Morphine administration by Paramedics: An application of the Theory of Planned Behaviour

Injury. Volume 43, Issue 9 , Pages 1393-1396, September 2012

Timely and appropriate pain management in the pre-hospital environment is paramount to effective patient care. Experts agree that there are many factors that hinder the delivery of adequate pain management to patients with pain. The purpose of this study was to use the Theory of Planned Behaviour (TPB) model to identify the factors influencing Ambulance Paramedics’ intention to administer morphine to patients with pain.

The authors attribute the failure to deliver adequate pain management to patients with pain to a variety of barriers, including lack of education of health professionals, as well as attitudes that interfere with appropriate clinical care of those patients with significant pain.

Participants of this study were Queensland Advanced Care and Intensive Care Paramedics who were deemed competent in morphine administration. Data were collected by means of a questionnaire that used the constructs of the TPB, including subjective norm, perceived behavioural control and attitude. Whilst participants reported strong intentions to administer morphine they also reported negative attitudes towards the behaviour. The authors found that paramedics were concerned with auditing of cases, danger and complications to patients and extra responsibility were factors that negatively impacted on their intentions to administer morphine to patients with pain.

The constructs of the TPB explained 26% of the variance in intention to administer morphine with subjective norm being the strongest significant predictor. The findings related to specific attitudes and normative pressures provide an understanding into paramedic’s pain management behaviour.

© Gary Wilson/ Pre-hospital Research Forum

According to the authors, findings from this study propose that interventions which target attitudinal change and increase perceptions of control should be used to aid in motivating the paramedics to develop a positive decision to act on their intentions to administer morphine to patients with pain. This could be achieved by increasing education on the benefits of morphine administration and that development of a supportive peer learning environment would probably result in positive pain management behaviour.

At the end of the day, we should all be attempting to manage the patient’s pain as failure can result in deleterious physiological, biochemical and behavioural effects. While morphine may not be the only form of analgesia utilised by paramedics, all paramedics should be aiming to assess and manage the patient’s pain and should not allow barriers, such as clinical auditing or a belief that they will get triaged higher if they are in pain, as reasons to withhold analgesia. While education is important with regard to identifying the risks and potential complications of analgesia, it should also be the role of colleagues to support less experienced or confident paramedics in delivering optimum analgesia as a failure to deliver this education and support is likely to have a negative affect on that paramedic’s intention to use analgesia in the future.

http://www.injuryjournal.com/article/S0020-1383(10)00824-7/abstract