The hospitals in the study had pain relief guidelines for patients with a substance dependency. Prior to implementation of the guidelines, there had been some cases of such patients discharging themselves at their own risk, which posed challenges to the interdisciplinary cooperation. The informants stated that the guidelines helped create a better common understanding among the nurses and doctors of the principles of pain management and prevented the treatment from being person-dependent.
The results from an Australian and a British study (1, 4) showed that patients with a substance dependency were treated with greater dignity and respect after the hospitals in the studies had implemented guidelines, and were less aggressive and manipulative. These findings are in line with our study and show that pain management guidelines are a success criterion for appropriate pain relief for the target group of patients.
All informants had a good working relationship with the ORT staff in relation to the collection of information about medication and identifying use of any additional substances by hospital patients. When the patients are hospitalised, the contact with the ORT staff is important for maintaining and continuing the right substitution dose (3, 5).
The Coordination Reform stipulates that the primary and specialist health services should coordinate their efforts when transferring patients between hospitals and municipalities (25). This emphasises the importance of the cooperation with GPs and ORT staff, who can ensure that de-escalation is organised as the final step in a comprehensive treatment programme.
The interviewers have experience as nurses in accident and emergency departments and are familiar with the patient’s challenges with pain relief in hospitals, but have no experience with pain teams. Prior understanding provides a good basis for recognising the challenges faced by the nurses in pain teams, and for asking illuminating questions during the interviews. However, preconceptions can also lead to certain matters being overlooked or underestimated.
We sought to reduce this risk by mapping preconceptions throughout the research process, and by including all the authors in the analysis process (13, 14). The last author is a specialist nurse with experience from an intensive care unit. However, there is always the possibility that analyses and interpretations by others will produce different results.
We chose these particular informants because they had many years of experience working in pain teams and were therefore able to highlight and elaborate on the specialist nurses’ experiences with relieving pain in patients with a substance dependency. Everyone was informed that we wanted to learn about both their positive experiences and their challenges. Nevertheless, most of the descriptions were positive, which suggests that the informants’ experiences from working in pain teams were predominantly positive.
Conversely, the interviewers could have asked more questions about the challenges. There is a known tendency for informants to give positive answers to questions in research interviews (13). We do not know if this tendency has affected the findings of our study, but it is nevertheless something to be aware of. We found that the dynamic between the informants and the interviewers was good, and that the informants shared their experiences willingly.
It is a strength that no similar studies have been published in Norway, and there is a need for knowledge based on experiences from specialist nurses in pain teams.
The experiences of specialist nurses in pain teams show that pain relief for patients with a substance dependency requires trust, expertise and cooperation in order for the patient to be safely guided through their stay in hospital. Having time for the patient is a success factor and a privilege afforded to specialist nurses in the pain team.
In order to meet the patient’s need for pain relief, ward staff need to increase their level of expertise. Healthcare personnel find support in the pain team when they have pharmacological questions and when preparing individual treatment plans. They also receive support in relation to establishing relationships of trust and communicating openly with the patient.
Good cooperation between healthcare personnel and pain teams is necessary during a patient’s stay in hospital in order to provide appropriate pain relief and comprehensive patient care. The pain team also has a unique role in facilitating follow-up plans after discharge from the hospital.
It may be interesting to investigate the target patients’ experiences with pain teams in future studies. Studies of whether healthcare personnel gain more knowledge about pain relief for patients with a substance dependency by working with pain teams may also be beneficial.
1. Blay N, Glover S, Bothe J, Lee S, Lamont F. Substance users’ perspective of pain management in the acute care environment. Contemporary Nurse: A Journal for the Australian Nursing Profession. 2012;42(2):289–97.
2. Organization WWH. ICD-10: Den internasjonale statistiske klassifikasjonen av sykdommer og beslektede helseproblemer 01/2018. Oslo: Direktoratet for e-helse; 2018. Available at: https://finnkode.ehelse.no/#icd10/0/0/0/-1(downloaded 19.04.2018).
3. Fredheim OMS, Nøstdahl T, Nordstrand B, Høivik T, Rygnestad T, Borchgrevink PC. Behandling av akutte smerter under legemiddelassistert rehabilitering. Tidsskrift for Den norske legeforening. 2010;130(7):738–40.
4. Wintle D. Pain management for the opioid-dependent patient. Br J Nurs. 2008;17(1):47–51.
5. Den norske legeforening. Retningslinjer for smertelindring. Oslo: Den norske legeforening; 2009. Available at: http://legeforeningen.no/PageFiles/44914/Retningslinjer%20smertebehandling%20dnlf.pdf(downloaded 14.12.2017).
