Ebrahim Khalighi1, Askar Soufinia2, Lale Solaimanizadeh3, Milad Borji4, Asma Tarjoman*5, Behrouz Soltany6, Hosein Hydaryian7
1-Assistant Professor of Anesthesiology, School of Medicine, Ilam University of Medical Sciences, Ilam, (Iran)
2- Assistant Professor of Cardiology, School of Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, (Iran)
3- Department of Nursing, Faculty of Nursing and Midwifery, Bam University of Medical Sciences, Bam, (Iran)
4- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, (Iran)
5- Student Research Committee, Ilam University of Medical Sciences, Ilam, (Iran)
6- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, (Iran)
7- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, (Iran)
Correspondence: Asma Tarjoman, Student Research committee, Ilam University of Medical Sciences, Ilam, (IR Iran): Tel: +98-918-340-4704;
E-mail: asmatarjoman@yahoo.com
Received: 8 September 2019;
Reviewed: 24, 30 September 2019; 6, 7 November 2019;
Revised: 5 November 2019;
Accepted: 12 November 2019
ABSTRACT
Introduction: Pain is a phenomenon that may be experience d every human being. Pain is one of the symptoms of the disease that has negative effects on patients and causes challenges in medical personnel. The aim of the present systematic review was to determine the knowledge, attitude, and pain management status in Iranian nurses.
Methodology: This is a systematic review carried out according to systematic review articles checklist (PRISMA). The search was conducted by two researchers separately. In case of inconsistency, the search was examined by a third researchers. In this study, articles that met the inclusion criteria and published between 2000 to June 2019, were included. The search process was carried out in Iranian and international databases. Data were reported in usinga descriptive method using Excel 2007 software.
Result: According to result 180 articles were extracted in the initial search, of which 50 were excluded from the study, and finally 19 articles entered the data extraction phase. The extracted articles were classified into 4 dimensions of knowledge, attitude, and practice in pain management, nurses'understanding of pain management, nurses' problems in pain relief, and the extent of pain management implementation and assessment, which are described as follows.
Conclusion: Nurses' knowledge, attitude, and managementregarding painmanagementis not in an excellent condition and many studies in Iran should include educational interventions for nurses to help improve their knowledge, attitude, and pain management.
Key words: Pain, Knowledge, Attitude, Practice, Nurse, Systematic Review
Citation: Khalighi E, Soufinia A, Solaimanizadeh L, Borji M, Tarjoman A, Soltany B, Hydaryian H. Knowledge, attitudes and barriers to pain management by nurses in Iran: A systematic review. Anaesth pain & intensive care 2019;23(4):360-369.
DOI: https://doi.org/10.35975/apic.v23i4.1168
INTRODUCTION
Nursing is a profession that plays an effective role in patient care,1,2 and it is important to provide compassionate nursing care.2 Nurses cooperate well together and this can improve the health of patients.3 One of the prerequisites for such goal is to have the specialized knowledge and knowledge required in nursing. Pain control is among the factors that require specialized knowledge.4, 5 Pain control is one of the tasks of nurses.6 Nurses' pain control can help improve the health of patients and it is essential to improve their knowledge and attitude.7, 8 In fact, all patients are entitled to pain relief, and one of the challenges for nurses is to ensure patient comfort and relieve pain.9
Pain is one of the symptoms of the disease that has negative effects on patients and causes challenges in medical personnel.10, 11 Pain is a phenomenon that may be experience d every human being.12-14 So that's the study Den Beuken-Van The prevalence of pain after treatment in cancer patients was 39.3%.15 also in the study Mansfield et al.showed prevalence of chronic widespread pain is between 0-24%.16 The pain had adverse effects on patients including poor mental health status,17 poor quality of life,18 and sleep disorders.19 Considering these negative effects, it is necessary to identify the factors affectingthe pain management and relief.20-22
Despite the great attention paid to the pain management program in nursing education and care programs, there are still challenges in this regard.23 So far, various tools have been designed to measure pain in patients or nurses24-26 and various studies have measured the knowledge and attitude of nurses and nursing students in this regard;5, 27, 28 however, the results of previous studies have provided different information. So that study showed that nursing students did not have knowledge and attitudes in pain management and assessment.5 Ekim, et al showed in a study that the highest score ranged between 15-65% and needed further training in this area.27 Al Qadire et al. also showed that nurses had a lower level of knowledge than other studies.28 The most common factors associated with inappropriate pain management may include nurses’ inadequate knowledge level, wrong assessment, shortage of nursing personnel, and fear of side effects of painkillers.29
AIM
Considering the role of nurses in pain control and management, as well as the role of pain in patients' quality of life, it is necessary to have access to sufficient information on knowledge, attitude, and barriers to pain management in nurses. This information can provide the pave the way for deciding o necessary interventions to improve nurses' knowledge, attitude, and barriers to pain management. Therefore, the aim of the present systematic review was to determine the knowledge, attitude, and pain management status in Iranian nurses.
