PRESELECCIÓN DE MOTORES QUE SUPLEN ESTA DEMANDA TÉRMICA

It is important to note that having knowledge about pain and knowing how to deal with it are two different issues. Ferrell and McCaffrey (2008) warned that nurses lacked knowledge of pharmacology, as revealed by their answers to the pharmacology questions on the KASRP. The KASRP tool has been validated; therefore, the results of the above studies are given significant credence. Together, they point to a serious problem of knowledge inadequacy among nursing staff, which is prevalent around the world, regardless of a country’s economic status. Lewthwaite et al. (2011) conducted a study of large, urban tertiary hospitals in Canada to explore registered nurses’ knowledge and attitudes using the KASRP tool, including their

knowledge of medicine. The sample included 761 nurses from a variety of clinical units. The study found that 49 % of participants scored 80 % or more on the KASRP, with a mean score of 79 %. The nurses had Bachelor degrees, although they were young and had limited work experience. In contrast, in Hong Kong, Liu et al. (2008) failed to find a significant correlation between educational level and pain management knowledge or attitudes. However, nurses with more professional clinical experience were able to apply their knowledge to daily practice and scored higher on the KASRP than those with less clinical experience (Liu et al., 2008). These authors have argued that a lack of formal pain education during nursing training was responsible for the nurses’ low scores on the KASRP. Brunier et al. (1995) found a KASRP mean passing score of 41 %, while Lewthwaite et al. (2011) found a mean passing score of 79 %.

Since the introduction of the KASRP tool, it has been used extensively to explore the knowledge and attitudes of healthcare staff regarding pain management. Thus, it was an appropriate instrument to use in this current study of knowledge and attitudes towards pain management in Saudi Arabia. Lai et al. (2003) examined the knowledge of 1,797 nurses randomly drawn from nine hospitals throughout Taiwan. An overall correct response to the questions was found to be 50.5 %, indicating a substandard level of knowledge. Those who scored above average had a Bachelor of Science or higher degrees, had received pain education, had more work experience and had always worked in cancer wards. In a similar study by Tsai et al. (2007), nurse subjects (N = 249) were recruited from nine hospitals chosen by stratified sampling throughout Taiwan. Data were collected using the Nurses’ Knowledge and Attitudes Survey—Taiwanese version, a scale to assess perceived barriers to pain management and a background information form. The overall average correct response rate for the knowledge scale was 49.2 %, with a range of 4.8–89.2 % for each survey question (Tsai et al., 2007). A major barrier to managing pain was identified by nurse participants as

the responsibility of caring for other acutely ill patients in addition to patients with pain. Knowledge of pain management had a significant negative relationship with perceived barriers to pain management and a significant positive relationship with the extent of clinical care experience and the total hours of prior pain management education (Tsai et al., 2007).

In another Taiwanese survey, Wang and Tsai (2010) examined the knowledge of 370 ICU nurses using the Nurses’ Knowledge and Attitudes Survey—Taiwanese version. An overall correct response score of 53.4 % demonstrated poor knowledge of pain management, which was in accordance with the findings of the previous reports, indicating that the situation had not changed over time. Another study conducted in the Australian state of Tasmania by Van- Niekerk and Martin (2001) explored the knowledge of pain management practice among the state’s nursing population. Based on the responses to a 29-item survey by 1,015 nurses, the authors concluded that the knowledge level was poor. Tse and Chan (2004) determined the knowledge level and attitudes regarding pain of 678 registered nurses working in three hospitals in Hong Kong. The KASRP questionnaire was used after being translated into Chinese. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test–retest reliability tests were performed. The overall correct response averaged 44 %.

In a recent study conducted in Jordan, Al-Khawaldeh, Al-Hussaini and Darawad (2013) explored the knowledge and attitudes regarding pain management among baccalaureate nursing students. A sample of 240 students from three different nursing schools participated in the survey. The average correct response score of only 34.1 % (SD=9.9) provides further support for the widespread phenomenon of inadequate knowledge and attitudes among nurses in relation to pain management. Another recent study was conducted in Lebanon by Abdul Rahman, Abu-Saad and Noureddine (2013) to assess nurses’ knowledge and attitudes

regarding pain. The total sample was 88 nurses working in a tertiary medical centre. Using the KASRP tool, the results showed that the mean score was 56.15 %, and only 3.4 % of the nurses obtained a passing score of 80 %. The results indicated poor knowledge regarding pain assessment and management.

A survey by Coulling (2005) included 82 nurses and doctors and found that a lack of adequate knowledge was the principal barrier to the management of postsurgical pain in patients. Results from other studies (Rieman & Gordon, 2007; Plaisance & Logan, 2006) reinforced the observation that the main constraint to pain relief treatment is healthcare professionals’ lack of appropriate knowledge.

