The social and political forces affecting prescribing practices for chronic pain.

Very little attention has been given to chronic nonmalignant pain in the nursing literature. Although there has been increasing debate concerning prescribing practices among physicians for patients with chronic nonmalignant pain, little, if any, understanding exists about advanced practice registered nurses (APRNs) in this context. This study critically examined subjective factors that influence the prescribing practices of APRNs for patients with chronic nonmalignant pain. It was grounded in the critical tradition of Habermas as well as the emancipatory theory of Freire and used a critical methodology. Data were collected through semistructured interviews with participating APRNs. Dialectical analysis and critique were used to interpret the interviews. Critical analysis of the data revealed that prescribing decisions for patients with chronic pain were characterized by a conflict of interests in which the patients' best interests were given a low priority. This conflict, which is socially and politically created and maintained, renders these nurses unlikely to fulfill their ethical responsibility to patients. Teaching basic pain management as an ethical responsibility of practice in graduate education is a first step toward ending the conflict and ensuring that the patients' best interests are addressed.