Nurses' perceived barriers to assessment and management of pain in a university hospital.

A self-report questionnaire was answered by 114 nurses working at the internal medicine, oncology, and surgery clinics. The most commonly perceived barriers to pain management were system-related barriers. Lack of psychosocial support services and patient-to-nurse ratio received the highest ratings. Institutional and governmental attempts are needed to increase the number of nurses in the clinics and to establish support services. Nurse-related barriers were less perceived as an obstacle when compared with the other barriers. A small percentage of the nurses agreed that nurses' inadequate knowledge of pain management (10%) and nurses' indifference (8%) were barriers to pain management. Inadequate time for health teaching with patients was agreed on by 65% of the nurses. Most commonly rated physician-related barriers were inadequate assessment of pain and pain relief by doctors (63%) and physicians' indifference (47%). Patients' difficulty with completing pain scales (56%) and consumers not demanding results (53%) were the most commonly reported patient-related barriers. A significant percentage of the participating nurses indicated that they have no idea about patient-related barriers. Regular and continuous pain education programs may help to establish a supportive team spirit between doctors and nurses.