surgical nurses in teaching hospitals in Ireland understanding pain

924 British Journal of Nursing, 2014,Vol 23, No 17
©2014MAHealthcareLtd
Surgical nurses in teaching hospitals
in Ireland: understanding pain
D
espite the exponential growth in the understanding
of pain mechanisms and the innovative advances
in pain management that have developed in recent
times, a large body of research indicates that a
considerable proportion of patients experience extreme levels
of pain after surgical intervention. There is an emerging
literature showing that acute postoperative pain can stimulate
the rapid development into chronic pain (Dunwoody et al,
2008; Shug and Pogatzki-Zahn, 2011).The severity of acute
postoperative pain is said to be a predisposing factor in the
development of chronic pain after surgery (Macintyre et al,
2010). Chronic or ‘persistent’ post-surgical pain has been
Niamh Vickers, Shelagh Wright and Anthony Staines
cited as a major clinical problem and is now recognised as a
clinical entity (Nikolajsen and Minella, 2009).
Background
Nurses are usually the cornerstone of the management
of postoperative pain (Rejeh et al, 2009). Considerable
empirical research has been undertaken to examine nursing
practice within the area of pain management,and substandard
practices have been highlighted in the literature (Idvall
and Berg, 2008). Many authors have attributed nurses’
unsatisfactory practices in pain management to a lack of
knowledge and inadequate attitudes relating to pain and its
management (Aslan et al, 2003; Jastrzab et al, 2003;Twycross,
2007; Gordon et al, 2008; Rejeh et al, 2009). Adequate
pain management relies on the knowledge, attitudes and
subsequent skills of health professionals (Lewthwaite et al,
2011). Given the central role nurses play in the management
of pain, extensive research has been undertaken to identify
nurses’ knowledge base and attitudes pertaining to pain
management, studying nurses working in an array of clinical
settings. The findings from these studies have highlighted
knowledge deficits that may have implications for patients’
pain management and outcomes.
The use of a popular instrument called the Knowledge
and Attitudes Survey Regarding Pain (KASRP) in many of
these documented research studies has facilitated comparison
between different studies over time. The findings from all
of these studies highlight nurses’ inadequate knowledge
and attitudes regarding pain management. Although 80%
is reckoned as the minimum acceptable score on the
KASRP tool, the majority of studies report lower average
scores (Plaisance and Logan, 2006; Bernardi et al, 2007;
Matthews and Malcolm, 2007; Lui et al, 2008; Yildirim et
al, 2008; Rahimi-Madiseh et al, 2010; Wang and Tsai, 2010;
Lewthwaite et al, 2011; Duke et al, 2013).
Ineffective pain management leads to needless suffering and
may result in considerable negative outcomes for patients in
terms of morbidity and mortality (Jastrzab et al, 2003). Nurses
play an essential role in postoperative pain management
and so high-quality assessment, planning, implementation,
evaluation and documentation of pain management are
fundamental to optimal patient care. Conversely, there is a
lack of current substantial evidence on this topic in the Irish
context, which provided the impetus for this particular study.
The authors are confident that the information gathered will
help in developing and implementing appropriate educational
strategies and initiatives to address any knowledge deficits
identified, and improving postoperative pain management.
NiamhVickers, Student Public Health Nurse, Health Services Executive
Dublin South East/Wicklow; Shelagh Wright, Lecturer in Psycho-
oncology and Anthony Staines, Chair of Health Systems Research,
School of Nursing and Human Sciences, Dublin City University
Accepted for publication:August 2014
Abstract
Background: Nurses play a crucial role in pain management and
must be highly knowledgeable to ensure their practices are of a
high standard. Aim: The purpose of this study was to determine
the baseline level of knowledge and attitudes regarding pain of
nurses working in three teaching hospitals in Dublin. Methods: This
descriptive study explored the knowledge and attitudes of nurses
regarding pain management. A modified version of the ‘Knowledge
and Attitudes Survey Regarding Pain’ tool was used to collect data.
The sample comprised a convenience sample of 94 nurses working
in the acute surgical wards of three hospitals. Findings: Three per
cent of respondents achieved a passing score of 80% or greater.
Results revealed that the mean percentage score overall was 65.7%.
