Abstract

To examine the influence of addiction risk (substance abuse history [SAH]) and pain relief (PR) on nursing and non-nursing students' perceptions of pain in a postoperative vignette patient. Using a 2 x 2 design, the independent variables SAH (present/+, absent/-) and PR (adequate, little) were varied systematically to produce four vignettes. Participants were randomly assigned to receive one of the four vignettes that described a 45-year-old man after a total hip replacement. Participants rated the vignette patient's experienced and reported pain intensity (PI) on a 0 mm to 100 mm visual analogue scale and addiction risk on a 0 mm to 100 mm visual analogue scale. A pain congruence (PC) score was calculated (PC = reported PI -- experienced PI), and was interpreted as congruent (+/-2 mm) or incongruent (+2 mm to +100 mm for expected pain over-reporting; -2 mm to -100 mm for expected pain under-reporting). Responses from undergraduate nursing (n=89) and non-nursing (n=88) students were analyzed. The estimated addiction risk was significantly lower in nursing (14% to 45%) versus non-nursing students (50%). Nursing students' mean PC scores were not significantly altered by SAH alone. Expectations of pain over-reporting were observed under conditions of SAH+/adequate PR, but not SAH+/little PR. In non-nursing students, SAH and PR were significant and independent factors influencing mean PC scores in the direction of pain over-reporting. Under most conditions, nursing students expected pain under-reporting by the postoperative vignette patient. However, nursing students did expect pain to be over-reported when addiction risk was high and PR was adequate. These data suggest that nursing students' expectations regarding pain over- and under-reporting were sensitive to perceptions of addiction risk, but involved additional factors (eg, level of PR).

Highlights

  • ObJeCTive: To examine the influence of addiction risk and pain relief (PR) on nursing and non-nursing students’ perceptions of pain in a postoperative vignette patient

  • Concerns regarding the risk of opioid addiction in postoperative patients have been well documented (16), and health care professionals’ attitudes and beliefs related to the risk of iatrogenic addiction have been associated with the “withholding of opioid analgesics” (1)

  • Data presented as mean ± SEM. *Overall visual analogue scale (VAS) addiction risk ratings were significantly greater in firstyear nursing students (FYN) compared with SYN students. †Substance abuse history (SAH) was a significant factor influencing mean VAS addiction risk ratings in both FYN and SYN groups. ‡Mean VAS addiction risk ratings in the non-nursing group were included to demonstrate the absence of significant influence of the substance abuse history (SAH) factor on addiction risk ratings in this group group, mean addiction risk scores were significantly greater in the SAH+ condition compared with the SAH– condition in the nursing group (48.2±4.0 mm versus 23.9±3.9 mm, P

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Summary

Program year

All data are reported as mean ± SEM unless otherwise specified. *P0.05, all comparisons).

Nursing group Adequate Little
Nursing group SYN FYN
SAH absent
SAH ABSENT CONDITION
Findings
ADEQUATE PAIN RELIEF CONDITION
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