Emergency nurses' perceived barriers to demonstrating caring when managing adult patients' pain

Pain is the most common presenting complaint in emergency departments and the primary reason patients seek medical care and take prescription medications. Improving inadequate pain control is a critical goal in emergency health care. As patients' primary health care advocates, emergency nurses play a vital role in resolving under-treated pain in their patients. The purpose of this qualitative study was to explore the perceptions of ED nurses regarding the processes used when managing adult patients' pain and to increase understanding of how these perceptions affect patients' pain management.

Participants were recruited from the membership of the local emergency nurses association and 6 hospital-based emergency departments in Northeast Florida. Fifteen emergency nurses with tenure ranging from 1 to 35 years were individually interviewed. Interviews were transcribed verbatim and analyzed using content analysis methodology.

The central core category that emerged highlighted the ED environment as a barrier to demonstrating caring when managing adult patients' pain. The core category was supported by 3 broad themes, each consisting of 3 subcategories: (a) feeling overwhelmed as a result of constant prioritizing and perceived lack of control and adequate staffing, (b) perceived non-cohesiveness of the health care team, including nurses, administrators, and emergency physicians, and (c) frustration concerning abuse of the emergency department, complexity of pain, and unrealistic patient expectations of the nurses' role.

Interventions that improve the ED environment and facilitate the process of pain management are warranted. Implications for accomplishing these interventions clearly exist in nursing education, practice, research, and public policy.