The Relationship Between Nurses’ Pain Beliefs and Ethical Attitudes to Pain

Abstract

Purpose: Pain is a multifaceted phenomenon shaped by biological, psychological, and social factors, as emphasized by cognitive-behavioral and biopsychosocial models. Understanding whether nurses prioritize the biological or psychological dimensions of pain is crucial, as their pain beliefs can directly influence their ethical attitudes and the quality of patient-centered care. Therefore, this study aimed to examine the relationship between nurses' pain beliefs and their ethical attitudes in pain management.

Design: A descriptive and correlational research design was used.

Methods: The study included 194 nurses working at a state hospital in Türkiye between April and May 2024. Data collection tools consisted of the "Introductory Information Form," the "Pain Beliefs Scale," and the "Ethical Attitudes in Pain Management Scale." Descriptive statistics and multivariate linear regression analysis were applied to evaluate the findings.

Results: The results showed that the nurses' average score for psychological pain beliefs was 4.75 ± 0.91, while the average score for organic pain beliefs was 3.62 ± 0.65. Additionally, the average score for nurses' ethical attitudes in pain management was 101.89 ± 11.56. It was found that organic pain beliefs negatively predicted nurses' ethical attitudes in pain management, whereas psychological pain beliefs positively predicted them (p < .05). The regression model explained 11.6% of the variance in ethical attitudes (R² = 0.116), with a small to medium effect size (Cohen's f² = 0.13), indicating practical significance alongside statistical significance.

Conclusions: This study highlights the influence of nurses' pain beliefs on their ethical decision-making. Given the differential effects of psychological and organic pain beliefs, tailored educational interventions emphasizing a holistic and ethical approach to pain management are recommended.

Clinical implications: The findings highlight the significant impact of nurses' pain beliefs on their ethical attitudes in pain management. Given that psychological pain beliefs positively influence ethical attitudes and organic beliefs have a negative effect, in-service training programs should be designed to include modules on ethical dilemmas specific to pain care (e.g., balancing patient autonomy with clinical judgment), holistic pain assessment techniques (addressing both physical and psychological dimensions), and the application of ethical frameworks in clinical decision-making. These targeted trainings can help nurses adopt a more patient-centered and empathetic approach, ensuring that ethical principles such as autonomy and dignity are upheld in pain management.