What Were They Thinking? Nursing Students' Thought Processes Underlying Pain Management Decisions

Article excerpt

ABSTRACT Patients' pain has not been adequately controlled due to inaccurate assessments, inadequate treatments, and inconsistent nursing care. The purpose of the study was to determine the extent of nursing students' accuracy in assessment ratings and treatment choices for patients in a case vignette who were experiencing pain and then to determine the thought processes underlying their decisions. Written rationales in response to two patient scenarios reveal students' thought processes when recording pain intensity levels on a numerical scale and choosing corresponding dosages of analgesics. Data collected from junior and senior nursing students provide insight for nurse educators and point to areas where curricula and instruction may be enhanced. Reforming teaching and learning practices when educating students about pain management could decrease patient suffering and lead to improved comfort and satisfaction.

Key Words Pain Assessment--Pain Management--Nursing Education--Andrew-Robert Survey--Subjective Pain Rating

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ONE HINDRANCE TO EFFECTIVE PAIN ASSESSMENT AND TREATMENT IS THE INABILITY TO ACCURATELY MEASURE AND MONITOR THE INTENSITY OF A PATIENT'S PAIN. Health care providers are responsible for assessing and treating pain based on a patient's verbal and nonverbal communication. But inconsistencies exist in the nursing process, based largely on such variables as a nurse's educational preparation, specialty area, and personal experience caring for others. These various factors may influence nurses' responses to and beliefs about pain (Brunier, Carson, & Harrison, 1995). * When treatment decisions are based on patients' behavioral responses, at the exclusion of verbal ratings, misinterpretation is likely to occur. Schilling (2003) recommends the following pain assessment technique: "Ask the patient to rank his pain on a scale of 0-10, with o denoting lack of pain and 10 denoting the worst pain level." According to McCaffery (1968), "Pain is what the experiencing person says it is, existing whenever he says it does" (p. 95). * As nursing students hold their own beliefs about proper ways to manage pain, it is important that faculty, early in the course of study, assess students' knowledge and attitudes about the treatment of pain. The nursing curriculum and instruction should not only include pathology and pain management, but current research on common misconceptions held by nurses about pain control. THE PURPOSE OF THIS STUDY WAS TO DETERMINE NURSING STUDENTS' ACCURACY IN ASSESSMENT RATINGS AND TREATMENT CHOICES FOR PATIENTS EXPERIENCING PAIN, AND THEN TO DETERMINE THE THOUGHT PROCESSES LEADING TO THEIR DECISIONS.

Review of the Literature Although some advancements have been made, knowledge deficits and misconceptions held by nurses, patients, and family members continue to inhibit pain relief and limit quality of life. The literature points to numerous reasons why this situation continues to exist in health care, including myths held by the general public, exaggerated fears about addiction, and knowledge deficits (Lasch et al., 2002).

McCaffery and Ferrell (1991) developed a case vignette instrument to assess how nurses rate a patient's pain intensity on a numerical rating scale. The researchers surveyed 456 hospital staff nurses in six cities, using a vignette where one patient displays expected or typical behavioral manifestations, while another expresses unexpected verbal and nonverbal reactions to pain. Both patients rate their own pain as 4 on a 0-5 scale. Using this scale, 40.7 percent of the nurses recorded the smiling patient's pain as 4, in contrast to 71.6 percent who recorded the grimacing patient's pain as 4. The authors noted that "a simple behavior such as smiling or grimacing isn't strong enough evidence to conclude that a patient's pain rating is anything other than what he says it is. In fact, research has repeatedly shown that many patients with pain deliberately smile or laugh, either to help themselves cope with the pain or to try to hide their pain from others" (p. …