https://doi.org/10.4081/scenario.2023.568

Pain management in the Emergency Department: a phenomenological study on nurses’ experiences

Vol. 40 No. 4 (2023)
Submitted: 29 October 2023
Accepted: 2 December 2023
Published: 20 December 2023
Analgesia, caregivers, emergency department, emergency nursing, pain, pain assessment
Abstract Views: 540
PDF: 114
PDF (Italiano): 295
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Catia Lenza
https://orcid.org/0009-0003-9768-8242
Emergency Department, Azienda Ospedaliera Sant'Anna e San Sebastiano, Caserta (CE); Master's degree in critical care nursing, Department of Medical and Surgical Sciences, University of Bologna, Italy.
Lara Meggiato
https://orcid.org/0009-0006-8088-9509
Master's degree in critical care nursing, Department of Medical and Surgical Sciences, University of Bologna; Emergency and SUEM, ULSS 3 Serenissima, Dolo (VE), Italy.
Vittoria Santuri
https://orcid.org/0009-0000-0525-3996
Master's degree in critical care nursing, Department of Medical and Surgical Sciences, University of Bologna; Emergency and SUEM, ULSS3 Serenissima, Mirano (VE), Italy.
Liliana Vivona
Master's degree in critical care nursing, Department of Medical and Surgical Sciences, University of Bologna; Pronto Soccorso Centrale, Azienda Ospedaliera di Padova (PD), Italy.
Stefano Sebastiani
https://orcid.org/0000-0002-3865-9818
Master's degree in critical care nursing, Department of Medical and Surgical Sciences, University of Bologna; Professional development and implementation of research in health professions, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
Boaz Gedaliahu Samolsky Dekel
https://orcid.org/0000-0002-9954-4117
Master's degree in critical care nursing, Department of Medical and Surgical Sciences, University of Bologna; Department of Medical and Surgical Sciences, University of Bologna, Italy.
Guglielmo Imbriaco
guglielmo.imbriaco.work@gmail.com
https://orcid.org/0000-0003-2385-989X
Master's degree in critical care nursing, Department of Medical and Surgical Sciences, University of Bologna; Department of Medical and Surgical Sciences, University of Bologna; Eastern Emilia Operations Center 118, AUSL of Bologna , Italy.

Introduction: pain is a subjective and complex phenomenon, representing the first cause of access to Emergency Departments. Early management of pain through nurse-led analgesia protocols improves outcomes and patient satisfaction.

Aim: this study aims to analyse the experiences of triage nurses regarding the pain of adult patients admitted to the Emergency Department, highlighting the main barriers to an objective pain assessment and the strategies adopted to manage it, to improve proper pain management.

Materials and Methods: this qualitative study has an interpretative phenomenological design; data is collected through semi-structured interviews. The study is reported according to the COREQ-32 checklist.

Results: twenty nurses in the Veneto region (Italy) Emergency Departments were interviewed. Seven themes were identified: nurse-led analgesia protocols, pain management in children, non-pharmacological interventions, differences between acute and chronic pain, the role of caregivers of elderly/cognitively impaired patients, nurses’ personal experience of pain, and objectivity of nurses’ pain assessment.

