Nurses and opioids: results of a bi-national survey on mental models regarding opioid administration in hospitals

Abstract

Objective

Pain remains insufficiently treated in hospitals. Increasing evidence suggests human factors contribute to this, due to nurses failing to administer opioids. This behavior might be the consequence of nurses’ mental models about opioids. As personal experience and conceptions shape these models, the aim of this prospective survey was to identify model-influencing factors.

Material and methods

A questionnaire was developed comprising of 14 statements concerning ideations about opioids and seven questions concerning demographics, indicators of adult learning, and strength of religious beliefs. Latent variables that may underlie nurses’ mental models were identified using undirected graphical dependence models. Representative items of latent variables were employed for ordinal regression analysis. Questionnaires were distributed to 1,379 nurses in two London, UK, hospitals (n=580) and one German (n=799) hospital between September 2014 and February 2015.

Results

A total of 511 (37.1%) questionnaires were returned. Mean (standard deviation) age of participants were 37 (11) years; 83.5% participants were female; 45.2% worked in critical care; and 51.5% had more than 10 years experience. Of the nurses, 84% were not scared of opioids, 87% did not regard opioids as drugs to help patients die, and 72% did not view them as drugs of abuse. More English (41%) than German (28%) nurses were afraid of criminal investigations and were constantly aware of side effects (UK, 94%; Germany, 38%) when using opioids. Four latent variables were identified which likely influence nurses’ mental models: “conscious decision-making”; “medication-related fears”; “practice-based observations”; and “risk assessment”. They were predicted by strength of religious beliefs and indicators of informal learning such as experience but not by indicators of formal learning such as conference attendance.

Conclusion

Nurses in both countries employ analytical and affective mental models when administering the opioids and seem to learn from experience rather than from formal teaching. Additionally, some attitudes and emotions towards opioids are likely the result of nurses’ cultural background.

Keywords:

• nurses
• opioids
• mental models
• decision-making

Supplementary material

Thank you for taking the time to complete this questionnaire in order to help me with my dissertation. The aim of my dissertation is to explore post-registration nurses’ views on administering opioids.

Figure S1 Questionnaire.

Acknowledgments

The authors would like to thank Dr Susan Childs for her comments on the questionnaires as well as Dr Bianca Kuehler and Rebecca Kuehler for their help in the translation process.

Author Contributions

C Guest and C Bantel designed the study and conducted the pilot experiments. F Sobotka did the statistical analysis. C Guest, C Bantel, A Karavasopoulou, and S Ward collected the data. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

Carsten Bantel has received funding for consultancy work for Mundipharma. The other authors report no conflicts of interest in this work.