene King’s Theory of Goal Attainment, whereby there is a significant opportunity to examine the different challenges related to the issue and to establish goals and objectives that are reasonable and appropriate in order to achieve the desired outcomes (Current Nursing, 2012). It is believed that “Transaction represents a life situation in which perceiver & thing perceived are encountered and in which person enters the situation as an active participant and each is changed in the process of these experiences” (Current Nursing, 2012). These factors represent an opportunity to examine the different constructs of goals and how to achieve them, using active and practical experiences a guide in this process (Current Nursing, 2012). These factors will enable older adults to understand the challenges of pain management and how to improve outcomes. From this perspective, older adults require an active and appropriate support system that is designed to encourage them to learn how to make positive decisions for themselves and to recognize the importance of developing strategies that are likely to improve their lives over the long term. Nonetheless, this requires support and knowledge to ensure that pain management is handled as best as possible.

Summary of the Case

The proposed case example provides a framework for advancing a critical health issue that impacts many adults in their most vulnerable years. This issue reflects the importance of having a strong and close-knit support system that will enable adults to obtain social and cognitive support in order to effectively manage their pain condition as best as possible. However, this is not achieved without a greater understanding of the issues that are likely to be most influential in improving the quality of life of adults so that they are able to address their health and pain management needs in a comprehensive manner. These circumstances require a high level of support and guidance in order to effectively demonstrate a new perspective that will positively impact adults who experience pain and support their own decision-making capabilities. The education and knowledge that would be provided by the advanced practice nurse supports adult learning and their ability to impart new lessons learned to others. There are considerable advantages in adopting nursing-based theories and in supporting the development of new ideas to encourage adults to make an effort to have a positive impact on the lives of children who require support, guidance, and an understanding of why specific behaviors are more appropriate than others. This process is instrumental in expanding knowledge and resources in order to effectively support adults who are lacking knowledge regarding how to effectively manage pain in other ways beyond pharmacological means. It is believed that these factors will encourage the development of new ideas to educate adults to make positive decisions regarding their pain as best as possible.

Proposed Solutions

Most importantly, the proposed intervention will be used to spread awareness of effective pain management solutions through education and example. This will support adults, understanding of pain and its many different patterns and how they must pay attention to these issues on a regular basis. Adults must also learn that pain management is a constant battle for many patients that requires ongoing attention and focus, yet it also requires a level of support and guidance that will have a positive impact on patient outcomes. This process requires advanced practice nurses with extensive knowledge of health issues, including pain management, in order to educate other adults in order to provide them with opportunities to make positive decisions of their own in this regard. In particular, the use of non-pharmacologic therapies is essential to this population and provides a greater sense of discovery and support in enabling adults to experience recovery from pain on a consistent basis.

It is also believed that the proposed education program will enable adults to recognize the importance of understanding pain and how to manage it through a variety of interventions. The intent is to enable adults to make positive decisions regarding pain management that will have a positive impact on their lives and their overall health. This process requires adults who will provide examples of social support and cognitive therapies who will be supportive of their needs during this vulnerable period. This process will engage adults regarding their own welfare and will encourage them to take the steps that are required to achieve effective outcomes and engage other factors in order to support pain management in a way that is consistent with established guidelines and that does not promote a dependency on pharmacological pain therapies that may impact patients over time.

Identification of Research Instrument

In order to evaluate the effectiveness of the proposed education program for adults with pain management needs, it is important to develop a survey instrument after the education program has taken place in order to determine if it has been effective in meeting its desired goals and objectives (Hadjistavropoulos, et.al, 2009). This process requires advanced practice nurses to develop an instrument that will determine whether or not the program provided any new forms of knowledge to the targeted adults. This process will also provide a basis for exploring other ideas to ensure that adults are able to use the education that they receive and transform it into a valuable approach and to pass the information on to others in a successful manner (Grantham & Brown, 2012). The questionnaire instrument provides a basis for exploring the dimensions of pain management and how this will impact patients across a variety of population groups who require different forms of therapy to meet their needs, including cognitive therapies. These options must be available to patients in order to improve their quality of life, while also considering other factors that will have a significant impact on patient outcomes and relationships between older adult patients and healthcare providers (Grantham & Brown, 2012).

