Abstract

Background: Patients experience physical pain for a myriad of reasons. The patients' expression of pain is often difficult to quantify and treat based on individuality of the patients and the viewpoint of the nurses. Therefore, the treatment of pain can become discounted or marginalized, especially in patients who use alcohol or drugs. The use of opioids is the gold standard for pain management, but current administering trends are to use less, or to use non-opioid treatments for fear of patient dependency. There is also an opioid epidemic and patients are sometimes categorized into this unfortunate situation as a precaution. Nevertheless, pain is real, it cannot be overlooked, and nurses need to assess and treat patient pain for maximum patient outcome. Conceptual Basis: The AACN Synergy Model was used as a model and mid-range theoretical framework. The AACN uses the patient characteristics and nurses' competencies to drive positive patient outcomes. In this study the patient characteristics are represented by the three patient scenarios. The nurses' competencies are represented by the measurement tools as follows: empathy (IRI); unit culture and drug use (DDPPQ); organizational environment (PESNWI); and the demographic questions. The patient outcomes are represented as pain assessment using the NPRS and CBS scores. Methods: This is a descriptive correlational design study that utilized the NPRS and CBS as dependent variables and the IRI, DDPPQ and PES-NWI as independent variables. A demographic questionnaire (CNS) was also used. Three of the same patient scenarios were used with one exception for each: the patient has no drug/alcohol history, the patient has a current drug/alcohol history, and the patient has a past drug/alcohol history. Anonymous surveys were sent to nurses using Data Axle, Giant Partners, and GMass emails and with TxtFlo texting. Data were entered into SPSS and analyzed for the relationships of patient drug/alcohol status and nurses' pain assessment. ANOVA was used and regression analysis to look for relationships between the nurses' demographics and responses to the IRI, DDPPQ, PES-NWI and their pain scoring in the patient scenarios. Findings: The dependent variable (NPRS) demonstrated statistically significant difference among the three scenarios (ANOVA; F = 9.4, df = 2, p < 0.001). Using ANOVA tests for the dependent variable (adjusted CBS) demonstrated statistically significant differences among the three scenarios (ANOVA; F = 12.12, df = 2, p = <.001). Multiple linear regression analysis was used with four models of the dependent variable (NPRS). Groups 2 and 3 versus group 1 in model 1, (R2 = 0.16); model 2 (R2 = 0.21); model 3 (R2 = 0.22). Models 1, 2 and 3 were statistically significant with p < 0.01. Model 4 was not significant. The total percent of explained variance for Model 3 was 22%. Scenarios 2 and 3 were observed to be significantly different from scenario 1 with respect to NPRS (p < 0.05), and the Betas indicated inverse relationships (Bgroup2 = -0.54. Bgroup3 = -0.25); indicating lower NPRS scores for scenarios 2 and 3 compared to scenario 1. Multiple linear regression analysis was used with four models to test the differences in the dependent variable (adjusted CBS) among the 3 groups (scenarios). In model 1, groups 2 and 3 were compared to group 1 (R2 = 0.16), model 2, (R2 = 0.21), model 3, (R2 = 0.26), model 4, (R2 = 0.40). Multiple linear regression analysis for four models showed statistically significant results with p < 0.01. Model 1 p = 001; model 2, p = .002, model 3, p = .001, and model 4, p = .001. The percent of explained variance increased with the models with a total of 40%. Unstandardized Betas indicated inverse relationships (Bgroup2 = -0.87. Bgroup3 = -0.72); suggesting lower adjust CBS scores in scenarios 2 and 3, compared to scenario 1. The demographics of age, gender, certification, and specialty (cardiovascular compared to post-op nurses) were significantly related to CBS scores in the final regression model (p < 0.05). Conclusions: Using the AACN Synergy Model, the relationship between nurses' empathy, drug perceptions, work environment and patient pain scoring were not significant. However, age, gender, certification, and specialty, (specifically cardiovascular) were shown to be predictors of lower pain scoring by nurses on the NPRS and CBS pain scales. Furthermore, the lower scores that was given by specialty nurses was identified as statistically significant as opposed to other educated or trained nurses. In examining scenarios 2 and 3 (current or past patient history of alcohol/drug use) compared to scenario 1 (no patient history of alcohol/drug use), scenarios 2 and 3 showed significantly lower pain scores compared to scenario 1; and their standardized betas were approximately of equal proportion (0.40 and 0.32, respectively).

Description

This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 30529575; ProQuest document ID: 2833337221. The author still retains copyright.

Author Details

Valerie A. Esposito Kubanick, PhD, RN, PMH-BC

Sigma Membership

Alpha Omega

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Descriptive/Correlational

Research Approach

Quantitative Research

Keywords:

Patient Care, Pain Management, Addiction

Advisors

Jacobowitz, William||Kabingting, Edwin||Liu, Shan

Degree

PhD

Degree Grantor

Adelphi University

Degree Year

2023

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2024-05-10

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