Acute pain treatment for older adults hospitalized with hip fracture: Current nursing practices and perceived barriers

Marita G. Titler, Keela Herr, Margo L. Schilling, J. Lawrence Marsh, Xian Jin Xie, Gail Ardery, William R. Clarke, Linda Q. Everett

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


This article examines acute pain management practices for patients 65 years of age and older who were hospitalized during 1999 for hip fracture. Data were collected from the medical records of patients (N = 709) admitted to 12 hospitals in the Midwest and from questionnaires on pain practices completed by nurses (N = 172) caring for these patients. The major variables examined were (1) pharmacological and nonpharmacological treatments for acute pain in hospitalized elders, (2) nurses' perceived stage of adoption for avoiding meperidine use and for administering analgesics around-the-clock, and (3) nurses' perceived barriers to optimal treatment of acute pain in elders. Acetaminophen was the most frequently administered analgesic, but administered doses were far less than the maximum daily recommended dose. More than one third (39%) of the nurses reported that they always avoided the use of meperidine, and over half reporting avoiding its use sometimes. However, the majority of patients (56.8%) received at least one dose of meperidine, even though evidence suggests that other analgesic agents are more appropriate for treatment of acute pain in elders. Only 27% of patients received patient-controlled analgesia, and only 22.3% of patients received around-the-clock administration during the first 24 hours after admission of analgesics that had been ordered on a prn basis. The majority of nurses were aware that around-the-clock administration of analgesics was preferable, but only 33.7% were persuaded (believed) that this method should be used. Intramuscular injection was used for 52.2% of patients, even though this route is not recommended for older adults. The most frequently used nonpharmacological intervention was repositioning, followed by use of pressure relief devices and cold application. Nurses reported difficulty contacting physicians and difficulty communicating with them about type and/or dose of analgesics as the greatest barriers to pain management. Findings from this multi-site study show that active and focused "translation" interventions are needed to promote adoption of evidence-based acute pain management practices by health care providers.

Original languageEnglish (US)
Pages (from-to)211-227
Number of pages17
JournalApplied Nursing Research
Issue number4
StatePublished - Nov 2003

ASJC Scopus subject areas

  • Nursing(all)


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