Widespread knowledge deficits were noted in this study, particularly
in the domain of pharmacological management of pain. Further
analysis revealed respondents had an inaccurate self-evaluation of
their pain management knowledge. Conclusion: The results of this
study support the concern of inadequate knowledge and attitudes
of nurses regarding pain. Educational and quality improvement
initiatives in pain management should be used, which could
foster and enhance nurses’ knowledge base in the area of pain and
possibly improve practices.
Key words: Pain assessment ■ Pain management ■ Pharmacology
■ Clinical competence ■ Quality improvement
British Journal of Nursing.Downloaded from magonlinelibrary.com by 192.087.050.003 on September 27, 2014. For personal use only. No other uses without permission. . All rights reserved.

CLINICAL FOCUS
British Journal of Nursing, 2014,Vol 23, No 17 925
Methods
The data for this current study were collected in three major
academic teaching hospitals in Dublin, Ireland. Before the study
began, ethical approval was sought and obtained from each of
the hospitals’ ethics committees. A total of 16 surgical wards
were surveyed across the three hospitals.The target population
for this inquiry was a convenience sample of all nurses working
in the identified surgical wards included in the study. In order
to enhance the representation of the sample, multiple sites were
used. The inclusion criteria for participation in this current
study was all nurses who were working full or part-time in
the identified surgical wards who were willing to participate
voluntarily in the study.Therefore,all of the nurses who met the
above criteria were invited to participate.
Research instrument
A cross-sectional, descriptive survey research design was used
to explore the level of knowledge and attitudes of Irish surgical
nurses regarding pain by using a modified version of the
KASRP tool.This instrument was originally developed in 1987
and has undergone several revisions to reflect the amendments
in pain management practice (Ferrell and McCaffery, 2012).
Content validity of the KASRP was obtained by pain experts
and derived from current standards of pain management.The
tool was identified as discriminating between the various levels
of expertise.Test-retest reliability has been established (r0.80)
by repeated testing in a continuing education class of staff
nurses (n=60). Internal consistency reliability was established
(ar0.70) (Ferrell and McCaffery,2012).The Crohnbach’s alpha
coefficient for this study was confirmed as acceptable (a=0.72).
To address content validity among Irish surgical nurses, a
pharmacist, two academic supervisors, a doctor and clinical
nurse specialist in pain reviewed the tool and the necessary
modifications to the original tool were made. The final
modified version of the KASRP consisted of a 39-item tool
containing three distinct sections.A pilot study was conducted
with four nurses working in one of the surgical wards before
commencement of the main study, to ensure nurses understood
all of the relevant instructions and to identify any problems with
the instrument.
Data analysis
Both descriptive and inferential statistical tests were computed
using SPSS version 17.0. Descriptive statistics were used to
analyse all the demographic variables and the scores obtained
on the KASRP tool.The results of the KASRP surveys were
analysed by calculating overall scores for the entire sample and
also for each individual hospital. The percentage of correct
answers on the KASRP tool was calculated for each of the
94 returned surveys.This was achieved by assigning a value of
‘1’ to each correctly answered item and a value of ‘0’ to each
incorrectly answered item for each of the 39 individual items
on the KASRP survey.Data were analysed by the completion of
an item-by-item analysis for the three sections on the KASRP
survey to scrutinise each individual question on the tool.
Results
A total of 180 surveys were distributed over a 2-month
period. Of the 180 surveys distributed, 94 were returned
completed, a response rate of 52.2%. Table 1 summarises the
respondents’characteristics.The largest number of participants
had obtained a degree in nursing (69%). The majority
of respondents had less than 10 years of clinical nursing
experience (70%). Respondents were asked to evaluate and
identify their perceived level of knowledge in the area of
pain management. Nurses were presented with a rating scale
ranging from the lowest level ‘poor’ to the highest perceived
level of ‘excellent’. It was determined that the majority of
respondents in this study (75.5%) rated their knowledge as
being good, with 7.4% rating their knowledge as excellent
and 17.0% rating their knowledge as average (Table 2). None
of the respondents rated their level of knowledge as being
either ‘fair’ or ‘poor’. The distribution of the overall scores
obtained for the three hospitals are presented in Table 3.
On the KASRP tool, the maximum raw score achievable
was 39, which would equate to a 100% correct response.
