E-Learning course for nurses on pain assessment in patients unable to self-report

The effectiveness of educational interventions in enhancing health professionals' and students' pain assessment for people living with dementia: A systematic review

OBJECTIVES

To evaluate the effectiveness of educational interventions in improving the knowledge, attitudes, beliefs, self-efficacy, and confidence of health professionals' and students' pain assessment in dementia.

DESIGN

A systematic review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Eight English databases were searched: Medline, Psychological Information Database, Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest, Scopus, and Web of Science.

REVIEW METHODS

Databases were searched without any time limit using synonyms for "health personnel", "health students", "pain assessment", "dementia", "educational intervention", "knowledge", "attitude", "beliefs", "self-efficacy", and "confidence". The review included studies published up to 26 March 2024. Reference lists and review papers were screened to identify additional papers. Data was synthesised according to the intervention designs and outcome measures and presented narratively.

RESULTS

The seven studies retained involved 517 registered nurses, 17 physical therapists, eight occupational therapists, 17 physicians, 99 nursing students, and 161 medical students. All seven studies evaluated the effectiveness of educational interventions on knowledge, three on attitudes, two on confidence, one on self-efficacy, and none on beliefs of pain assessment in dementia. Health professionals' and students' knowledge scores improved irrespective of the training delivery mode and duration. Their confidence scores improved irrespective of training duration. Health professionals' self-efficacy scores improved upon completion of online training. Overall attitude scores for most health professionals and students did not increase upon educational intervention completion, irrespective of the training delivery mode and duration. Educational interventions mainly focused on methods that assess pain in both communicative and non-communicative people with dementia.

CONCLUSIONS

Educational interventions enhance health professionals' and students' knowledge, self-efficacy, and confidence in pain assessment in dementia. Studies showed mixed findings related to attitudes, and there is a limited understanding of interventions' effectiveness in correcting erroneous beliefs.

Bridging Gaps in Pain Management: The Effectiveness of Educational Intervention for Nurses in a Teaching Hospital of Low- and Middle-Income Countries

Background: Regular on-the-job training and educational courses may improve nurses' knowledge and practice regarding pain assessment and initial treatment. Objectives: To assess the impact of a newly developed educational course in terms of improvement in knowledge regarding pain assessment and initial treatment by using pretest and posttest multiple-choice question scores and to determine the retention of knowledge 3 months after the educational course and perceived change in clinical practices among nurses working in adult surgical and medical wards at the Aga Khan University Hospital. Methods: After getting approval from the institutional review committee, an education course was developed and conducted. A total of 86 participants attended both online and physical components. Teaching methodologies included online lectures, small group tutorials and hands-on workshops using demonstrations of locally developed videos. Pretests and posttests were conducted to assess the knowledge. All participants were requested to complete an online questionnaire to know the impact of the course on their clinical practice. Results: Eighty-six participants completed the course, of which 52 (60.5%) were female and 34 (39.5%) were male. The mean difference between the pretest and posttest scores of participants was 4.72 (39.66%), which was statistically significant (p ≤ 0.001). The mean posttest multiple-choice question score of participants was 16.70 ± 3.56, and the mean posttest multiple-choice question score of participants after 3 months was 15.60 ± 4.09 with a mean difference of 1.10 (6.59%), which was not statistically significant (p=0.121). Conclusion: The hybrid educational course had a significant learning impact on the knowledge of participants and their clinical practice.

NursPainPrevent: A Prospective Observational Study on Pain During a Bed Bath

BACKGROUND

Although bed baths are known to cause pain, the engendered pain frequency and intensity remain poorly studied. This prospective, observational study was undertaken to examine prospectively, on a given day, patients' bed bath-associated pain in the general in-hospital population.

METHODS

Eight external investigators observed 166 bed baths given in 23 units in 5 hospitals. Using validated assessment scales specific to the patients' clinical situations, they established pain scores.

RESULTS

Expert observers rated bed bath-induced pain as moderate-to-severe for 48% of the patients, among whom 51.9% had not received prophylactic analgesia prior to the procedure. Only 7.2% benefited from evaluation with a validated pain scale. Astute attention-distraction techniques were applied to shift attention during 16.8% of the bed baths. Caregivers used verbal guidance for 85% of the procedures, and adapted touch and rhythm of the gestures for 84.3%.

CONCLUSION

Bed baths generate moderate-to-severe pain intensity. Evaluation and recourse to analgesia remain insufficient despite caregivers' attention accorded to patient comfort and positioning.

CLINICAL IMPLICATIONS

The results of this study could contribute to sensitizing professionals to preventing pain linked with routine nursing care. Four axes for improvement were highlighted: evaluation improvement, analgesia, nonpharmacological approaches, and adapted mobilization techniques.

