Critical Care Nurses' Pain Assessment and Management: A Survey in Taipei

Purpose:

Pain is a common problem among critically ill patients in intensive care units. Critical care nurses employed at intensive care units play an important role on pain assessment/management for critically ill patients. The aims of this study were to (1) investigate critical care nurses’ pain assessment/management practices for critically ill patients, (2) understand enablers and barriers related to critical care nurses’ pain assessment/ management practices, and (3) explore associated factors of critical care nurses’ frequent utilization of pain assessment tools among non-communicative critically ill patients.

Methods:

This study was a cross-sectional, descriptive, correlational study. In total, 381 critical care nurses who were full-time employed at intensive care units in Taipei area were recruited. A structured questionnaire was used to collect related information. The Chinese scale developed to assess pain assessment/management practice comprises 29 items. SPSS 19.0 software was used to analyze collected information. Statistical significance was established at p < .05. Descriptive statistics was used to demonstrate critical care nurses’ individual characteristics, pain assessment/management practice for critically ill patients, and enablers/barriers related to critical care nurses’ practices of pain assessment/management. Logistic regression was used to examine associated factors of frequent utilization of pain assessment tools for non-communicative critically ill patients. For the final model of logistic regression, estimated odds ratios and associated 95% confidence intervals of frequent utilization of pain assessment tools for each independent variable were obtained.

Results:

Of the 381 critical care nurses, the majority were female (n = 366, 96.1%), had bachelor degrees (n = 276, 72.4%), and had received intensive care training (n = 310, 81.4%). For communicative critically ill patients, the majority of critical care nurses (n = 370, 97.1%) reported that they would use pain assessment tools, and considered patients themselves could provide the most accurate pain assessment (n = 297, 78.0%). The majority of critical care nurses (n = 328, 86.1%) reported that they would use pain assessment tools for non-communicative critically ill patients, and considered nurses as the persons who could provide the most accurate pain assessment (n = 252, 66.1%). A small portion of the critical care nurses did not use pain assessment tools for non-communicative critically ill patients (n = 50, 13.1%), and indicated that frequent assessing/recording pain was slightly important or not important at all (n = 40, 10.5%). The critical care nurses reported that availability of standardized pain assessment tools (n = 262, 68.7%) and pain management guidelines (n = 251, 65.8%) at working settings, and physicians’ prescriptions of sufficient analgesic dosage (n = 252, 66.1%) were the enablers of their pain assessment/management practices. The barriers of their pain assessment/management practices were taking care of non-communicable patients (n = 203, 53.2%), taking care of patients with unstable conditions (n = 196, 51.4%) (e.g., hemodynamic instability), and working load (n= 195, 51.1 %).  Factors associated with critical care nurses’ frequent utilization of pain assessment tools among non-communicative critically ill patients were hospital type, working unit, and availability of pain assessment tools. Critical care nurses employed at the Joint Commission International (JCI) accredited hospitals (OR=5.51, 95% CI 2.93-10.34, p < .001), the units with patients receiving surgical treatments (OR=2.49, 95% CI 1.52-4.06, p < .001), or the institutions implementing pain assessment tools for non-communicative patients (OR=3.35, 95% CI 1.55-7.24 , p < .01) were more likely to frequently utilize pain assessment tools than those employed at the hospitals without JCI accreditation approvals, the units without patients receiving surgical treatments, or the institutions without implementing pain assessment tools for non-communicative patients.

Conclusion:

Pain is a major stressor for critically ill patients. Our study findings could be applied to the following areas: clinical practice, education, and research. Implementing standardized pain assessment tools and pain management guidelines at healthcare institutions is suggested to improve healthcare providers’ pain assessment/management practices for critically ill patients. Delivering education or training related to pain assessment/management for critically ill patients at healthcare institutions or medical education institutions is recommended to improve healthcare providers’ capabilities of performing pain assessment/ management for this specific population. The Chinese scale developed to assess healthcare providers’ pain assessment/management practices for critically ill patients could be used in education settings or future research to examine healthcare providers’ pain assessment/management practices and effects of related education interventions.