Nurses' pain assessment practices with critically ill adult patients.

OBJECTIVES: This study aimed to describe the perceived barriers, enablers and acute pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting. BACKGROUND: Acute pain is a common problem among critically ill adult patients, and nurses' play a central role in its control. Very few studies have examined nurses' acute pain assessment practices in resource-limited settings. METHODS: A descriptive and cross-sectional design was used. A total of 170 nurses working in a Ugandan hospital were enrolled. Data were collected using a questionnaire measuring various aspects of pain assessment for critically ill adult patients. RESULTS: The majority of nurses had poor pain assessment practices. The most commonly performed pain assessment practices were documenting assessment findings, discussing pain assessment and management during nurse-to-nurse reports, and assessing for analgesics need before wound care. The main barriers to pain assessment were workload; lack of education and familiarity with assessment tools; poor documentation and communication of pain assessment priorities. The only reported enabler was physician's prescriptions for analgesia. Pain assessment practices were significantly associated with perceived workload and priority given to pain assessment. CONCLUSION: Pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting are affected by several barriers. IMPLICATION FOR NURSING AND HEALTH POLICY: Interventions to reduce barriers and enhance enablers of acute pain assessment are needed to improve pain management in critically ill adult patients. To be effective, the interventions have to be holistic and implemented by professional bodies and employers of nurses.

Patient safety culture among nurses.

BACKGROUND: Patient safety is considered to be crucial to healthcare quality and is one of the major parameters monitored by all healthcare organizations around the world. Nurses play a vital role in maintaining and promoting patient safety due to the nature of their work. AIMS: The purpose of this study was to investigate nurses' perceptions about patient safety culture and to identify the factors that need to be emphasized in order to develop and maintain the culture of safety among nurses in Oman. METHODS: A descriptive and cross-sectional design was used. Patient safety culture was assessed by using the Hospital Survey on Patient Safety Culture among 414 registered nurses working in four major governmental hospitals in Oman. Descriptive statistics and general linear regression were employed to assess the association between patient safety culture and demographic variables. RESULTS: Nurses who perceived more supervisor or manager expectations, feedback and communications about errors, teamwork across hospital units, and hospital handoffs and transitions had more overall perception of patient safety. Nurses who perceived more teamwork within units and more feedback and communications about errors had more frequency of events reported. Furthermore, nurses who had more years of experience and were working in teaching hospitals had more perception of patient safety culture. CONCLUSION: Learning and continuous improvement, hospital management support, supervisor/manager expectations, feedback and communications about error, teamwork, hospital handoffs and transitions were found to be major patient safety culture predictors. Investing in practices and systems that focus on improving these aspects is likely to enhance the culture of patient safety in Omani hospitals and others like them. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Strategies to nurture patient safety culture in Omani hospitals should focus upon building leadership capacity that support open communication, blame free, team work and continuous organizational learning.