Evaluating Nurses Knowledge, Misconceptions, and Attitudes Towards Treating Patients with Chronic Pain : A Pilot Study

Abstract


INTRODUCTION
In recent years, the complexity and prevalence of chronic pain has become increasingly apparent, making it a major health concern.Chronic pain affects millions of individuals worldwide and it is often nurses who provide a majority of care and treatment to these patients [1].
Pain is a complex biopsychosocial phenomenon.According to the International Association for the Study of Pain (IASP), pain manifests as, "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage" [1].Chronic pain is a common and complex condition that can be challenging to treat effectively.People experiencing pain often suffer from multiple co-morbidities, including 20-50% of people also suffering from depression simultaneously [1].The shift from acute to chronic pain is typically placed at a 12-week duration and the focus of chronic pain is more on addressing the effects of the pain and maximizing quality of life rather than treatment [1].It is estimated that around 20-30% of Americans suffer from chronic pain, which is similar amongst other places such as Canada, Australia, and other European Countries [2], [3], [4].This equates to nearly 100 million adults in the United States suffering from chronic pain [1].In addition, chronic pain is one of the most common forms of chronic illness affecting individuals younger than 60 years of age [5].
Chronic pain management is very important, complex and time-consuming [5].
The effectiveness of several interventions is denoted when collaboration as a team of healthcare professionals takes place [5] Additional research evaluated 400 nurses on two patient scenarios both involving pain.It was reported that nurses are less likely to increase an opioid dose in which is ineffective for a smiling patient compared to grimacing patient [13].A tendency for nurses'' personal opinions come into play during treatment instead of focusing on recorded pain assessments which influence the opioid dose adding to under treatment of pain [13].
Thus, it is not surprising that pain management remains a major concern for health care worker and patients.Most recent debate has concluded that challenges by nurses are knowledge deficits, negative attitudes, inadequate record keeping, poor patient assessment, and improper analgesic use [14], [13], [15], [16], [17], [18].Even using pain scales has shown to have poor knowledge [19].
As we look further into this issue, the The research question of this study aimed to evaluate nurses' knowledge and attitudes of treating patients with chronic pain and determine if this chosen subset of nurses selected from faculty members and members of a nursing honour society will produce similar results to the literature.

Design Setting
This cross-sectional survey consisted of a 38item questionnaire and a demographics form.
The location of the study was a school in Northern California.Recruitment was also done within an honour society in which the chapters location was also Northern California.Recruitment was done via email and survey was completed online using the platform Qualtrics and was fully anonymous.

Data Analysis
Descriptive analysis of the data was conducted which evaluated frequency, percentages, mean, mode, and standard deviation of several categories.Inferential analysis was used consisting of independent sample t-tests.The statistical significance was considered as a p-value of less than 0.05.

Ethical Clearance
The study adhered to all ethical guidelines and approval from an Institutional Review Board (IRB) was obtained to ensure participant rights, confidentiality, and overall ethical conduct related to the study.All IRB protocols were followed and approved by California State University Chico IRB committee.The study number and approval was IRB-2023-65, which was approved on 8.8.23.

RESULTS
The results were analysed from 9 participants who volunteered to partake in this research.
Participants ages ranged from 25-to greater than 55 years of age.
For the purpose of the study the scores of less than 50% were classified as poor, 50%-75% were classified as acceptable, and scores greater than or equal to 75% were classified as having good knowledge and attitudes on the survey [20].Data revealed that 55.5% of As seen in the graphic (Figure 2). it appears more the higher experience levels resulted in higher knowledge test scores.When looking at if the respondents have taken care of a patient who has suffered from chronic pain, data showed that 88.8% of participants have taken care of a patient with chronic pain before.Lastly, when looking at the most missed questions, the data showed that the most frequently missed questions had to do with specific pain medications and correct dosing based off physicians' orders and patient reported pain levels.

FUNDING
The researchers had no funding for this research.

CONFLICT OF INTEREST
Authors declare there was no conflict of interest regarding this study.

ACKNOWLEDGEMENT
Authors want to express gratitude to all nurses who volunteered to partake in this study.
knowledge and attitudes of nurses towards pain management emerge as crucial factors that can affect treatment negatively.Nurses play a vital role in the decision-treatment of pain management, yet studies have shown significant gaps in their knowledge and misconceptions about pain management.Previous works indicates a lack of knowledge and the potential for negative attitudes and misconceptions when caring for these patients.This research by focusing on nurses selected from faculty members and members of a nursing honour society, aims to determine whether these professionals' knowledge and attitudes align with broader literature findings or if they exhibit different characteristics.The urgency and importance of this research lies within the population sample.Faculty members are teaching the future generations of nurses and nurses who are members of an honour society often are leaders within organizations.
Correlation research study was done to look at numerous variables of participants knowledge, attitudes, and perceptions of treating with patients with chronic pain.Data was collected over a 3-month period of time Fall of 2023.Participants A convenience sample was chosen.This sample consisted of Faculty members of a School of Nursing on the west coast of the United States and members of the Sigma International Honors Society of Nursing.After completion of recruitment of both sample populations nine registered nurses completed the study.The inclusion criteria for this study included members of the Sigma International Honors Society of Nursing and/or members of Nursing Faculty with a school of nursing on the west coast of the United States.In addition, these members from either group must be a licensed registered nurse who currently works or has worked in a hospital setting.The registered nurses must be at least eighteen years of age to participate.Lastly, the participants had to be willing and able to participate in the study by filling out the survey tool provided and by giving their informed consent to participate.The exclusion criteria for this study included nursing students, new graduate nurses or nurses who have been in the clinical setting for less than a year, those unwilling to participate, and those who do not give their informed consent to participate.Instrument This study utilized the "Knowledge and Attitudes Survey (KAS) Regarding Pain" tool [13].The KAS tool was developed over several years and content validity was established by review of pain experts [13].The survey is intended to determine the significant difference in the mean total knowledge score.It is a 38-question survey that includes 22 true or false questions, 14 multiple-choice questions, and 2 case study questions.No permission is required to use the KAS survey tool because the authors allowed its use for research.The KAS inventory does not divide scores between knowledge and attitudes, it is a combined score.Data Collection Two population samples were used, Faculty members at a school of nursing and members of a nursing honour society.Recruitment for both groups was done via email which include all information about the study along with the survey links.After the initial email several more recruitment emails went out of the course of several months to increase participation.Participants were asked to sign the consent form and begin to fill out the surveys at their earliest convenience.Both the KAS and demographics were housed on the platform Qualtrics.Data collected from participants during the data collection period 9 to 11 2023.
ranked in the category of "good knowledge and attitudes" while 44.% scores fell into the "acceptable knowledge of attitudes" category.Numerical scores ranged from 29-34.Max score possible on the KAS is 39.The average score was 31.78 with a standard deviation of 2.22.When comparing the scores to years of experience, the five individuals who scored within the "good knowledge and attitudes" range all listed having 20-30 years of experience, while the 4 scores considered "acceptable" all listed having 20 or less years of experience.

Table 1
Test Score Statistics Fig. 2. Average score by years of experience

Table 2
Participants by gender