Emergency nurses' knowledge, attitude and clinical decision making skills about pain

Highlights

• The majority of nurses were not using a scale for pain assessment.

• Nurses reported pain relief should be postponed because it might adversely affect the diagnosis in emergency departments.

• They believed opioids lead to respiratory depression at any dose.

Abstract

Introduction

Pain is the most common reason that patients come to the emergency department. Emergency nurses have an indispensable role in the management of this pain.

Aim

The aim of this study was to examine emergency nurses' knowledge, attitude and clinical decision-making skills about pain.

Methods

This descriptive study was conducted in a state and a university hospital between September and October 2012 in Malatya, Turkey. Of 98 nurses working in the emergency departments of these two hospitals, 57 returned the questionnaires. The response rate was 58%. Data were collected using the Demographic Information Questionnaire, Knowledge and Attitude Questionnaire about Pain and Clinical Decision Making Survey. Frequency, percentage, mean and standard deviation were used to evaluate data.

Results

75.4% of participant nurses knew that patients' own statement about their pain was the most reliable indicator during pain assessment. Almost half of the nurses believed that patients should be encouraged to endure the pain as much as possible before resorting to a pain relief method. The results also indicate that most of nurses think that a sleeping patient does not have any pain and pain relief should be postponed as it can influence the diagnosis negatively. It is determined that the pain scale was not used frequently. Only 35.1% of nurses reported keeping records of pain.

Conclusion

Despite all the recommendations of substantial past research the results of this study indicate that emergency nurses continue to demonstrate inadequate knowledge, clinical decision-making skills and negative attitudes about pain.

Introduction

Pain is a common symptom in many emergency department cases. However, patients may be discharged either with unchanged or increased levels of pain (Berben et al, 2008, Todd et al, 2007). A previous study conducted in Turkey reported that all adult trauma patients admitted to the emergency department experienced pain, with 51.7% of them describing their pain as very severe and 62.9% indicating that they still had pain despite treatment (Eti Aslan et al., 2008).

Effective pain management requires accurate knowledge, positive attitudes, and clinical decision-making skills about pain (Kuzeyli Yıldırım et al., 2008). Many nurses gain their perceptions about pain from their knowledge. However, knowledge deficits in this area of practice may yield negative attitudes that can interfere with their clinical decision-making skills and add to the complexity of the pain management issue (El-Rahman et al, 2013, Young et al, 2006).

Incorrectly evaluating pain as less severe than it is, believing that the patient exaggerates his/her pain, lack of knowledge regarding pain medications, concerns regarding addiction, beliefs that pain treatment would delay the diagnostic tests, and effects of age and gender result in inadequate pain management in emergency departments (Wheeler et al., 2010). Furthermore, effective pain management in emergency departments is hampered by reasons including concerns that it could mask primary symptoms and cause respiratory depression, not adopting multidisciplinary team work, and a lack of widespread use of new pain control methods (Eren Çevik et al, 2011, Eti Aslan et al, 2008, Karaçay et al, 2006). In previous studies on this subject, emergency nurses stated that a lack of knowledge about pain assessment and relief, lack of time, inadequate pain management until after a diagnosis was obtained, and a patient's use of alcohol or other stimulant substances were important factors that hampered pain management (Duignan, Dunn, 2009, Tanabe, Buschmann, 2000).

Nurses have an indispensable role in providing effective pain management. The important factors that differentiate nurses in pain control from the other team members are that nurses have learned patients' previous pain experiences and methods to deal with pain and use them when necessary, they spend more time with patients, they teach patients strategies to cope with pain, they observe the efficiency and results of the planned treatments, and they have an emphatic approach (Çöçelli et al., 2008).

From an ethical standpoint, a patient should not be left to suffer if his/her pain can be relieved. Patients have the right to receive treatment and care for relieving or alleviating their pain (Çöçelli et al., 2008). For correct management of pain, which is a universal, complex, and subjective experience, nurses must use a proper pain scale to assess pain appropriately, believe the level of pain reported by patients is accurate and support them in this regard, use pain relief methods, and evaluate the efficacy of these methods (McGuire, 2006, Smeltzer et al, 2008). Through these techniques, nurses can contribute to decrease morbidity and mortality rates, reduce hospitalisation periods, and increase patient satisfaction (Eren Çevik et al, 2011, Eti Aslan et al, 2008, Karaçay et al, 2006, Özer et al, 2006, Yılmaz, Gürler, 2011). However, in some studies conducted in Turkey, it has been determined that nurses have insufficient knowledge of, attitudes, and clinical decision-making skills about pain (Özer et al, 2006, Yılmaz, Gürler, 2011).

Despite the numerous studies about pain reported in international literature, only a limited number evaluate emergency nurses' knowledge of, attitudes, and clinical decision-making skills about pain. A study has examined triage nurses' clinical decision-making (Gerdtz and Bucknall, 2001), but little is known about emergency nurses' attitudes and clinical decision-making skills regarding pain. In Turkey, although these issues have been investigated among nurses working in different clinics, they have not previously been studied with emergency nurses. Therefore, this research will form the basis for future studies with emergency nurses in Turkey. In addition, we believe that the results of the current study will provide useful information to the body of literature regarding what emergency nurses know and their attitudes and clinical decision-making skills about patients' pain.