6. Duelund S, From M, Bastrup L. Smerteteam inddrager patienter med kroniske smerter i postoperativ smertebehandling. Sygeplejersken. 2014;114(14):76–80.
7. Li R, Andenæs R, Undall E, Nåden D. Smertebehandling av rusmisbrukere innlagt i sykehus. Sykepleien Forskning. 2012(3):252-60. DOI: 10.4220/sykepleienf.2012.0131.
8. McCreaddie M, Lyons I, Watt D, Ewing E, Croft J, Smith M, et al. Routines and rituals: a grounded theory of the pain management of drug users in acute care settings. J Clin Nurs. 2010;19(19–20):2730–40.
9. Morgan BD. Nursing attitudes toward patients with substance use disorders in pain. Pain Manag Nurs. 2014;15(1):165–75.
10. Morley G, Briggs E, Chumbley G. Nurses' experiences of patients with substance-use disorder in pain: A phenomenological study. Pain Manag Nurs. 2015;16(5):701–11.
11. Helsedirektoratet. Veileder IS-2190. Organisering og drift av tverrfaglige smerteklinikker. I: Helsedirektoratet, ed. Oslo; 2015. Available at: https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/873/Veileder-Organisering-og-drift-av-tverrfaglige-smerteklinikker-IS-2190.pdf(downloaded 19.02.2019).
12. Ljoså TM, Undall E. Akuttsmerteteam (AST) i HSØ. Sykehuset Telemark; 2018 [PP presentation from a conference]. Available at: https://docs.wixstatic.com/ugd/1c047b_9e9ab7b9bb5f4d7e8bbfdd8323b1572d.pdf(downloaded 19.04.2018).
13. Kvale S, Brinkmann S, Anderssen TM, Rygge J. Det kvalitative forskningsintervju. 2. ed. Oslo: Gyldendal Akademisk; 2009.
14. Lundman B, Graneheim UH. Kvalitativ innehållsanalys. I: Granskär M, Höglund-Nielsen B, eds. Tillämpad kvalitativ forskning inom hälso- och sjukvård. 2. ed. Lund: Studentlitteratur; 2012.
15. World Medical Assosiation. Declaration of Helsinki – Ethical principles for medical research involving human subjects 2013. Available at: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/(downloaded 14.12.2017).
16. Nielsen AS. Behandlingsarbejde i team: teambaseret behandling med behandlerrotation. København: Hans Reitzels Forlag; 2010.
17. Skau GM. Gode fagfolk vokser: personlig kompetanse i arbeid med mennesker. 5. ed. Oslo: Cappelen Damm Akademisk; 2017.
18. Liberto LA, Fornili KS. Managing pain in opioid-dependent patients in general hospital settings. Medsurg Nurs. 2013;22(1):33.
19. Krokmyrdal KA, Andenæs R. Nurses' competence in pain management in patients with opioid addiction: A cross-sectional survey study. Nurse Educ Today. 2015;35(6):789–94.
20. Ruyter KW, Førde R, Solbakk JH. Medisinsk og helsefaglig etikk. 3. ed. Oslo: Gyldendal Akademisk; 2014.
21. Stubberud D-G, Eikeland A, Søjbjerg IL. Psykososiale behov ved akutt og kritisk sykdom. Oslo: Gyldendal Akademisk; 2013.
22. Eide H, Eide T, Keeping D, Eide E. Kommunikasjon i relasjoner: personorientering, samhandling, etikk. 3. ed. Oslo: Gyldendal Akademisk; 2017.
23. Lov 2. juli 1999 nr. 64 om helsepersonell m.v. (helsepersonelloven). Available at: https://lovdata.no/dokument/NL/lov/1999-07-02-64(downloaded 15.02.2019).
24. Orvik A. Organisatorisk kompetanse: innføring i profesjonskunnskap og klinisk ledelse. 2. ed. Oslo: Cappelen Damm Akademisk; 2015.
25. St.meld. nr. 47 (2008–2009). Samhandlingsreformen: Rett behandling – på rett sted – til rett tid. Oslo: Helse- og omsorgsdepartementet; 2008. Available at: https://www.regjeringen.no/contentassets/d4f0e16ad32e4bbd8d8ab5c21445a5dc/no/pdfs/stm200820090047000dddpdfs.pdf(downloaded 14.12.2017).