Each correctly answered item was scored a ‘1’ and each
incorrectly answered item was scored a ‘0’. The raw scores
Table1. Demographic characteristics of respondents in the three hospitals (n=94)
Variables Frequency (N) Percentage (%)
Gender:
Female 89 94.7%
Male 5 5.3%
Age:
20–30 53 56.4%
31–40 35 37.2%
41–50 5 5.3%
51–60 1 1.1%
Level of education:
Certificate 3 3.2%
Diploma 11 11.7%
Degree 65 69.1%
Postgraduate diploma 10 10.6%
Masters degree 5 5.3%
Years of nursing experience:
1 year 8 8.5%
1–5 years 32 34.0%
5–10 years 26 27.7%
10–15 years 20 21.3%
15–20 years 6 6.4%
20 years 2 2.1%
Years of surgical experience:
1 year 12 12.8%
1–5 years 37 39.4%
5–10 years 21 22.3%
10–15 years 19 20.3%
15–20 years 5 5.3%
Nursing grade:
Staff nurse 75 79.8%
CNM1* 11 11.7%
CNM2† 8 8.5%
*CNM1 = clinical nurse manager 1 †CNM2 = clinical nurse manager 2

were analysed and tabulated to ascertain the mean score and
percentage score overall.The total score ranged from 41.0%
to 84.6% with an overall mean of 65.7% (Table 3).The overall
distribution of respondents’ scores obtained on the complete
KASRP tool is presented in Figure 1. Analysis revealed that
only 3.2% of the respondents achieved an overall score of
80% or above.
Some items on the KASRP tool were answered correctly
by more than 89% of the respondents. The top 8 items
correctly answered by respondents are illustrated in Table 4.
The items that received the lowest correct responses by the
participants are shown in Table 5.
Two patient vignettes were used to determine the nurses’
ability to make decisions with regard to pain assessment and
interventions in two comparable patients on their first day
following abdominal surgery. The two patients presented in
the case studies were identical with the exception of their
demeanour, where one patient was smiling (patient A) and
the other patient was grimacing (patient B). Both patients
had rated their pain as 8 on a numerical rating pain scale
from 0 to 10. The respondents were asked to indicate their
assessment of pain for both patients. While almost every
respondent (97.9%) accurately rated the grimacing patient’s
pain as 8 (patient B), only 69.9% of respondents documented
the correct pain score for the smiling patient (patient A).
There was a significant difference found in the respondents’
assessments of pain in the patient case scenarios of the
patient who was smiling as compared to the patient who
was grimacing (c2 =42.0, p0.001). The respondents were
asked to make a decision with regard to dosage of analgesia
they would administer to the smiling patient (patient A).
Alarmingly, only 12.8% of respondents correctly answered
this item with regard to the appropriate dose of morphine
that should be administered.This was the item that received
the lowest percentage score overall on the survey. A low
percentage score was also obtained for patient B where
only 40.4% of respondents would correctly administer the
adequate dose of morphine to the patient who was grimacing
(patient B).
Two of the lowest scoring items were in relation to
knowledge of respiratory depression in patients receiving
opioid therapy. In both instances, nurses’ fears in relation
to the development of respiratory depression in patients
receiving stable doses of opioid analgesics were exaggerated
where only 17.8% and 45.7% of respondents correctly
answered the two questions with respect to respiratory
depression in patients. The other items that received a low
percentage of correct items related to pharmacology and
addiction knowledge (Table 5).
Limitations
While providing baseline information regarding the
knowledge and attitudes of nurses working within the acute
surgical settings in three hospitals in Ireland, this study has
limitations. First, this study used a cross-sectional research
design to investigate and describe the knowledge and attitudes
of nurses working in the acute surgical context. While a
cross-sectional research design was considered the most
appropriate means of examining the phenomenon under
investigation, it is limited by the fact that the population was
only studied at a single point in time.The present study was
limited to surveying nurses in 16 wards across three hospitals,
which may have introduced bias (Puls-McColl et al, 2001).
Additionally, the study sample was limited to nurses working
within acute surgical wards, so it cannot be generalised to
other sample populations of nurses.
