MANAGEMENT KNOWLEDGE, ATTITUDES AND CLINICAL-PRACTICE - THE IMPACT OFNURSES CHARACTERISTICS AND EDUCATION

This study examined the knowledge attitudes, and clinical practice of registered nurses (N = 120) regarding pain management. Data were colle cted from nine varied clinical units in a large, university-affiliated , teaching hospital in an urban area of the Northeast. Demographic inf ormation was also collected to explore the relationship between nurses ' characteristics, including previous pain education, clinical experie nce, area of clinical practice, and other variables, and knowledge, at titudes, and clinical practice. Three instruments were wed in the stud y: (a) the Pain Management: Nurses' Knowledge and Attitude Survey; (b) a 12-item demographic questionnaire; and (c) a Pain Audit Tool (PAT) to gather data regarding pain assessment, documentation, and treatment practices from charts. Mean scores frp, the nursing knowledge and att itudes survey on pain revealed knowledge deficits and inconsistent res ponses in many areas related to pain management (mean, 62%; range, 41% -90%). The top two nurse-ranked barriers to pain management were relat ed to patient reluctance to report pain and to take opioids for pain r elief Demographic data revealed that education about pain was most ina dequate in the following area: nonpharmacological interventions to rel ieve pain, the difference between acute and chronic pain, and the anat omy and physiology of pain. Chart audits with the Pain Audit Tool reve aled that 76% of the charts (N = 82) lacked documentation of the we of a patient self-rating tool by nurses to assess pain, despite a high r eported we (76%) of such a self-rating tool. Adjunct medications were ordered with some consistency but appeared to be underutilized. This w as especially true of nonsteroidal anti-inflammatory agents (mean use, 1%). Ninety percent of the charts had no documentation of the we of n onpharmacological interventions to relieve pain. Although this clinica l setting has policies and resources in place regarding the management of pain, it would appear that they are not optimal. Practical recomme ndations are presented for increasing nurses' knowledge about pain man agement; improving the quality and the consistency of the assessment, documentation and treatment of pain; and disseminating pain management information.