BackgroundMorphinofobia among the general population (GP) and among health care professionals (HP) is not without danger for the patients: it may lead to the inappropriate management of debilitating pain. The aim of our study was to explore among GP and HP the representation and attitudes concerning the use of morphine in health care.MethodsA cross-sectional study was done among 412 HP (physicians and nurses) of the 4 hospitals and 10 community health centers of Beira Interior (Portugal)and among 193 persons of the GP randomly selected in public places. Opinions were collected through a translated self-administered questionnaire.ResultsA significant difference of opinion exists among GP and HP about the use of morphine. The word morphine first suggests drug to GP (36,2%) and analgesia to HP (32,9%.). The reasons for not using morphine most frequently cited are: for GP morphine use means advanced disease (56%), risk of addiction (50%), legal requirements (49,7%); for HP it means legal risks (56,3%) and adverse side effects of morphine such as somnolence - sedation (30,5%) The socio-demographic situation was correlated with the opinions about the use of morphine.ConclusionsFalse beliefs about the use of morphine exist among the studied groups. There seems to be a need for developing information campaigns on pain management and the use of morphine targeting. Better training and more information of HP might also be needed.
BackgroundIn Switzerland, nurses are allowed to prescribe and administer morphine in emergency situations without a doctor. Still, nurses and other health professionals are often reluctant to prescribe and administer morphine for pain management in patients. No valid French-speaking instrument is available in Switzerland to assess the attitudes of nurses and other health professionals towards the prescription and administration of morphine. In this study, we evaluated the psychometric properties of the French version of the questionnaire “Attitudes towards morphine use”.MethodsThe instrument was derived from an Italian version. Forward and back translations of the questionnaire were performed. Item analysis and construct validity were assessed between April and December 2010 in a cross sectional study including five Swiss hospitals in a sample of 588 health professionals (533 nurses, mean age 38.3 ± 10.2 years). Thirty subjects participated in test-retest reliability.ResultsThe time to complete the instrument ranged between 12 and 15 minutes and neither floor nor ceiling effect were found. The initial 24-item instrument showed an intraclass correlation (ICC) of 0.69 (95% CI: 0.64 to 0.73, P < 0.001), and a Cronbach’s α of 0.700. Factor analysis led to a six-component solution explaining 52.4% of the total variance. After excluding five items, the shortened version showed an ICC of 0.74 (95% CI, 0.70 to 0.77, P < 0.001) and a Cronbach’s α of 0.741. Factor analysis led to a five-component solution explaining 54.3% of the total variance. The five components were named “risk of addiction/dependence”; “operational reasons for not using morphine”; “risk of escalation”; “other (non-dependence) risks” and “external (non-operational) reasons”. In test-retest, the shortened instrument showed an ICC of 0.797 (95% CI, 0.630 to 0.911, P < 0.001) and a Cronbach’s α of 0.797.ConclusionsThe 19-item shortened instrument assessing attitudes towards the prescription and administration of morphine showed adequate content and construct validity.
There is little information regarding risk perceptions and attitudes towards morphine use in Switzerland. Thus, we aimed at assessing such attitudes in a sample of health professionals drawn from five nonuniversity hospitals in the French-speaking canton of Valais, Switzerland. The sample included 431 nurses and 40 physicians (age range: 20-63 years), and risk perceptions and attitudes towards morphine use were assessed using a validated questionnaire. More than half of the participants showed a negative attitude regarding most adverse events related to morphine. In bivariate analyses, participants working in geriatrics showed a more negative attitude towards use of morphine than did participants working in medicine and surgery. Compared with Swiss participants, non-Swiss participants also showed a more negative attitude regarding use of morphine. Conversely, no differences were found between the sexes, professions (nurses versus physicians), years of experience (#14 years versus .14 years), or religions (Catholic versus other/no religion). These findings were further confirmed by multivariate adjustment. Our results indicate that attitudes regarding morphine use are mainly driven by its potential adverse effects and vary according to specialty and nationality. Educational measures directed at health professionals working in geriatrics or coming from abroad might reduce the high morphinophobia levels observed in these groups.
Contexte : L'opiophobie de certains professionnels de santé n'est pas anodine : elle peut entraîner une prise en charge inappropriée des patients présentant des douleurs invalidantes. Objectifs : Cette étude avait pour objectifs de comparer l'opiophobie entre médecins et infirmières d'une part ; et d'autre part de décrire les représentations que ces professionnels de santé ont de la morphine et leur attitude face à sa prescription et à son utilisation ainsi que les raisons évoquées. Méthode : Enquête par questionnaire autoadministré auprès des médecins et infirmières des hôpitaux et centres médicosociaux à Beira Interior au Portugal. Résultats : Le mot morphine évoque en premier lieu l'analgésie (médecins 32 % et infirmières 27 %) et en deuxième lieu le cancer (médecins 12 % et infirmières 27 %). L'attitude en ce qui concerne le recours à la morphine diffère entre médecins et infirmières, notamment en fonction de l'expérience professionnelle. Les raisons les plus fréquemment évoquées de non-administration de la morphine chez le patient algique sont les difficultés légales d'usage (médecins 79 % et infirmières 84 %), le risque de dépression respiratoire (médecins 70 % et infirmières 68 %) et le risque de dépendance (médecins 50 % et infirmières 69 %).Conclusion : L'existence de fausses croyances quant à la prescription et l'utilisation de la morphine dans notre collectif. Une différence significative existe pour plusieurs fausses croyances relatives à la prescription et à l'utilisation de la morphine entre infirmières et médecins. Ces résultats suggèrent que l'on forme mieux les professionnels de santé dans la gestion de la douleur. Mots clés Opiophobie · Morphine · DouleurAbstract Context: Opiophobia in health care professionals is not without danger for patients: it may lead to the inappropriate management of debilitating pain. Objectives: To describe and compare how nurses and physicians perceive morphine, and their attitudes to prescribing and administering it. Methods: A cross-sectional study of physicians and nurses in Beira Interior (Portugal), through a self-administered questionnaire. Results: The word morphine firstly recalls analgesia (physicians 32% and nurses 27%); secondly it is associated with the word "cancer" (physicians 12% and nurses 27%). Attitudes towards the use of morphine show significant variations among physicians and nurses, depending on their professional experience. The reasons for not administrating morphine most frequently cited are: legal problems (physicians 79% and nurses 84%), the risk of respiratory depression (physicians 70% and nurses 68%) and the risk of dependency (physicians 50% and nurses 69%). Conclusion: There are significantly differing attitudes and beliefs concerning the prescription and use of morphine
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