Pain Assessment and Management in Intensive Care Unit: Nurses' Practices, Perceived Influencing Factors, and Educational Needs

Abstract

Background: Critically ill patients and those mechanically ventilated or unable to communicate may not be able to report any pain they experience. Consequently, pain assessment and management (PAM) is challenging and underestimated in intensive care units (ICUs), where patients suffer alteration of consciousness, sedation, invasive procedures and mechanical ventilation. Aim: This study aimed to investigate ICU nurses’ PAM practices, their perceptions of influencing factors, and their related educational needs. Methods: A descriptive cross-sectional design was employed, using a valid self-reported questionnaire. Results: Among the sample of 171 nurses, 55% were male and 83% held a bachelor’s degree. 60% reported performing pain assessment for patients able to report pain and 50% for those unable to do so. Almost 40% of participants reported that pain management plans and scores were not discussed in medical rounds. Workload and lack of guidelines were reported as the most common barriers to PAM, while the most common enablers were perceived to be prescribing analgesia and considering pain a priority. Nurses recognized the need for education regarding pain, especially the physiological (50%) and psychological (47%) consequences of untreated pain. Conclusion: Nurses’ reported performance of pain assessment for ICU patients remains suboptimal. Therefore, healthcare professionals, organizations, nursing schools, and policymakers should work together to improve nurses’ PAM knowledge and practices.

Nurses’ Knowledge and Attitudes Regarding Pain Assessment and Management in Saudi Arabia

“…Because pain is a multifaceted and subjective phenomenon influenced by an individual’s culture, beliefs, previous pain experience, and ability to cope [ 2 , 3 ], it is defined as “pain is whatever the experiencing person says it is, existing whenever he says it does”. Pain cannot be verified, and self-report is the only reliable measure to assess the presence and intensity of pain [ 1 , 4 ].…”

“…These effects include fear, anxiety, sleep disturbance, hopelessness, weak memory, decreased cognitive function, social isolation, and a lowered quality of life [ 5 , 7 , 8 ]. Undertreated pain delays the mobilization of the patient, delays wounds healing, depresses immunity, slows recovery, increases the risk of complications, increases hospital stay, and healthcare costs [ 3 , 4 , 5 , 7 , 9 ]. Mismanaged pain has numerous costs for the patients, families, healthcare professionals, healthcare services, and the community [ 9 , 10 ].…”

“…The effective management of pain is an important and sensitive indicator of the quality of nursing and healthcare [ 14 , 15 ]. Although achieving satisfactory pain relief needs interdisciplinary team collaboration and is an ethical and moral responsibility of all teams [ 10 , 11 , 19 ], nurses play a vital role in alleviating the patient’s pain as experts in pain assessment, management, and patient education in all healthcare settings [ 4 , 8 , 10 ]. The accurate assessment and effective management of pain require nurses to understand the concepts and acquire current knowledge, an appropriate attitude, and effective skills related to the assessment and management of pain [ 10 , 20 ].…”

Determination of procedural pain intensity among Critically-Ill patients: Using Behavioral Pain Scale (BPS)

“…These procedures include blood sampling, endotracheal suctioning, and dressing changes. Surprisingly, most patients (99.3%) suffered an unacceptable intensity of pain (6)(7)(8)(9)(10)(11). This results supported by Considine et al (2020).…”

“…Untreated pain can also lead to respiratory disorders like airway obstruction and pneumonia, as well as limited mobility, deep vein thrombosis, chronic pain syndromes, and psychological issues including anxiety, depression, disorientation, and post-traumatic stress disorder. 9 Mechanically ventilated patients and critically ill patients are unable to verbalize their pain because of altered consciousness, being sedated, and being unable to communicate to express their pain, which may be agonizing. As a result, quantifying pain caused by altered awareness, anesthesia, invasive procedures, and artificial ventilation is both a difficult and underappreciated topic.…”