Iran Journal of Nursing

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Mohammad Aliha J, Najafi Ghezeljeh T, Haghani S, Nasrollah Nejhad S. The Attitude and Performance of Nurses Regarding Pain Management in the Patients Admitted to the Emergency Department. IJN 2020; 32 (122) :41-54
URL: http://ijn.iums.ac.ir/article-1-3133-en.html

Background & Aims: Pain management is an integral part of patient care in emergency departments. Nurses play a key role in the pain management of patients, and all patients deserve to be free of pain. One of the biggest challenges in nursing is ensuring patients’ comfort and lack of pain. Not only effective pain relief in patients results in their physical comfort but also increases their quality of life and rapid return to daily life and decreases their hospital stay duration and costs. Nurses are the first people present at the patient's bedside during pain and have the longest stay with the patient. Therefore, the most successful nurses are those who have competence in assessing pain. Nurses are required to make timely decisions in the dynamic and changing situation of clients by using technical skills and professional knowledge. In addition, they must make a proper clinical judgment about patients’ health status through acquiring basic information about clients, determining natural and unnatural functions and abilities of clients, and using proper information. Positive attitude and proper performance of health care providers towards pain management is very important and is part of patients' rights. Therefore, the present study aimed to determine the knowledge of nurses regarding pain management in the patient referring to the emergency departments of the hospitals.
Materials & Methods: This descriptive, cross-sectional study was conducted on 150 emergency department nurses selected via census sampling in the hospitals affiliated to Iran University of Medical Sciences in 2018. The inclusion criteria were the minimum education level of master's degree and six months of work experience in the emergency department. Data were collected using the demographic questionnaire (included six items to determine the demographic characteristics of nurses such as age, gender, level of education, type of hospital, and work experience) and the questionnaire of knowledge of pain management (included 20 items), in which the responses of the participants determined their attitude toward the use of narcotics, the person responsible for pain control and use of non-pharmaceutical interventions). The items were scored based on a four-point Likert scale from completely agree (four scores) to completely disagree (one score). In addition, the score range of the instrument was 35-62, where a score above 62%, between 35% and 62%, and below 35% was indicative of positive, moderate and negative attitude, respectively. The construct validity of the tool was assessed by comparing the scores of experienced and skilled nurses, which demonstrated a difference in the expertise of different groups. On the other hand, the performance questionnaire encompassed four items on patients’ pain level and type, analgesics and one item on the tools applied to measure pain (the name of the tool used to measure pain). The tool was completed by nurses (through self-report) and the scores were 0-2 (0=no, 1=to some extent, and 2=yes). In the end, the performance score was obtained, where the lowest and highest scores were zero and eight, respectively. In this respect, a score higher than the median (i.e., four) indicated good performance, whereas a score below the median demonstrated poor performance. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency tables, mean, and standard deviation) and inferential statistics (Pearson's correlation coefficient).
Results: Mean age of the participants was 31.98 ± 5.52 years. The majority of the nurses (82.9%) had no prior experience of pain management training. Regarding pain management in the emergency department, 82.7% of the subjects had a moderate attitude (35-62 scores) while 17.3% had a positive attitude and no subject had a negative attitude. Moreover, the mean attitude score was reported to be 57.16 ± 5.22, and the mean and standard deviation of performance was 6.02 ± 2.53, which was higher than the median score of the tool. The results indicated no significant difference between the mean scores of attitude and performance with the demographic characteristics of the participants (P>0.05).
Conclusion: According to the results, the emergency department nurses had a moderate knowledge level regarding pain management. In addition, they declared proper performance in this regard. Nevertheless, they had insufficient knowledge of pain tools and their method of use. The findings of the present study showed that although the nurses stated that they had good performance and knowledge about the importance of recording and controlling pain, it seems that the necessity of completing the initial assessment form caused nurses to repeat and practice how to complete the form. In this respect, the forms demonstrated better performance of nurses while they had insufficient knowledge of the tools. Therefore, the provision of periodic training and pain assessment facilities and the implementation of proper policies and methods for pain assessment could be effective in this regard. In addition, the performance of nurses in managing patients' pain in the present study was indicated through a self-report questionnaire. As such, it is recommended that the performance of nurses be assessed through observation. It is also suggested that pain management by nurses in emergency departments be assessed from the viewpoint of patients and the effect of pain management education on the knowledge and performance of nurses.