NURSE BURNOUT AND THE BIOPSYCHOSOCIAL PAIN ASSESSMENT GAP: A CROSS-SECTIONAL STUDY IN ITALIAN COMMUNITY NURSING
G. Fedelfranco | Social Health Local District of Bari, Unified Access Point / Multidimensional Assessment Unit, Bari; University of Bari "Aldo Moro", Bari, Italy
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Background and Aims. Chronic pain and psychological comorbidity are bidirectionally linked: 30–50% of chronic pain patients present with concurrent depression and/or anxiety (PHQ-ADS; Kroenke et al., PMC 2016). Nurse burnout impairs clinical judgment across all care domains (Li et al., JAMA Netw Open 2024; N=288,581); yet the specific impact of burnout on biopsychosocial pain assessment—integrating physical and psychological dimensions—remains unmeasured in Italian community nursing. This study examines whether nurse burnout severity predicts failure to screen for psychological pain comorbidity alongside physical pain management adequacy.
Methods. Cross-sectional correlational study (PROSPERO pre-registered). Participants: N=150 community nurses, ASL Bari territorial services (COT, Casa della Comunità, PUA/UVM). Instruments: Maslach Burnout Inventory (MBI); record audit — NRS documentation + Hospital Anxiety and Depression Scale (HADS) or PHQ-9 administration rate; Pain Management Index (PMI). Multiple regression: MBI emotional exhaustion → HADS/PHQ-9 administration rate and PMI adequacy simultaneously. Ethical approval: ASL Bari IRB.
Results. Preliminary data (N=38 nurses, 760 records): HADS or PHQ-9 administered in 8.2% of chronic pain records. PMI negative (undertreated) in 62.4%. The MBI emotional exhaustion score independently predicted both absent psychological screening (OR=2.1, p=0.004) and PMI negativity (OR=2.3, p=0.002).
Conclusions. Burnt-out community nurses simultaneously undertreat physical pain and fail to screen for psychological comorbidity—the double neglect of the biopsychosocial pain model. Systems-level burnout prevention is a multimodal pain management priority with direct policy implications for Italian NHS territorial models.
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