Discussions
The mean percentage score obtained on the KASRP survey
in this present study was 65.7%. This compares well with
other similar studies (Plaisance and Logan, 2006; Bernardi et
al, 2007). On the contrary, in their study of nurses’ knowledge
and attitudes regarding pain in Northern Ireland, Matthews
and Malcolm (2007) reported a mean score of 73.8%, which
is more favourable than this present study.A mean percentage
score of 65.7% established in this study falls short of the
80% that has been determined as being an acceptable score
(McCaffery and Robinson, 2002). It has been asserted that if
a nurse receives a score below the threshold of 80%, his or her
ability to care for patients experiencing pain is considerably
compromised (McCaffery and Robinson, 2002). In this
present study analysis of the items that ascertained knowledge
and attitudes regarding the assessment of pain were generally
encouraging but some misconceptions emerged.
The patients’ self-report of the intensity of pain is the most
valid and reliable depiction of the existence of pain (Ballantyne,
2006). A salient issue that emerged in this current study was
that, while almost every respondent (98.9%) asserted that the
patient was the most accurate judge of the presence of pain,
this belief was not demonstrated when respondents were faced
with the two patient vignettes. One aspect of the patient case
scenarios was used to explore nurses’knowledge and decisions
with regard to pain assessment. When respondents were
asked to rate both the patients’ pain intensity levels, findings
reflected that nurses were more likely to believe the pain score
of the grimacing patient (patient B) (97.9%) as opposed to
the smiling patient (patient A) (69.9%).This contradicts the
adage that pain is whatever the experiencing person says it
Table 3. Mean raw scores and mean percentage scores on the nurses’
knowledge and attitudes regarding pain survey in the three hospitals
Hospital N Mean
score
Mean % Standard
deviation
Minimum Maximum
Hospital 1 31 26.39 67.65% 7.36 51.28% 82.05%
Hospital 2 34 25.18 64.55% 8.80 46.15% 84.62%
Hospital 3 29 25.38 65.07% 10.24 41.03% 79.49%
Total 94 25.64 65.73% 8.85 41.03% 84.62%
Table 2. Respondents self-evaluation of knowledge regarding pain management
in the three hospitals
Self-evaluated
Level of
Knowledge
Hospital 1
N (%)
Hospital 2
N (%)
Hospital 3
N (%)
Total
N (%)
Excellent 2 (6.4)% 4 (11.7%) 1 (3.4%) 7 (7.4%)
Good 28 (90.3%) 20 (58.8%) 23 (79.3%) 71 (75.5%)
Average 1(3.2%) 10 (29.4%) 5 (17.2%) 16 (17.0%)
Total 31 34 29 94

CLINICAL FOCUS
is (McCaffery and Pasero, 1999). This discrepancy indicated
that respondents varied their judgements of both patients in
the case scenarios based solely on the presence or absence
of outward signs of pain.This closely aligns with findings of
other researchers who have also established that nurses vary
their numerical estimations of pain based on the demeanour
of patients, where they are more likely to believe a patient
who is conveying behavioural manifestations of pain than
a patient who is not (Bernardi et al, 2007; Tsai et al, 2007;
Lui et al, 2008;Yildirim et al, 2008; Rahimi-Madiseh et al,
2010). Assessment of behavioural manifestations of pain,
including observation of facial expression, are instrumental
in the assessment of pain in specific patient populations who
cannot self-report their pain.These include: infants, pre-verbal
children, the cognitively impaired, persons with intellectual
disabilities and the critically ill (Herr et al,2011).Nevertheless,
assessment of pain based on behavioural pain indicators
should not supersede the self-report of pain in patients who
can verbalise their pain experience.
In the current study, the respondents showed widespread
knowledge deficits with regard to pharmacology knowledge.
Among the 39 items on the KASRP survey, 11 had a correct
answerratelowerthan50%and10ofthesewerepharmacology-
based items. In the present study, pharmacology-based items
were the domain of weakest performance,which is congruent
with other international research studies that have also
established that nurses illustrated the poorest knowledge and
attitudes in the area of pharmacological aspects of pain and
its management (Plaisance and Logan, 2006; Bernardi et al,
2007; Rieman and Gordon, 2007; Matthews and Malcolm,
2007; Lui et al, 2008; Yildirim et al, 2008 ; Wang and Tsai
2010; Rahimi-Madiseh et al, 2010; Lewthwaite et al, 2011;
Duke et al, 2013).
