Nurses’ Pain Assessment and Management of Hospitalized Thai Elderly Patients with Postoperative Pain

Background: Postoperative pain is a critical symptom experience, especially for elderly patients. Unrelieved postoperative pain is associated with longer hospital stays, increased recovery periods, and higher healthcare costs. According to the theory of planned behavior (TPB), attitudes, perceived norms, and perceived behavioral control can predict human behavior through intentions. Although investigators have used the TPB to examine factors influencing nurses’ intentions to perform pain management, they have not measured all the major theory constructs, nor have they studied postoperative pain management for elderly patients in Thailand. Purpose: The purpose of this cross-sectional study was to determine the relationships among the TPB constructs and nurses’ pain management for hospitalized elderly Thai patients with postoperative pain. Methods: In part 1 of the study, I completed the preparation, revision, and translation of the Pain Assessment Questionnaire and Pain Management Questionnaire for use as measures of the TPB constructs—behavioral, normative, and control beliefs; attitudes; perceived norms; perceived behavioral control; and intentions—with respect to Thai nurses’ pain assessment and PRN opioid analgesic administration for hospitalized elderly patients with postoperative pain. English versions of the questionnaires were pilot tested with 30 bilingual Thai nurses before they were translated into the Thai language using the committee approach. The accuracy of the translations was confirmed by conducting cognitive interviews. Instrument content validity was assessed by three Thai experts on both pain management and the TPB. Cronbach’s alpha coefficients for the instrument subscales indicated good internal consistency. In part 2, 140 nurses working in adult inpatient units at three hospitals in Bangkok, Thailand, responded to the questionnaires. Results: Nurses’ behavioral, normative, and control beliefs regarding pain assessment and PRN opioid analgesic administration had direct effects on their attitudes, perceived norms, and perceived behavioral control, respectively. Only nurses’ attitudes and perceived norms had direct effects on their intentions to assess pain and administer PRN opioid analgesics. However, nurses’ intentions had no direct effect on their pain assessment and PRN opioid analgesic administration. Conclusions: Further study is needed to better understand factors predicting nurses’ pain management in order to improve the quality of pain care for elderly patients.