title: Hearing new voices: registered nurses and health technicians experience caring for chronic pain patients in primary care clinics.
abstract: Recent national estimates from the U.S. reveal that as many as one-third of all Americans experience chronic pain resulting in high prevalence rates of visits to primary care clinics (PCC). Indeed, chronic pain appears to be an emerging global health problem. Research has largely ignored the perspective of PCC staff other than physicians in providing care for patients with chronic pain. We wanted to gain insights from the experiences of Registered Nurses (RNs) and Health Technicians (HTs) who care for this patient population. Krippendorff's method for content analysis was used to analyze comments written in an open-ended survey from fifty-seven primary care clinic staff (RNs-N=27 and HTs-N=30) respondents. This represented an overall response rate of 75%. Five themes emerged related to the experience of RNs and HTs caring for patients with chronic pain: 1) Primacy of Medications and Accompanying Clinical Quandaries; 2) System Barriers; 3) Dealing with Failure; 4) Primacy of Patient Centered Care; and 5) Importance of Team Based Care. This study demonstrates that nursing staff provide patient-centered care, recognize the importance of their role within an interdisciplinary team and can offer valuable insight about the care of patients with chronic pain. This study provides insight into strategies that can mitigate barriers to chronic pain management while sustaining those aspects that RNs and HTs view as essential for improving patient care for this vulnerable population in PCCs.
authors.affiliation: Yale University School of Nursing, Yale University West Campus, P.O. Box 27399, West Haven, CT 06516-7399, USA.
authors.forename: Linda H
authors.initials: LH
authors.lastname: Pellico
authors.affiliation: Primary Care Mental Health Integration, VA New Mexico Health Care System, 1501 San Pedro S.E. MC 116, Albuquerque, NM 87108, USA.
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Gilliam
authors.affiliation: Yale School of Medicine and VA Connecticut Healthcare System, PRIME Center/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, Building 35A, Rm 222, West Haven, CT 06516, USA.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Lee
authors.affiliation: VA Connecticut Healthcare System and Yale University, PRIME Center/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, Building 35A, Rm 201, West Haven, CT 06516, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
keywords: Chronic pain; Krippendorff method; content analysis; primary care clinic.