The Attitudes of Nurses Toward Opioid Analgesics at a Hospital in Colombia
- Jairo R. Moyano, MD
, 
, - Sofía C. Zambrano, Psci, Mgrief, PC Couns,
- Natalia Melgarejo, Psci
- Anesthesia Department, University Hospital Fundación Santafé de Bogotá, and the Facultad de Ciencias Sociales, Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia; and the Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
- Available online 16 November 2011.
We have read with great interest the articles “Palliative Care Education in Ghana: Reflections on Teaching in West Africa” and “Providing Pain and Palliative Care Education Internationally,” which were published in the July/August 2011 issue of the Journal of Supportive Oncology. [1] and [2] We agree with Dr Fisch, Dr Paice,
and colleagues that one must be familiar with the local situation when implementing an educational effort in developing countries, which should include a frank discussion about the main barriers to opioid use.
For example, our pain and palliative care unit prepared a workshop on morphine use for all the nursing staff from our hospital, University Hospital Fundación Santafé de Bogotá, Colombia. As part of our continuing professional education program, the pain-management clinic conducts a session once a year for the nurses employed by our hospital as well as those who are professionally linked to the hospital. The purpose of this session is to update staff regarding the assessment and treatment of acute pain, including the administration of rescue doses of opioid analgesics. We had the attendees complete a survey which included 13 statements assessing their attitudes toward the following:
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1. The patients' responses to pain.
2. The patients' probability of addiction.
3. The use of measuring scales to analyze pain intensity.
4. The need for analgesic management for breakthrough pain.
5. The use of placebo in place of pain medication.
6. A fear of patients' suffering from respiratory depression.
7. The patients' concern that dose size may indicate addiction.
8. How they approached patients on whether or not patients were experiencing pain.
The answers were graded by means of a 0–5 Likert scale, in which 0 corresponds to “totally disagree” and 5 to “totally agree.” We also asked if the nurse had received previous training in pain management. The purpose of the questionnaire was to identify aspects of professional practice or concepts regarding the treatment of pain and the use of opioids that could be improved through education.
The analysis of the responses according to professional nurses versus auxiliary nurses showed no significant differences in the statement on fear of respiratory depression as the main barrier to use of morphine (registered nurses mean = 3.89, SD = 1.62; auxiliary nurses mean = 3.82, SD = 1.59; P = .4251 Mann-Whitney test). In regard to answers by age groups, the only significant difference was that nurses older than the age of 40 were less likely to administer the rescue dose. Trained pain clinic nurses are less in agreement with the statement that the patient's concern about dose may indicate addiction. Nurses trained in pain management are more in disagreement with the administration of a placebo. Our findings indicated that the knowledge gained on assessment and treatment of pain increased confidence in the administration of rescue doses of opioids for breakthrough pain, as well as instilled reluctance to administer placebos.
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