Pain is a multidimensional phenomenon that varies with each individual and each painful experience (Watson, Garfinkel, Gallop, Stevens, & Strenier, 2000). Within the past 20 years there have been dramatic advances in pain control (Carr, 1997). However, under treatment of pain continues to be a major public health problem (Berry & Dahl, 2000). McCaffery and Pasero (1999) noted that barriers to pain management are numerous and complex. The aim of this critical analysis is to explore some barriers to pain management, and the implications these issues have on nursing practice.
Nurses have a unique role in pain assessment and management given that, of all health professionals, they spend the most time with patients in pain (Musclow, Swhney, & Watson, 2002). Failure of nurses to assess pain is a critical factor leading to under treatment (Chuk, 2002). Despite the numerous research articles on the under treatment of pain barriers continue to exist (Shannon & Bucknell, 2003). Some identified health care barriers include: inadequate pain assessment and documentation by nurses, under treatment of pain with analgesics, inadequate knowledge of nurses regarding pain management and pain medications, nurses’ fear over sedating patients, which could produce respiratory suppression, and the perceptual differences of pain between patients and nurses (Holley, McMillian, Hagen, & Palacois, 2005), Bouvette, Bourbonnais, & Perreault, 2001, Clarke et al., 1996, McCaffery & Pasero, 1999).
Pain assessment is an essential part of the pain management process (Treadwall, Vichinsky, & Frank, 2002). Research has demonstrated that when routine standardized nursing pain assessment is implemented, patients receive improved analgesia, experienced less pain, and are more satisfied with care (Treadwall et al., 2002). There have been a variety of tools developed to assess pain (Bouvette et al., 2001); however, inaccurate assessment of pain continues to exist (Shannon & Bucknell, 2003) .
The major barriers to effective pain management are incomplete and inconsistent assessment and documentation (Bouvette et al., 2001). A survey undertaken demonstrated that 45% of the nurses did not use a pain rating scale when assessing pain (de Rond et al., 1999). Furthermore, an audit of charts in one hospital revealed that 76% of the charts showed no evidence of nurses using an assessment tool or flow sheet measuring pain (Clarke et al., 1996). There have also been difficulties reported with various pain scales as some patients and their relatives experienced problems in associating numbers with particular grades of pain (Fenwick, 2006). There are disparities between nurses’ and patients ratings of pain that have been well documented in the literature; however, this may be caused by the different interpretations of pain scales (Manias, Botti, & Bucknall, 2002). Researchers also report inadequacies regarding documentation (Clarke et al., 1996). There are issues such as: not having a specific place to document pain assessment and/or ongoing treatment; or the failure to document the patient’s pain rating appropriately, which can result in the lack of adequate planning for pain management (McNeil, Sherwood, & Starck, 2004).
The difficulties associated with pain are that it is not like any other objective health problem (Resnik, Rehm, & Minard, 2001). Pain is highly subjective and does not fit into the casual, explanatory, clinical structure of scientific medicine (Resnik et al., 2001). Therefore, pain is often viewed unreal or merely psychological (Resnik et al., 2001). Numerous studies have shown that the patient’s self report is the most reliable indicator of pain, and given the subjective nature of pain, this self report is the optimal way to assess and treat the patient (McColl, Holden, & Bucschmann, 2001). However, many nurses’ do not use the patients self report of pain, but instead use their personal perceptions of the patients’ pain (Watson et al.,...
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