Nurses' pain management practices in cognitive impaired older adults and related factors: A comparative study

Effective pain management in cognitively impaired older adults can reduce behavioral and psychological symptoms. This study examined how nurses' knowledge and attitudes towards pain assessment and management, pain management practices, self-efficacy in pain management, collaboration with physicians, and nursing work complexity varied by hospital type, education levels, work units, and experience.

A comparative cross-sectional study was conducted among 174 nurses from a quaternary-care and a tertiary-care hospital in central Thailand (September-October 2023). Data were collected using a modified Tool for Evaluating the Ways Nurses Assess Pain, the Pain Management Self-Efficacy Questionnaire, the Collaboration and Satisfaction about Care Decisions Instrument, and the Environmental Complexity Scale. Chi-square tests, independent t-tests, Mann-Whitney U tests, and one-way ANOVA were performed (SPSS version 29, p < 0.05).

Nurses at the tertiary-care hospital had significantly higher scores in knowledge and attitudes towards pain assessment and management (p = 0.004), self-efficacy in pain management (p < 0.001), and nursing work complexity (p = 0.027). However, nurses at the quaternary-care hospital had significantly higher pain management practices (p < 0.001) and collaboration with physicians (p < 0.001). Nurses with a master's degree had higher knowledge and more positive attitudes than those with a bachelor's degree (p = 0.004). More experienced nurses demonstrated greater knowledge and more positive attitudes towards pain assessment and management (p < 0.001) and pain management practices (p < 0.001).

Results highlight that education and work experience are important determinants of greater knowledge, more positive attitudes, and improved practices. Hospital settings should provide ongoing training using technologies tailored to their environments to improve pain management practices.