Nurse'S Perceptions of Pain Assessment and Pain Managment for Patients with Myocardial Infarction in a Coronary Care Unit

Abstract

Background: Pain is one of the most common medical problems that occur in hospitals; in spite of its incidence, there are many patients who suffer with untreated pain. Unrelieved pain can negatively impact a person's quality of life, causing activity life disturbances like psychological distress; anxiety, depression and lack of sleep. Cardiovascular disorder is a significant global health problem, which accounts for the death of a third of people of the world. Chest pain is the most common symptom of heart attacks. However, some patients will present with pain in other areas like pain in arm, shoulder, neck, teeth, jaw and back pain. In literature there is little observational research to investigate actual pain assessment and management practices of critical care nurses in routine clinical practice for patients with myocardial infarction. Aim: The aim of this study was to explore nurses' perceptions regarding pain assessment and pain management for patients with Myocardial Infarction in a coronary care unit. Methodology: The study was a qualitative design, using semi structured interviews. Ten critical care nurses who work in a coronary care unit were interviewed. The author used a qualitative content analysis approach to analyze the interviews by doing the manual analyzing and having different themes. Result: Three main themes were indentified in this study and each theme had different categories which are presented as the following: Dealing with patients who have myocardial infarction pain is challenging; there are different approaches in pain assessment including subjective and the third theme is Holistic approaches to pain management. Conclusion: Critical care nurses need more skills and knowledge to practice good pain assessment and effective pain management when they deal with patients who have myocardial infarction pain. In this study patients who do not verbalized their pain lack the proper assessment of pain due to inability to communicate their pain. More research is needed in this area of pain assessment and management especially for patients with myocardial infarction.

Nurses’ Perceived Barriers to and Facilitators of Pain Assessment and Management in Critical Care Patients: A Systematic Review

“…The selected 20 articles were found to employ different methodologies. Four studies were qualitative, 13–16 six were correlational, 17–22 three were quasi-experimental, 23–25 six were descriptive, 26–31 and one was longitudinal. 21 The included studies were conducted on critical care patients admitted to various clinical settings, including cardiac units, 13 , 18 oncology units, 28 emergency critical care units, 29 and neurosurgical units.…”

“…Four studies were qualitative, 13–16 six were correlational, 17–22 three were quasi-experimental, 23–25 six were descriptive, 26–31 and one was longitudinal. 21 The included studies were conducted on critical care patients admitted to various clinical settings, including cardiac units, 13 , 18 oncology units, 28 emergency critical care units, 29 and neurosurgical units. 22 In addition to the abovementioned clinical settings, the majority of the studies also included other settings, such as medical-surgical units, medical units, and burn units.…”

“…Six of the studies were conducted in European countries. 13 , 15 , 16 , 21 , 26 , 32 Of the remaining studies, five were conducted in Asia, 14 , 17 , 20 , 27 , 28 five in North America, 18 , 19 , 22 , 23 , 25 and four in East Africa. 24 , 29–31 Critical care nurses’ pain assessment and management practices used among intensive care unit patients were measured using the Pain Assessment and Management for the Critically Ill survey in three of the studies.…”

“…Fifteen of the selected studies reported poor knowledge among nurses regarding critically ill patients’ pain as being a barrier to effective pain relief. Eight of the 15 studies reported nurses’ lack of knowledge regarding pain assessment, 13 , 14 , 18 , 19 , 25 , 27 , 33 five reported poor knowledge regarding pain management, 20 , 23 , 24 , 29 , 34 and only two reported both. 28 , 31 The remaining studies did not discuss the link between nurses’ knowledge and pain assessment and management in critically ill adult patients.…”

“… 24% 842 ICU nurses Survey of assessment and management of pain for critically ill adults A large percentage of critical care nurses did not assess nonverbal pain using formal pain assessment tools and were unaware of published guidelines for critically ill patients’ pain management. IV Alasiry et al, 13 Sweden Qualitative To discuss pain assessment & pain management in critically ill patients from nurses’ perspective. 100% 10 coronary care unit nurses Semi-structured interviews Adequate pain assessment and management needs more knowledge and improved practice among critical care nurses while dealing with pain in myocardial infarction patients.…”