Nurses' Perceived Barriers to Assessment and Managementof Pain in a University Hospital

Abstract

A self-report questionnaire was answered by 114 nurses working at the internal medicine, oncology, and surgery clinics. The most commonly perceived barriers to pain management were system-related barriers. Lack of psychosocial support services and patient-to-nurse ratio received the highest ratings. Institutional and governmental attempts are needed to increase the number of nurses in the clinics and to establish support services. Nurse-related barriers were less perceived as an obstacle when compared with the other barriers. A small percentage of the nurses agreed that nurses' inadequate knowledge of pain management (10%) and nurses' indifference (8%) were barriers to pain management. Inadequate time for health teaching with patients was agreed on by 65% of the nurses. Most commonly rated physician-related barriers were inadequate assessment of pain and pain relief by doctors (63%) and physicians' indifference (47%). Patients' difficulty with completing pain scales (56%) and consumers not demanding results (53%) were the most commonly reported patient-related barriers. A significant percentage of the participating nurses indicated that they have no idea about patient-related barriers. Regular and continuous pain education programs may help to establish a supportive team spirit between doctors and nurses.

Identification and Comparison of Barriers to Assessing and Combating Acute and Postoperative Pain in Elderly Patients in Surgical Wards of Polish Hospitals: A Multicenter Study

“…Similar results were presented in the study [9], where 70% of the 247 nurses studied had difficulty communicating with physicians to discuss pain management in patients. In Egan's study, this barrier was also ranked first [1]. Nurses in Poland, despite the fact that in 1996 they became professionally independent and can now study to obtain the 1 st , 2 nd and 3 rd cycle degrees, are still not viewed as doctors' partners at work but are rather expected to merely execute doctors' orders.…”

“…To achieve this, meetings of the two professional groups should be organized to discuss issues related to pain management and look at the measures proposed. Insufficient pain management is not an insoluble problem [1]. Education is an effective way of removing the barriers to pain assessment and management.…”

“…In addition, the nurses believe that elderly patients find it difficult to complete pain rating scales. In the study [1], over half of the nurses pointed to problems with completing numerical pain rating scales 0-10. Pain intensity scales used during hospital and out-of-hospital treatment can serve as an incentive for discussion and education, especially in relation to patients who find it difficult to precisely describe pain intensity.…”

Problems and Barriers in Ensuring Effective Acute and Postoperative Pain Management - an International Perspective

“…There are still significant barriers to comprehensive pain management, limiting the capacity for effective pain management. The Agency for Healthcare Research and Quality in the USA distinguishes the following types of barriers to pain management: healthcare system-related, medical staff-related and patient-related [8,10,16].…”

“…At the national levels (e.g. in China, Great Britain, the Netherlands, Spain, Turkey, USA) the greatest burden of inadequate pain management is borne by the elderly, pregnant and breastfeeding women, children, people coping with addictions to harmful substances, and the mentally ill [6][7][8][9][10][11][12][13][14][15]. There are still significant barriers to comprehensive pain management, limiting the capacity for effective pain management.…”