After institutional review board approval, an online examine was sent to 104 nurses from the two nursing units. Before sending the survey, two educators, four nurses, and the center’s nursing research committee established the content validity of the survey method by reviewing it and reaching a consensus.
The survey method consisted of 15 items. Of these, three demographic items spoke of age, sex, and length of experience as a nurse; two items asked whether the nurse believed she understood nonpharmacologic pain interventions and whether she had used any combination of pharmacologic and nonpharmacologic interventions in her nursing practice, and ten items addressed the use or nonuse of nonpharmacologic interventions.
Data from patient interviews and data review from the Hospital Consumer Healthcare Providers and Systems (HCAHPS ) examine addressed the efficacy of pain management and non-pharmacological interventions and allowed data triangulation. For patient interviews, the principal investigator asked the nurse manager of each unit to recommend patients who were not disoriented but had reported pain.
The principal investigator then went to visit the suggested patients (eight in each unit) and asked them the following questions:
- Do you feel your nurse(s) have managed your pain well?
- Have you noticed if techniques other than pharmacological (medications) have been used to support pain treatment?
- If so, which ones? Hot or cold therapy, music, positioning/repositioning, relaxation and imagery, spiritual practices, superficial massage.
- Have non-pharmacological interventions helped?
- During your stay, has more than one nurse offered you any non-pharmacological intervention for pain?
- Per hospital protocol, HCAHPS surveys emailed to patients after discharge include several items dedicated to patient care and satisfaction. For this study, the HCAHPS analysis was limited to patient responses to one survey item: “During your hospital stay, how often did the hospital staff do everything possible to help you with your pain?”
Discussion And Implications
It was encouraging that all nurses stated that they understood non-pharmacological interventions and reported using pharmacological and non-pharmacological interventions in their nursing practice. However, the limited use of some of the non-pharmacological interventions, such as light massage, relaxation, imagery, and spiritual practices, indicates that more staff training is needed to better encourage the adoption of these strategies. Furthermore, TENS was rarely used as a non-pharmacological intervention. Only seven nurses (10.3%) indicated that they used this intervention. In the center in question, the application of TENS requires a medical prescription. Considering that the systematic review of six studies on TENS showed that it reduces pain
Therefore, education on this strategy and its benefits may prompt nurses to request this intervention when reporting a patient’s pain.
Patient interviews were used, and the principal investigator conducted all interviews. However, he did not review medical records, so it was not clear either the cause or site of the pain or whether the patient’s pain was acute or chronic. In addition, the question to patients about whether their pain has been adequately managed may need to be rephrased more precisely, such as: “Describe how the nurses have tried to relieve your pain.” Based on the response to this open-ended item, the principal investigator could list pharmacological and non-pharmacological interventions and ask which interventions were used.
Although the findings revealed three cases of significance related to the length of nursing experience and specific non-pharmacological interventions, the limitations of this study must be considered. Among these limitations, we find the case of cross-sectional data collection through a convenience sample of nurses in a tertiary care medical center and a relatively small number of patient interviews. Still, the findings provide a foundation for this critical and timely issue and offer further research opportunities. The continued study could shed light on current practice, changing trends in non-pharmacological interventions, and nurses’ age and work experience influence on non-pharmacological interventions.…