Selección de las reacciones estudiadas en la tesis doctoral

The KASRP tool covers many aspects of pain management, and it is widely used to assess nurses’ knowledge and attitudes in relation to pain assessment, patient variables, addiction, knowledge in pharmacology and interventions to manage pain.

The frequency distribution of the correct answers (per cent) obtained by n = 303 participants was normal, indicated by the symmetrical bell-shaped histogram (Figure 4.1).

Figure 4.1: Frequency distribution of correct answers (per cent) by n = 303 participants

above the mean and 152 below the mean, as would be expected from a normally distributed variable. The majority (n = 227, 75.0 %) scored between 35 % and 47.5 %. There were a few outliers, reflected by n = 7 (2.3 %) of the participants who scored ≤ 20 % and n = 11 (3.6 %) with scores ≥ 60 % and only two participants obtained a passing score of ≥ 80 %. Table 4.2 shows the distributions of scores for the Knowledge and Attitudes Questionnaire Regarding Pain.

Table 4.2: Distributions of Scores for the Knowledge and Attitudes Questionnaire Regarding Pain % Correct N (%) 70 + 3 (1%) 60–69 8 (2%) 50–59 52 (17%) 40–49 136 (44%) 30–39 84 (27%) Below 30 20 (6%)

As shown in Table 4.2, which presents the distribution of correct answers, the majority (44 %) of participants scored in the range of 40–49 % correct answers, with only 1% receiving scores above 70 and 6 % below 30. It is also evident that only 67 % of participants were able to score 40 % or above, indicating that one in three nurses lacked adequate knowledge on the material included in the questionnaire.

To understand the specific areas of strengths and weaknesses in knowledge, the NKASRP questions were ranked based on the percentage of correct answers obtained, and the results are presented in Table 4.3.

Table 4.3: Ranking of NKASRP Answers from Most Correct to Least Correct

Question Correct

answers

n (%)

16. After an initial dose of opioid analgesic is given, subsequent doses should be adjusted in

accordance with the individual patient’s response: (T). 255 (84.2%) 22. Narcotic/opioid addiction is defined as a chronic neurobiological disease, characterised by

behaviours that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm and craving: (T).

250 (82.5%)

34. The time to peak effect for morphine given intravenouslyis: (15 min.). 233 (76.9%) 15. Patients’ spiritual beliefs may lead them to think pain and suffering are necessary: (T). 209 (69.0%) 24. The recommended route administration of opioid analgesics for patients with brief, severe pain

of sudden onset such as trauma or postoperative pain is: (intravenous).

209 (69.0%) 25. Which of the following analgesic medications is considered the drug of choice for the

treatment of prolonged moderate to severe pain for cancer patients: (morphine).

207 (68.3%) 7. Combining analgesics that work viadifferent mechanisms (e.g. combining an opioid with an

NSAID) may result in better pain control with fewer side effects than using a single analgesic agent: (T).

196 (64.7%)

21. Benzodiazepines are not effective pain relievers unless the pain is due to muscle spasm: (T). 189 (62.4%) 27. Analgesics for postoperative pain should initially be given: (around the clock on a fixed

schedule).

186 (61.4%) 12. Elderly patients cannot tolerate opioids for pain relief: (F). 181 (59.7%) 31. The most accurate judge of the intensity of the patient’s pain is: (the patient). 181 (59.7%) 32. Which of the following describes the best approach for cultural considerations in caring for

patients in pain: (Patients should be individually assessed to determine cultural influences).

169 (55.8%) 6. Respiratory depression rarely occurs in patients who have been receiving stable doses of

opioids over a period of months: (T).

175 (57.8%) 14. Children less than 11 years old cannot reliably report pain, so nurses should rely solely on the

parent’s assessment of the child’s pain intensity: (F).

156 (51.5%) 29. The most likely reason a patient with pain would request increased doses of pain medication

is: (The patient is experiencing increased pain).

155 (51.2%) 2. Astheir nervous system is underdeveloped, children under two years of age have decreased pain

sensitivity and limited memory of painful experiences: (F).

151 (49.8%) 20. Anticonvulsant drugs such as gabapentin (Neurontin) produce optimal pain relief after a single

dose: (F).