Pain in non-communicative older adults beyond dementia: a narrative review

Aging is associated with an increased risk of developing pain, especially in the presence of concurrent chronic clinical conditions. Similarly, multimorbidity can affect the perception and ability of older adults to appropriately respond to and communicate pain, and there is a clinical heterogeneity in the processing of painful sensations in different neurological conditions. The present narrative review is aimed at assessing the prevalent diseases associated with poor communication and pain in older adults, together with the available diagnostic instruments for the clinical assessment of pain in such a vulnerable population. Dementia was the most described pathology identified in the current literature associated with poor communication in older adults affected by pain, along with Parkinson's disease and stroke. Notably, a common pattern of pain behaviors in these neurological disorders also emerged, indicating potential similarities in the clinical presentation and appropriate diagnostic workout. At the same time, there are many differences in the way patients express their pain according to their main neurological pathology. In addition to this, although a plethora of observation-based tools for pain in patients with dementia have been developed, there is no gold standard, and the clinical utility of such measurements is still largely unaddressed. Meanwhile, there is substantially no standardized observation-based tool for pain in non-communicative patients with Parkinson's disease, and only a few for stroke. Overall, the present narrative review provides an update on the prevalent diseases beyond dementia associated with a communicative disability and a painful condition in older adults.

Online Learning to Improve Nurses' Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults

BACKGROUND

Older adults undergoing total knee arthroplasty may develop chronic pain without effective postoperative pain management. Increasing nurses' knowledge, changing their attitudes, and developing their pain management self-efficacy could improve the effectiveness of pain management.

AIM

To determine the effectiveness of an online learning program to help registered nurses to manage postoperative pain in older adults undergoing total knee arthroplasty.

DESIGN

A quasi-experimental pre-test-post-test design with intervention and control groups.

METHOD

Six inpatient units were randomly selected at a large tertiary care medical center. Sixty nurses were evenly divided between intervention and control groups to participate in online learning about postoperative pain management in patients undergoing total knee arthroplasty. The content was based on Kolb's experiential learning theory. Data were collected on nurses' knowledge and attitudes toward pain management and pain management self-efficacy at baseline and after completion. Data were analyzed using descriptive statistics, chi-square tests, paired t-tests, and independent t-tests.

RESULTS

The knowledge and attitudes about pain management and pain management self-efficacy toward older adults undergoing total knee arthroplasty of nurses in the intervention group significantly improved compared to the baseline and were also significantly higher than in the control group.

CONCLUSIONS

An online learning program improves nurses' understanding and ability to manage pain in older adults undergoing total knee arthroplasty. This was therefore an effective learning method.

Initiatives Targeting Health Care Professionals: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults

OBJECTIVES

Pain is often undertreated in older adult populations due to factors, such as insufficient continuing education and health care resources. Initiatives to increase knowledge about pain assessment and management are crucial for the incorporation of research evidence into practice. Knowledge translation (KT) studies on pain management for older adults and relevant knowledge users have been conducted; however, the wide variety of KT program formats and outcomes underscores a need to evaluate and systematically report on the relevant literature.

MATERIALS AND METHODS

Using a systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related KT programs targeted towards older adults, their informal caregivers, and health care professionals were examined. Initiatives focusing on health care professionals are the focus of this review. Initiatives focusing on older adults are reported in a companion article.

RESULTS

From an initial 21,669 search results, 172 studies met our inclusion criteria. These studies varied widely in focus and delivery format but the majority were associated with significant risk of bias. In this report, we are focusing on 124 studies targeting health care professionals; 48 studies involving initiatives targeting older adults are reported in a companion article. Moreover, most programs were classified as knowledge mobilization studies without an implementation component. Across all studies, knowledge user satisfaction with the initiative and the suitability of the material presented were most commonly assessed. Patient outcomes, however, were underemphasized in the literature.

CONCLUSION

Patient and clinical outcomes must be a focus of future research to fully conceptualize the success of KT programs for older adult individuals. Without implementation plans, disseminated knowledge does not tend to translate effectively into practice.

Continuous training based on the needs of operating room nurses using web application: a new approach to improve their knowledge

INTRODUCTION

Since university education and intensive and limited pre-service training do not provide an acceptable level of performing the duties of operating room nurses, and considering the limitations of traditional training methods in the field of operating room; This study was conducted with the aim of determining the effect of using the electronic education approach based on web application, leveled, personalized and based on the needs of nurses on their level of knowledge and satisfaction.

MATERIALS AND METHODS

This research is a quasi-experimental type of single-group multi-center pre-test-post-test, which during that, four stages of educational needs assessment, educational content design, web application design for training and evaluation of operating room nurses and determining the effectiveness of this method are included. Based on their knowledge and satisfaction, during this period, 36 nurses from the operating rooms that met the study criteria were included in the study by stratified random sampling based on the determined sample size. The data collection includes a four-choice test to measure the knowledge of operating room nurses in heart anatomy (score range 0-20), the principles of movement, transferring and positioning of the patient in the operating room (score range 0-15), the principles of ergonomics in the operating room (score range score 0-10) and satisfaction questionnaire (score range 0-28). Data collected using descriptive statistical tests (percentage of frequency and frequency, mean and standard deviation) and analytical tests (paired sample t-test, independent samples t-test, ANOVA, Pearson correlation, chi-square) with the software SPSS version 16 was analyzed.