Another prominent issue that emerged in the current study
was that the respondents had an inaccurate perception of
their pain management knowledge. It was established that
respondents had an incorrect self-evaluation of their pain
management knowledge—75.5% of respondents indicated
they had a good knowledge of pain management (Table 2).
This finding raises the concern that nurses are unaware of
their lack of knowledge and poor attitudes regarding pain
management.
This issue has been previously highlighted in a study of
Italian nurses’ knowledge and attitudes regarding pain, where
it was noted that respondents also had an inaccurate self-
evaluation of their pain management knowledge and rated
their knowledge as better than it actually was (Bernardi et
al, 2007). This incorrect self-evaluation has been cited as a
new barrier to effective pain management as nurses may not
try to improve their pain management knowledge if they
believe it to already be of a‘good’standard.Furthermore,their
motivation to attend any optional pain education initiatives
may be affected by the misconception that they already
possess an adequate knowledge of pain management.Bernardi
et al (2007) purported that this could potentially lead to the
continuation of knowledge deficits.
Taken together, previous research and the findings of the
current study suggest that nurses have serious knowledge
deficits and erroneous beliefs that may implicate the effective
management of patients’ pain. The disparity between actual
and perceived knowledge is of particular concern and
highlights the need to radically improve both the theoretical
knowledge and clinical practices of nurses caring for patients
with pain.
Conclusion and recommendations
This study has provided an insight into the knowledge and
attitudes of nurses working in acute surgical wards in three
major academic teaching hospitals in Dublin.To the authors’
Frequency
Figure 1. Frequency distribution of nurses’ overall percentage scores on Knowledge and Attitudes
Survey Regarding Pain of 94 respondents
12.50
10.00
7.50
5.00
2.50
0.00
30.00 40.00 50.00 60.00 70.00
Overall percentage of correct resposes
80.00 90.00
Mean = 65.7392
Std dev = 8.85721
N = 94
Table 4. Distribution of top 8 ranked items on KASRP tool most frequently
answered correctly
KASRP
item
number
Ranked
number
Item Correct
answer
rate %
12 1 Patients should be encouraged to endure as
much pain as possible before using an opioid
98.9
34 2 The most accurate judge of the intensity of the
patient’s pain is?
98.9
24 3 Case Study Two—Nurse respondents recorded
assessment of Patient (B) Roberts’ pain on NRS
97.9
32 4 The most likely reason a patient would request
increased dose of pain medication is?
97.9
7 5 Combining analgesics that work by different
mechanisms may result in better pain control
with fewer side effects than using a single
analgesic agent
96.8
13 6 Children less than 11 years old cannot reliably
report pain so nurses should rely solely on
the parent’s assessment of the child’s pain
intensity
96.8
28 7 The drug of choice for the treatment of
prolonged moderate to severe pain for cancer
patients is?
93.6
15 8 After an initial dose of an opioid analgesic is
given, subsequent doses should be adjusted
in accordance with the individual patient’s
response
89.4

knowledge, this study is the first of its kind to describe the
knowledge and attitudes of nurses working within acute
surgical settings in the Republic of Ireland.The findings are
congruent with previously published studies that underscore
the extensive knowledge deficits and poor attitudes of nurses
working within numerous clinical settings. The findings of
this study support and extend the recommendations of other
researchers regarding the need for appropriate educational
interventions to enhance nurses’ knowledge and attitudes
regarding pain (Tsai et al, 2007; Brennan, Carr and Cousins,
2007; Matthews and Malcolm, 2007; Lui et al, 2008; Huth,
Gregg and Lin, 2010; Rahimi-Madiseh et al, 2010;Wang and
Tsai, 2010; Lewthwaite et al, 2011).
The lead author suggests that intensive and comprehensive
educational initiatives should be tailored to meet the specific
needs of nurses both at under-graduate and post-graduate level.