150 (49.5%) 8. The usual duration of analgesia of 1–2 mg morphine IV is 4–5 hours: (F). 131 (43.2%) 35. The time to peak effect for morphine given orally is: (1–2 hours). 124 (40.9%) 18. Vicodin (hydrocodone 5 mg + acetaminophen 500 mg) PO is approximately equal to 5–10 mg

of morphine PO: (T).

122 (40.3%) 9. Research shows that promethazine (Phenergan) and hydroxyzine (Vistaril) are reliable

potentiators of opioid analgesics: (F).

113 (37.3%) 30. Which of the following is useful for treatment of cancer pain: (All of the above). 109 (36.0%) 3. Patients who can be distracted from pain usually do not have severe pain: (F). 108 (35.6%) 5. Aspirin and other non-steroidal anti-inflammatory agents are NOT effective analgesics for

painful bone metastases:(F).

102 (33.7%) 1. Vital signs are always reliable indicators of the intensity of a patient’s pain: (F). 99 (32.7%) 38 A. On the patient’s record, you must mark his pain on the scale below. Circle the number that

represents your assessment of Robert’s pain: (8).

97 (32.0%) 13. Patients should be encouraged to endure as much pain as possible before using an opioid: (F). 94 (31.0%) 26. Which of the following IV doses of morphine administered over a four-hour period would be

equivalent to 30 mg of oral morphine given q 4 hours: (Morphine 10 mg IV).

91 (30.0%) 33. How likely is it that patients who develop pain already have an alcohol and/or drug abuse 86 (28.4%)

11. Morphine has a dose ceiling (i.e. a dose above which no greater pain relief can be obtained): (F).

85 (28.1%) 17. Giving patients sterile water by injection (placebo) is a useful test to determine if the pain is

real: (F).

71 (23.4%) 10. Opioids should not be used in patients with a history of substance abuse:(F). 66 (21.8%) 4. Patients may sleep despite severe pain: (T). 59 (19.5%) 28. A patient with persistent cancer pain has been receiving daily opioid analgesics for

twomonths. Yesterday the patient was receiving morphine 200 mg/hour intravenously. Today he has been receiving 250 mg/hour intravenously. The likelihood of the patient developing clinically significant respiratory depression in the absence of new comorbidity is: (less than 1 per cent).

56 (18.5%)

36. Following abrupt discontinuation of an opioid, physical dependence is manifested by the following: (sweating, yawning, diarrhoea and agitation with patients when the opioid is abruptly discontinued).

55 (18.2%)

23. The recommended administration of opioid analgesics for patients with persistent cancer- related pain is: (oral).

44 (14.5%) 38 B. Check the action you will take at this time: (Administer morphine 3 mg IV now). 38 (12.5%) 37 A. On the patient’s record, you must mark his pain on the scale below. Circle the number that

represents your assessment of Andrew’s pain: (8).

28 (9.2%) 19. If the source of the patient’s pain is unknown, opioids should not be used during the pain

evaluation period, as this could mask the ability to correctly diagnose the cause of pain: (F).

22 (7.3%) 37 B. Check the action you will take at this time: (Administer morphine 3 mg IV now). 9 (3.0%)

T= True, F= False

Ten questions at the top of Table 4.3 were correctly answered by the majority of nurses (n = 180, 59.7 % to n = 255, 84.2 %). Nine of these 10 questions required factual knowledge about the use of analgesics (e.g. opioids, morphine, NSAID, Benzodiazepines), suggesting that nurses were quite knowledgeable in this area. Ten questions at the bottom of Table 4.3 were correctly answered by less than one-quarter of nurses (n = 9, 3.0 % to n = 23.4 %). These questions did not require as much factual knowledge about the use of analgesics as the top 10. This showed that the questions that the nurses found most difficult to answer were those that required them to: make decisions or personal value judgements, assess the value of a

particular treatment, determine what action should be taken in a given situation, assess the outcome of a particular treatment, and evaluate the severity and source of pain. In general, 25 questions were answered incorrectly by more than 50 % of participants.

4.4 Effect of Demographic and Cultural Factors on the Delivery of Effective Pain