Nurses attitudes on pain
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is the most common reason for seeking health care. It occurs in many disorders, diagnostic tests, and treatments. Pain disables and distresses more people than any single disease. Since nurses spends more time with the patient than any health care professionals, the nurse needs to be aware and knowledgeable about the physiologic and psychological consequences of acute and chronic pain and the methods used to treat pain. Nurses encounters patients with pain in a variety of settings, including acute care, out patient and long term care settings, as well as in the home. Nurses play a key role in managing pain of patients. So it is very important that the nurse possess the right knowledge and skills to assess pain, to implement pain relief strategies and to evaluate the effectiveness of these strategies regardless of the setting.
Pain management includes different types of pain experiences throughout an individual’s life cycle, from birth to the end of life. Pain experiences may include acute and chronic pain, pain fro a chronic deteriorating condition, or pain as one of the symptoms of the patient receiving palliative care. Pain is not only physiological but pain includes the spiritual, emotional and psychosocial aspect of the patient as well. The goal of pain management throughout the life cycle is similar, to address the whole aspect of pain and provide maximum pain relief with minimal side effects. According to the different studies and literature used majority of patients do not receive adequate pain management. Factors including the inaccurate information, myths, fear, rumors and cultural issues contribute to the inadequate management of pain by nurses. Because of the advances in the field of pain management such as the pharmacological interventions, nurses may have incomplete or inaccurate information about pain and how patients demonstrate their pain. Due to several barriers adequate pain management, many patients are at risk for low quality treatment of pain. Communication barriers with the patient and the nurse also risks the chance of patients to receive inadequate pain management because pain is identified, felt and reported by the patient thus communication between the nurse and the patient is also important for better understanding and management of pain.
Despite these knowledge and information regarding pain management there are still evidence and research studies that shows pain remains to be untreated symptoms among patients seeking medical care. Effective pain management still continues to be a complaint of hospitalized patients despite the emphasis on the patient’s right of appropriate pain management and the increased awareness of the detrimental effects of pain that is inadequately treated and managed. Prejudices persist among nurses regarding the patient complaints of pain and the need for pharmacological interventions.
The importance of pain relief is in the optimal recovery of patients who are ill or those having other health problems. Pain relief is important because it plays a major role in the recovery of patients. If pain is managed this would give the patient more comfort and the patient would be more cooperative in their care and treatment regimen. The reason why some patients are not cooperative and does not participate in their care or treatments is because they have pain or their pain is not managed well so they remain agitated and irritated to comply with their treatment regimen. Analgesic therapy in managing pain is the cornerstone of pharmacological treatment for many patients that experiencing pain, especially those patients who have undergone extensive procedures that causes severe pain and cancer pain.
There have been many studies that carried out investigation regarding the nurse’s attitudes and knowledge in pain management. They have all showed a clear deficit of nurse’s knowledge and attitudes in pain management which are often attributed to the inadequate education, inaccurate knowledge of pharmacology of analgesics and poor pain assessment. Many hospitalized patient that suffers from pain are not adequately managed. There are many factors why such incidence happens. Some of the reasons why pain is inadequately managed are due to the insufficient knowledge of both doctors and nurses regarding the pain felt by the patient and the appropriate action to be taken. Another reason is that many nurses today relies only on the verbal report of patients regarding their pain without considering to assess the patient on how he/she really feels. Some nurses also take for granted their duty of understanding the patient’s feelings and understanding regarding pain thus pain management may lack. The ongoing development and improvement of current standards and practices in the acute and chronic settings of pain management and the tools used by nurses enables a fresh thought to be analyzed by the nursing staff. As the technology advances and new medicines are implemented the nurses and other health care providers must also be aware of these changes in order to update the learning and skills in managing pain.
These issues are very important to me as well as other aspiring nurses because this can serve as awareness for us on how to improve the quality of nursing care given to the patient. As a nurse it is important that the needs and feelings of the patient are taken into account in their care that is why the nurse’s attitudes and knowledge regarding their patient is also important in giving holistic care. It is not just about giving the right meds or doing what the doctor ask, giving care also involve the nurse patient relationship. These issues interest me also because nurse’s attitudes affect the pain management and the care that is given to the patient. As a future nurse, it is important that I take note of these issues and take it into account to improve the care that I provide especially in the areas such as managing the pain in order to alleviate the suffering of patient and to shorten the hospital stay of the patient.
