Pain Management among Nurses: Literature Review

Introduction

Pain is indicated to be among the major symptoms that most patients highlight during their hospital visits. Despite the advances in the medical field, cases of under-treatment of pain remain rampant as most nurses are noted to have inadequate knowledge and wrong attitude towards pain management. It is for this reason that the paper proposes a change to the practice by training the nurses and equipping them with necessary skills needed to identify, assess, and relieve pain relative to the situation at the current practice. The initiative is geared towards improving efficiency in pain management among patients. The initiative proposed is an enriched pain management education program that will assist the nurses to improve their skills and knowledge in controlling pain among patients.

A comparison of Research Questions

The research question in a majority of the articles under review sought to investigate the effects of education on pain management to the nurses. In their article, Adrian, Emilio, Kory, Terry, and Debbie (2017) sought to understand the effects of implementation and experience of pain neuroscience education. This had a more focused approach as it focused on a particular education program. The study by Martinez et al. (2014) sought to determine the effect of educational interventions on pain management among cancer patients. A study by Oldenmenger et al. (2017) sought to understand the effects of a nursing education intervention within a particular hospital setting on pain management. The study by Adam, Burton, Bond, De Bruin, and Murchie, (2017) sought to determine the nurse knowledge and attitudes towards pain management. The last study sought to establish the effects of a pain management initiative within the emergency department in a healthcare facility.

A comparison of Sample Populations

The study by Adrian et al. (2017) involved a sample size of 286 physical therapists who were engaged in an online survey. A study by Martinez, et al. (2014) was a systematic review that considered 19 studies with a sample size of 45 participants. The article by Oldenmenger  et al (2017) reviewed 26 articles making a total of 4735 participants. The article by Adam et al. (2017) reviewed the findings from 29 articles comprised of 5234 unique trial participants. A study by Rosalind, Bond, and Murchie (2014) reviewed 8 articles for the study. The article by Drake, Amanda, and Williams (2017) used in the study used 15 articles to review the interventions on pain management among nurses. The study by Samarkandi (2018) used a sample size of 247 participants to explore the knowledge level and the attitudes of nurses toward pain management. The article by Varndell, Fry, and Elliot (2018) involved a review of 12 article that facilitated the review of different analgesics and administration routes in the management of pain ranging from mild to severe.

A comparison of the Limitation of the Study

The different studies under review had several limitations. In their article Martinez, et al. (2014) highlighted a number of limitations to their study such as a restriction on patients with advanced cancer and review of articles that had a small sample size. The article by Oldenmenger et al. (2018) indicated that it had a limitation where the interpretation of results was made difficult by the differences in the quality of the randomized controlled trials. The methodology used to assess the risk of bias was generalized as opposed to scoring each article individually. The article by Adam, Burton, Bond, Bruin, and Murchie (2016) noted that a major limitation for their study was problems with intervention and trial, which introduces bias in the study. For their study, Drake and Amanda (2014) noted that their systematic review conducted a wide search of databases and had no language limit and failed to extract the qualitative data from the studies, thereby, limiting the insights that could be acquired from the articles reviewed. Samrkandi (2018) observed that the study was limited due to the small amount of sample size and had a level of bias introduced by convenience sampling technique.

Conclusion and Recommendations.

Louw, Peuntedura, Zimney, Cox, and Rico (2016) highlight that most physical therapists using post neuroscience education struggle to establish the suitability of this technique to an individual patient. In this case,  further studies are recommended to establish the factors that are related to success and failure of post-science education. Martinez et al, (2014) concluded that there exists a level of association between high levels of pain and poor quality of life, thereby, making an initiative focused on pain reduction among individuals. The authors recommended for further studies to establish the appropriate intervention content, timing, and intensity. Oldenmenger et al. (2018) arrived at a conclusion that patient pain education programs can lead to the improvement of patients’ knowledge with regard to pain caused by cancer. The study made a recommendation to carry out further studies to establish the effects of education programs on pain intensity and the interference of pain with daily activities. Adam et al. (2016) reached a conclusion that interventions used for patient-reported measurements to attain management of cancer pain have yielded a moderate reduction of cancer-associated pain intensity. Drake et al. reached a conclusion that suggests the need to improve in design and evaluation of nursing education interventions, which lead to the recommendation on the need for further studies to establish the use of the theory of behavior change to inform the design of interventions.

References

Adam, R., Burton, C. D., Bond, C. M., De Bruin, M., & Murchie, P. (2017). Can patient-reported measurements of pain be used to improve cancer pain management? A systematic review and meta-analysis. BMJ Supportive & palliative care, 7(4), 373-382.

Drake, G., & Williams, A. C. D. C. (2017). Nursing education interventions for managing acute pain in hospital settings: a systematic review of clinical outcomes and teaching methods. Pain Management Nursing, 18(1), 3-15.

Louw, A., Puentedura, E. J., Zimney, K., Cox, T., & Rico, D. (2017). The clinical implementation of pain neuroscience education: A survey study. Physiotherapy theory and practice, 33(11), 869-879.

Martinez, K. A., Aslakson, R. A., Wilson, R. F., Apostol, C. C., Fawole, O. A., Lau, B. D., … & Dy, S. M. (2014). A systematic review of health care interventions for pain in patients with advanced cancer. American Journal of Hospice and Palliative Medicine®, 31(1), 79-86.

Oldenmenger, W. H., Geerling, J. I., Mostovaya, I., Vissers, K. C., de Graeff, A., Reyners, A. K., & van der Linden, Y. M. (2017). A systematic review of the effectiveness of patient-based educational interventions to improve cancer-related pain. Cancer treatment reviews, 63, 96-103.

Samarkandi, O. A. (2018). Knowledge and attitudes of nurses toward pain management. Saudi journal of anaesthesia, 12(2), 220.

Varndell, W., Fry, M., & Elliott, D. (2018). Quality and impact of nurse-initiated analgesia in the emergency department: a systematic review. International emergency nursing, 40, 46-53.