Emergency nurses’ knowledge and attitude towards pain: A survey of a metropolitan ED

Wayne Varndell1,2, Elizabeth Ryan,1 Alison Jeffers1 and Nadya Marquez-Hunt1

1 Prince of Wales Hospital Emergency Department, Barker Street, Randwick, NSW, 2031
2 Faculty of Health, University of Technology, Broadway, Sydney, Australia, NSW, 2007

Background: Over 75% of patients that present to ED do so due to pain.The initial assessment and management of pain is primarily the responsibility of emergency nurses as they have the most interaction with patients.  The quality of pain management depends on the knowledge and attitudes of the emergency nurse.  Inadequate knowledge about pain, analgesia and negative attitudes towards pain amongst nurses can be a significant barrier to optimal pain management.

Aim: The aim of this descriptive cohort study was to evaluate emergency nursing staff knowledge and attitudes towards pain using the Nurses’ Knowledge and Attitudes Survey Regarding Pain.2

Methods: The Nurses’ Knowledge and Attitudes Survey Regarding Pain consists of 39-items: 21 true or false questions; 16 multiple-choice questions; and, 2 scenarios.  Participant information was limited to gender, years working in ED, highest qualification and highest ED clinical role for anonymity.

Results: A total of 60 (62%) completed surveys were returned.  Most participants were female (65%), had worked in ED for over 5 years (33%), and worked in the resuscitation area (20%) or as nurse-in-charge (15%).  Few (23%) had postgraduate qualifications.

Mean score for all participants was 69%.  While only 4 (7%) participants scored 85% and over, 57 (95%) participants scored over 50% correct. A total of 19 questions (48%) dealt with pharmacology, and where the least (36%) correctly answered.  Of these, knowledge relating to equivalence between oral and IV opiate dosages (33%), use of opiates in drug abusing patients (34%) and use of opiates in older patients (35%) were the least correctly answered.  Participants were presented with two scenarios and asked to judge (0-10) the patient’s pain.  In scenario 1 (patient was talking whilst reporting “8 out of 10 pain”), average (mean) pain score was 5.2/10, 33% agreed with the patient’s self-report of pain and 83% would administer opiate analgesia.  In scenario 2 (patient grimacing with their eyes shut whilst reporting “8 out of 10 pain”), average (mean) pain score was 6.9/10, 47% agreeing with the patient’s self-report and 95% would administer opiate analgesia.

Conclusion: Unresolved pain is one of the main reasons people attend ED, yet is often under evaluated and undertreated.  Pain management education rarely forms part of nurse training.2 Patients predominantly present to ED in pain.  The first and continuing point of contact is the emergency nurse.  Optimal pain management relies upon the knowledge and positive attitudes of clinicians. This study has highlighted several areas for improvement.


  1. NHMRC (2011) Emergency care acute pain management manual. Canberra
  2. FERRELL B, MCCAFFERY M. (2014) Knowledge and Attitudes Survey Regarding Pain. City of Hope Pain & Palliative Care Resource Centre.


Wayne Varndell is Clinical Nurse Consultant at Prince of Wales Hospital Emergency Department, and NSW Branch President for the College of Emergency Nursing Australasia.  Wayne has held various educational and advanced practice roles in emergency nursing, and is an active academic within the field of emergency care.  His research interests include quality of care and illness experiences of individuals presenting to ED, extended and advanced nursing practice, and pain and sedation management of critically ill intubated patient in ED.  He has received over $950,000 in research and project funding, and in 2014, was awarded Australasian Emergency Nurse of the Year.