A study was conducted on the implementation of a pain monitoring programme for nurses in daily clinical practice in order address the patients who suffers from pain which treatment of pain is often inadequate. According to the study, the reason for inadequate treatment of pain is the failure of the nurses to assess pain on daily clinical basis and insufficient knowledge about the pain and pain management in both nurses and physicians. The aim of the implemented program was to educate the nurses regarding pain and management of pain. The study was conducted in on five hospitals consisting of 277 nurses and 115 physicians. The participants were given a pretest, posttest that measured the implementation and long term effects of the pain management program (de Rond, M. et al., 2001, p. 590-598).
The results of the study showed those nurses who used the pain management program were able assess pain better and the knowledge regarding pain management. The implementation of daily pain assessment also showed a positive remark in the attitude of nurses regarding the importance of managing the pain of their patient. It increased their awareness and their performance in managing pain effectively. After the implementation of the program the quality of the pain management by the nurse also improved. Thus showing that implementation of pain management program on hospitals increases the nurse’s knowledge and improves the quality of pain management in patients (de Rond, M. et al., 2001, p. 590-598).
There have been many studies that have been conducted to investigate nurse’s attitude and knowledge regarding pain and management of pain. A study conducted in the late 1980’s on 2459 nurses showed a lack of information about assessment and control of pain. The study found that nurses rely on behavior as an indicator of pain. The study also indicated that placed significance on the patient related barriers such as the patient’s reluctance to report pain and did not consider the nurse related barriers such as inadequate knowledge with regards to pain management and their reluctance in administering opiates. According to Mathews and Malcolm, in comparison to the survey of nurses during the late 1980’s and early 1990’s, it was found that the knowledge of nurses with regards to pain management improved. On their studies regarding the knowledge and attitudes of nurses with regards to pain and its management their study showed that there is improve in assessment and management of pain when they were given education regarding the proper assessment and management of pain. The nurses were able to assess the patient’s pain better and they were able to control the pain of the patient in a tolerable level. The study also pointed out the importance of continued mandatory training of nurses in order to ensure that pain management is kept in a high level by nurses (Mathews, E., & Malcolm, C., 2007, p. 174-179).
Nash et al., conducted a study on the implementation and evaluation of educational interventions that aimed in enhancing the attitudes and beliefs of the patients and nurses regarding the pain and pain management with narcotic analgesia. The study was conducted in order assess the nurses perception about pain and the administration of analgesia. The participants of this study included groups of nurses in different divisions of focus groups. Over all, the discussions of the focus groups have made a profound insight into the nurses’ perceptions of pain and administration of analgesia. There were a number of issues that contributed to the understanding with regards to the factors that influenced nurses’ actions in caring for patients in pain. Nurses also concluded that pain management is an important priority in the practice of nursing and should be a priority. It is important that there is proper assessment in order to manage pain better in patients.
The study also highlighted the importance of nurse’s knowledge with regards to pain management and administration of analgesia; this plays an important role in the clear judgment of nurses with regards to how they are going to manage the pain of the patient and how narcotics are to be given to them. Another important issue that the study mentioned is the personal factors that influence the nurse with regards to pain and management. The type of environment, colleagues and friends the nurses is a factor that influences her decision with regards to pain management. However even though there is a great significant awareness among the conducted nurses and they have quiet knowledge on the pain management, there is still much scope to be considered in developing educational initiatives of nurses with regards to pain management and narcotic analgesia. The study also concluded that educational strategies should not only focus on knowledge enhancement of nurses, but should focus also on the wider issues that affects the nurse and should also consider their collaboration with health care professionals (Nash, et al., 1999, 180-189).
Pain also contributes to a decision making of women in giving birth. Women change their birth preferences because of the intense pain and duration of labor especially if they feel they are not supported by nurses. According to Carlton et al, these factors add up to the complexity, difficulty and occasional feeling of women making decisions with regards to their pain management during labor. Pain management makes a major contribution for these women because giving birth entails a lot of pain thus it is an important factor considered by labor women. That is why it is important that nurses are able to manage post partum pain as well as labor pain in women who are giving birth. The nurses need to take into account the pain that is felt by the women giving birth in order to have a non traumatic experience with regards to labor (Carlton et al., 2005, p. 145-152).