Conclusions: the interviews revealed a series of factors hindering optimal pain management related to the setting, such as Emergency Department overcrowding, or categories of difficult patients, such as children or elderly people with cognitive impairments. Positive experiences have also emerged, such as the usefulness of non-pharmacological techniques and the participatory role of family members and caregivers, during pain assessment of cognitively impaired patients.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Van Woerden G, Van Den Brand CL, Den Hartog CF, et al. Increased analgesia administration in emergency medicine after implementation of revised guidelines. Int J Emerg Med 2016;9:4.
Pretorius A, Searle J, Marshall B. Barriers and enablers to emergency department nurses' management of patients' pain. Pain Manag Nurs 2015;16:372-9.
Cabilan CJ, Boyde M. A systematic review of the impact of nurse-initiated medications in the emergency department. Australas Emerg Nurs J 2017;20:53-62.
Varndell W, Fry M, Elliott D. Quality and impact of nurse-initiated analgesia in the emergency department: A systematic review. Int Emerg Nurs 2018;40:46-53.
Muscat C, Fey S, Lacan M, et al. Observational, Retrospective Evaluation of a New Nurse-Initiated Emergency Department Pain Management Protocol. Pain Manag Nurs 2021;22:485-9.
Burgess L, Kynoch K, Theobald K, et al. The effectiveness of nurse-initiated interventions in the Emergency Department: A systematic review. Australas Emerg Care 2021;24:248-54.
Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med 2004;43:494-503.
Brown T, Shetty A, Zhao DF, et al. Association between pain control and patient satisfaction outcomes in the emergency department setting. Emerg Med Australas 2018;30:523-9.
Hachimi-Idrissi S, Coffey F, Hautz WE, et al. Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines-part 1: assessment. Intern Emerg Med 2020;15:1125-39
Carter D, Sendziuk P, Eliott JA, Braunack-Mayer A. Why is Pain Still Under-Treated in the Emergency Department? Two New Hypotheses. Bioethics 2016;30:195-202.
Todd KH. A Review of Current and Emerging Approaches to Pain Management in the Emergency Department. Pain Ther 2017;6:193-202.
Fosnocht DE, Heaps ND, Swanson ER. Patient expectations for pain relief in the ED. Am J Emerg Med 2004;22:286-8.
Vuille M, Foerster M, Foucault E, Hugli O. Pain assessment by emergency nurses at triage in the emergency department: A qualitative study. J Clin Nurs 2018;27:669-76.
Admassie BM, Lema GF, Ferede YA, Tegegne BA. Emergency nurses perceived barriers to effective pain management at emergency department in Amhara region referral hospitals, Northwest Ethiopia, 2021. Multi-center cross sectional study. Ann Med Surg (Lond) 2022;81:104338.
Wheeler E, Hardie T, Klemm P, et al. Level of pain and waiting time in the emergency department. Pain Manag Nurs 2010;11:108-14.
Martorella G, Kostic M, Lacasse A, et al. Knowledge, Beliefs, and Attitudes of Emergency Nurses Toward People With Chronic Pain. SAGE Open Nurs 2019;5:2377960819871805.
Allione A, Pivetta E, Pizzolato E, et al. Determinants of inappropriate acute pain management in old people unable to communicate verbally in the emergency department. Turk J Emerg Med 2017;17:160-4.
Chen M, Hughes JA. The role of cognitive impairment in pain care in the emergency department for patients from residential aged care facilities: a retrospective, case-control study. Australas Emerg Care 2020;23:114-8.
Ross Deveau S. Pain assessment tools for use with children in acute pain in the emergency department. Emerg Nurse 2023;31:21-26.
Pierik JG, Berben SA, IJzerman MJ, et al. A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain. Int Emerg Nurs 2016;27:3-10.
Al-Kalaldeh M, Amro N, Qtait M, Alwawi A. Barriers to effective nurse-patient communication in the emergency department. Emerg Nurse 2020;28:29-35.
Sasso L, Bagnasco A, Ghirotto L. La ricerca qualitativa. Una risorsa per i professionisti della salute Milano: Edra; 2016.
Mortari L, Zannini L. La ricerca qualitativa in ambito sanitario. Roma: Carocci Editore; 2017.
Lopez KA, Willis DG. Descriptive versus interpretive phenomenology: their contributions to nursing knowledge. Qual Health Res 2004;14:726-35.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19:349-57.
Giusti GD, Reitano B, Gili A. Pain assessment in the Emergency Department. Correlation between pain rated by the patient and by the nurse. An observational study. Acta Biomed 2018;89:64-70.
Musazzi UM, Rocco P, Brunelli C, et al. Do laws impact opioids consumption? A breakpoint analysis based on Italian sales data. J Pain Res 2018;11:1665-72.
Butti L, Bierti O, Lanfrit R, et al. Evaluation of the effectiveness and efficiency of the triage emergency department nursing protocol for the management of pain. J Pain Res 2017;10:2479-2488.
Williams S, Keogh S, Douglas C. Improving paediatric pain management in the emergency department: An integrative literature review. Int J Nurs Stud 2019;94:9-20.
Abouzida S, Bourgault P, Lafrenaye S. Observation of Emergency Room Nurses Managing Pediatric Pain: Care to Be Given… Care Given…. Pain Manag Nurs 2020;21:488-94.
Ferrante P, Cuttini M, Zangardi T, et al. Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals. BMC Pediatr 2013;13:139.
Fry M, Chenoweth L, MacGregor C, Arendts G. Emergency nurses perceptions of the role of family/carers in caring for cognitively impaired older persons in pain: a descriptive qualitative study. Int J Nurs Stud 2015;52:1323-31.
Fealy GM, Treacy M, Drennan J, et al. A profile of older emergency department attendees: findings from an Irish study. J Adv Nurs 2012;68:1003-13.
Rance S, Westlake D, Brant H, et al. Admission Decision-Making in Hospital Emergency Departments: The Role of the Accompanying Person. Glob Qual Nurs Res 2020;7:2333393620930024.
Bridges J, Collins P, Flatley M, et al. Older people's experiences in acute care settings: Systematic review and synthesis of qualitative studies. Int J Nurs Stud 2020;102:103469.
Gordon J, Sheppard LA, Anaf S. The patient experience in the emergency department: A systematic synthesis of qualitative research. Int Emerg Nurs 2010;18:80-8.
Gauntlett-Gilbert J, Rodham K, Jordan A, Brook P. Emergency Department Staff Attitudes Toward People Presenting in Chronic Pain: A Qualitative Study. Pain Med 2015;16:2065-74.
Mota M, Cunha M, Santos MR, Silva D, Santos E. Non-pharmacological interventions for pain management in adult victims of trauma: a scoping review protocol. JBI Database System Rev Implement Rep 2019;17:2483-90.

How to Cite

Lenza, C., Meggiato, L., Santuri, V., Vivona, L., Sebastiani, S., Samolsky Dekel, B. G., & Imbriaco, G. (2023). Pain management in the Emergency Department: a phenomenological study on nurses’ experiences. Scenario® - Il Nursing Nella Sopravvivenza, 40(4). https://doi.org/10.4081/scenario.2023.568
Copyright (c) 2023 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Aniarti has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.