Ineffective nurses role in pain management

Question: Think of a troubling condition you have had as a nursing student, as a practicing nurse, as an educator, or as a nurse administrator according to your experience and try to identify a problem that you wish to solve or to contribute to its solution. Ask yourself a series of questions until you have a researchable one. Try to formulate a related problem and purpose statement. Try to address a relevant research questions and do your best to make specific predictions about answers to pose hypotheses. Answer:

According to my personal experiences in clinical settings I wish to conduct a study to solve the following problem: Study title Ineffective nurse’s role in pain management in Jordanian hospitals.

Problem statement
Pain is a common problem among patients and it effects on patients’ quality of life. Effective pain management is a critical issue in health care, and it gives a significant indicator for a quality of care services which were provided to the patient. Literatures and reports revealed that the majority of patients continue to experience unnecessary pain and they receive inadequate pain management. Nurses play an important role to promote pain management practices for patients, a critical component of the nurse’s role in pain management is pain assessment, medications administration, organizing and delivering patient care activities, advocating for patient rights, educating patients and contact with physicians regarding changes in patient conditions; these nursing functions are critical in the management of pain.

Unfortunately nurses in Jordan face many challenges and barriers when they participate in pain management process. These barriers are related to nurses themselves, patient’s behaviors and attitudes toward pain management and organization regulations. As a result of such barriers nurses perform their role in pain management in an inefficient way. Ineffective pain management can cause negative health outcomes as leading patients to lose hope; decrease their response and compliance to treatment and damage their quality of life (Al-Atiyyat, 2008). All those consequences increase the cost and influence negatively in the quality of care. In Jordan, many studies conducted in the field of pain management specially pain with cancer patient, however the picture of pain management still needs more clarification. Upon my knowledge limited studies evaluated the all related barriers contributing the nurse’s role in pain management process from nurse’s perspectives. So this study will help to establish baseline information about the all related barriers that affect on nurse’s role in pain management, this information could guide health care administrators, decision makers and workers to suggest alternatives, protocols, policies and guidelines to improve nurse’s role in pain management. Purpose statement

The purpose of this study is to evaluate the effectiveness of nurse’s role in pain management, to investigate the barriers that affect on nurses role in pain management and to suggest alternatives to improve nurse’s role in pain management by addressing the all related barriers to pain management in Jordan.

Research Questions
1. Do nurses act effectively in pain management?
2. Why do many patients complain of unnecessary pain?
3. What are the Barriers that affect on the effectiveness of nurse’s role in pain management?
4. What are the areas in the nurse’s role in pain management that need improvement? Research Hypotheses

In order to answer the research questions I predict the following research hypotheses based on the barriers and challenges that affect on nurse’s role in pain management: (barriers to pain management are presented in page number 6) HA-1: There is a relationship between work overload and the efficiency of nursing role in pain management. HA-2: There is a relationship between the nurse’s knowledge level and the efficiency of nursing role in pain management. HA-3: The patient to nurse trust relation promotes the efficiency of nursing role in pain management. HA-4: Increase the level of authority that nurses had contributes positively in the efficiency of nursing role in pain management. Gathering information and analyzing problem

Clinical real scenario
According to my clinical practical, educational and administrative experiences in different health care settings in Jordan, I observed many behaviors indicate ineffective nurse’s role in pain management, here are some real situations and observations are considered such examples:

During my training experience as nursing student, while I was doing dressing with registered nurse to remove lines and chest tubes for the female patient, the patient was complaining of sever pain and she asked for analgesia, I told the incharge shift about patient needs, his answer was “ she has female syndrome, don’t worry”. Situation analysis: from this situation I have two questions: What would happen if the nurse believes in patient pain reporting? Does pain level depend on gender? As we know that pain is a pure subjective issue and it doesn’t depend on the gender differences, here is an example about nurse related barrier to pain management. A 3 years female child patient with first and second degree burns, the nurse did the dressing for her , then after doing the dressing she gave the patient a paracetamol suppository, even that the doctor order was to give pain killer before dressing not after.

The child was complaining of severe pain during dressing procedure, and she was crying a lot. Situation analysis: from this situation my question is what would happen if the nurse give the medication before doing the dressing procedure as doctor request? Also, here is an example about nurse related barrier to pain management. 68 years old patient asked to transfer him to more quiet room he said “I want to sleep, but I can’t because there are a lot of noisy sounds in the room, “the noisy sounds were from nurses, they were talking about their social issues” Situation analysis: from this situation my question is: isn’t our role to provide good and comfort environment to the patients? Also, here is an example about nurse related barrier to pain management.

In conclusion, previous real situations indicating and focusing the highlight to a big problem that is the ineffective nurses’ role in pain management process. In my opinion the ineffective nurse’s role is related to three main barriers: (1) the nurse related barriers (2) patient related barriers and (3) organization or system related barriers. In order to improve the nurse’s role in pain management we have to evaluate and screen all these barriers. Barriers to pain management

According to my clinical experiences, I think that the following barriers may influence in the efficiency of nurse’s role in pain management: Limited time to do good assessment for the patient, Work overload, Absence of authority to give medication for the patient who has acute pain, if the resident doctor delays in coming to prescribe the medication, Some patients don’t trust for nurses instructions and information about pain, Misbelieves between patients that pain management means addiction, Nurses knowledge deficit about certain issues as medication management, or dealing with addiction patient, Misbelieves between nurses that pain management is the role of physician not nurses, Some nurses believe that pain management means legal accountability; so they don’t like to be responsible for this role. Absence of commitment from nurses toward our profession, patient rights and nursing role

Reference
American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author Al-Atiyyat NM (2008). Patient-related barriers to effective cancer pain management. J Hosp Palliative Nurs 10(4):_198–204 Polit, D. & Beck, C. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice (8th ed.) Lippincott Williams and Wilkins. Philadelphia.