Ethics code: IR.TUMS.FNM.REC.1398.150


XML Print


1- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2- Muhimbili Natinal Hospital, Dar es Salaam, Tanzania
3- Red Crescent Society of the Islamic Republic of Iran, Ministry of Health and Medical Education, Research and Technology Office, Tehran, Iran
4- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran , bahramnezhad@sina.tums.ac.ir
Abstract:   (124 Views)

Background: Inadequate pain management among critically ill nonverbal patients in ICUs is a significant public health issue that can lead to prolonged mechanical ventilation and poor quality of life. Critical care nurses play a vital role in mediating pain management, and identifying barriers they face is essential for developing effective pain relief policies. This study aimed to assess nurses' perceived barriers to pain management in ICUs.
Methods: The study employed a cross-sectional design, adhering to STROBE reporting guidelines, and was conducted from January to May 2022 across four national referral hospitals in Tanzania, including university-affiliated and public hospitals. It utilized the Eastern Cooperative Oncology Group (ECOG) barrier tool to assess critical care nurses' perceived barriers to pain management in the ICU, with data analyzed using the Kruskal-Wallis test. A total of 202 nurses were recruited through census sampling. Data collection involved demographic questionnaires alongside the ECOG barrier tool to evaluate the challenges faced by nurses in managing pain effectively.
Results: The findings revealed that there were perceived nurse barriers related to medical staff and patients with the overall mean 4.57± 1.25 and 3.90±1.17 respectively.  ICU nurses did not perceive barriers related to the healthcare system with an overall mean 2.33±0.78.
Conclusion: Critical care nurses perceive barriers related to medical staff and patients as significant obstacles to effective pain management in ICUs. Intensive training on diagnosis and assessment, along with the use of tools like the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT), is essential for improving outcomes. Additionally, integrating patients' cultural backgrounds into pain assessments is crucial for effective management.

 

