Tuesday, November 6, 2007

This presentation is part of : Creative Strategies for Chronic Health Issues
Decision Making between Patients with Chronic Kidney Disease and Nurses about Managing Pain
Elizabeth Manias, RN, MPharm, PhD and Allison Williams, BNurs, PhD. School of Nursing, The University of Melbourne, Carlton Victoria 3053, Australia
Learning Objective #1: The learner will be able to: explain the characteristics of patient involvement in passive, collaborative and active decision styles in pain management decisions.
Learning Objective #2: The learner will be able to: identify practical ways in which patients could be encouraged to participate collaboratively or actively in pain management decisions.

OBJECTIVES: To examine how decisions were made between patients with chronic kidney disease and nurses about managing pain, and how these decisions affected the types of analgesic and adjuvant therapies administered.

METHODS: A naturalistic, observational design was used in all five adult renal units in Victoria, Australia. Observations of 2-4 hours were undertaken at random times on a nurse-patient dyad. Individual interviews were completed after each observation to obtain further information about pain decision-making. All observations and interviews were audio-taped and transcribed verbatim. Three decision styles of passive, collaborative and active decision styles comprised the overarching thematic framework. Transcripts were subjected to thematic analysis and descriptive statistical analysis was undertaken in relation to analgesic and adjuvant medications administered during observations.

RESULTS: Data collection was carried out with 14 nurses and 53 patients, and 103 pain activities occurred during observations. Of the 103 pain activities observed, 78 involved a passive decision style between the nurse and patient, 19 involved a collaborative decision style, and 6 comprised an active decision style. Passive decision-making occurred because of language barriers, alterations of patient affect, physical isolation of patients, and patients' desire not to be involved. The majority of routine analgesic and adjuvant medications administered involved the use of a passive decision style. There were more situations that led to administration of a pro re nata opioid medication using a collaborative or active decision style compared to when a passive style was used. Most notably, 10.5% of passive style decisions observed resulted in no administration of an analgesic or adjuvant medication. All collaborative and active decision styles observed resulted in administration of some form of analgesic or adjuvant.

CONCLUSIONS: Patients with chronic kidney disease should be encouraged to participate in pain management decisions to optimise their chances of receiving appropriate and adequate analgesic relief.