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end-of-life care, opioid infusion, opioid titration



  1. Barnett, Margaret L. RN, MS, APRN, BC-PCM
  2. Mulvenon, Carol J. MS, RN-BC, AOCN, ACHPN
  3. Dalrymple, Patricia A. MSN, ARNP, CHPN
  4. Connelly, Lynne M. PhD, RN


Opioids are commonly given to provide comfort at the end of life, yet patients often experience poor control of pain. The management of symptoms using opioids varies among nurses. To improve patient outcomes, a better understanding is needed of the way nurses titrate opioid infusions and the criteria involved in the decisions to adjust opioid doses. The purpose of this study was to investigate nurses' current knowledge, attitudes, and practice patterns. An investigator-developed survey was returned by 181 acute care nurses at three medical centers in a Midwest urban area who were 91% female, with an average age of 40 years old and average of 13 years of RN experience, working in a variety of units: ICU (22%), medical-surgical (15%), oncology (11%), or telemetry (11%). A majority of nurses (78%) felt always/often comfortable titrating opioids. Nurses who used titration in the last year (n = 104) and those with more experience were significantly more comfortable (P =.007 and.013). However, only one knowledge question was answered correctly by greater than 50% of respondents (68.5%). Most nurses used similar assessment parameters to determine appropriate doses. A majority (82.9%) indicated a need for more education, and 56.4% were unaware of hospital policies regarding opioid titration.