Factors influencing pain management by nurses in emergency departments in Central Africa

Abstract

Objective: To observe pain management practices by nurses in emergency departments (EDs) in Central Africa and to study the various factors influencing these practices. Methods: Time to first analgesic treatment was recorded in 53 patients presenting to the ED of a Central African hospital in February 2005. A survey was simultaneously conducted on the attitudes and commitment of nurses towards the management of pain. All 28 nurses assigned to the ED agreed to participate in the survey. Results: Severity of pain was the factor most influencing the time to first analgesia following admission to the ED. Severe pain was assessed as a score of ⩾7 on a 1–10 visual analogue scale. The median time to first analgesia in patients with severe pain was 150 min, which was considerably longer than in patients without severe pain (p = 0.003). A quarter of the 28 nurses had no official training in pain management and most (>80%) were unable to carry out a formal assessment of pain. The majority (>90%) were confident of their ability to treat pain. Thirteen (48%) were of the opinion that cultural factors influenced their management of pain and 67% admitted that they had some fears about administering morphine to patients in the ED. Conclusion: Pain management by nurses in the ED in Central Africa is inadequate. Cultural factors greatly influence how nurses manage pain in the emergency room. Patients would benefit considerably if nurses received additional education about the diagnosis and management of acute pain in EDs in Central Africa.