The ethics of postoperative pain management: Mapping nurses' views.
OBJECTIVE
We explored the positions of nurses working in hospitals regarding the acceptability of refusing to give a repeat dose of painkiller to a postoperative patient who requested it. These positions were compared with that of lay people, physicians, and other health professionals.


METHODS
Factorial design was used to assess the impact of 6 situational factors: the patient's age, the current level of pain as assessed by the nurse, the number of requests, the level of risk associated with the administration of a repeat dose, the outcome of surgery, and the giving of alternative mild analgesics. We implemented a combination of scenario technique and of cluster analysis. Data were collected from April 2013 to December 2015.


METHODS
138 registered nurses, 32 nurse's aides, 33 physicians, 23 psychologists, and 169 lay people participated in the study.


RESULTS
We found 4 qualitatively different meaningful positions. A plurality of participants (57% of nurses) considered that refusing was not acceptable, irrespective of circumstances. A substantial minority of participants (but 52% of physicians) considered that refusing was acceptable only if the level of pain was low and the risk was high. Other participants (mostly lay people) considered that refusing was always acceptable each time a risk of side effects, either serious or simply mild, was present.
Jean-Jaurès University, Toulouse, France.
Maria Dolores
MD
Cano Romero
Jean-Jaurès University, Toulouse, France.
Maria Teresa
MT
Muñoz Sastre
Victor-Segalen University, Bordeaux, France.
Bruno
B
Quintard
Albany Medical College, New York, USA.
Paul C
PC
Sorum
Institute of Advanced Studies (EPHE), Paris, France.
Etienne
http://orcid.org/0000-0002-1707-3914
E
Mullet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D059408:Pain Management / Q000941:ethics*; D010147:Pain Measurement / Q000941:ethics*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
France; lay people; nurses; nursing; pain management; physicians