Barriers to Effective Pain Management

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Barriers to Effective Pain Management


Pain is a fundamental and inevitable form of human suffering, the experience which is unique to every individual.

Nurses have a unique role in alleviating the pain experienced by their patients. With their professional knowledge and regular close contacts with patients, they are ideally placed to listen and respond to any concerns. Taking time to assess the individual will allow for the development of a thrusting relationship between the nurse and patient. Accurate assessment and documentation can help to chart the multi- dimensional nature of the pain, aiding decision making and patient care planning (Mcguie 1992).

Adequate control of pain is only achieved in 50% of patients in Western societies. This emphasizes that pain control is a serious problem for a great number of patients. Health care professionals, patients and the health care system itself all contribute to this problem. Other factors that add to this undesirable situation include the following:

- Poor decision making on part of health care professionals - myths and misconceptions about pain and opoids
- patients non compliance with treatment and their reluctance to report pain - Problems within the organization of health care

Pain assessment and management is an integral part of the daily nursing routine. Health care professionals must strive to overcome the barriers to effective pain management in practice. The tendency to under medicate older adults may be related to several factors, including misguided beliefs, fears regarding complications, and a failure to assess ant treat confused older adults. It is imperative that nurses don’t act upon false misconceptions in delivering patient care.

The management of pain in the elderly represents a considerable nursing challenge. This is because the elderly are more likely to experience both acute and chronic pain than their younger counterparts. Age related factors may also complicate the assessment and management of the individual’s pain. Failing sight and hearing, cognitive impairment, confusion and dementia create communication difficulties and therefore pose significant barriers to pain assessment particularly in the use of the measurement tools.

Lack of knowledge of the Doctor and nurse / poor communication:

An individuals pain is complex, the management should not rely on one professional clinical judgment and action. The pain control process should be interwoven between numerous health care professionals. The nurse must strive to exercise their communication skills in discussing aspects of patient care with the MDT team. A lack of confidence and knowledge are the common reasons for poor communication and teamwork.

There is ample evidence to demonstrate that both nurses and doctors have poor knowledge about pain and its management. It is also known that contemporary nursing and medical education programs do not equip health care professionals with significant information on the nature of pain, the methods of pain assessments and the principles of pain management.

With a lack of knowledge and basic fundamental management skills, nurses may feel unprepared to care for patients suffering from pain, and consequently make incorrect decisions regarding the management of patient’s pain. Poor decision making on behalf of the nurse can reflect on the following:

➢ Underestimation of the severity of the illness ➢ Overestimation of the effectiveness of the interventions ➢ Reluctance to administer parental analgesia ➢ Administering a low dose of opoid rather than the required dose needed to control the severity of patient’s pain. ➢ Nurses rarely employing non pharmacological strategies

In addition, the lack of knowledge and confidence of the nurse may interfere with his or her ability to effectively communicate aspects of patient care to...
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