An Exploration of Nursing Perspective
The findings from this research suggest crucial insights about hospital nurses’ perception regarding pain as well as the barriers to adult pain management. According to the participants, patients are usually aware of the pain they are undergoing; thus, they tend to have confidence in patients’ expression of pain, and would act appropriately based on the manner, in which a patient expresses pain. Still, some participants prefer performing clinical evaluations rather than relying on the word of the patient expressing pain or lack thereof. There is no doubt that pain usually entails an unpleasant feeling attributed to hurtful stimuli. Self-reporting has been considered the most reliable method of measuring pain despite the fact that majority of healthcare practitioners have a tendency to underestimate the severity of pain. In nursing, in most operational definitions of pain, emphasis is often placed on the subjective attribute of pain and significance of trusting patient reports. As Barry, Parsons, Passmore, & Hughes (2012) explain, pain is usually whatever an individual undergoing it says it is, at any time he/she says he/she is experiencing it. There is a widespread agreement in literature that pain is subjective. As a result, it is best expressed by an individual experiencing it (Berben, Meijs, van Grunsven, Schoonhoven, & van Achterberg, 2011; Coker, et al., 2010). Because of the fact that pain is often unpleasant, patients experiencing it are likely to express it in some way. Hospital nurses who participated in this study reported that they depend significantly on the patient’s expression of face, and act accordingly based on how patients report pain.
Notwithstanding of the significance of having faith in patients as regards pain, the value of clinical assessments in determining pain has also been indicated by Abdalrahim, Majali, Stomberg, & Bergbom (2011) and Elcigil, Maltepe, Esrefgil, & Mutafoglu (2011), who focus on barriers to pain reporting. For instance, self-reporting of pain is not an option for a patient who is not capable of speaking; therefore, observation is crucial and hospital nurses are supposed to monitor particular behaviors that act as pain indicators, such as changes in mental status, alterations in routine patterns of behavior, a decreased or increased vocalizations, and facial grimacing. Other pain indicators that have to be monitored by hospital nurses include reduced appetite and food intake, agitation and aggression, which are indicators of discomfort. Elcigil, et al. (2011) highlighted the socio-cultural dimension of pain in the sense the manner, in which an individual experiences and reacts to pain, is influenced by a number of factors including age, ethnicity, and gender. In addition, a person’s ability to identify pain may also be hampered by using several prescription drugs or illness. Depression has also been identified as a barrier to reporting pain. Some patients refrain from reporting pain on the ground that they may be compelled to undertake surgery or medications that they are likely to develop addiction (Wang & Tsai, 2010). Adults may also refrain from reporting pain because they may not want to be perceived as weak (Vallerand et al., 2011). Moreover, some adults consider reporting pain shameful. Cultural barriers have also been identified to as barriers to reporting pain. In this study, hospital nurses also emphasized on the importance of performing clinical assessments using pain scales and patient observation rather than solely relying on what a patient is saying.
Findings from this study also pointed out a number of issues that nurses bump into during pain management including the unknown psychological effects of analgesics and narcotics on the patient’s behavior; the vague and subjective nature of the self-reported pain scale, and the likelihood of patients becoming addicted to pain medications. With respect to the unknown psychological effects of analgesics and narcotics on the patient’s behavior, studies have linked pain medications to confusion (Wang & Tsai, 2010), anxiety (Vallerand et al., 2011), loss of sexual ability (Coker, et al., 2010), and sleep problems (Berben, et al., 2011). Similarly, hospital nurses who participated in this research expressed concerns about the unknown behavioral effects of pain medications, especially causing patients to be disoriented and anxious, as well as the likelihood of patients reacting differently to the same pain medication. The issue of patients developing addiction to pain medications has also been widely acknowledged (Vallerand, et al., 2011, Wang & Tsai, 2010). As Vallerand, et al. (2011) reported, prolonged usage of opioids increases the risk of the patient developing addiction, diversion, chemical dependency, and drug tolerance. In this respect, Vallerand, et al. (2011) report that individuals who rely regularly on opioids to relieve pain for prolonged durations often require higher doses for pain to lessen, which is attributed to tolerance. The concern of addiction to pain medication has not only been raised by nurses, but also patients. For instance, Barry, at al. (2012) reported that many individuals fear the stigma associated with addiction. As a result, they tend to shun pain treatment in order to avoid the possibility of being prescribed drugs that may be potentially addictive. Another concern raised by hospital nurses relates to the subjective nature of pain. Pain has been considered as one of the most subjective signs, and pain assessment on a patient may indicate significant variability depending on variables that cannot be evaluated like previous experiences and one’s emotional status. The subjective attribute of pain has been an issue of contention. As Barry et al. (2012) explained, despite the fact that pain is an extremely subjective experience, the management of pain requires objective care standards. These concerns have also been raised by hospital nurses, who consider pain scales as vague to be used in the assessment of pain, which is a very subjective phenomenon. Consistent with the views of nurses expressed in this research study, Berben, et al. (2011) noted that an individualized attribute of pain experience makes it extremely variable, which poses a challenge for nurses treating pain.