Managing pain in older adults with cancer is a serious concern that requires further evaluation in order to better understand the scope of this practice and its impact on health and wellbeing. It is important to identify the tools and resources that are required to ensure patients receive successful treatments that will positively influence outcomes that will alleviate pain through specific recommended therapies. Social cognitive theory-based approaches must be considered as part of the pain management process, and patients must be receptive to these recommendations. These issues are critical to the success of the endeavor and demonstrate an opportunity to examine the different constructs of pain management and their impact on health and wellbeing. It is believed that pain management techniques must reflect an opportunity to promote healing and to improve quality of life, particularly for patients who experience chronic pain on a continuous basis. Therefore, education must be provided to older adults as a means of addressing specific circumstances that will support and guide patients through difficult periods when their pain is difficult to bear. With cognitive and social support, however, it is believed that these practices will improve and patients will receive the type of care and treatment that is necessary to improve their health and wellbeing as best as possible. Cancer patients must receive social support and guidance in managing their disease and the pain that accompanies it, as these practices will ensure that they are able to stimulate some degree of recovery and improvement of their lives in different ways that will have a positive impact on their overall health status and level of mood.

Al Samaraee, A. (2010). Factors contributing to poor post-operative abdominal pain management in adult patients: a review. Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 8(3), 151-158.

Barr, J., Fraser, G. L., Puntillo, K., Ely, W., Gelinas, C., Dasta, J. F., Jaeschke, R., et al (2013).

Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: Executive summary. 70, 53-8.

Current Nursing (2012). Imogene King’s Theory of Goal Attainment. Retrieved from currentnursing.com/nursing_theory/goal_attainment_theory.html

Grantham, D., & Brown, S. (2012). Pain Assessment and Management: Clinical Practice

Guidelines. Winnipeg Regional Health Authority. Retrieved from http://www.whra.mb.ca

Gropelli, T., & Sharer, J. (2013). Nurses’ perceptions of pain management in older adults. Medsurg Nursing, 22(6), 375-382.

Hadjistavropoulos, T., Hunter, P., & Fitzgerald, T. (2009). Pain assessment and management in older adults: Conceptual issues and clinical challenges. Canadian Psychology, 50(4), 241-254.

Klassen, B. L. (2009). Pain management best practice with older adults: Effects of training on staff knowledge, attitudes, and patient outcomes. Physical and Occupational Therapy in Geriatrics, 27(3), 173-197

McLiesh, P., Mungall, D., & Wiechula, R. (2009). Are we providing the best possible pain management for our elderly patients in the acute- care setting? International Journal of Evidence Based Healthcare, 7, 173-180

Michaels, T. K., Hubbart, E., Carroll, S. A., & Hudson-Barr, D. (2007). Evaluating an Educational Approach to Improve Pain Assessment in Hospitalized Patients. Journal of Nursing Care Quality, 22, 260-265

Raingruber, B. (2013). Contemporary Health Promotion in Nursing Practice. Jones & Bartlett Learning.

Reid, M., Bennett, D., Chen, W., Eldadah, B., Farrar, J. T., & Gallagher, R. M. (2011). Improving the pharmacologic management of pain in older adults: Identifying the research gaps and methods to address them. Pain Medicine, 12(9), 1336-1358.

Topolovec-Vranic, J., Canzian, S., Innis, J., Pollman-Mudryj, M. A., McFarlan, A. W., & Baker, J., et al., (2010). Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale. American Journal of Critical Care, 19(4), 345-355

Tracy, B. (2013). Pain management in older adults. Clinical Therapeutics, 35(11), 1659-1668

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Pain Management in Nursing Practice: PICOT Question Essay

Study population, research design.

