Nurses' Knowledge, Attitudes, and Barriers Toward Pain Assessment and Management in Assir Region, Saudi Arabia

Predictive Clinical Factors of Pain-Related Quality of Recovery Following Elective Gastrointestinal and Hepato-Pancreato-Biliary Surgery: An Observational Study in Norway

Purpose

This observational cohort study aimed to identify predictive factors associated with pain-related quality of recovery among patients undergoing elective gastrointestinal and hepato-pancreato-biliary surgery.

Patients and Methods

This study involved a secondary analysis of the data collected from five hospitals across all healthcare regions in Norway to validate the Norwegian version of the Quality of Recovery-15 (QoR-15NO). The sample consisted of 268 adult patients who underwent elective gastrointestinal and hepato-pancreato-biliary surgery between September 2021 and May 2022. Data were collected using QoR-15NO upon admission for surgery and on the first postoperative day, and surgery severity was classified using the Surgical Outcome Risk Tool. A linear mixed model and multivariate linear regression were used to investigate associations between postoperative scores and possible predictive clinically relevant factors.

Results

The results of this study showed that postoperative pain was significantly associated with age, gender, severity of surgery, and changes from pre- to postoperative status. Younger patients, compared to older patients (b=0.23, 95% CI: [0.03, 0.41]), female patients (b=-0.61, 95% CI: [-1.19, -0.04]), patients undergoing minor and intermediate surgeries compared to major surgeries (b=0.96, 95% CI: [0.00, 1.92]) all reported higher levels of postoperative pain. There was a significant decline in QoR post-surgery due to increased pain severity (b=-1.91, 95% CI: [-2.33, -1.50]; p <0.001). No clinically significant associations were found between ASA physical status, surgery duration, and pain-related QoR.

Conclusion

This study identified age, gender, and surgery severity as key predictors of postoperative pain. Younger and female patients and those undergoing minor surgeries are at higher risk for severe postoperative pain. Proactive approaches for minor surgeries and tailored pain management for younger patients and females might enhance recovery and postoperative pain outcomes. Thus, future research should focus on the long-term effects of individualized pain management and additional strategies for high-risk patient groups.

Understanding nursing perspective towards barriers to the optimal delivery of enteral nutrition in intensive care settings

BACKGROUND

The management process of Enteral Nutrition (EN) typically involves the interaction between a team of health care practitioners. Nurses being the closest to the patients, have crucial responsibilities and play a major role in feeding delivery along with other medical treatments. This study was conducted to investigate the perception of the nurses working in adult and paediatric intensive care Units (ICUs) regarding the EN barriers and identify the factors that influenced their perception.

METHODS

The data in this cross-sectional study was collected via online survey between 15 October 2021 and January 2022. All nurses working in adult or paediatric ICUs across Saudi Arabia were eligible to participate. The tool used for the data collection was adapted from Cahill et al. (2016) and then reviewed and modified by the researchers. The survey collected information about the demographics of the nurses, and it included 24 potential EN barriers where the participants were asked to rate their importance on a scale from 1 to 5. Descriptive statistics were performed to describe the variables, univariant analysis were performed to compare the perceptions of the nurses regarding the EN barriers based on their characteristics followed by stepwise linear regression analysis.

RESULTS

A total of 136 nurses working in adult and paediatric ICUs were included in this study. The results showed that the most important barriers as perceived by the nurses was "Frequent displacement of feeding tube, requiring reinsertion" [3.29 ± 1.28], "Delays in initiating motility agents in patients not tolerating enteral nutrition" [3.27 ± 1.24] and "Enteral formula not available on the unit". [3.27 ± 1.24]. Our results showed that the responses of the participants statistically varied based on their work settings, gender, region, and educational level for some items in the survey (P-value ≤ 0.05). In the regression analysis, gender was the only variable statistically influenced the total Likert rating scores of the participants (r = -0.213, p-value = 0.013).

