Emergency nurses’ perceptions and practices in assessing and managing acute pain in critically ill adult patients: a mixed-methods study
- Publication Type:
- Thesis
- Issue Date:
- 2023
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Background: Over three-quarters of patients presenting to an emergency department (ED) do so due to pain; of note, over 60% of critically ill patients experience severe pain that is unrelieved during care. Critically ill patients experience pain from multiple intrinsic and extrinsic sources in the process of resuscitation and stabilisation. While emergency nurses are positioned to manage acute pain, complexity of nursing practice, judgment and factors influencing pain management for critically patients in this clinical context remains unknown.
Aim: The primary study aim was to explore emergency nurses’ perceptions and practices managing acute pain in critically ill adult patients.
Method: An explanatory sequential mixed-methods study design was used. Phase 1 was a quantitative survey utilised to identify emergency nursing pain management practice. Phase 2 comprised non-participant observations of nursing pain management practices in the resuscitation area (156.5 hours) of two trauma designated EDs in New South Wales, with concurrent semi-structured interviews (n=30) exploring nurse perceptions of pain management in critically ill patients.
Findings: The study identified that the emergency nurse was primarily responsible for the continuity of patient care and optimisation of pain control for critically ill patients. Survey results highlighted significant gaps in policy, pain management knowledge and training, poor ability to influence pain control or goals, and limited use of evidence-based pain assessment instruments. Findings were supported from observations and interviews of nurses working in the resuscitation area. Observation and interview findings identified that nurses were less confident in their ability to detect and manage acute pain in non-verbal or unconscious critically ill patients. While nurses actively sought ways to provide a reassuring presence and comfort to critically ill patients, this was limited by unpredictable workloads, availability of staff, and communication challenges.
Conclusion: Timely effective pain management in critically ill patients relies upon the knowledge, skills, expertise and confidence of the emergency nurse. However, poor levels of pain management knowledge, unpredictable workloads, geographical isolation, communication, and lack of evidence-based tools or protocols, increases the risk of poor pain management in critically ill or injured patients. Further investigations are urgently needed to examine interventions to develop effective training and education, and guidelines to assist emergency nurses manage acute pain for critically ill patients.
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