title: Challenges faced by nurses in managing pain in a critical care setting.
abstract: OBJECTIVE
  To explore nurses' challenges in managing pain among ill patients in critical care.
  
  
  BACKGROUND
  Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill.
  
  
  METHODS
  Qualitative prospective exploratory design.
  
  
  METHODS
  This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses.
  
  
  RESULTS
  Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself.
  
  
  CONCLUSIONS
  Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience.
  
  
  CONCLUSIONS
  There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines.
authors.affiliation: Department of Nursing Science, University of Malaya, Kuala Lumpur, Malaysia. pathmawathi@um.edu.my
authors.forename: Pathmawathi
authors.initials: P
authors.lastname: Subramanian
authors.forename: Nick
authors.initials: N
authors.lastname: Allcock
authors.forename: Veronica
authors.initials: V
authors.lastname: James
authors.forename: Judith
authors.initials: J
authors.lastname: Lathlean
mesh_terms: D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D006113:United Kingdom