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      Nurses’ Behavior Regarding Pain Treatment in an Emergency Department: A Single-Center Observational Study

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          Abstract

          Purpose

          The aim of this prospective study was to assess the behavior of emergency department (ED) nurses with regard to pain and their role in pain management in a real-life clinical setting.

          Methods

          A total of 509 consecutive patients were enrolled during a 6-week period. A case-report form was used to collect data on nurses’ approaches to pain, time to analgesia provision, and patient-perceived quality of analgesia.

          Results

          Triage nurses actively inquired about pain in almost every case, but they did not estimate pain intensity in a third of patients. In the majority of cases, triage nurses did not report pain-related findings to the physician, who was the only professional that could prescribe analgesia to patients. The assignment of the color-coding of triage by nurses appears to be related to the perceived severity of the clinical case and a more comprehensive evaluation of pain. More than half of patients were at least fairly satisfied with analgesia.

          Conclusion

          Pain is increasingly screened during triage, but its comprehensive assessment and management still lack systematic application. We believe that further education and implementation of analgesia protocols may empower nurses to manage ED patients’ pain more effectively and in a more timely manner.

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          Most cited references 18

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          Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study.

          Pain is the most common reason for emergency department (ED) use, and oligoanalgesia in this setting is known to be common. The Joint Commission on Accreditation of Healthcare Organizations has revised standards for pain management; however, the impact of these regulatory changes on ED pain management practice is unknown. This prospective, multicenter study assessed the current state of ED pain management practice. After informed consent, patients aged 8 years and older with presenting pain intensity scores of 4 or greater on an 11-point numerical rating scale completed structured interviews, and their medical records were abstracted. Eight hundred forty-two patients at 20 US and Canadian hospitals participated. On arrival, pain intensity was severe (median, 8/10). Pain assessments were noted in 83% of cases; however, reassessments were uncommon. Only 60% of patients received analgesics that were administered after lengthy delays (median, 90 minutes; range, 0 to 962 minutes), and 74% of patients were discharged in moderate to severe pain. Of patients not receiving analgesics, 42% desired them; however, only 31% of these patients voiced such requests. We conclude that ED pain intensity is high, analgesics are underutilized, and delays to treatment are common. Despite efforts to improve pain management practice, oligoanalgesia remains a problem for emergency medicine. Despite the frequency of pain in the emergency department, few studies have examined this phenomenon. This study documents high pain intensity and suboptimal pain management practices in a large multicenter ED network in the United States and Canada. These findings suggest that there is much room for improvement in this area.
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            Pain Management Practices by Nurses: An Application of the Knowledge, Attitude and Practices (KAP) Model

            Pain is one of the most common reasons that drive people to go to hospitals. It has been found that several factors affect the practices of pain management. In this regard, this study aimed at investigating the underlying determinants in terms of pain management practices. Based on reviewing the previous studies and the suggestions of the KAP model, it was hypothesized that the main elements of the KAP model (attitudes and knowledge) significantly predict the variation in the practices of nurses regarding pain management. A questionnaire comprising the KAP model’ s constructs, i.e. knowledge and attitude towards pain management, as well as pain management practices, was used to collect data from 266 registered nurses (n=266) who are deemed competent in the management of patients’ pain in the Jordanian public hospitals. The two constructs, attitude and knowledge, which are the main determinants of the KAP model were found to independently predict nurses’ practices of managing patients’ pain. Knowledge of pain management was found to be the strongest predictor. Additionally, it was found that about 69% of the variance in pain management could be explained by the constructs of the KAP model. Therefore, it is recommended that the Jordanian hospitals and universities focus on nurses’ knowledge and attitude towards pain management in order to enhance their practices in the field of pain management.
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              Quality of pain management in the emergency department: results of a multicentre prospective study.

              The purpose of this study was to evaluate pain management in a large sample of emergency departments (EDs) and identify potential corrective measures. METHOLOGY: A multicentre prospective study was performed in 50 EDs participating in a national quality improvement programme. The rate of inclusion was determined a priori in each ED. Patients were questioned about their pain and pain intensity was assessed by a visual analogue scale. A bivariate and a multivariate analysis were conducted to identify the criteria associated with inadequate pain management. A total of 11 670 patients were included and 7265 patients reported pain on admission. On arrival, pain intensity was assessed in 90% of patients (44% experienced severe pain). However, reassessments were performed less often (48% on discharge). Fifty-one percent of patients received pain treatment. Intravenous morphine was used in only 9% of patients with severe pain. Initial treatment was provided within 60 min of admission to 74% of patients. Among patients who were assessed on discharge, 27% still had pain (8% with severe pain). Delay for pain management was significantly related to the ED volume, lack of triage nurses, patients' disorders and initial pain intensity. This multicentre study conducted on a nationwide scale shows that pain relief can be improved in the ED. Pain intensity is not sufficiently reassessed, analgesics are underutilised, morphine sulfate is rarely used and delay in treatment is common. Reasons for inadequate analgesia were identified in order to identify relevant corrective measures to improve quality of pain management in the ED.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                jpr
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                22 September 2020
                2020
                : 13
                : 2355-2359
                Affiliations
                [1 ]Anesthesia and Intensive Care Unit, University of Cagliari , Cagliari, Italy
                [2 ]Department of Medical Sciences and Public Health, University of Cagliari , Cagliari, Italy
                [3 ]RN-BC, University of Cagliari , Cagliari, Italy
                [4 ]ATS Sardegna, ASSL Cagliari SS , Cagliari, Italy
                [5 ]Department of Anesthesiology and Pain Medicine, Cattolica University , Rome, Italy
                Author notes
                Correspondence: Maura GallettaDepartment of Medical Sciences and Public Health, University of Cagliari , Highway 554 (exit for Sestu), Monserrato 09042, Cagliari, ItalyTel +39 070-675-3108 Email maura.galletta@gmail.com
                Article
                266087
                10.2147/JPR.S266087
                7519805
                © 2020 Sardo et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 0, Tables: 11, References: 18, Pages: 5
                Funding
                Funded by: not receive;
                This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No sponsor(s) were involved in this project.
                Categories
                Original Research

                Anesthesiology & Pain management

                emergency, ed, nurse, oligoanalgesia, pain, triage

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