     
Type of study: Original Article | Subject: Nursing

References
1. Ayasrah SM. Pain among non-verbal critically Ill mechanically ventilated patients: Prevalence, correlates and predictors. J Crit Care. 2019;49:14-20. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Salim I, Ejheisheh MA, Ayed A, Aqtam I, Batran A. Barriers and practices in pain management for intubated patients: A study of critical care nurses in Southern West Bank hospitals. PloS one. 2025;20(3):e0320430. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Hajiesmaeili MR, Safari S. Pain management in the intensive care unit: do we need special protocols? Anesth Pain Med. 2012;1(4):237-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Bennett S, Hurford WE. When should sedation or neuromuscular blockade be used during mechanical ventilation? Respir Care. 2011;56(2):168-80. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Rani V, Kour P. Attitudes of Nurses Towards Pain Management in Geriatric Care. 2025. [View at Publisher] [Google Scholar]
6. Park J-M, Kim JH. Assessment and treatment of pain in adult intensive care unit patients. The Korean J Crit Care. Med2014;29(3):147-59. [View at Publisher] [DOI] [Google Scholar]
7. Brennan F, Lohman D, Gwyther L. Access to Pain Management as a Human Right. Am J Public Health. 2019;109(1):61-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Batiha A-M. Pain management barriers in critical care units: A qualitative study. International Journal of Advanced Nursing Studies. 2014;3(1):1. [View at Publisher] [DOI] [Google Scholar]
9. Shrestha S, Sapkota S, Teoh SL, Kc B, Paudyal V, Lee SWH, et al. Comprehensive assessment of pain characteristics, quality of life, and pain management in cancer patients: a multi-center cross-sectional study. Qual Life Res. 2024;33(10):2755-71. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Deldar K, Froutan R, Ebadi A. Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study. BMC Nurs. 2018;17:11. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Choi J, Campbell ML, Gélinas C, Happ MB, Tate J, Chlan L. Symptom assessment in non-vocal or cognitively impaired ICU patients: implications for practice and future research. Heart Lung. 2017;46(4):239-45. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Zakeri H, Mahtosh P, Radmehr M, Rahbani R, Montazeri L, Moalemi S, et al. Pain Management strategies in Intensive care unit: challenges and Best Practice. Galen Med J. 2024;13:e3264. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. D'emeh WM, Yacoub MI, Darawad MW, Al-Badawi TH, Shahwan B. Pain-related knowledge and barriers among Jordanian nurses: a national study. Health. 2016;8(06):548. [View at Publisher] [DOI] [Google Scholar]
14. Akbar N, Teo SP, Hj-Abdul-Rahman NA, Hj-Husaini A, Venkatasalu MR. Barriers and Solutions for Improving Pain Management Practices in Acute Hospital Settings: Perspectives of Healthcare Practitioners for a Pain-free Hospital Initiative.Ann Geriatr Med Res. 2019;23(4):190-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Darawad M, Alnajar MK, Abdalrahim MS, El-Aqoul AM. Cancer Pain Management at Oncology Units: Comparing Knowledge, Attitudes and Perceived Barriers Between Physicians and Nurses. J Cancer Educ. 2019;34(2):366-74. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Kassa RN, Kassa GM. Nurses' attitude, practice and barrier s toward cancer pain management, Addis Ababa, Ethiopia. J Cancer Sci Ther. 2014;6(12):483-7. [View at paplisher] [DOI] [Google Scholar]
17. Mędrzycka-Dąbrowska W, Dąbrowski S, Gutysz-Wojnicka A, Basiński A, Kwiecień-Jaguś K. Nurses' knowledge and Barriers Regarding Pain Management. J Perianesth Nurs. 2018;33(5):715-26. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Rababa M, Al-Sabbah S, Hayajneh AA. Nurses' Perceived Barriers to and Facilitators of Pain Assessment and Management in Critical care Patients: A Systematic Review. J Pain Res. 2021:14:3475-91. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Wang HL, Tsai YF. Nurses' knowledge and barriers regarding pain management in intensive care units. J Clin Nurs. 2010;19(21‐2):3188-96. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Shoqirat N, Mahasneh D, Al-Khawaldeh O, Al Hadid L. Nurses' Knowledge, Attitudes, and Barriers Toward Pain Management Among Postoperative Patients in Jordan. J Perianesth Nurs. 2019;34(2):359-67. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Samwel R, Boniface R. Pain management and factors associated with its severity among post surgical patients admitted in the intensive care unit at Muhimbili national hospital, Tanzania. Open Journal of Anesthesiology. 2019;9(2):23-33. [View at Publisher] [DOI] [Google Scholar]
22. Tanzania D. Ministry of Health, Community Development, Gender, Elderly and Children. [View at Publisher] [Google Scholar]
23. Fan B. Medication Treatment for Visceral Pain. Visceral Pain: From Bench to Bedside: Springer; 2024. p. 89-98. [View at Publisher] [DOI] [Google Scholar]
