Acute pain assessment among critically ill adult patients: Nurses' knowledge, practices, and perceived barriers

Background: Pain, a universal health problem, affects a substantive number of individuals in chronic or acute form. In the emergency and critical care settings, patients suffer moderate-to-severe acute pain from numerous sources. If not adequately managed, acute pain can transform to a chronic pain syndrome. The physical disabilities and psychological disorders associated with poorly controlled pain diminish patients' comfort and quality of life among the survivors. The study aimed at describing the knowledge and practices related to pain assessment, and perceived barriers among nurses caring for critically ill - adult patients (CIAP). Methods: A descriptive cross-sectional design was employed to collect data from 170 nurses caring for CIAP in Uganda using a standardized survey tool. Results: Nurses had adequate knowledge levels with gaps regarding the need for pre-emptive analgesia for painful procedures like airway suctioning, invasive line placement, and spontaneous breathing trial. Substantively, nurses did not know that the patient is the most accurate rater of their pain experience. Nurses reported poor pain assessment practices, including lack of use of pain assessment tools and guidelines, which were significantly associated with workload and the low priority set to pain assessment and management. Physicians' prescription of adequate analgesics was the only perceived enabler. Conclusion: There is need to reprioritize pain management in emergency and critical care settings. This can be achieved through strategies that enhance the quality and quantity of resources for health care to reduce the perceived barriers and boost the enablers. Continuous professional education, provision of medication, human resources and guidelines for pain management can promote good pain assessment and management practices.