Nursing Paper on Identifying Barriers to Pain Management in Long-Term Care

Identifying Barriers to Pain Management in Long-Term Care

Identifying Barriers to Pain Management in Long Term Care by Egan & Cornally (2013) examined patient, caregiver, and organizational-related issues that hinder pain management in long term care. A large number of long-term care (LTC) suffer chronic pain, which, when unresolved, can lead to complications such as loss of function, depression and anxiety, lack of interest in socialization, and sleep disturbance. Since these complications would have adverse effects on quality of life, effective pain management is essential in long-term care. The research was conducted at three LTC facilities with 83 participants. The researchers aimed at studying the barriers to pain management in LTC from a nursing perspective in order to deliver a multifaceted approach to pain management.

Egan & Cornally’s research aims at identifying the extent to which issues related to caregivers, patients, and organizations hinder the delivery of optimal pain management (2013). This research question is important because it provides a different approach to this problem, which widens the scope of the practice of pain management. LTC residents suffering from chronic pain, according to the American Geriatrics Society (AGS), ranges between 45% and 80% (2002). The past studies in this discipline have revealed barriers like pain management knowledge deficit, patient’s fear of medication and cognitive impairment, and lack of or inadequate policies on pain management treatment. Various researchers including Baier et al. have revealed the effectiveness of a multifaceted approach to enhance the practice of pain management (2004). Furthermore, Blomqvist notes that efforts to relieve pain can be greatly influenced by caregivers’ perceptions on the validity of the patient’s pain (2003). No study has examined nurses’ perceptions on patient, caregiver, and organizational barriers to pain management. Egan & Cornally, therefore, explore the extent to which registered Nurses (RN) perceive barriers to pain management (2013). The findings will provide a clear understanding of nurses’ experiences, which will guide the development of strategies of effective pain management.

The present study is a quantitative, cross-sectional, descriptive design. Cross-sectional designs are fast and inexpensive since data is collected using self-report surveys, enabling researchers to analyze data from a bigger sample size (HealthKnowledge, 2017). Since this type of study involves participants with different key characteristics, researchers are able to collect different variables. This helps them to determine how differences like age, education, sex, and social status influence the critical variable being studied (HealthKnowledge, 2017). Also, cross-sectional study designs provide useful information to further research. The involvement of people with varying key characteristics can provide new discoveries not intended to be studied at the time of the research. However, finding specific participants with similar characteristics but vary in others can be a daunting task since studies of this nature always require large samples for effectiveness. The researchers utilized this design to reduce the likelihood of generating atypical results, which could hinder generalisability.

The research sample consisted of 83 nurses working with older people in three public and two private LTC facilities. Even though 83 is not a great number for an effective study, the use of multi-cites validates the findings of the study. Nurses from different facilities, including private and public, provide a wide scope of experiences in different environments. The findings can be related to other nursing populations in private and public hospitals. Also, the sample included varying ages, educational level, and job position. However, since the sample included only four male nurses among the 83, views of the male nurses are underrepresented, undermining the generalisability of the findings to the male population. Also, occasional part-time nurses were only three while only one had an MSc degree. Due to the small representations of the two mentioned groups, it is difficult to apply the findings on other similar groups.

Self-report questionnaires were used to collect data. Coker et al.’s questionnaire design was utilized but modified for use with nurses in LTC facilities (2010). The questionnaire consisted of two parts. Part 1 had questions on barriers to pain management while part 2 aimed at collecting demographic information of the participants. The questions in the first part had multiple choices with numerical values. The second part’s questions intended to record demographic characteristics to suit an Irish setting. The Statistical Package for Social Sciences version 20.0 for Windows was utilized in statistical analysis of the data. Descriptive statics like averages and percentages were used to describe data (Egan & Cornally, 2013). The researchers were given ethical approval from the Cork Teaching Hospital’s clinical research ethics committee.

While the study was performed in multi-cites with a varied sample, groups like male nurses, part-time nurses, MSc degree holders, and nurses between ages 20 and 29 are underrepresented. As a result, it is difficult to generalize the findings to these groups. Furthermore, one facility only has 5 participants, a size that is too small to represent the experiences of the nurses at the facility. The researchers only focused on the Irish nurses, which undermines the application of the findings to other cultures. Additionally, since self-reports were used to collect data, participants are likely to submit inaccurate responses, invalidating the findings. For effective results, future studies can ensure to achieve gender balance and represent all demographic categories equally. Also, cultural diversity can be achieved by conducting research in different cultural settings.

The most reported caregiver-related barrier is the administration of antipsychotics before pain medication. Poor communication between nurses and physicians was also cited as a barrier to optimal pain management. Nurses with more experience were most likely to report more negative barriers compared to those with less nursing experience (Egan & Cornally, 2013). Participants also highlighted poor communication by patients due to sensory impairment as a barrier to the practice of pain management. When patients are unable to communicate effectively about their pain, they are susceptible to receiving sub-optimal treatment. Patients’ need to endure and hide pain was also reported by the patients. Stoic patients do not feel the need of communicating their pain to family or caregivers, which deters pain management. Among organizational-related barriers, lack of opportunities to discuss patient’s conditions with the care team was the most reported (Egan & Cornally, 2013). Another obstacle was inadequate time invested in health teaching of older patients. Despite underrepresentation of other groups in the sample population, the findings are credible since they were provided nurses from different facilities, with different experiences, positions, among other demographic variables.

The present study aimed at examining the limiting factors in pain management in LTC. The study involved nurses from three public and two private facilities of LTC and elf-report questionnaires were utilized in the study. The researchers revealed barriers like poor communication between physicians and nurses, administration of psychotics before pain relievers, and patient’s poor communication due to sensory impairment. The findings of the present study, however, are not different from the previous studies’.  Nonetheless, strategies like collaboration between physicians and nurses and the prioritization of patient pain management in organizations should be emphasized. Non-pharmacologic pain management methods should also be promoted in facilities in order to maximize the results.

References

American Geriatrics Society. (2012). The management of persistent pain in older persons. Journal of the American Geriatrics Society, 50(6), 205-224. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12067390

Baier, R., Gifford, D., & Party, G. (2004). Ameliorating pain in nursing homes: a collaborative quality-improvement project. Journal of the American Geriatrics Society, 52(12), 1988-1882. Retrieved from https://www.google.com/search?q=Ameliorating+pain+in+nursing+homes%3A+a+collaborative+quality-improvement+project&oq=Ameliorating+pain+in+nursing+homes%3A+a+collaborative+quality-improvement+project&aqs=chrome..69i57.259j0j7&sourceid=chrome&ie=UTF-8

Blomqvist, V. (2003). Older people in persistent pain: nursing and paramedical staff perceptions and nursing management. Journal of Advanced Nursing, 41(6), 1877-1882. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12622866

Coker, E., Papaioannou, A., & Kaasalaleinen, S. (2010). Nurses’ perceived barriers to optimal pain management in older adults on acute medical units. Applied Nursing Research, 23(3), 139-146). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20643323

Egan, M. & Cornally, N. (2013, Sep). Identifying barriers to pain management in long-term care. Nursing Older People, 25(7), 25-31. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23984702

HealthKnowledge. (2017). Designs, applications, strengths, and weaknesses of cross-sectional, analytical studies (including cohort, case-control and nested case-control studies). HealthKnowledge. https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-epidemiology/cs-as-is