24. Sukhram SD, Yilmaz G, Erichsen S, Vassilevich S. Exploring the Efficacy and Safety of Ketamine for Managing Acute Renal Colic in Emergency Departments: A Systematic Review of Recent Clinical Trials. Int J Mol Sci. 2025;26(1):371. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Elm EV, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP,et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. . Bull World Health Organ. 2007;370(9596):1453-57. [View at Publisher] [DOI] [PMID] [Google Scholar]
26. Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA,et al. Pain and its treatment in outpatients with metastatic cance. N Engl J Med. 330(9):592-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Iklima N, Maidartati M, Irawan E, Nurlianawati L, Nuryanti L. Identifying Barriers to Optimal Pain Management in ICU Nurses: A Cross-Sectional Analysis. Journal Medical Informatics Technology. 2025:1-7. [View at Publisher] [DOI] [Google Scholar]
28. Severgnini P, Pelosi P, Contino E, Serafinelli E, Novario R, Chiaranda M. Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016;4:68. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Thomas D, Kuruppasseril AJ, Samad RA, George EJ. Comparative Accuracy of Critical Care Pain Observation Tool (CPOT), Behavioral Pain Scale (BPS), and Non-verbal Pain Scale (NVPS) for Pain Assessment in Mechanically Ventilated Intensive Care Unit Patients: A Prospective Observational Study. Indian J Crit Care Med. 2025;29(6):492-7. [View at paplisher] [DOI] [PMID] [Google Scholar]
30. Wadumanannalage P, Kumara PR, Arachchilage A, Amarasinghe RP. Pain Management in the intensive care. Descriptive literature review. 2025. [View at Publisher] [Google Scholar]
31. Berben SAA, Meijs THJM, van Grunsven PM, Schoonhoven L, van Achterberg T. Facilitators and barriers in pain management for trauma patients in the chain of emergency care. Injury. 2012;43(9):1397-402. [View at Publisher] [DOI] [PMID] [Google Scholar]
32. Gerber K, Willmott L, White B, Yates P, Mitchell G, Currow DC, et al. Barriers to adequate pain and symptom relief at the end of life: A qualitative study capturing nurses' perspectives. Collegian. 2022;29(1):1-8. [View at Publisher] [DOI] [Google Scholar]
33. Pu L, Barton M, Kodagoda Gamage M, Okada M, Todorovic M, Moyle W. Pain Assessment and Management in Dementia Care: Qualitative Perspectives of People With Dementia, Their Families, and Healthcare Professionals. J Clin Nurs. 2025;34(7):2933-47. [View at Publisher] [DOI] [PMID] [Google Scholar]
34. Miller EL, Okour A. Pain Management Among the Cognitively Impaired. Pain Manag Nurs. 2024;25(2):101-3. [View at Publisher] [DOI] [PMID] [Google Scholar]
35. Rababa M, Al-Sabbah S. Nurses' Pain Assessment Practices for Cognitively Intact and Impaired Older Adults in Intensive Care Units. Dement Geriatr Cogn Dis Extra. 2022;12(2):115-21. [View at Publisher] [DOI] [PMID] [Google Scholar]
36. Papanikita M, Pavlatou N. Knowledge and attitudes of nurses regarding pain in adults' intensive care units. Health AND Research Journal. 2025;11(1):29-41. [View at Publisher] [DOI] [Google Scholar]
37. Graczyk M, Borkowska A, Krajnik M. Why patients are afraid of opioid analgesics: a study on opioid perception in patients with chronic pain. Pol Arch Intern Med. 2018;128(2):89-97. [View at Publisher] [DOI] [PMID] [Google Scholar]
38. Bulls HW, Hamm M, Wasilko R, de Abril Cameron F, Belin S, Goodin BR, et al. "I Refused to Get Addicted to Opioids": Exploring Attitudes About Opioid Use Disorder in Patients With Advanced Cancer Pain and Their Support People. J Pain. 2023;24(6):1030-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
39. Vranken MJ, Linge-Dahl L, Mantel-Teeuwisse AK, Radbruch L, Schutjens M-HD, Scholten W, et al. The perception of barriers concerning opioid medicines: A survey examining differences between policy makers, healthcare professionals and other stakeholders. Palliat Med. 2020;34(4):493-50. [View at Publisher] [DOI] [PMID] [Google Scholar]
40. Al-Mahrezi A. Towards Effective Pain Management: Breaking the Barriers.Oman Med J. 2017;32(5):357-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
41. Rogger R, Bello C, Romero CS, Urman RD, Luedi MM, Filipovic MG. Cultural Framing and the Impact on Acute Pain and Pain Services. Curr Pain Headache Rep.2023;27(9):429-36. [View at Publisher] [DOI] [PMID] [Google Scholar]
42. Jamal K, Alameri RA, Alqahtani FM, AlGarni RS, Alamri NA, Elshnawie HA, et al. Knowledge and Attitudes of Critical Care Nurses Regarding Pain Management in Saudi Arabia. Med Arch. 2023;77(1):49-55. [View at Publisher] [DOI] [PMID] [Google Scholar]
43. Kuhlmann EH, Tallman BA. The Impact of Nurses' Beliefs, Attitudes, and Cultural Sensitivity on the Management of Patient Pain. J Transcult Nurs. 2022;33(5):624-31. [View at Publisher] [DOI] [PMID] [Google Scholar]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2025 CC BY-NC 4.0 | Journal of Research Development in Nursing and Midwifery

Designed & Developed by : Yektaweb