Resarch Study and Commentary by Dana Rutledge, Phd, RN, Nursing Research Facilitator

RESEARCH STUDY AND COMMENTARY

Schulman-Green, D. et al. (2005). Unlicensed staff members’ experiences with patients’ pain on an inpatient oncology unit. Implications for redesigning the care delivery system. Cancer Nursing, 28, 340-347. Staff at SJO/CHOC can access the full text of this article through the library's web site.

Authors’ Abstract

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice sitaut9on, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses’ aides, and housekeepers (n = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationship with patients, interpreting patients’ pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients’ pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain an expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.

Commentary by Dana Rutledge, PhD, RN, Nursing Research Facilitator

In this qualitative study, researchers described results of focus groups of unlicensed hospital staff who were asked about experiences with patient and pain. Nurses might be surprised at some of the important ways these staff perceive that they impact pain and its management. Patient care assistants (14, the largest group of staff) noted that they were assessing pain using the 0 – 10 score at the time they did vital signs. They reported having difficulty identifying the nature of pain when patients found the 0-10 scale confusing or difficult to respond to. Is this a problem that could occur at St. Joseph?

Those interviewed mentioned their roles in assisting in patient comfort by giving emotional and physical care. Some use nonpharmacologic pain management techniques such as distraction or listening. These staff members consider comfort care important to their roles. Most unlicensed staff reported communicating patient pain to nursing staff, and consider this one of their most important roles.

As with nurses, unlicensed staff identified challenges to dealing with patients’ pain. One was their overall heavy workloads, which interfered when they wanted to spend time with patients in pain. They emphasized the importance of teamwork, individualizing care, and empathy in caring for their patients.

In the discussion of their results, Schulman-Green and colleagues suggest that care redesign that enhances PCA-nurse relationships, expands training for unlicensed staff, and debriefing at intervals would improve pain management for patients in pain. What do you think?