What are the barriers and enablers to emergency department nurses' management of patients' pain?

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Authors
Pretorius, Annatjie
Author ORCID Profiles (clickable)
Degree
Master of Nursing
Grantor
Eastern Institute of Technology
Date
2012
Supervisors
Marshall, Bob
Searle, Judy
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
New Zealand
emergency nurses
emergency departments (EDs)
pain management
pain assessment
oligoanalgesia
barriers
surveys
ANZSRC Field of Research Code (2020)
Citation
Pretorius, A. (2012). What are the barriers and enablers to emergency department nurses' management of patients' pain? (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
Abstract
BACKGROUND Pain is the most common presentation to the Emergency Department (ED) and ranked as the highest reason for seeking emergency care. Patients expect rapid pain relief when presenting to the ED and this expectation is often not met in many EDs worldwide resulting in oligoanalgesia; the phenomenon of failure to recognise or properly treat pain. Despite great improvements in available pain management strategies and tools for pain assessment, it has been noted that there are still barriers to nurses’ pain assessment, pain management, documentation and reassessment of pain. Pain results in a significant cost to the individual and society. AIMS The aim of this study was to identify ED nurses’ perceived enablers and barriers to pain management in New Zealand (NZ). This research also explored ED nurses’ knowledge of pain management principles. The research aims were to provide information regarding educational gaps on pain assessment and pain management of ED nurses, creating an opportunity to enhance and improve the patients’ pain management by nurses in the ED. RESEARCH APPROACH A quantitative, descriptive and non-experimental study was conducted. An email was sent via the College of Emergency Nurses New Zealand (CENNZ) to all their members inviting them to participate in a research project. An introduction to the researcher and the purpose of the study was given in the email, as well as a link to the Survey Monkey™ questionnaire. The questionnaire had four separate sections. In the first and second section the nurses answered yes or no to possible enablers and barriers and had opportunity to provide other enablers or barriers not mentioned in the study. In the third section the nurses answered questions regarding their general knowledge of pain and pain management. The fourth section requested demographic information. The data were analysed using descriptive statistics. RESULTS A total of 172 questionnaires were analyzed. The majority of respondents were: female (92%); NZ European (80%); with more than 15 years nursing experience (66%) and with post graduate qualifications (64%). The majority of respondents (97%) thought that having pain management protocols were important and that pain management courses would be beneficial. It was identified that only a few EDs had a pain management champion and most of the respondents (86%) thought that this would be an enabler to their management of a patient’s pain. The responsibility of caring for acutely ill patients in addition to a patient with pain was identified as the biggest barrier (83%) with lack of time a close second (80%). Although it was identified that the respondents had good (71%) general knowledge they lacked current opioid knowledge and had a few gaps in their general knowledge. The majority of the respondents (90%) knew that the best judge of pain was the patient. DISCUSSION This research identified a few important enablers to pain assessment and management of patients’ pain as perceived by ED nurses and they include the following; nurse initiated analgesic protocols and guidelines; ED pain management champions and on-going education regarding pain management principles. The above enablers have been discussed and supported in previous studies and therefore implementation of these enablers needs to be a priority in all EDs. There were similar barriers identified in this research to previous research studies and include; lack of time, workload and reluctance of clinicians to prescribe analgesia. While the respondents demonstrated good knowledge regarding general pain management principles, gaps were found regarding current knowledge of opioids. This research identified that nurses needed on-going education regarding pain management principles, especially regarding the usage of opioids. It was also identified that nurses need education or possibly a change of attitude regarding the patients’ right to expect total pain relief as a consequence of treatment. CONCLUSION Evidence exists that oligoanalgesia is still present in the ED and that ED nurses lack knowledge regarding the use of opioids. Opportunities exist in NZ for nurses to enhance their knowledge and become pain management champions. Raising awareness that oligoanalgesia exists in the ED amongst all nurses is essential. There is an urgent need for action to reduce oligoanalgesia in the ED. ED nurses are in the unique position to become leaders in pain assessment and pain management.
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