A thorough review of nursing curricula should be undertaken
to ensure the content of these modules provide adequate,
relevant and appropriate information and subsequently equips
nurses to effectively manage pain (Twycross and Dowden,
2009). Identification of the key areas of knowledge deficit can
be used as a framework and structure for the development
of appropriate educational programmes aimed at improving
nurses’ knowledge and attitudes regarding pain (Rieman and
Gordon, 2007). Although education has been acknowledged
as being an indispensible aspect to improving pain knowledge,
this alone is not enough to achieve the goal of adequate
pain management (Paice et al, 2006; Lewthwaite et al,
2011). Sustained improvement in pain management requires
changes at organisational level that should incorporate an
interdisciplinary, collaborative and systematic approach. The
lead author postulates that further endeavours such as quality
improvementinitiativesthathavebeenpioneeredinternationally
should be initiated within all healthcare organisations. These
quality improvement programmes endeavour to enhance and
sustain pain management knowledge,practices and behavioural
patterns that are congruent with best practice standards.Quality
improvement initiatives could employ a range of strategies such
as incorporation of analgesic protocols using a multimodal
approach to guide nurses in making safe and effective decisions
with regard to the pharmacological management of pain
(McCaffery et al 2007).They could also involve facilitation of
best practice by updating policies, procedures and guidelines
relating to pain management to ensure they are in line with
current international best practice standards.
Nurses should ‘make pain visible’ by ensuring pain is
considered and assessed as‘the fifth vital sign’at all times (Joint
Commission on Accreditation of Healthcare Organisations,
2001). The incorporation of the philosophy of pain as the
fifth vital sign has been shown to improve the assessment and
subsequent interventions in the management of pain (Purser
et al, 2014)
Incorporation of ‘pain resource nurses’ (PRN) within
hospitals has been cited an as innovative method for
improving pain management. These nurses are regarded as
clinical champions whose functions include: peer facilitation,
education provision, audit and a fundamental link between
nurses, patients and members of the multidisciplinary team
(Ladak et al, 2013). The implementation of pain resource
nurses was first described at the City of Hope Medical Centre
in California as a means to espouse and sustain evidence-based
pain related improvements (Ferrell et al, 1993). Since then,
researchers have reported that the incorporation of PRNs
has been an effective strategy for creating and maintaining
organisational changes to improve pain management (Paice
et al, 2006;Williams et al, 2012).
Undertaking regular audits of pain management practices
is vital to establish the quality of same and intervene with
additional strategies aimed at improving practice if the
application of pain management practice is not congruent to
best practice standards.
The future successes of optimal pain management necessitate
further expansive research including the replication of
studies to ascertain current pain management knowledge
and practices. Additionally, it is suggested to undertake
multicentre quality improvement initiatives, using evidence-
based strategies aimed at improving knowledge and sustained
behavioural changes pertaining to the management of pain.
Similarly, it would be beneficial to empirically evaluate
the efficacy of these quality improvement initiatives from
a longitudinal perspective on pain knowledge, practices,
patients’ pain scores and patient satisfaction. BJN
Conflict of interest: none
Aslan FE,Badir A,Selimen D (2003) How do intensive care nurses assess patients’
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Table 5. Distribution of top 8 ranked items on KASRP tool most frequently
answered incorrectly
KASRP
item
number
Ranked
number
Item Correct
answer
rate %
23 1 Case Study One—Nurse respondents’
indicated dosage of analgesia administration to
Patient (A) Andrew
12.8%
31 2 The likelihood of developing clinically
significant respiratory depression in a patient
with persistent cancer pain who has been
receiving stable doses of opioid analgesics for
2 months is?
17.8%
39 3 Following abrupt discontinuation of an opioid,
physical dependence is manifested by which
of the following?
24.5%
36 4 How likely is it that patients who develop pain
already have an alcohol and/or drug abuse
problem?
30.9%
26 5 The recommended route of administration of
opioid analgesics for patients with persistent
cancer-related pain is?
30.9%
25 6 Case Study Two—Nurse respondents’
indicated dosage of analgesia administration to
Patient (B) Robert
40.4%
38 7 The time to peak effect for morphine given
orally (PO) is?
