Pain management knowledge, attitudes and clinical practice: the impact of nurses' characteristics and education.

This study examined the knowledge, attitudes, and clinical practice of registered nurses (N = 120) regarding pain management. Data were collected from nine varied clinical units in a large, university-affiliated, teaching hospital in an urban area of the Northeast. Demographic information was also collected to explore the relationship between nurses' characteristics, including previous pain education, clinical experience, area of clinical practice, and other variables, and knowledge, attitudes, and clinical practice. Three instruments were used in the study: (a) the Pain Management: Nurses' Knowledge and Attitude Survey; (b) a 12-item demographic questionnaire; and (c) a Pain Audit Tool (PAT) to gather data regarding pain assessment, documentation, and treatment practices from charts. Mean scores from the nursing knowledge and attitudes survey on pain revealed knowledge deficits and inconsistent responses in many areas related to pain management (mean, 62%; range, 41%-90%). The top two nurse-ranked barriers to pain management were related to patient reluctance to report pain and to take opioids for pain relief. Demographic data revealed that education about pain was most inadequate in the following areas: nonpharmacological interventions to relieve pain, the difference between acute and chronic pain, and the anatomy and physiology of pain. Chart audits with the Pain Audit Tool revealed that 76% of the charts (N = 82) lacked documentation of the use of a patient self-rating tool by nurses to assess pain, despite a high reported use (76%) of such a self-rating tool. Adjunct medications were ordered with some consistency, but appeared to be underutilized. This was especially true of nonsteroidal anti-inflammatory agents (mean use, 1%). Ninety percent of the charts had no documentation of the use of nonpharmacological interventions to relieve pain. Although this clinical setting has policies and resources in place regarding the management of pain, it would appear that they are not optimal. Practical recommendations are presented for increasing nurses' knowledge about pain management; improving the quality and the consistency of the assessment, documentation and treatment of pain; and disseminating pain management information.

The management of patients undergoing arterial reconstructive surgery.

Management of the patient undergoing arterial reconstructive surgery is multidisciplinary and challenging. It involves vigilant monitoring, early detection, and treatment of high frequency complications of the underlying disease process (atherosclerosis) and the diagnostic and surgical procedures for limb-threatening occlusive lesions. The purpose of this article is to address patterns of peripheral arterial disease, indications for surgery, types of surgical procedures, and expected outcomes. In addition, nursing care guidelines related to preoperative care, postoperative care, and discharge planning are provided.