THURSDAY, July 29 (HealthDay News) -- Nurses' perceptions of barriers preventing optimal pain management in older adults in acute medical units, as well as their perceived adoption of specific evidence-based guidelines, are not always consistent with actual practice, according to a study published in the August issue of Applied Nursing Research.

Esther Coker, R.N., of McMaster University in Hamilton, Canada, and colleagues evaluated the extent to which nurses caring for older adults with persistent pain on acute medical units believe they have adopted four evidence-based practices related to pain management and assessment. They also aimed to determine nurses' perceived barriers to optimal management of pain. In Phase 1 of the study, 36 nurses reviewed the findings of a previous study conducted in their units and generated potential facilitators and barriers to optimal pain management and assessment. In phase 2, 115 nurses were surveyed about 40 potential barriers to optimal pain management and assessment.

The researchers found that nurses' perceptions of barriers preventing optimal pain management were often incongruent with actual practice, as were their perceptions of the extent to which they had adopted certain evidence-based practices for pain management and assessment. The researchers write that, to target the 12 highest-impact barriers, nurses should elicit reports of pain, provide regular pro re nata pain relief, use pain assessment tools in patients who are cognitively impaired, redesign documentation processes and tools, make nonpharmacological alternatives available, and help patients and their families manage side effects.

"Appropriate strategies to minimize potential barriers can be developed to better enable nurses to implement practice guidelines to generate effective pain management in older adults," the authors write.

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