METHODOLOGY
Study protocol
This is a systematic review carried out according to systematic review articles checklist (PRISMA).30 The search was conducted by two dominant researchers separately in the field of search. In case of inconsistency, the search was examined by a third researchers.
Search strategy
In this study, articles that met the inclusion criteria and published between 2000 to June 2019, were included. The search process was carried out in Iranian databases such as SID, Regional Information Center for Science and Technology (RICST), Mag-Iran, IranDoc, Barakat Knowledge Network System, Iranian National Library and international databases such as PubMed / Medline, Cochrane Library, Scopus, Science Direct, Web of Sciences, Embase, EBSCO, and Google Scholar. The search was performed using MESH-related English words and their Persian equivalents: "Pain", "Nurse", Knowledge "," Attitude "," Understanding "," Barriers "," Perspective "," Painkiller "," Pain Severity "," Pain control barriers "," Pain assessment "," Non-drug pain control "," Iran "and the above keywords were combined using " AND "and" OR "search strategies. An example of a search strategy in Pubmed is as follows:
(Pain[Title/Abstract]) OR Knowledge[Title/Abstract]) OR Attitude[Title/Abstract]) OR Understanding[Title/Abstract]) OR Barriers[Title/Abstract]) OR Perspective[Title/Abstract]) OR Painkiller[Title/Abstract]) OR Pain Severity[Title/Abstract]) OR Pain Control barriers[Title/Abstract]) OR Pain Assessment[Title/Abstract]) OR Non-drug Pain Control[Title/Abstract]) AND Iran[Title/Abstract]) AND Nurse[Title/Abstract])
Inclusion criteria
Inclusion criteria: Assessment of knowledge, attitude, pain management methods and factors related to the research topic in nurses, availability of full-text articles.
Exclusion criteria
Exclusion criteria: Interventional studies, case-control studies, review, qualitative and interventional studies, re-publish studies
Data extraction
A checklist including author's name, year of publication, location, sample size, method, questionnaire used, and findings were designed.
Statistical analysis
Data were reported in using a descriptive method using Excel 2007 software.
RESULTS
According to Figure 1, Number 80 articles were extracted in the initial search, of which 50 were excluded from the study, and finally 19 articles entered the data extraction phase (Figure 1). The extracted articles were classified into 4 dimensions of knowledge, attitude, and practice in pain management, nurses’ understanding of pain management, nurses' problems in pain relief, and the extent of pain management implementation and assessment, which are described as follows.
The findings of Table 1 show the status of Knowledge, attitude, and practice in pain management in Iranian nurses. According to the findings of this table, there were 8 studies in this field in which knowledge and attitude about pain management were not in excellent condition.
The findings of Table 2 show the results of studies of nurses' perceptions of pain in Iran. According to the findings, 3 studies were conducted in the Nurses of Rasht and Hamadan, which explained the perception of pain control in the findings of the table.
The findings in Table 3 showed the results of systematic reviews of Problems in Pain Relief. There were 5 articles in this field that showed that nurses' problems were in the studied areas.
The findings in Table 4 showed the results of systematic reviews of Problems in Implementation of pain management and assessment there were 5 articles in this field that showed that nurses' problems were in the studied areas.
