Background & Aims
Prevalence of pain in older adults with cognitive impairment is between 49.57% and 65.60%1-2. Ineffective pain management could then lead to more agitation and level of ability to perform activities, resistance of care, and induced more cognitive decline3-4. Nurses’ knowledge and attitudes toward pain management was significantly related with self-efficacy for pain management5 and pain management practices6. Higher perception on collaboration and year of nursing experience could also promote self-efficacy7 and nurses’ pain management practices8-10. However, perceived self-efficacy acts as a mediator in these relationships were unknown. The aim of this study was to examine causal relationships among nurses’ knowledge and attitudes toward pain management, nurses’ perception on collaboration with physician, years of nursing experience, nurses’ pain management self-efficacy, and nurses’ pain management practices in older adults with cognitive impairment.
Methods
A cross-sectional descriptive design with a convenience sample was used in this study. The samples were 240 registered nurses working at three hospitals in Thailand. The questionnaires included the demographic questionnaire, the nurses’ knowledge and attitudes towards pain management in older adults with cognitive impairment11, The Collaboration and Satisfaction about Care Decisions Instrument (CSACD)12, the Pain Management Self-Efficacy Questionnaire (PMES)13and the nurses’ pain management practices questionnaire. Structural Equation Model was used to examine a hypothesized model.
Results
Using the chi-square, a model of nurses’ pain management practice in older adults with cognitive impairment was statistically nonsignificant (?2 = .009; df = 1; p = .922) which was fitted with the empirical data and explained 29% of variance. For direct effect, nurses’ knowledge and attitudes towards pain management, nurses’ perception on collaboration with physician, and year of nursing experience had positive direct effect on and self-efficacy (? = .29, p = .000; ? = .23, p = .000; ? = .28, p = .000, respectively). Self-efficacy and nurses’ collaboration with physician also had positive direct effect on nurses’ pain management practice (? = .39, p = .000; ? = .20, p = .000, respectively). For indirect effect, nurses’ knowledge and attitudes towards pain management, nurses’ collaboration with physician, and year of nursing experience had positive indirect effect on nurses’ pain management practice through self-efficacy (? = .11= .000; ? = .09, p =.001; ? =.11, p = .000, respectively).
Conclusions
Higher nurses’ perception on their collaboration with physician, knowledge and attitudes toward pain management, and years of experience can improve self-efficacy. Increasing of nurses’ self-efficacy and perception on their collaboration with physician can then lead to improvement on nurses’ pain management practice. This study highlighted the need to develop an intervention to promote nurses’ knowledge and attitudes, nurses’ perception on their collaboration with physician, and nurses’ self-efficacy for pain management to improve their pain management practice in older adults with cognitive impairment.
References
1. Lin PC, Li CH, Chou PL, Chen YM, Lin LC. Prevalence of pain-related diagnoses in patients with dementia: a nationwide study. J Pain Res 2018; 11, 1589–98.
2. Atee M, Morris T, Macfarlane S, Cunningham C. Pain in dementia: Prevalence and association with neuropsychiatric behaviors. J Pain Symptom Manage 2021; 61, 1215–26.
3.Bell T, Franz CE, Kremen, WS. Persistence of pain and cognitive impairment in older adults. J Am Geriatr Soc 2022; 70, 449–458.
4. Resnick B, Boltz M, Galik E, Holmes S, Vigne E, Fix S, Zhu S. Pain assessment, management, and impact among older adults in assisted living. Pain Manag Nurs 2019; 20, 192–197.
5. Alzghoul BI, Abdullah NAC. Pain management practices by nurses: Application of the self-efficacy theory. Glob J Health Sci 2020; 12, 44–49.
6.Al Omari D, Alhabahbeh, A, Subih M, Aljabery A. Pain management in the older adult: The relationship between nurses’ knowledge, attitudes and nurses’ practice in Ireland and Jordan. Appl Nurs Res 2021; 57, 151388.
7. Nørgaard B, Draborg E, Vestergaard E, Odgaard E, Jensen DC, Sørensen, J. (2013). Interprofessional clinical training improves self-efficacy of health care students. Med Teach 2013, 35, e1235–42.
8.Youngcharoen P, Aree-Ue S. A cross-sectional study of factors associated with nurses’ postoperative pain management practices for older patients. Nurs Open 2023; 10. 90-98.
9. Asman O, Slutsker E, Melnikov S. Nurses’ perceptions of pain management adequacy in mechanically ventilated patients. J Clin Nurs 2019; 28, 2946–52.
10. Rababa M, Al-Sabbah S, Eyadat AM, Abusbaitan HA. The association between socio-demographic characteristics and using pain assessment tools among critically ill patients. Medicina 2023; 59, 759.
11. Ng SQ, Brammer, Creedy D K, Klainin-Yobas P. Tool for evaluating the ways nurses assess Pain (TENAP): psychometric properties assessment. Pain Manag Nurs 2014; 15, 807–818.
12. Baggs JG. Development of an instrument to measure collaboration and satisfaction about care decisions. J Adv Nurs 1994; 20, 176-182.
13. Macindo JRB, Soriano CAF, Gonzales HRM, Simbulan PJT, Torres GCS, Que JC. Development and psychometric appraisal of the Pain Management Self-Efficacy Questionnaire. J Adv Nurs 2018;74:1993-2004.
Presenting Author
Phichpraorn Youngcharoen
Poster Authors
Topics
- Pain in Special Populations: Elderly