Emergency Nurses' Perceptions and Experiences in Managing Acute Pain in Critically Ill Adult Patients: A Qualitative Study

Abstract

Aim: The aim of this study was to examine the perceptions and experiences of emergency nurses managing acute pain in critically ill patients. Design: Qualitative descriptive study. Method: Non-participant observations (n = 46, 157 h across 10 shifts) and semi-structured interviews (n = 30) were conducted at two Australian metropolitan emergency departments from November to December 2020. Transcribed data were analysed using reflexive thematic analysis. Results: The qualitative analysis yielded three main themes and eight subthemes: (i) being in the resuscitation area in which participants detail learning to work in the resuscitation area; influences in managing critically ill patients and confidence in acute pain management; (ii) prioritising pain management identified the challenges in optimising pain management and balancing departmental demands; and (iii) between being and doing and how nurse–patient interactions and care behaviours impacted on optimising pain management and comfort in the resuscitation area. Conclusion: Emergency nurses were primarily responsible for the continuity of patient care and optimisation of pain control for critically ill patients. Confidence in managing acute pain in critically ill patients was variable. While nurses actively sought ways to provide a reassuring presence and comfort to critically ill patients, this was limited by unpredictable workloads, availability of staff and communication challenges. Implications for the Profession and/or Patient Care: These study findings may assist in the development of policy and formal education of emergency nurses transitioning into the resuscitation area and the management of acute pain in critically ill patients. Impact: Pain is under-assessed and managed in critically ill patients, and this could stem from emergency nurses' practices. The findings could inform interventions to enhance pain management and practices. Patient or Public Contribution: No patient or public contribution. Reporting Method: This study adhered to the COREQ criteria.