An exploration of factors impacting on changing pain assessment practice on a medical unit

• Main Author: Gregory, Julie
• Published: Manchester Metropolitan University 2011
• Subjects: 362.1960472
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.551269

This is a reflexive exploratory study examining the recognition and assessment of pain on a medical unit at a District General Hospital in the North West of England to answer the following research question: What factors impact on the management of pain and how can these be addressed when changing pain assessment practice on a medical unit? There had been little investigation into pain management specifically within medical wards prior to this study which explored pain assessment practice on the medical unit using action research to examine the factors influencing pain assessment practice and at the same time change practice. Following an initial assessment of practice and examination of pain assessment literature a theoretical framework was produced that identified seven elements relevant to pain assessment. The study interventions were guided by and tested the theoretical framework. During the study participation and collaboration between the researcher and practitioners developed resulting in a deeper understanding and awareness of everyday practice on the unit. This led to critical reflections and focus group discussions that enabled practitioners to change their practice. Over the study period documentation of pain assessment increased from 16% to 98%. The number of patients identified as requiring an intervention by the Acute Pain Team increased from 39 patients a year prior to the study to 181 patients a year. Knowledge of pain management was found to be variable and initially this knowledge was not used in practice. Observation of practice identified pain assessment as one of a large number of everyday requirements of a nurses' role which was not an aspect of nursing practice initially, but was conducted more consistently during the evaluation observation. This study identified five of the seven elements identified in the theoretical framework impacting on pain assessment on the medical unit. Two elements had strong influences on pain assessment practice. These were knowledge of pain and pain assessment and the context of clinical practice. The provision of education was an intervention used throughout the study to increase knowledge of pain management and was necessary to increase practitioners' awareness of pain assessment. The context of individual wards within the unit was found to influence the use of knowledge in practice. Attitudes and behaviour were affected by social norms, the values and beliefs and the history of a group, which in turn influenced the changes in practice. The consistent use of one pain assessment tool and the provision of a chart to record a pain score were identified as factors that increased the documentation of pain assessment but were affected by the context and practitioners awareness of pain assessment. The researcher's interventions were also found to be a strong factor influencing the changes in recognising and assessing pain.