The research article selected for this critique discusses barriers to pain management in long-term care. As prolonged and unresolved pain can have both physical and psychological outcomes for the patient, it is vital to address it. The article discusses the nursing perspective of pain management and how the nursing practice could adapt to the issue. The aim of the study is to identify and resolve patient-related barriers to pain management in long-term care.
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There is an inherent difficulty in diagnosing and managing pain due to problems with cognition and communication in older patients which limits their ability to identify pain on a scale. To optimize pain management care, targeted interventions should focus to eliminate these barriers and provide a competent level of treatment that would resolve negative consequences.
Unresolved chronic pain affects 45 to 80 percent of geriatric patients (Egan & Cornally, 2013). This can lead to significant discomfort and severe psychosocial problems such as depression, loss of sleep and function, anxiety, and isolation, decreasing the general quality of life. Barriers in care can either be caregiver-related such as gaps in knowledge or poor attitudes, poorly understanding the validity of pain, or being overly cautious.
However, there are numerous patient-related barriers as well. There are common misconceptions that pain is a natural part of aging and cannot be treated. Patients do not communicate with nurses because they fear judgment, medication, or simply feel like it would not resolve anything. The risk of not identifying pain can increase due to these barriers (Egan & Cornally, 2013). The author of this critique notes that this topic is relevant as geriatric patients are often difficult to communicate with as they choose to avoid crucial details. This trend may be due to generational differences and a lack of health literacy in modern medicine that would ensure they receive adequate care.
The study uses a cross-sectional, quantitative, descriptive design (Egan & Cornally, 2013). The strengths of this type of design are that it is quick and cheap to conduct, able to focus on collecting data at a specific point in time while highlighting multiple outcomes or influences. Weaknesses include difficulty to determine causality, incidence and can be susceptible to bias (Shantikumar, 2018). The authors chose this cross-sectional and descriptive design as it effectively collects data on a population at this particular point and can determine a relationship between a health-related outcome and a particular variable.
The sample consisted of nurses that work with geriatric patients in long-term care in both private and public facilities. A sample of 83 nurse medical professionals was used for the study that fully completed the questionnaire. This sample size is relatively small, also known as a convenience sample. It is adequate for the purposes of the study to highlight potential barriers, but the results are not necessarily generalizable to the general nursing population. The distribution of the staff was fairly appropriate. However, the biggest gap was that the percentage of males in the sample did not exceed 5 percent.
A self-report questionnaire was used as a data collection tool, which was adapted from previous studies on the topic. The questionnaire was offered to nurses. Questions followed a Likert scale multiple choice answer. Furthermore, demographic and general qualifications in nursing and pain management were collected. Data was collected by the primary researchers. Ethical approval for the study was received from an independent clinical research committee. All participants were notified and were aware of the research purpose.
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The main limitation of the study is the small convenience sample which undercuts its generalizability. Furthermore, only one method of data collection was used, which presents room for error. Not all eligible respondents completed the questionnaire which may create sample bias (Egan & Cornally, 2013). These limitations are important as the issue is prevalent in many long-term care facilities and it is important to determine factors that can be generalized to developing evidence-based interventions. Limitations can be overcome by increasing the scope of future studies and offering multiple ways, both qualitative and quantitative to collect data.
Findings concluded that patient-related barriers were interfering with pain management and optimal care more often than the nurse or organizational-based barriers. Among these aspects included difficulty with assessing pain due to declining cognition, difficulty to identify pain levels, and general communication issues in geriatric patients. Similar findings were concluded in another more recent study, highlighting that from a nursing perspective, pain management barriers include underreporting and poor communication due to cognitive states of the patient as well as limited knowledge of pain management techniques by the staff (Medrzycka-Dabrowka, Dąbrowski, Gutysz-Wojnicka, Gawroska-Krzemińska, & Ozga, 2017).
This provides credibility to the findings. They support the research question of the study is attempting to identify prevalent barriers to pain management in long-term care facilities.
Chronic pain is a prevalent issue in geriatric patients, causing physical and psychological consequences. However, pain management is often challenged by numerous factors. Patient-related aspects such as limited communication often cause the most barriers to optimal treatment in long-term care facilities. This study’s findings warrant a change in practice to change the nursing and organizational-based approaches to limit barriers from these perspectives and encourage communication from patients.
Staff should be adequately trained to work on the challenges that geriatric patients may pose, and organizational collaboration should be promoted. Evidence from this and other related studies demonstrates that there should be a change in practice. In conclusion, pain management should not be avoided in the geriatric population even if it is not actively communicated by the patients.
Egan, M., & Cornally, N. (2013). Identifying barriers to pain management in long-term care. Nursing Older People, 25(7), 25-31.
Medrzycka-Dabrowka, W., Dąbrowski, S., Gutysz-Wojnicka, A., Gawroska-Krzemińska, A., & Ozga, D. (2017). Barriers perceived by nurses in the optimal treatment of postoperative pain. Open Medicine, 12, 239-246. Web.
Shantikumar, S. (2018). Design, applications, strengths and weaknesses of cross-sectional, analytical studies (including cohort, case-control, and nested case-control studies), and intervention studies (including randomized controlled trials). Web.