Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

Abstract Background: Acute pain is frequently encountered in the prehospital setting, and therefore, is known to be a fundamental aspect of quality emergency care. Research has shown a positive association between pain management practices and health care providers’ knowledge of, and attitudes towards pain. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers in relation to acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management, describe pain assessment and management behaviours and practices and identify barriers to and enablers of pain care. Methods: A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results: The mean age of respondents (n=100), was 34.74 (SD 8.13) years and the mean years’ experience 10.02 (SD 6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational emergency care providers (85%) with 54% of respondents having attended medical education on pain assessment and management in the last two years. The overall mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD 15.66) with gaps identified in various aspects of pain and pain care. Practitioners with a higher qualification, more years’ experience and those who did not attend medical education on pain, achieved higher overall scores. Alcohol and drug use by patients were the most commonly selected barrier to pain care while the availability of higher qualified practitioners was the most frequently selected enabler. Practitioners did not assign pain scores as self-reported by patients while overall, limited pain relief was provided. Conclusion: Our results suggest that there is suboptimal knowledge and attitudes regarding pain among most emergency care providers. Further, gaps in pain knowledge, attitudes and practices were identified and can be addressed in undergraduate curricula and through tailored educational initiatives for qualified practitioners Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated to explore.

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Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

10.21203/rs.2.12353/v3 ◽

2020 ◽

Author(s):

Andrit Lourens ◽

Peter Hodkinson ◽

Romy Parker

Keyword(s):

South Africa ◽

Emergency Care ◽

Pain Assessment ◽

Prehospital Setting ◽

Western Cape ◽

Care Providers ◽

Attitudes And Practices ◽

The Mean ◽

Pain Care ◽

Knowledge Attitudes And Practices

Abstract Background: Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between health care providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods: A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results: Responses of 100 participants was included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD8.13) years and the mean years’ experience 10.02 (SD6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last two years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion: Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Further, gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.

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Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

10.21203/rs.2.12353/v1 ◽

2019 ◽

Author(s):

Andrit Lourens ◽

Peter Hodkinson ◽

Romy Parker

Keyword(s):

Pain Management ◽

Acute Pain ◽

Emergency Care ◽

Pain Assessment ◽

Prehospital Setting ◽

Western Cape ◽

Care Providers ◽

Attitudes And Practices ◽

Knowledge And Attitudes ◽

Knowledge Attitudes And Practices

Abstract Background: Acute pain is frequently encountered in the prehospital setting, and therefore, is known to be a fundamental aspect of quality emergency care. Research has shown a positive association between pain management practices and health care providers’ knowledge of, and attitudes towards pain. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers in relation to acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. Methods: A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results: A hundred (n=100) respondents, with a mean age of 34.74 (SD 8.13) years and mean of 10.02 (SD 6.47) years of experience participated. Most respondents were male (69%), employed in the public/government sector (93%) as operational emergency care providers (85%) with 54% (n=54) of respondents having attended medical education on pain assessment and management in the last two years. The overall mean percentage of correct answers for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD 15.66) with gaps identified in various aspects of pain and pain management including: basic knowledge of pain physiology; pain assessment; indicators of severe pain; pharmacological and non-pharmacological pain management; culture and spiritual influences; and pain expression. Practitioners with a higher qualification, more years’ experience and those who did not attend medical education on pain, achieved higher overall scores. Pain scores were not assigned to patients’ as self-reported while overall, limited pain relief was provided. Conclusion: Our results suggest that there is suboptimal knowledge and attitudes regarding pain among most levels of emergency care qualifications. Pain education is essential, it should occur regularly, and specific educational initiatives aimed at addressing pain knowledge and attitudes have been indicated. Future work should focus on the additional description of the gaps in pain knowledge and attitudes among emergency care providers and exploring the decline over time. Description of barriers to and enablers of pain care in the South African prehospital setting is imperative. Organisational culture should endorse and monitor prehospital pain care.

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Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A Knowledge, Attitudes and Practices Survey

10.21203/rs.2.12353/v4 ◽

2020 ◽

Author(s):

Andrit Lourens ◽

Peter Hodkinson ◽

Romy Parker

Keyword(s):

South Africa ◽

Emergency Care ◽

Pain Assessment ◽

Prehospital Setting ◽

Western Cape ◽

Care Providers ◽

Attitudes And Practices ◽

The Mean ◽

Pain Care ◽

Knowledge Attitudes And Practices

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Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: a knowledge, attitudes and practices survey

BMC Emergency Medicine ◽

10.1186/s12873-020-00315-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Andrit Lourens ◽

Peter Hodkinson ◽

Romy Parker

Keyword(s):

South Africa ◽

Acute Pain ◽

Pain Assessment ◽

Prehospital Setting ◽

Western Cape ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

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Emergency care providers' perspectives of acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A qualitative study

International Emergency Nursing ◽

10.1016/j.ienj.2021.101042 ◽

2021 ◽

Vol 58 ◽

pp. 101042

Author(s):

Andrit Lourens ◽

Romy Parker ◽

Peter Hodkinson

Keyword(s):

South Africa ◽

Qualitative Study ◽

Acute Pain ◽

Emergency Care ◽

Pain Assessment ◽

Prehospital Setting ◽

Western Cape ◽

Care Providers

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Acute Pain in the African Prehospital Setting: A Scoping Review

Pain Research and Management ◽

10.1155/2019/2304507 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 4

Author(s):

Andrit Lourens ◽

Michael McCaul ◽

Romy Parker ◽

Peter Hodkinson

Keyword(s):

Acute Pain ◽

Scoping Review ◽

Pain Assessment ◽

Grey Literature ◽

Prehospital Setting ◽

Prehospital Emergency Care ◽

Inclusion Criteria ◽

Ongoing Research ◽

Comprehensive Search ◽

Pain Care

Background. Acute pain is a common reason for seeking prehospital emergency care. Regrettably, acute pain is often underestimated and poorly managed in this setting. The scoping review was conducted to gain insight into existing research on the topic and to make recommendations for future work. Objectives. To identify all available evidence related to acute pain assessment and management in the African prehospital setting, describe the extent of the evidence, encapsulate findings, and identify research gaps. Methods. The scoping review considered primary and secondary research related to acute pain assessment and management of both medical and traumatic origins in all age groups in the African prehospital setting. The search strategy aimed to identify published, unpublished, and ongoing research which met the inclusion criteria. Potentially eligible studies were identified by a comprehensive search of electronic databases, trial registers, dissertation/thesis databases, grey literature databases, and conference proceedings. Screening and data extraction were conducted independently and in duplicate. Results. The comprehensive search identified 3823 potential studies, duplicate titles were removed, and 3358 titles/abstracts were screened. Full text of 66 potentially eligible titles was screened, 60 were excluded, and six publications met the inclusion criteria. Despite recommendations for pain assessment during general patient care, most studies reported no/limited pain assessment. In general, pain management was concluded to be insufficient and not conforming to best practice. Conclusions. Only six publications addressing prehospital acute pain care in Africa could be identified, possibly indicative of a knowledge gap. Future research is indicated to enable a better understanding of the epidemiology of acute pain and barriers and enablers of acute pain care and to develop evidence-based clinical practice guidelines (CPGs) catering for all EMS systems in Africa. Additionally, educational initiatives should be implemented to improve the quality of acute pain care and to monitor quality through continuous quality improvement (CQI) programs.

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