DISCUSSION
Pain affects the health of patients and calls for special attention.47, 48 The aim of the present systematic review was to determine the knowledge, attitude, and pain management of nurses in Iran. The extracted articles were classified into 4 dimensions of knowledge, attitude, and practice in pain management, nurses’ perception of pain control, nurses' problems in pain relief, and frequency of pain management implementation and assessment.
The findings on the knowledge and attitude domain showed varying knowledge and attitude levels ranging from poor to high levels of knowledge and attitude; while the most common most knowledge and attitude scores were at the moderate range. Previous studies on the knowledge and attitude of nurses in Jordan,49 Saudi Arabia,25 and India50 showed that most of them had poor knowledge and attitude, which was inconsistent with the results of the present study. Lui et al. showed in a study in Hong Kong that nurses had a good attitude toward pain management but their practice and attitude were different.51 Alnajar et al. revealed in a study that 51.5% of nurses had a positive attitude toward pain management in cancer patients,8 which is consistent with the present study.
The findings also showed that another dimension included nurses' problems regarding pain management. The most important areas of nurses' problems included management, educational, environmental-equipment, and motivational dimensions. Shoqirat showed in a qualitative study that nurses 'problems in pain management were classified in two dimensions: patient-related problems (including patient violence, significant number of companions, etc.), and emergency-related problems (including physicians' mastery of pain management and shortage of nursing personnel). Nurses also emphasized the role of environmental factors on pain management.52 In the study of in the United States, Czarnecki et al. referred to inadequate physician prescriptions and low priority of pain management as barriers to pain management in nurses.53 Pretorius also stated in a study that pain management barriers included unwillingness to prescribe pain relievers, lack of time, heavy workload, and nurses’ lack of knowledge of narcotic use,54 which is consistent with the present study.
CONCLUSION
Nurses' knowledge, attitude, and management regarding pain management is not in an excellent condition and many studies in Iran should include educational interventions for nurses to help improve their knowledge, attitude, and pain management.
Acknowledgment: Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran (Grant Number: 3008508).
Conflict of Interests: No conflict of interest was reported.
Authors contribution: All authors took part in literature search, analysis and manuscript preparation.
REFERENCES
1-Assistant Professor of Anesthesiology, School of Medicine, Ilam University of Medical Sciences, Ilam, (Iran)
2- Assistant Professor of Cardiology, School of Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, (Iran)
3- Department of Nursing, Faculty of Nursing and Midwifery, Bam University of Medical Sciences, Bam, (Iran)
4- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, (Iran)
5- Student Research Committee, Ilam University of Medical Sciences, Ilam, (Iran)
6- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, (Iran)
7- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, (Iran)
Correspondence: Asma Tarjoman, Student Research committee, Ilam University of Medical Sciences, Ilam, (IR Iran): Tel: +98-918-340-4704;
E-mail: asmatarjoman@yahoo.com
Received: 8 September 2019;
Reviewed: 24, 30 September 2019; 6, 7 November 2019;
Revised: 5 November 2019;
Accepted: 12 November 2019
ABSTRACT
Introduction: Pain is a phenomenon that may be experience d every human being. Pain is one of the symptoms of the disease that has negative effects on patients and causes challenges in medical personnel. The aim of the present systematic review was to determine the knowledge, attitude, and pain management status in Iranian nurses.
Methodology: This is a systematic review carried out according to systematic review articles checklist (PRISMA). The search was conducted by two researchers separately. In case of inconsistency, the search was examined by a third researchers. In this study, articles that met the inclusion criteria and published between 2000 to June 2019, were included. The search process was carried out in Iranian and international databases. Data were reported in usinga descriptive method using Excel 2007 software.
Result: According to result 180 articles were extracted in the initial search, of which 50 were excluded from the study, and finally 19 articles entered the data extraction phase. The extracted articles were classified into 4 dimensions of knowledge, attitude, and practice in pain management, nurses'understanding of pain management, nurses' problems in pain relief, and the extent of pain management implementation and assessment, which are described as follows.
Conclusion: Nurses' knowledge, attitude, and managementregarding painmanagementis not in an excellent condition and many studies in Iran should include educational interventions for nurses to help improve their knowledge, attitude, and pain management.
