A Qualitative Study of Nurses' Perceptions of Narcotic Administration after Subarachnoid Hemorrhage

Perceptions of Nurses Regarding Opioid Administration: A cross-sectional study

BACKGROUND

Opioids are important drugs used in pain management due to their strong analgesic effects. However, there is limited research on nurses' perceptions of administering opioids.

PURPOSE

This study aims to determine nurses' perceptions of administering opioids.

DESIGN

This study used a descriptive cross-sectional design.

SETTINGS

A university hospital located in the south of Turkey.

METHODS

A self-reporting survey was provided to a convenience sample of 190 nurses. The data were collected with the "Introductory Information Form," and the "Nurses' Perceptions on Opioid Medications Administration Questionnaire." Descriptive statistics were applied for data analysis.

RESULTS

The mean age of the nurses was 33.11 ± 7.82 and 86.3% were female. The majority of the nurses did not receive any training on opioid administration other than their undergraduate education. Among the nursing staff, 90.0% expressed the importance of having trust in the prescribing doctor for their comfort in administering opioids. Of the nurses, 30% were undecided about "Nurses associate opioids with drug abuse." and 78.9% disagreed with the statement "Nurses often associate giving opioids with helping patients to die."

CONCLUSIONS

The results of this study provided further insight into nurses' perceptions of administering opioids that potentially contribute to pain management. Nurses had information needs and some prejudices regarding opioid administration. Also, relying on the prescribing doctor was important, and problems with prescribing were an obstacle to pain control.

CLINICAL IMPLICATIONS

Determining the knowledge and needs of nurses regarding opioid administration and providing in-service training on this subject would positively affect their approach to opioids.

Acute Headache Management for Patients with Subarachnoid Hemorrhage: An International Survey of Health Care Providers

BACKGROUND

Severe headaches are common after subarachnoid hemorrhage. Guidelines recommend treatment with acetaminophen and opioids, but patient data show that headaches often persist despite multimodal treatment approaches. Considering an overall slim body of data for a common complaint affecting patients with SAH during their intensive care stay, we set out to assess practice patterns in headache management among clinicians who treat patients with SAH.

METHODS

We conducted an international cross-sectional study through a 37-question Web-based survey distributed to members of five professional societies relevant to intensive and neurocritical care from November 2021 to January 2022. Responses were characterized through descriptive analyses. Fisher's exact test was used to test associations.

RESULTS

Of 516 respondents, 329 of 497 (66%) were from North America and 121 of 497 (24%) from Europe. Of 435 respondents, 379 (87%) reported headache as a major management concern for patients with SAH. Intensive care teams were primarily responsible for analgesia during hospitalization (249 of 435, 57%), whereas responsibility shifted to neurosurgery at discharge (233 of 501, 47%). Most used medications were acetaminophen (90%), opioids (66%), corticosteroids (28%), and antiseizure medications (28%). Opioids or medication combinations including opioids were most frequently perceived as most effective by 169 of 433 respondents (39%, predominantly intensivists), followed by corticosteroids or combinations with corticosteroids (96 of 433, 22%, predominantly neurologists). Of medications prescribed at discharge, acetaminophen was most common (303 of 381, 80%), followed by opioids (175 of 381, 46%) and antiseizure medications (173 of 381, 45%). Opioids during hospitalization were significantly more prescribed by intensivists, by providers managing higher numbers of patients with SAH, and in Europe. At discharge, opioids were more frequently prescribed in North America. Of 435 respondents, 299 (69%) indicated no change in prescription practice of opioids with the opioid crisis. Additional differences in prescription patterns between continents and providers and while inpatient versus at discharge were found.

CONCLUSIONS

Post-SAH headache in the intensive care setting is a major clinical concern. Analgesia heavily relies on opioids both in use and in perception of efficacy, with no reported change in prescription patterns for opioids for most providers despite the significant drawbacks of opioids. Responsibility for analgesia shifts between hospitalization and discharge. International and provider-related differences are evident. Novel treatment strategies and alignment of prescription between providers are urgently needed.