Observing pain management practice on a medical unit following changes arising from an action research study

To describe pain assessment practice within a medical unit, to identify factors that may affect the assessment of pain and evaluate changes in practice.

Pain is a problem for patients in all areas of a hospital, but its assessment and management on medical units had not been investigated. An initial assessment of practice found that pain was not consistently assessed and managed on the unit. A variety of activities have been employed during an action research study to change pain management practice.

Naturalistic unstructured participant observation of nurses and structured patient interviews were conducted.

The need to communicate with many people led to interruptions, multi-tasking and practical problems were observed which appeared to affect the provision of nursing care, in particular, the administration of medications. These factors also prevented a comprehensive assessment of pain, although the assessment of pain intensity appeared to have increased.

The constant activity and interruptions observed may make it difficult for patients to discuss their experience of pain in detail. These accepted, every day and taken-for-granted aspects of nursing observed appeared to reduce opportunities for comprehensive pain assessment.

Pain assessment is one of a number of nursing activities, obtaining a pain score appears to have become routine practice. Nursing takes place in a complex environment, which may disrupt the provision of nursing care and impede communication.

To increase nurses awareness of the complexity of every day practice, the numerous tasks required, interruptions to the provision of care and the resultant effect on pain assessment and management. They need to then identify and reflect on these factors prior to attempting to change their practice.