Key words: Pain, Knowledge, Attitude, Practice, Nurse, Systematic Review
Citation: Khalighi E, Soufinia A, Solaimanizadeh L, Borji M, Tarjoman A, Soltany B, Hydaryian H. Knowledge, attitudes and barriers to pain management by nurses in Iran: A systematic review. Anaesth pain & intensive care 2019;23(4):360-369.
DOI: https://doi.org/10.35975/apic.v23i4.1168
INTRODUCTION
Nursing is a profession that plays an effective role in patient care,1,2 and it is important to provide compassionate nursing care.2 Nurses cooperate well together and this can improve the health of patients.3 One of the prerequisites for such goal is to have the specialized knowledge and knowledge required in nursing. Pain control is among the factors that require specialized knowledge.4, 5 Pain control is one of the tasks of nurses.6 Nurses' pain control can help improve the health of patients and it is essential to improve their knowledge and attitude.7, 8 In fact, all patients are entitled to pain relief, and one of the challenges for nurses is to ensure patient comfort and relieve pain.9
Pain is one of the symptoms of the disease that has negative effects on patients and causes challenges in medical personnel.10, 11 Pain is a phenomenon that may be experience d every human being.12-14 So that's the study Den Beuken-Van The prevalence of pain after treatment in cancer patients was 39.3%.15 also in the study Mansfield et al.showed prevalence of chronic widespread pain is between 0-24%.16 The pain had adverse effects on patients including poor mental health status,17 poor quality of life,18 and sleep disorders.19 Considering these negative effects, it is necessary to identify the factors affectingthe pain management and relief.20-22
Despite the great attention paid to the pain management program in nursing education and care programs, there are still challenges in this regard.23 So far, various tools have been designed to measure pain in patients or nurses24-26 and various studies have measured the knowledge and attitude of nurses and nursing students in this regard;5, 27, 28 however, the results of previous studies have provided different information. So that study showed that nursing students did not have knowledge and attitudes in pain management and assessment.5 Ekim, et al showed in a study that the highest score ranged between 15-65% and needed further training in this area.27 Al Qadire et al. also showed that nurses had a lower level of knowledge than other studies.28 The most common factors associated with inappropriate pain management may include nurses’ inadequate knowledge level, wrong assessment, shortage of nursing personnel, and fear of side effects of painkillers.29
AIM
Considering the role of nurses in pain control and management, as well as the role of pain in patients' quality of life, it is necessary to have access to sufficient information on knowledge, attitude, and barriers to pain management in nurses. This information can provide the pave the way for deciding o necessary interventions to improve nurses' knowledge, attitude, and barriers to pain management. Therefore, the aim of the present systematic review was to determine the knowledge, attitude, and pain management status in Iranian nurses.
METHODOLOGY
Study protocol
This is a systematic review carried out according to systematic review articles checklist (PRISMA).30 The search was conducted by two dominant researchers separately in the field of search. In case of inconsistency, the search was examined by a third researchers.
Search strategy
In this study, articles that met the inclusion criteria and published between 2000 to June 2019, were included. The search process was carried out in Iranian databases such as SID, Regional Information Center for Science and Technology (RICST), Mag-Iran, IranDoc, Barakat Knowledge Network System, Iranian National Library and international databases such as PubMed / Medline, Cochrane Library, Scopus, Science Direct, Web of Sciences, Embase, EBSCO, and Google Scholar. The search was performed using MESH-related English words and their Persian equivalents: "Pain", "Nurse", Knowledge "," Attitude "," Understanding "," Barriers "," Perspective "," Painkiller "," Pain Severity "," Pain control barriers "," Pain assessment "," Non-drug pain control "," Iran "and the above keywords were combined using " AND "and" OR "search strategies. An example of a search strategy in Pubmed is as follows:
(Pain[Title/Abstract]) OR Knowledge[Title/Abstract]) OR Attitude[Title/Abstract]) OR Understanding[Title/Abstract]) OR Barriers[Title/Abstract]) OR Perspective[Title/Abstract]) OR Painkiller[Title/Abstract]) OR Pain Severity[Title/Abstract]) OR Pain Control barriers[Title/Abstract]) OR Pain Assessment[Title/Abstract]) OR Non-drug Pain Control[Title/Abstract]) AND Iran[Title/Abstract]) AND Nurse[Title/Abstract])
Inclusion criteria
Inclusion criteria: Assessment of knowledge, attitude, pain management methods and factors related to the research topic in nurses, availability of full-text articles.
