The Effect of a Nurse Initiated Therapeutic Conversation Compared to Standard Care for Patients With Acute Pain in the ED

Abstract

Acute pain is a common presenting complaint in the emergency department (ED) and is most often treated with opioid or nonopioid analgesia. However, studies have shown that receiving analgesia alone does not always influence patient satisfaction with pain management in the ED. Pain anxiety and catastrophizing have been shown to affect pain intensity and patients' response to analgesia. The objective of this study was to determine whether a brief therapeutic conversation would improve patient satisfaction with pain management compared with standard care for adult patients presenting to the ED with moderate to severe acute pain. Adult (18 years or older) patients presenting to the ED with moderate to severe acute pain were randomized to either the standard care group or the intervention group. Patients in the intervention group participated in a brief therapeutic conversation with an ED nurse to discuss their perceived cause of pain, level of anxiety, and expectations of their pain management. Prior to discharge, all patients were asked to complete a self-reported, 9-item questionnaire to assess their level of satisfaction with their overall ED experience. A total of 166 patients (83 in each group) were enrolled. Patient satisfaction with ED pain management and the proportion of patients who received analgesia in the ED were similar in both the control (n = 57; 68.7%) and intervention (n = 58; 69.9%) groups (Δ 1.2%; 95% CI [12.6, 15]). Qualitative findings demonstrate that patients place high importance on acknowledgment from ED staff and worry about the unknown cause of pain. This study suggests that patient satisfaction with pain management in the ED is multifactorial and complex. Further research should investigate additional methods of integrating nurse-led interventions into the care of patients in acute pain.

Adult pain and anticipatory anxiety assessment in the emergency department: An integrative literature review

“…The literature search identified eight quantitative descriptive studies (Bahreini et al, 2015; Hughes, Jones, et al, 2021; Pacella‐LaBarbara et al, 2021; Patel et al, 2014; Pickering et al, 2013; Reinstein et al, 2017; Uri et al, 2015; Wells et al, 2018), four randomised controlled trials (Behrbalk et al, 2014; Gur & Tekin, 2021; Shillington et al, 2021; Zitek et al, 2018) and three non‐randomised studies (Moustafa et al, 2017; Parlar Kilic et al, 2015; Sikka et al, 2019).…”

“…The eight quantitative descriptive studies included two cross‐sectional studies (Bahreini et al, 2015; Pacella‐LaBarbara et al, 2021), one prospective psychometric evaluation (Hughes, Jones, et al, 2021), one prospective observational study (Patel et al, 2014), one feasibility study (Pickering et al, 2013), one observational retrospective pilot study (Reinstein et al, 2017), one non‐interventional study (Uri et al, 2015) and one prospective evaluation study (Wells et al, 2018). The four randomised controlled trials consisted of one multi‐centre, double‐blind, study (Zitek et al, 2018), one single centre double blind placebo‐controlled study (Gur & Tekin, 2021), one prospective single‐blinded study (Behrbalk et al, 2014) and one prospective controlled study (Shillington et al, 2021). The three non‐randomised studies consisted of one prospective self‐controlled interventional study (Sikka et al, 2019), one controlled experimental study (Parlar Kilic et al, 2015) and one prospective interventional study (Moustafa et al, 2017).…”

“…One study (Hughes, Jones, et al, 2021) focused on a tool intervention for both pain and anticipatory anxiety assessment. Eleven studies used a combination of single symptom tools for the assessment of both pain and anticipatory anxiety (Behrbalk et al, 2014; Hughes, Jones, et al, 2021; Pacella‐LaBarbara et al, 2021; Parlar Kilic et al, 2015; Patel et al, 2014; Reinstein et al, 2017; Shillington et al, 2021; Sikka et al, 2019; Uri et al, 2015; Wells et al, 2018; Zitek et al, 2018).…”

“…The four randomised controlled trials consisted of one multi-centre, double-blind, study (Zitek et al, 2018), one single centre double blind placebo-controlled study (Gur & Tekin, 2021), one prospective single-blinded study (Behrbalk et al, 2014) and one prospective controlled study (Shillington et al, 2021). The three non-randomised studies consisted of one prospective self-controlled interventional study (Sikka et al, 2019), one controlled experimental study (Parlar Kilic et al, 2015) and one prospective interventional study (Moustafa et al, 2017).…”

“…The use of identified pain and /or anticipatory anxiety tools to assess the co‐occurring symptoms of pain and anxiety in day‐to day ED practice has not been reported. When these tools were assessed together in reported literature (Behrbalk et al, 2014; Hughes, Jones, et al, 2021; Pacella‐LaBarbara et al, 2021; Parlar Kilic et al, 2015; Patel et al, 2014; Reinstein et al, 2017; Shillington et al, 2021; Sikka et al, 2019; Uri et al, 2015; Wells et al, 2018; Zitek et al, 2018), their validity and translation to day‐to‐day use were not reported, leaving a significant gap in knowledge.…”