Pain management is a significant concern in many areas of nursing practice, including oncological care. Adequate pain management leads to improved quality of life by reducing cancer patients’ symptoms following chemotherapy treatment. Although opiates are used as the primary pain management strategy, cannabis-based treatment could also be effective. The chosen PICOT question is, “In cancer patients(P), how does Cannabidiol (CBD) (I) compared with opioids (C) affect pain(O) over chemotherapy treatment? (T)”.

The selected population includes cancer patients undergoing chemotherapy treatment. This type of treatment is associated with several unwanted side effects, including peripheral neuropathic pain (Park, 2014). Cancer patients can also experience pain for other reasons, and the pathophysiology of cancer pain is often poorly understood (Fallon et al., 2018). The primary need of patients with cancer who are in chemotherapy is to maintain the highest possible quality of life.

Pain often prevents them from being socially active and interferes with coping, which may lead to poor mental health outcomes. Patients with cancer pain that cannot be managed using non-opioid analgesics usually receive prescriptions for opioids (Fallon et al., 2018). Nevertheless, opioids are highly addictive and pose threats related to overdosing. This can inhibit the beneficial effect of pain management on cancer patients’ quality of life. Hence, considering other options, such as cannabidiol, would be helpful.

The key nursing theory that can be applied to cancer pain management is Katharine Kolcaba’s Theory of Comfort. This theory posits that nursing is the process of assessing patients’ need for comfort and meeting it using appropriate care plans (Puchi, Paravic-Klijn, & Salazar, 2018). There are three types of comfort described in Kolcaba’s theory: relief, ease, and transcendence. This theory is relevant because cancer patients experience the need for all of these types of comfort because they experience both physical and psychological challenges. Successful cancer pain management aims to provide lasting relief, thus meeting patients’ comfort needs. Practicing by Kolcaba’s theory also requires nurses to address patients’ mental health needs, for instance, by referring them to a qualified counselor or offering recommendations for achieving higher levels of social support.

Evidence-based practice is the key to successful pain management because it enables nurses to use research to develop appropriate care plans (Melnyk & Fineout-Overholt, 2019). Evidence-based practice usually relies on results from quantitative studies because they provide statistically sound findings (Turner, Balmer, & Coverdale, 2013). Hence, determining the comparative effectiveness of cannabidiol and opioids for cancer pain management requires the use of a quantitative method. In particular, it would be useful to conduct a randomized controlled trial by measuring patients’ numerical pain rating and comparing the results between the intervention and the control group (Ingham-Broomfield, 2014). This design would allow collecting information required to support positive changes in evidence-based practice, thus helping to enhance cancer pain management.

Overall, cancer pain is an important problem because it reduces patients’ quality of life and affects their overall well-being. Patients with cancer need adequate pain management to participate in regular activities and cope with their diagnosis more effectively. Kolcaba’s Theory of Comfort is suitable for oncological nursing practice because it stipulates the nurse’s role in providing physical and psychological comfort to patients.

Based on this theory, appropriate pain management strategies offer comfort in the form of pain relief. To study cannabidiol as an alternative to opioid pain management, it would be useful to apply the randomized controlled trial methodology to measure the level of pain reported by patients using one or the other medication. The results of the trial will provide reliable results that could enhance evidence-based practice in cancer pain management.

Fallon, M., Giusti, R., Aielli, F., Hoskin, P., Rolke, R., Sharma, M.,… ESMO Guidelines Committee. (2018). Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology, 29 (4), iv166-iv191.

Ingham-Broomfield, R. (2014). A nurses’ guide to quantitative research. The Australian Journal of Advanced Nursing, 32 (2), 32-38.

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Walters Kluwer.

Park, H. J. (2014). Chemotherapy-induced peripheral neuropathic pain. Korean Journal of Anesthesiology, 67 (1), 4-7.

Puchi, C., Paravic-Klijn, T., & Salazar, A. (2018). The comfort theory as a theoretical framework applied to a clinical case of hospital at home. Holistic Nursing Practice, 32 (5), 228-239.

