Hearing New Voices: Registered Nurses and Health Technicians Experience Caring for Chronic Pain Patients in Primary Care Clinics

Abstract

Recent national estimates from the U.S. reveal that as many as one-third of all Americans experience chronic pain resulting in high prevalence rates of visits to primary care clinics (PCC). Indeed, chronic pain appears to be an emerging global health problem. Research has largely ignored the perspective of PCC staff other than physicians in providing care for patients with chronic pain. We wanted to gain insights from the experiences of Registered Nurses (RNs) and Health Technicians (HTs) who care for this patient population. Krippendorff’s method for content analysis was used to analyze comments written in an open-ended survey from fifty-seven primary care clinic staff (RNs-N=27 and HTs-N=30) respondents. This represented an overall response rate of 75%. Five themes emerged related to the experience of RNs and HTs caring for patients with chronic pain: 1) Primacy of Medications and Accompanying Clinical Quandaries; 2) System Barriers; 3) Dealing with Failure; 4) Primacy of Patient Centered Care; and 5) Importance of Team Based Care. This study demonstrates that nursing staff provide patient-centered care, recognize the importance of their role within an interdisciplinary team and can offer valuable insight about the care of patients with chronic pain. This study provides insight into strategies that can mitigate barriers to chronic pain management while sustaining those aspects that RNs and HTs view as essential for improving patient care for this vulnerable population in PCCs.

A Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management

“…We employed mixed qualitative and quantitative methods to evaluate these quality improvement efforts on key processes and outcomes, and to inform the sustainable quality improvement approach. 22 While results of the qualitative evaluations have been reported elsewhere, [23][24][25] in this report, we focus on implementation efforts related to opioid safety, given the importance and timeliness of the topic with respect to public health and because this objective was prioritized by our VHA partners. Here we report solely on quantitative outcomes of primary care provider behavior based on the VHA electronic health record (EHR).…”

“…[23][24][25] Consistent with published recommendations 21,26 , a multifaceted, partnered approach to promote organizational improvements was identified and enacted. Although a comprehensive discussion of the initiatives undertaken is beyond the scope of this paper, we summarize initiatives that are most relevant to improving care among patients receiving long-term OT for chronic pain.…”

Knowledge and Beliefs about Chronic Non Cancer Pain Management for Family Medicine Group Nurses

“…The introduction of the Family Medicine Group (FMG) model could optimize CNCP management in primary care (Lalonde et al, 2014). An FMG consists of several family physicians working in close collaboration with nurses to provide integrated care and care continuity, especially for vulnerable groups, such as patients with chronic conditions (Pomey, Martin, & Forest, 2009). Given the high prevalence of CNCP, its association with the chronic health issues seen in FMGs (diabetes, chronic obstructive pulmonary disease, etc.…”

“…To intervene adequately, nurses must possess sufficient knowledge and appropriate beliefs about pain management (Patiraki-Kourbani, Tafas, McDonald, Papathanassoglou, Katsaragakis, & Lemonidou, 2004;RNAO, 2013). The challenges they face in conducting pain management must also be understood (Pellico, Gilliam, Lee, & Kerns, 2014;Siedlecki, Modic, Bernhofer, Sorrell, Strumble, & Kato, 2014) and addressed. Those challenges, and the knowledge and beliefs of FMG nurses about CNCP, have not yet been documented.…”

Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for Screening

“…In our study participants were paid for urine testing, which might not happen in a primary care setting, so motivation to provide a urine sample may be different. While we are not advocating urine screening as the initial step for screening in a clinical setting, some clinicians may use it as a tool to work with patients with a history of substance use to validate their reported use and not as a test, which could penalize the patient (Pellico, Gilliam, Lee, & Kerns, 2014). Although substance use levels differed by screening modality in our study, the evidence clearly pointed to high levels of substance use in this HIV clinic sample.…”