Ritically analyse 2-4 facilitators and/or barriers to effective pain assessment, within a clinical setting.

Requirements for the 1000 word essay
Critically analyse 2-4 facilitators and/or barriers to effective pain assessment, within a clinical setting.
My chosen barriers are:
i?¶ Nurse related barrier :Poor knowledge and attitudes
i?¶ Patient related : Communication
1. The discussion of each facilitator/barrier should critically evaluate current practice against research findings and policy developments, and offer suggestions for best practice.
2. References to appropriate nursing, pain management and wider literature should underpin the discussion and references should be recent.
3. I have also included what l have done so far, l have the introduction therefore l need assistance with writing the body which includes requirement number 1 and conclusion.
Thank you in advance

Pain is an experience a human being undergoes which is difficult to define and describe (Brennan 2007). According to Brennan (2007), pain is unique to every individual as individuals have different perceptions and tolerance on pain. In nursing, pain assessment and management plays an important role as it is fundamental in daily nursing routine. Therefore health care professionals must strive to overcome the barriers to effective pain management in practice. According to research, adequate pain control is only achieved in 50% of patients in Western societies. This highlights that the control of pain is a serious issue for a large number of patients that are hospitalised (Daniel & Carr 2001).
This essay will explore lack of knowledge and attitude as nurse-related barriers to effective pain assessment and management with respect to elderly patients. Communication will also be discussed as patient-related barrier in assessing and managing pain. These barriers will be further explored and discussed throughout this essay and will be supported by the relevant literature. Furthermore, the discussion will also concentrate on how these barriers can be overcome using various educational texts, within the healthcare context.
There is a lot of evidence to demonstrate that nurses a have poor knowledge about pain and its management. Howell et al, (2000) research suggests that nurse education in the UK may be falling short in this regard. A recent study carried out by Carr (2001) also suggests that modern-day nursing and medical education programs do not equip health care professionals with significant information on the nature of pain, the methods of pain assessments and the principles of pain management hence bringing about barriers to effective pain management.

Hamilton and Edgar (1992) used McCafferyas (1989) knowledge and attitude report to examine nursesa knowledge and understanding of the physiological and pharmacological aspects of pain assessment and management. The study was to investigate the nurseas knowledge and attitude in pain assessment and management. The results concluded that nurses had lack of knowledge in basic concepts and principles in pain assessment and management. Hamilton and Edgar (1992). Concluded that lack of pain knowledge and general attitude are barriers in pain assessment and management which nursing professional should address to effectively manage pain.

King (2004) identified how nurses confirm that they have a limited understanding of pharmacology and claim they are dissatisfied with the educational experience, leading to feelings of anxiety following qualification which affects their attitude towards pain assessment and management. The nurses acknowledged that they needed pharmacological knowledge to underpin their practice of patient assessment, nurse prescribing and drug administration. With a lack of knowledge and basic fundamental management skills, nurses may feel unprepared to care for patients suffering from pain, and consequently make incorrect decisions regarding the management of patientas pain.
Pain management in elderly patients represents a significant challenge to nurses. This is because elderly patients are more likely to experience both chronic and acute pain compared to younger patients. Prevalence of cognitive impairment, failing sight, hearing, confusion and dementia contribute to communication difficulties and as a result this poses significant barriers to pain assessment particularly when using pain assessment tools.
Dementia with ageing, are problems that may present serious barriers to the assessment of pain. A study of 60 Alzheimers patients who were unable to communicate verbally showed that 26 had conditions commonly associated with pain but only three were given analgesics (Marzinski 1991). Parmelee et al. (1993) studied 758 patients in nursing homes, and concluded that although cognitively impaired patients slightly under-reported pain, their self-reports were as valid as for patients with no cognitive deficit. This suggests that cognitively impaired patients should be believed when they complain of pain. Where there is such impairment, frequent assessments of current pain may be required since pain recall may be unreliable.