A study in the US examined both the knowledge of nurses in pain management and barriers to optimal pain management (Tapp & Kropp, 2005). Two studies explored the effects of a pain education program in altering the knowledge level and attitudes of nurses (Huth & Gregg, 2010; Howell, Butler, Vincent, Watt-Watson & Stearns, 2000). These studies were conducted in Mexico and Canada respectively, and they found that a pain intervention nurse education program significantly improved participants’ skills in effective pain management. These results indirectly confirm the findings regarding nurses’ lack of knowledge in pain management. It was based on responses to a survey by 23 registered nurses at an urban

teaching hospital in Ohio, US. The average performance was below what it should be, with an overall score of 69.4 %. Although the nurses showed better knowledge regarding general pain assessment and management, their scores were severely reduced by their weak knowledge in the areas of analgesics and their usage.

However, more encouraging scores have emerged from a few recent studies conducted in hospitals in the US. In a survey by Moceri and Drevdahl (2012), who used the KASRP tool

on 91 nurses in the emergency departments of five hospitals in north-western America, the knowledge level (average correct score = 76 %) among nurses was comparatively higher than those of other similar studies. They found no correlation of the test score with factors such as age, education level, years of general nursing experience or duration of emergency

department experience. Similarly, Al-Shaer, Hill and Anderson (2011) surveyed 129

registered nurses from 10 separate nursing units in a mid-western US metropolitan hospital. Data were collected using the KASRP. In this survey, the nurses scored relatively high (average = 81.2 %, SD = 8.1). With no significant trend in the relationship between

knowledge and any of the demographics tested (age, years of experience), the reason for the superiority in performance is unclear. Perhaps it can be attributed to better preparation at the primary nurse training level. Another US study that examined the same parameters in relation to children’s pain was reported by Vincent and Denyes (2004). Their survey of 67 nurses yielded an average correct response of 77 %. In relation to attitude, 55 % of nurses believed that 20 % of children generally over-reported their pain. Regarding their ability to detect pain and its severity, 82 % of nurses did well when the child’s report was coupled with behavioural manifestations. However, in the absence of behavioural clues, only 49 % detected pain

accurately.

Interestingly, a survey of the university curricula in medicine, nursing, dentistry, pharmacy and veterinary medicine found that two-thirds do not include specific teaching on pain in the undergraduate curriculum, with veterinary students being exposed to five times more

instructions on pain management topics than medical or nursing students (Watt-Watson et al., 2009). In contrast, according to Brown et al. (1999), KASRP scores based on clinical

specialty or practice setting did not correlate significantly with nurses working in various units in a hospital in the US. However, this was based on a poor response rate, and the mean KASRP score was 65 %, limiting the validity of the data. However, the study recognised the

existence of the problem of inadequate knowledge of pain management, although most nurses considered their knowledge of pain to be good (Brown et al., 1999). Problems related to inadequate knowledge and improper attitudes regarding pain management may be why there is a relatively higher prevalence of pain in medical units (Dix, Sandhar, Murdoch &

MacIntrye, 2004; Whelan, Jin & Meltzer, 2004; Gregory &Haigh, 2008; Sawyer, Haslam, Daines &Stilos, 2010). Appendix A outlines recent studies that have utilised the KASRP tool to examine nurses’ knowledge and attitudes regarding pain.

Students studying for a BSc (Nursing) degree in Iran were found to have limited knowledge of pain management, as revealed by Rahimi-Madizeh, Tavakol and Dennick (2010). Based on responses to a questionnaire of 36 standard items, the overall average correct score was 36.9 % (SD=7.7). However, the authors of the study suggested a possible negative bias in the results due to some issues regarding the translation of the survey tool from English to Persian, and due to the influence of cultural factors.

In a recent study conducted in the US by Duke, Haas, Yarbrough and Northam (2013), the KASRP tool was used to identify the knowledge and attitudes of nursing students and faculty regarding pain. The study surveyed a sample of 162 junior and senior students enrolled in a baccalaureate nursing program and 16 nursing faculty. The results showed that while senior students scored only 68 %, the faculty did not perform much better, with a mean score of only 71 % (Duke et al., 2013), indicating the existence of a serious problem regarding knowledge of pain and its management. A survey involving 313 nursing students in degree programs in the state of Louisiana, US, was carried out to determine their knowledge and attitudes towards pain management (Plaisance & Logan, 2006). The overall correct response rate was 64 %, again showing an unsatisfactory level of knowledge. Their performance was particularly

found wanting on analgesic administration and duration of action, and they seemed to possess an exaggerated fear of addiction to analgesics.

Kaki (2011) assessed knowledge and attitudes regarding cancer pain management among a sample of 325 medical students at the King Abdul Aziz University Hospital in Saudi Arabia using a self-conducted questionnaire. The results revealed that, overall, students’ knowledge on the subject was poor. Further, they displayed a poor understanding of cancer-related pain and negative attitudes regarding pain management. This conclusion is based on the findings that 54 % of respondents believed that less than 40 % of cancer patients really had pain. Forty per cent believed that cancer pain could not be relieved with medication, while 68 % were reluctant to use opioids for pain relief because they were afraid of addiction problems.

In many of the above mentioned studies, nurses were found to be particularly deficient in certain knowledge areas, such as pharmacology, addiction, under-estimation of pain, medication withdrawal, substance abuse and cancer-related pain. Chronic conditions are viewed by nurses as conditions with less pain compared to that of acute conditions. This assumption is detrimental to older patients with chronic conditions such as diabetes and renal diseases.