Turner, T. L., Balmer, D. F., & Coverdale, J. H. (2013). Methodologies and study designs relevant to medical education research. International Review of Psychiatry, 25 (3), 301-310.

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IvyPanda. (2021, August 11). Pain Management in Nursing Practice: PICOT Question. https://ivypanda.com/essays/pain-management-in-nursing-practice-picot-question/

"Pain Management in Nursing Practice: PICOT Question." IvyPanda , 11 Aug. 2021, ivypanda.com/essays/pain-management-in-nursing-practice-picot-question/.

IvyPanda . (2021) 'Pain Management in Nursing Practice: PICOT Question'. 11 August.

IvyPanda . 2021. "Pain Management in Nursing Practice: PICOT Question." August 11, 2021. https://ivypanda.com/essays/pain-management-in-nursing-practice-picot-question/.

1. IvyPanda . "Pain Management in Nursing Practice: PICOT Question." August 11, 2021. https://ivypanda.com/essays/pain-management-in-nursing-practice-picot-question/.

Bibliography

IvyPanda . "Pain Management in Nursing Practice: PICOT Question." August 11, 2021. https://ivypanda.com/essays/pain-management-in-nursing-practice-picot-question/.

Nurse coaching to explore and modify patient attitudinal barriers interfering with effective cancer pain management

Affiliation.

• 1 Palliative Care, El Camino Hospital in Mountain View, CA, USA. [email protected]
• PMID: 18321835
• DOI: 10.1188/08.ONF.233-240

Purpose/objectives: To describe a complex coaching intervention to help patients with cancer pain explore beliefs and attitudinal barriers interfering with pain management. Patients were coached to explore beliefs about pain, communications about pain management, and the use of analgesics and nonpharmacologic interventions.

Data sources: Published journal articles, abstracts, and psychology textbooks.

Data synthesis: Personal beliefs, related attitudinal barriers, and associated behaviors impede patient adherence to and success with pain management treatments. Interventions targeting beliefs help patients overcome attitudinal barriers, improve treatment adherence, and obtain better pain relief.

Conclusions: Coaching patients to explore beliefs reduces ineffective behaviors and improves pain treatment adherence.

Implications for nursing: A coaching intervention incorporating assessment of patient beliefs promotes self-management, self-efficacy, and adherence to pain management treatment plans. Advanced practice nurses should consider incorporating this intervention into their communications with patients experiencing cancer pain.

• Health Knowledge, Attitudes, Practice*
• Neoplasms / complications*
• Neoplasms / nursing*
• Neoplasms / psychology
• Oncology Nursing / methods*
• Pain / etiology*
• Pain / nursing*
• Pain / psychology
• Patient Education as Topic / methods
• Telemedicine / methods

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Home > ETDs > Master's Projects and Capstones > 432

Master's Projects and Capstones

Improving pain reassessment and documentation through nurse education.

Reina Batto Follow

Date of Graduation

Winter 12-16-2016

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Elena Capella

The aim of the CNL Internship Project is to improve quality of patient care and pain management through improved pain reassessment and documentation. The project is to be implemented in the surgical unit of a community hospital in the California Bay Area. The unit has a maximum capacity of 38 beds and is staffed by 47 RNs and 4 LVNs. A nurse survey was conducted to assess the needs of the staff and the unit, and an education plan was created for the unit. Educational materials, including: highlighted academic articles, posters, handouts, and small posted reminders at nurse computers were all created to supplement the individual teaching to be implemented. Review of literature suggests that through the improvement of pain reassessment and documentation, an improvement in pain management and patient satisfaction will follow. The project is pending approval from the hospital and will be implemented immediately following approval. Data will be collected at and prior to June 2017 through HCAHPS in order to assess patient satisfaction with pain management.

Recommended Citation

Batto, Reina, "Improving Pain Reassessment and Documentation Through Nurse Education" (2016). Master's Projects and Capstones . 432. https://repository.usfca.edu/capstone/432

Since December 08, 2016

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