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Facilitators and barriers in pain management for trauma patients in the chain of emergency care

Facilitators and barriers in pain management for trauma patients in the chain of emergency care
Facilitators and barriers in pain management for trauma patients in the chain of emergency care
Introduction: the aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands.

Patients and methods: a qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA.

Results: this study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs.

Conclusion: identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift in attitudes is needed, together with constant surveillance and feedback to emergency care providers. Implementation efforts need to be aimed at the identified barriers and facilitators, tailored to the chain of emergency care and the multi-professional group of emergency care providers
pain, pain measurement, wounds and injuries, attitude of health personnel, knowledge, feedback, patient participation
0020-1383
Berben, Sivera A.A.
b6255534-a8bb-418b-9961-c320200283cf
Meijs, Tineke H.J.M
8c26e913-9c0e-48ad-a811-eec26a4f2740
van Grunsven, Pierre M.
d86f6be8-4138-4ebf-8f8c-05680a6739f8
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Achterberg, Theo van
3d5841d3-1c5e-49ca-b5ed-35ee36754d1d
Berben, Sivera A.A.
b6255534-a8bb-418b-9961-c320200283cf
Meijs, Tineke H.J.M
8c26e913-9c0e-48ad-a811-eec26a4f2740
van Grunsven, Pierre M.
d86f6be8-4138-4ebf-8f8c-05680a6739f8
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Achterberg, Theo van
3d5841d3-1c5e-49ca-b5ed-35ee36754d1d

Berben, Sivera A.A., Meijs, Tineke H.J.M, van Grunsven, Pierre M., Schoonhoven, Lisette and Achterberg, Theo van (2011) Facilitators and barriers in pain management for trauma patients in the chain of emergency care. Injury. (doi:10.1016/j.injury.2011.01.029). (PMID:21371708)

Record type: Article

Abstract

Introduction: the aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands.

Patients and methods: a qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA.

Results: this study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs.

Conclusion: identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift in attitudes is needed, together with constant surveillance and feedback to emergency care providers. Implementation efforts need to be aimed at the identified barriers and facilitators, tailored to the chain of emergency care and the multi-professional group of emergency care providers

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More information

e-pub ahead of print date: 2 March 2011
Keywords: pain, pain measurement, wounds and injuries, attitude of health personnel, knowledge, feedback, patient participation
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339199
URI: https://eprints.soton.ac.uk/id/eprint/339199
ISSN: 0020-1383
PURE UUID: 397a596c-ced7-4ba6-833f-c5a723548a24
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

Catalogue record

Date deposited: 25 May 2012 08:58
Last modified: 06 Jun 2018 12:30

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