Factors Influencing Nurses’ Willingness to Provide Pain Relief: A Factorial Vignette Study

PURPOSE: To examine how nurses' willingness to provide pain relief is influenced by patients' self-reported pain intensity, observable pain behavior, and sex when evaluating hypothetical clinical scenarios. DESIGN: A cross-sectional study using a 2 × 2 × 2 factorial vignette-based design. METHODS: Overall, 127 registered nurses completed eight randomized clinical vignettes describing patients differing in sex (male/female), self-reported pain intensity (moderate/high), and visible pain behavior (present/absent). After each vignette, the nurses rated their willingness to administer over-the-counter analgesics on a 0%-100% scale. A mixed-design ANOVA was used to analyse the main and interaction effects, with nurse sex, pain-management training, and workplace setting included as between-subjects variables. RESULTS: Nurses reported a higher willingness to provide analgesics in vignettes depicting high (vs. moderate) self-reported pain intensity and when pain behavior was present. The main effect of patient sex was not statistically significant. A significant self-reported pain intensity × pain behavior interaction indicated that pain behavior had a stronger influence when the self-reported pain intensity was moderate. Between-nurse analyses showed that nurse sex, training, and workplace setting were associated with small variations in willingness ratings, whereas patient sex did not meaningfully shift the overall patterns of response. CONCLUSIONS: Within the vignette context, nurses' willingness ratings were primarily associated with patients' self-reported pain intensity, with observable pain behavior exerting additional influence at moderate pain levels. These findings describe judgment tendencies under standardized hypothetical scenarios and should not be interpreted as direct indicators of clinical behavior. CLINICAL IMPLICATIONS: Understanding how nurses weight patient cues in hypothetical decision-making may help identify potential cognitive biases and inform educational discussions about pain assessment. Although these results do not represent actual treatment behavior, reflecting on such judgment patterns may support more consistent and evidence-informed pain-management practices.