Exclusion criteria
Exclusion criteria: Interventional studies, case-control studies, review, qualitative and interventional studies, re-publish studies
Data extraction
A checklist including author's name, year of publication, location, sample size, method, questionnaire used, and findings were designed.
Statistical analysis
Data were reported in using a descriptive method using Excel 2007 software.
RESULTS
According to Figure 1, Number 80 articles were extracted in the initial search, of which 50 were excluded from the study, and finally 19 articles entered the data extraction phase (Figure 1). The extracted articles were classified into 4 dimensions of knowledge, attitude, and practice in pain management, nurses’ understanding of pain management, nurses' problems in pain relief, and the extent of pain management implementation and assessment, which are described as follows.
The findings of Table 1 show the status of Knowledge, attitude, and practice in pain management in Iranian nurses. According to the findings of this table, there were 8 studies in this field in which knowledge and attitude about pain management were not in excellent condition.
The findings of Table 2 show the results of studies of nurses' perceptions of pain in Iran. According to the findings, 3 studies were conducted in the Nurses of Rasht and Hamadan, which explained the perception of pain control in the findings of the table.
The findings in Table 3 showed the results of systematic reviews of Problems in Pain Relief. There were 5 articles in this field that showed that nurses' problems were in the studied areas.
The findings in Table 4 showed the results of systematic reviews of Problems in Implementation of pain management and assessment there were 5 articles in this field that showed that nurses' problems were in the studied areas.
DISCUSSION
Pain affects the health of patients and calls for special attention.47, 48 The aim of the present systematic review was to determine the knowledge, attitude, and pain management of nurses in Iran. The extracted articles were classified into 4 dimensions of knowledge, attitude, and practice in pain management, nurses’ perception of pain control, nurses' problems in pain relief, and frequency of pain management implementation and assessment.
The findings on the knowledge and attitude domain showed varying knowledge and attitude levels ranging from poor to high levels of knowledge and attitude; while the most common most knowledge and attitude scores were at the moderate range. Previous studies on the knowledge and attitude of nurses in Jordan,49 Saudi Arabia,25 and India50 showed that most of them had poor knowledge and attitude, which was inconsistent with the results of the present study. Lui et al. showed in a study in Hong Kong that nurses had a good attitude toward pain management but their practice and attitude were different.51 Alnajar et al. revealed in a study that 51.5% of nurses had a positive attitude toward pain management in cancer patients,8 which is consistent with the present study.
The findings also showed that another dimension included nurses' problems regarding pain management. The most important areas of nurses' problems included management, educational, environmental-equipment, and motivational dimensions. Shoqirat showed in a qualitative study that nurses 'problems in pain management were classified in two dimensions: patient-related problems (including patient violence, significant number of companions, etc.), and emergency-related problems (including physicians' mastery of pain management and shortage of nursing personnel). Nurses also emphasized the role of environmental factors on pain management.52 In the study of in the United States, Czarnecki et al. referred to inadequate physician prescriptions and low priority of pain management as barriers to pain management in nurses.53 Pretorius also stated in a study that pain management barriers included unwillingness to prescribe pain relievers, lack of time, heavy workload, and nurses’ lack of knowledge of narcotic use,54 which is consistent with the present study.
CONCLUSION
Nurses' knowledge, attitude, and management regarding pain management is not in an excellent condition and many studies in Iran should include educational interventions for nurses to help improve their knowledge, attitude, and pain management.
Acknowledgment: Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran (Grant Number: 3008508).
Conflict of Interests: No conflict of interest was reported.
Authors contribution: All authors took part in literature search, analysis and manuscript preparation.
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