The findings of this research also highlighted problems associated with ignorance of pain prescriptions by nurses, and administration of medication without proper pain assessment, which has been mainly attributed to lack of time on the part of nurses because of busy schedules. A study by Berben, et al. (2011) also raised similar concerns by pointing out that many hospital nurses opt not to work with patients who are having persistent pain issues. The study pointed out that nurses fear working with pain-related cases, which the author partly attributes to the fact that pain management does not constitute a major component of the majority of medical trainings. This is further compounded by the fact that nurses who took part in the study showed unwillingness to use pain medications in managing pain. According to Barry et al. (2012), despite the fact that nurses usually encounter several patients having pain issues while practicing, they only receive a few hours training about the use of pain medications, such as opioids, while in medical schools.
The crucial role that nurses play in pain management has been emphasized by Wang & Tsai (2010), and Coker, et al. (2010). Coker et al. (2010) pointed out that pain management is a key aspect of nurses; therefore, nurses have the responsibility of effectively managing pain in patients, but this not often imply utilizing analgesic. Similar opinions were recounted by nurses who took part in this study and who were of the opinion that nurses are in a position to decide what is best for their patients by drawing upon clinical judgment. According to Berben, et al. (2011), it is often impossible for nurses to ascertain when their patients are hurt, the manner in which they are feeling pain, or suppress pain. Patients’ pain experiences are usually their own; however, through patients’ expression, nurses are in apposition to respond to pain. Owing to the fact that bodily pain defies objectivity, it varies significantly. Nurses face a significant challenge trying to understand how patients feel, how they cope, endure, and respond to pain (Vallerand et al., 2011). Despite the fact that patients are the only ones in a position to give meanings to pain, the entire situation depends on the ability of a nurse to hear patients’ expressions associated with pain (Wang & Tsai, 2010).
Participants also outlined a number of barriers to pain management, which included controlling pain for a patient who is yet to be examined by a physician; making sure that the patient experiencing pain is comfortable; and determining the most appropriate dosage of pain medication. The barriers identified in this study are a novel contribution to literature. The most commonly cited barriers to pain management are physician-related, which include patients having problems completing the pain scales (Vallerand et al., 2011); physicians’ indifference, and insufficient pain assessment by physicians (Vallerand et al., 2011). Other barriers that have been reported in literature include inadequate knowledge regarding pain management; the need for doctor’s approval for appropriate pain medication prescription, and challenges managing the side effects associated with pain medications.
Participants also stressed on the significance of educating the nursing staff on pain management in order to advance nurses’ knowledge on the subject of pain. This view has been resounded by Abdalrahim, et al. (2011) and Coker, et al. (2010), who have recognized educational deficits in pain management nursing and commended the usage of training to advance pain management knowledge among nursing staff.
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The results of the current research show the crucial role that nurses play in pain management as well as the challenges and barriers they encounter when managing patients’ pain. Data obtained in the course of the study suggest that regardless of the nurses relying on the patients’ expression of pain, clinical assessments are also vital in addressing the barriers associated with self-reporting of pain. Findings from the research have also pointed out a number of issues that nurses face when managing pain; the unknown psychological effects of analgesics and narcotics on the patients’ behavior; the vague and subjective nature of the self-reported pain scale, and the likelihood of patients becoming addicted to pain medications. Other issues identified in this study associated with pain management nursing include ignorance of pain prescriptions by nurses, and administration of medication without proper pain assessment. In addition, the barriers to adult pain management as identified in this study include difficulties in controlling pain for a patient who is yet to be examined by a physician; ensuring that the patient feeling pain is comfortable, and determining the most appropriate dosage of pain medication.