Factors Influencing the Type of Pain Interventions in Patients Who are Nonverbal and Unable to Self-Report
Purpose: To describe the factors contributing to pain intervention being delivered to adult patients who are nonverbal and unable to self-report through any other mechanism within progressive care unit settings. Background: It is important to understand what factors may prevent a patient with reduced ability to communicate from receiving an appropriate pain intervention. The study theoretical underpinning utilized was Donabedian’s Structure-Process-Outcome Framework. The structure reflects the environment where care takes place while the process is the way care is delivered. Having the right structure and process will lead to the desired outcome. Methods: Using electronic health record case data and organizational nurse education data, this retrospective cross-sectional design described the relationships between select patient sociodemographics, clinical characteristics, staff nursing characteristics, pain rating, and type of pain intervention being delivered. Descriptive statistics characterized the sample and tests of association described the relationships between the variables. Multinomial logistic regression was not conducted due to insufficient sample size. Findings: Case sex was related to both cancer type and if violence was committed during admission; race/ethnicity was related to preferred language; disability status to oncology diagnosis; palliative care status to inpatient hospice status, code status, intensity of treatment, and oncology diagnosis; and staff nursing preparation or nursing educational degree level to oncology diagnosis. Cases with patients who were middle age, preferred English, and without documented disability had more potent forms of pain analgesia provided compared to cases with patients who were younger or advanced in age, preferred non-English language, and had documented communication or cognitive disability. Implications for Research: Future studies using larger samples should investigate potential structural factors, such as age, preferred language, disability status, and additional nursing characteristics; as well as staffing practices, patient assignment patterns, staff nursing educational preparation, type of oncology diagnosis—all for the likelihood of a type of pain intervention being delivered. Conclusion: Patients who are younger or advanced in age, prefer non-English language, or have documented disabilities may be vulnerable to undertreatment when unable to self-report their pain. Recognizing these risks highlights the importance of reliable instruments and further research to ensure equitable pain management in this population.
palliative care, pain assessment, behavioral pain scales, end-of-life, Critical Care Nursing, Geriatric Nursing, Palliative Nursing
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