Nurses are responsible and accountable in ensuring that the patient receives appropriate evidence-based nursing assessment and intervention which effectively treats the patient’s condition and meets the recognized standard of care. The nursing practice includes the knowledge of one’s self through the assessment of attitudes, values, beliefs and cultural background that influences and formed each of us an individual. These factors affect the nurse in assessing, evaluating and interpreting the patient’s reports, response and appearance. The greatest barriers to patient in achieving effective management are the nurse’s individual experiences, personal use medications and or non pharmacological methods in managing patients and the nurse’s family or significant other’s history or experience that may contribute to personal care of patient.
Nurses are influenced or constrained by personal factors, thus the nurse may not assess, evaluate or communicate the patient’s care effectively and objectively. Another factor also is if the nurse does not have the adequate knowledge regarding management of condition which results to mismanagement. Most of the patient’s complain is subjective, thus the patient is the only one that can identify and respond in the management of his care. The nurse must utilize the nursing process in the management of his condition that is why adequate measurement and management includes the knowledge of the nurse in assessment. In doing so, they utilized and developed appropriate, standardized assessment tool. This includes assessment measurement tool. It is also the nurse’s responsibility to observe the patient’s physiologic signs that may be an indicator of another physiologic problem.
Standard care of nursing also require having a positive nurse-patient relationship and teaching is one way of managing care of the patient because open communication with the patient would promote patient cooperation which is essential to the success in management and his care as well. A positive relationship between the patient and the nurse promotes trust that is important in order to convey to the patient the belief that he/she is in his/ her condition, the patients are able to reduce their anxiety. Acknowledging what is felt by the patient often eases the patient’s mind. Occasionally, patients who feel fear nurses when their condition is reported is relieved when they know that the nurse can be trusted to be believe that what is felt by the patient exists. Teaching the patient is also important because the patient needs to be responsible as well in management of his care. Patient teaching about his conditions promotes patient interaction and. By providing the patient with information through explanation and entertaining questions from the patient, helps in promoting better patient-nurse relationship.
The nurse’s primary commitment toward the health of the patient is to ensure the welfare, comfort and safety of the patient. Self awareness, knowledge in assessment and the knowledge of the standard of care enhances the nurse’s ability in advocating for and assuring effective management for each patient. As the patients advocate, the nurse takes all reasonable ways to ease or improve the patient’s pain and suffering. In addition to this, today collaborates and consults with the physician in managing of care in order to assure an effective interdisciplinary treatment plan in addressing the care of the patient. When the patient’s needs are not recognized and adequately addressed, it is still the nurse’s responsibility to advocate for the patient through other means such as referring the patient to other organizational committee that can address and manage the care of patients.
It is also the nurse’s obligation to support all patients in the aggregate. When an organizational policies, procedures and practices are insufficient to provide a consistent effective management and care, the nurse must work through appropriate committees and channels to insure that the patient’s management needs are addressed. This particular issue is important in order for the nurses to continue self awareness and enhance his/her learning in order to remain current in nursing knowledge and skills that are relative to management of patient care. It is still the nurses who are responsible and accountable to provide and work towards effective management of patient’s through assessment, intervention and patient advocacy. As nurses, management and care is an important factor in the nurse’s practice that should be integrated and practiced in order to relief patients pain and suffering.
References
Carlton, T., Callister, L. C., Stoneman, E., (2005). Decision Making in Laboring Women: Ethical Issues for Perinatal Nurses. Journal of Perinatal & Neonatal Nursing, 19(2), pp. 145-154
De Rond, M., de Wit, R., van Dam, F., (2001). The implementation of a Pain Monitoring Programme for nurses in daily clinical practice: results of a follow up study in five hospitals. Journal of Advanced Nursing, 35(4), pp. 590-598
Matthews, E., Malcolm, C., (2007). Nurses’ knowledge and attitudes in pain management practice. British Journal of Nursing, 16(3), pp. 174-179
Nash, R., et al., (1999). Pain and administration of analgesia: what nurses say. Journal of Clinical Nursing, 8, pp. 180-189