CONCLUSION

This study identified several barriers that exist in the nursing practice of EN in critical care settings. There are distinct differences in the perception of the nurses to these barriers based on their characteristics. Understanding such differences is important for implementing future strategies for units that needed the most help in prioritizing EN delivery.

Nurses' knowledge of and attitude toward postoperative patient-controlled analgesia (PCA) and the associated factors

BACKGROUND

Postoperative pain control is pivotal for surgical care; it facilitates patient recovery. Although patient-controlled analgesia (PCA) has been available for decades, inadequate pain control remains. Nurses' knowledge of and attitude toward PCA may influence the efficacy on clinic application.

PURPOSE

The purpose of this study is to evaluate nurses' knowledge of and attitude toward postoperative PCA and investigate the associated factors.

METHODS

This is a cross-sectional study. We enrolled registered nurses from a 2200-bed medical center in northern Taiwan within one year. The participants completed an anonymous self-reported PCA knowledge inventory and PCA attitude inventory. Data were analyzed descriptively and associated were tested using logistic regression.

RESULTS

With 303 participants enrolled, we discovered that nurses had limited knowledge of and a negative attitude toward PCA. Under half of the participants know how to set up a bolus dose and lockout intervals. The majority held misconceptions regarding side effect management for opioids. The minority agree to increase the dose when a patient experienced persistent pain or suggested the use of PCA. Surprisingly, participants with a bachelor's or master's degree had lower knowledge scores than those with a junior college degree. Those with 6-10 years of work experience also are lower than those with under 5 years of experience. However, the participants with experience of using PCA for patient care had higher knowledge scores and a more positive attitude.

CONCLUSIONS

Although postoperative PCA has been available for decades and education programs are routinely provided, nurses had limited knowledge of and a negative attitude toward PCA. A higher education level and longer work experience were not associated with more knowledge. The current education programs on PCA should be revised to enhance their efficacy in delivering up-to-date knowledge and situation training which may convey supportive attitude toward clinical application of PCA.

The Association between Socio-Demographic Characteristics and Using Pain Assessment Tools among Critically Ill Patients

Background and Objectives: Pain is still undertreated among ICU patients, especially cognitively impaired patients. Nurses play a crucial role in their management. However, previous studies found that nurses had insufficient knowledge about pain assessment and management. Some nurses' socio-demographic characteristics, such as being female; age; years of experience; type of unit, either medical or surgical; education level; years of nursing experience; qualification; position; and hospital level, were found to be associated with their practices of pain assessment and management. This study aimed to examine the association between nurses' socio-demographic characteristics and the use of pain assessment tools for critically ill patients. Materials and Methods: A convenience sample of 200 Jordanian nurses responded to the Pain Assessment and Management for the Critically Ill questionnaire to achieve the study's aim. Results: The type of hospital, academic qualification, years of experience as a critical care nurse, and hospital affiliation were significantly associated with increased use of self-report pain assessment tools for verbal patients, while the type of hospital and hospital affiliation was significantly associated with an increased use of observational pain assessment tools for nonverbal patients. Conclusion: Examining the association between socio-demographic characteristics and the use of pain assessment tools for critically ill patients is essential for quality pain practice.

Critical care nurses' perceived barriers and enablers of pain assessment and management

Aim: To examine critical care nurses' perceived barriers and enablers of pain assessment and management. Materials/methods: This descriptive correlational study recruited a convenience sample of 200 Jordanian nurses. Pain Assessment and Management for the Critically Ill questionnaire was used to measure the study variables. Results: The most common barriers to pain assessment and management were patient inability to communicate (57.5%), patient instability (56.5%), and the lack of protocols/guidelines for pain assessment (55.0%). Whereas the most common enablers for effective pain management practices were the ongoing education on pain for nurses (60.5%) and physicians who prescribe adequate doses of analgesia (60.0%). Conclusion: Addressing nurses' perceived barriers and the enablers of pain assessment and management is crucial for optimal pain practice.