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Factors Associated With Behavioral Intentions Toward Pain Assessment and Management Among Critical Care Nurses: A
Zhi-Han Cai1,2, Tsung-Cheng Hsieh3, Li-Hwa Lin4,5
1Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, nctu.edu.tw.
Background:
Optimal pain management remains elusive despite the implementation of standard practice guidelines. The theory of planned behavior (TPB) offers a framework for understanding nurses' clinical practices. Developing and validating theory-based instruments enables an in-depth exploration of the sociopsychological factors underlying nurses' behavioral intentions and practices in pain assessment and management.
Aims:
This study aimed to develop and validate the Intention to Perform Pain Assessment and Management Questionnaire (IPPAMQ) and a Behavioral Scale, identify factors associated with nurses' behavioral intentions, and evaluate the explanatory power of the TPB for nurses' clinical practices.
Methods:
A two-phase cross-sectional study was conducted across seven institutions (December 2023-April 2025). Phase I (n = 200) employed a methodological design to establish the psychometric properties of the developed instruments. Phase II (n = 308) utilized the validated instruments to identify factors associated with nurses' behavioral intentions and to evaluate the TPB's explanatory power for nurses' self-reported practices through path analysis.
Results:
Both instruments demonstrated satisfactory psychometric properties. Nurses' attitudes, subjective norms, and perceived behavioral control were significantly associated with their behavioral intentions, explaining 65% of the total variance, with perceived behavioral control being the strongest correlate. Nurses' behavioral intentions were significantly associated with self-reported practices, accounting for 47% of the variance and supporting the TPB's substantial explanatory power for nurses' practices.
Conclusions:
This study provides psychometrically robust instruments tailored to the TPB framework within the critical care context. The TPB framework effectively highlighted key sociopsychological correlates of nurses' behavioral intentions and adequately accounted for nurses' self-reported pain assessment and management practices.
Implications For Nursing Management:
The IPPAMQ enables nurse managers and policymakers to conduct data-driven evaluations of the sociopsychological factors and identify areas for tailored interventions. The TPB framework's substantial explanatory power underscores the need for multilevel strategies to narrow the gap between nurses' behavioral intentions and clinical practices.
