Addressing patients' concerns about pain management and addiction risks.
Fear of engendering addiction is frequently reported as both a provider and a patient barrier to effective pain management. In this study, a clinical scenario ascertained nursing staff members' usual practice in addressing addiction fears for patients with concerns about the addictive potential of pain medication. One hundred forty-five Veterans Health Administration nursing staff members from eight ambulatory care sites were queried to identify variables associated with proclivity to address patient fears about addiction risks in a population where pain is prevalent and the risk for substance abuse is high. Regarding addressing addiction concerns, 66% of nursing staff were very likely, 16% somewhat likely, 9% unsure, 6% somewhat unlikely, and 2% very unlikely to take action. Health technicians were less likely to address addiction concerns than registered or licensed vocational nurses (odds ratio [OR] 0.116; p=.004). Nursing staff with more years' experience (OR 1.070; p=.005) and higher levels of self-efficacy/confidence (OR 1.380; p=.001) were more likely to engage in discussions related to addiction risks. Targeted efforts to improve pain management activities should focus on retaining experienced nursing staff in initial assessment positions and improving the skills and confidence of less experienced and less skilled staff.
Department of Nursing, California State University, Long Beach, California 90840-0201, USA. jgoebel@csulb.edu
Joy R
JR
Goebel
Cathy D
CD
Sherbourne
Steven M
SM
Asch
Lisa
L
Meredith
Angela B
AB
Cohen
Emily
E
Hagenmaier
Andy B
AB
Lanto
Barbara
B
Simon
Lisa V
LV
Rubenstein
Lisa R
LR
Shugarman
Karl A
KA
Lorenz
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D010146:Pain / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D010353:Patient Education as Topic; D057184:Practice Patterns, Nurses' / Q000458:organization & administration; D012307:Risk Factors; D020377:Self Efficacy; D019966:Substance-Related Disorders / Q000209:etiology / Q000517:prevention & control; D014481:United States; D014493:United States Department of Veterans Affairs