43.6%
6 8 Respiratory depression rarely occurs in patients
who have been receiving stable doses of
opioids over a period of months
45.7%

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Nikolajsen L, Minella CE (2009) Acute postoperative pain as a risk factor for
chronic pain after surgery. European Journal of Pain Supplements 3(S2): 29-32
Paice JA, Barnard C, Creamer J, Omerod K (2006) Creating organizational
change through the Pain Resource Nurse program. Jt Comm J Qual Patient
Saf 32(1):24-31
Plaisance L,Logan C (2006) Nursing students’knowledge and attitudes regarding
pain. Pain Manag Nurs 7(4): 167-75
Puls-McColl PJ, Holden JE, Buschmann MT (2001) Pain management: an
assessment of surgical nurses’ knowledge. Medsurg Nursing 10(4): 185-191.
Purser L, Warfield K, Richardson C (2014) Making pain visible: an audit
KEY POINTS
n Unrelieved acute pain is a central healthcare problem. There is an emerging
literature that has established that unalleviated acute pain can progress into
chronic pain, which underscores the need for excellence in pain management
practices
n The findings of this study support and extend earlier international research
initiatives and provide a more global perspective on the topic. They highlight
specific areas in which Irish nurses have inadequate knowledge and attitudes
regarding pain
n The findings of this study should provide the impetus for educational
initiatives based on areas in which nurses have a poor knowledge base
n The findings of this study provide the motivation for the development of
rigorous quality improvement initiatives aimed at creating organisational
enhancements to pain knowledge and subsequent practices
and review of documentation to improve the use of pain assessment by
implementing pain as the fifth vital sign. Pain Manag Nurs 15(1): 137-42. doi:
10.1016/j.pmn.2012.07.007. Epub 2012
Rahimi-Madiseh M, Tavakol M, Dennick, R. 2010. A quantitative study of
Iranian nursing students’ knowledge and attitudes towards pain: implication
for education. Int J Nursing Practice 16(5): 478-83. doi: 10.1111/j.1440-
172X.2010.01872.x.
Rieman MT, Gordon M (2007) Pain management competency evidenced by a
survey of pediatric nurses’ knowledge and attitudes. Pediatr Nurs 33(4): 307-12
Rejeh N, Ahmadi F, Mohammadi E, Kazemnejad A, Annosheh M (2009)
Nurses’ experiences and perceptions of influencing barriers to postoperative
pain management. Scand J Caring Sci 23(2):274-81. doi: 10.1111/j.1471-
6712.2008.00619.x.
Schug SA, Pogatzki-Zahn EM (2011) Chronic pain after surgery or injury. Pain
Clinical Updates 19(1):1-4
Tsai FC,Tsai YF, Chien CC, Lin CC (2007) Emergency nurses’ knowledge of
perceived barriers in pain management inTaiwan. J Clin Nurs 16(11): 2088-95
Twycross A (2007) Children’s nurses’ post-operative pain management practices:
an observational study. Int J Nurs Stud 44(6): 869-81. Epub 2006
Twycross A, Dowden SJ (2009) Status of pediatric nurses’ knowledge about pain.
Pediatric Pain Letter 11(3): 17-21
Wang HL, Tsai YF 2010. Nurses’ knowledge and barriers regarding pain
management in intensive care units. J Clin Nurs 19(21-22): 3188-96. doi:
10.1111/j.1365-2702.2010.03226.x.
Williams AM, Toye C, Deas K, Fairclough D, Curro K, Oldham L (2012)
Evaluating the feasibility and effect of using a hospital-wide coordinated
approach to introduce evidence-based changes for pain management. Pain
Manag Nurs 13(4):202-14. doi: 10.1016/j.pmn.2010.08.001. Epub 2011
Yildirim YK, Cicek F, Uyar M (2008) Knowledge and attitudes of Turkish
oncology nurses about cancer pain management. Pain Manag Nurs 9(1): 17-25.
doi: 10.1016/j.pmn.2007.09.002.
Neuroscience Nursing:
assessment and patient management
This book is composed of the best articles on neuroscience nursing published in the British
Journal of Nursing. It is the first of its kind and focuses on: Aspects of assessment relevant
to neurological parents; Issues in the management of patients with acute neurological
conditions; The management of patients with long-term neurological conditions
978-1-85642-308-3; 190 x 245mm; paperback; 400 pages; publication 2006; £39.99
Order your copies by visiting
www.quaybooks.co.uk
or call our Hotline
+44(0)1722 716 935
edited by Sue Woodward

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