title: Nurses' Experiences of Patients with Substance-Use Disorder in Pain: A Phenomenological Study.
abstract: Patients with substance-use disorder and pain are at risk of having their pain underestimated and undertreated. Unrelieved pain can exacerbate characteristics that are believed to be 'drug-seeking' and in turn, perceived drug-seeking behavior can contribute to a patient being stigmatized and labeled 'difficult'. Previous literature has indicated that negative attitudes towards patients with substance-use disorder may affect their pain management but little is known about the specific barriers. This study explored nurses' experiences of working with patients with substance-use disorder in pain, providing an in-depth insight into their perspective. Descriptive phenomenology was employed as a framework for conducting semi-structured interviews to reveal the experiences of registered nurses. A convenience sample of registered nurses from a variety of clinical backgrounds were recruited and interviewed. This rich data was analyzed according to Giorgi's five-stage approach. Participants described feelings of powerlessness and frustration due to patient non-compliance, discrepancies in patient management amongst team members and external pressures effecting pain management. Participants described characteristics believed to be common, including psychosocial factors such as complex social backgrounds or mental health issues. Nurses' education and support needs were identified. Stereotyping and stigmatism were found to potentially still exist, yet there was also a general awareness of some specific clinical issues such as opioid tolerance and opioid-induced hyperalgesia. Further emphasis is required on interprofessional education and communication to improve patient management, alongside an appreciation of patient's rights facilitated by a concordance model of care.
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London; Imperial College Healthcare NHS Trust, Charing Cross Hospital, London. Electronic address: Georgina.Morley@bartshealth.nhs.uk.
authors.forename: Georgina
authors.initials: G
authors.lastname: Morley
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London.
authors.forename: Emma
authors.initials: E
authors.lastname: Briggs
authors.affiliation: Imperial College Healthcare NHS Trust, Charing Cross Hospital, London.
authors.forename: Gillian
authors.initials: G
authors.lastname: Chumbley
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015897:Comorbidity; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009726:Nurses; D010146:Pain / Q000453:epidemiology / Q000451:nursing*; D059408:Pain Management; D010147:Pain Measurement; D057545:Social Stigma; D013240:Stereotyping; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000451:nursing*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid