Barriers and enablers of intensive care unit nurses' assessment and management of patients' pain

Abstract

Background: Inadequate pain assessment and management is a problem in hospitalized patients that impairs their well-being. Intensive care unit nurses' pain practices are affected by several barriers and enablers.Aims and objectives: To explore intensive care unit nurses' pain education, perceived barriers, and enablers of pain assessment and management practices among critically ill patients.Design: A cross-sectional descriptive design was used in the study.Methods: Convenience sampling technique was used, including 300 nurses recruited from 22 intensive care units in Jordan. The Pain Assessment and Management for Critically Ill Adults Survey was used to collect data. Descriptive statistics, spearman correlation, and chi-square tests were used to analyse the data.Results: Only 127 (42.3%) of the nurses reported moderate to extreme satisfaction about receiving professional development education related to pain among critically ill patients. Nurse workload (65.3%), patient instability (54.4%), patient inability to communicate (53.3%), and sedation interfering with pain assessment (50%) were reported by nurses as the most frequent barriers impacting pain assessment and management. Enablers of pain assessment and management reported most frequently were "pain assessment and management is a unit priority" (63.7%), "enthusiastic and motivated staff" (61.3%), "protocols and guidelines are in use" (57.4%), and "standardized assessment tools are in use" (57%). Some barriers and enablers to pain assessment and management and pain education differed significantly according to nurses' experience and hospital type. Conclusion:This study identified a range of enablers and barriers to pain assessment and management practices perceived by intensive care unit nurses. Nurse workload was an important barrier while making pain assessments, and management a unit priority was an important enabler for pain assessment and management. Frequent assessment of barriers and enablers of pain assessment and management is needed in critical care units to improve nurses' practices. Pain education should be included in the hospitals' continuous educational program.

Existence and perceived application of pain management protocols in German neonatal intensive care units

“…Nevertheless, they communicate their pain by behavioral pain‐signaling, for example, crying, body movements, and facial expressions 37 . Yet, prior research has described the restricted ability of children to cooperate and communicate as a barrier to pain relief methods by nurses 23,25 . This might be especially true for VLBW infants.…”

“…20 More aspects that were revealed as barriers in pain assessment and management were time pressure and a high workload, respectively. [23][24][25] Our study followed two main aims. First, we aimed to explore and describe the existence and the application of written SOPs for PM by nurses and physicians in German NICUs.…”

“…Besides the importance of clinical training, it was reported that a nurse's professional experience was positively associated with a higher knowledge of guidelines and protocols. 20 Hamdan et al 23 reported that nurses with a working experience of more than 5 years read recommendations by their country's Pain Society more often.…”

“…More aspects that were revealed as barriers in pain assessment and management were time pressure and a high workload, respectively. 23 , 24 , 25 …”

Spotlight on Randomised Controlled Trials

“…The other papers in this issue address diverse but equally important topics in contemporary critical practice. These include post‐caniotomy fever, 9 prone positioning of critically ill patients, 10 the implications of obesity in critical care settings, 11 pain assessment and management, 12,13 thirst distress, 14 airway management in patients with COVID 14 and healthcare‐associated infections 15–17 . We (or I) hope that you find this issue useful to reflect on and challenge your own ideas and practices.…”