Pain management of adult sedated and ventilated patients in the intensive care units: A survey with free text responses

Background

Pain management of sedated and ventilated patients in intensive care units lacks consistency.

Objectives

To investigate nurses’ training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses’ perspectives.

Methods

A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to.

Outcome measures

Demographics, training, governance, clinical practice, knowledge, and attitudes.

Results/findings

108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor’s preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses’ knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between “knowledge scores” and “years of ICU experience” and weak negative relationship r = [-0.119], p = [0.260] between “knowledge scores” and “hours of clinical practice” was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: “Pain assessment, where is it?” And “Priorities of critical illness.”

Conclusion

The study uncovered pain management situation and examined nurses’ demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management.

Implications for clinical practice

Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses’ role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.