Why is pain management suboptimal on surgical wards?

Abstract

The strength of this work is that it identified two types of potential barriers to effective pain management, recognized and more subconscious ones, and both need to be addressed before introducing systems aimed at improving pain management.

Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods

“…This might encourage direct assessment of pain (e) rather than reliance on behavioral indicators (Schafheutle et al, 2001), and regular assessment with appropriate pain rating scales (f). given nurses' tendency to under-assess (Sloman et al, 2005).…”

“…Many of these responsibilities are covered by guidelines on best practice in assessment and treatment (McCafferty & Pasero, 1999). Assessment is ideally by patient report (McCaffery & Pasero, 1999;Turk & Melzack, 2011), but nurses may fail to assess pain adequately (Sloman, Rosen, Rom & Shir, 2005) and/or may substitute their own estimates of pain (Schafheutle, Cantrill, & Noyce, 2001). Treatment may be undermined by excessive fears of unwanted analgesic effects and by inadequate appreciation of pharmacological and nonpharmacological resources to reduce suffering (Liu, So & Fong, 2008;Sloman et al, 2005).…”

Nurse prescribing for inpatient pain in the United Kingdom: A national questionnaire survey

“…Inadequate analgesic prescribing by physicians coupled with a shortage of staff, have been cited as reasons for suboptimal pain management on surgical wards (Schafheutle et al 2001). It is anticipated that by prescribing for patients in pain, nurses will bring about improvements to the efficiency and quality of pain service provision.…”

Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom

“…Reasons underpinning poor practice are many, including; lack of knowledge and understanding, lack of empathy, the socialisation of nursing and other health care professionals, organisational constraints and patient focused barriers (Sjostrom et al 2000, Schafheutle et al 2001, Lofmark et al 2003, Brockopp et al 2004, Manias et al 2005, Young et al 2006, Dihle et al 2006, Clabo 2008, Duncan et al 2014, Mackintosh-Franklin 2014. This paper focuses on one of these key issues; the educational preparation of undergraduate preregistration nurses in the United Kingdom (UK) which underpins their ability to successfully assess and manage pain and prevent subsequent suffering.…”