RESULTS

Generally, the average knowledge scores of operating room nurses before and after the intervention were 5.96 ± 3.96 vs. 13.6 ± 3.77, in the course of principles of moving, transferring and positioning the patient in the operating room were 6.3 ± 3.42 vs. 13.3 ± 1.32, respectively 8.7 ± 3.97 vs. 18.1 ± 1.07 (in heart anatomy), 1.57 ± 2.6 vs. 0.73 ± 9.1 (in the principles of ergonomics in the operating room) and the average Knowledge scores after the intervention were significantly higher than before the intervention (P<0.001). Also, the average satisfaction score of nurses was 21.3 ± 5.83 and 22 nurses (64.7%) were satisfied with the e-learning course.

CONCLUSION

The use of the electronic education approach based on the web application, leveled, personalized and based on the needs of the nurses, led to the improvement of the level of knowledge and satisfaction of the operating room nurses. E-learning can be used as a complementary educational tool and method for continuous training of operating room nurses in other specialized fields of operating room and surgery.

HIGHLIGHTS

• Educational content in the form of educational videos taught by professors of medical sciences universities on each of the topics of heart anatomy (28 episodes of 5-10 minutes), principles of ergonomics in the operating room (7 episodes of 5-25 minutes) and movement principles. The transfer and positioning of the patient in the operating room (16 episodes of 10-20 minutes) were designed in three primary, intermediate and advanced levels. • The results of this study showed that the use of an electronic education approach based on the web application, levelled, personalized and based on the needs of nurses, led to the improvement of the knowledge of operating room nurses. Also, operating room nurses were delighted with electronic training courses. E-learning can be used as a complementary educational tool and method for continuous training of operating room nurses in other specialized fields of operating room and surgery. • Based on the results of this study, the use of an electronic education approach based on the needs of operating room nurses can be used as a complementary tool to conventional continuous education. Since this method allows interactive, personalized education is levelled, and asynchronous. It can be used at any time and place on a laptop, tablet or mobile phone; a wide range of operating room nurses in the hospitals of the Islamic Republic of Iran can use it for educational justice to Many borders should be established in the country. However, there are studies to evaluate the generalizability and the effect of using the e-learning approach on the clinical skills of operating room nurses and to compare the effect of e-learning with other methods and educational tools on the knowledge and skills of the learners and the extent of consolidating the learned material in their memory.

Pain management education needs for nurses caring for older adults undergoing total knee replacement

INTRODUCTION

Effective postoperative pain management is necessary to improve the outcomes of older adults undergoing total knee replacement (TKR). Discovering what registered nurses (RNs) need to know about pain management may be beneficial to improving the quality of care.

AIM

The study aimed to identify the information needed to develop pain management education for RNs caring for older adults undergoing TKR.

METHODS

A qualitative descriptive design was used in this study. Three focus groups were conducted with 22 staff RNs with experience caring for older adults undergoing TKR at a supra-tertiary care hospital in Bangkok, Thailand; one focus group was conducted with five members of the hospital's nursing pain management committee. Data were analyzed using content analysis.

RESULTS

Two themes relevant to pain assessment education were pain assessment and pain management. Subthemes of pain assessment included challenges in cognitively impaired older adults, inadequate knowledge and misconceptions, and re-assessing pain. Three subthemes of pain management were created, including knowledge of pain medication, new trends in pharmacological pain management and devices, and non-pharmacological pain management using cold compression.

CONCLUSIONS

RNs require current information about pain management to provide effective postoperative care for older adults undergoing TKR. The findings may be used in pain management education to update RNs' knowledge of pain management.

Effect of Pain Education Interventions on Registered Nurses' Pain Management: A Systematic Review and Meta-Analysis

OBJECTIVES

This review and meta-analysis aims to reveal how pain education interventions affect registered nurses' pain management.

DESIGN

A systematic review and meta-analysis DATA SOURCES: PubMed, Scopus, CINAHL (EBSCOhost), and ERIC REVIEW METHODS: A systematic search of four electronic databases was conducted to identify relevant peer-reviewed English or Finnish-language articles published between 2008 and 2021. The review included a quality appraisal and a meta-analysis of articles providing group-level data before and after the intervention (n = 12). The methods followed the PRISMA guidelines.

RESULTS

Overall, 23 articles met the inclusion criteria for the review, of which 15 were evaluated as good quality. Based on the articles on document audits (n = 10), pain education interventions reduced the risk of not receiving the best pain management by 40%, whereas based on the articles on patients' experiences (n = 4), they reduced the risk by 25%. The study quality and design of these articles were considerably heterogenous.

CONCLUSIONS

Pain education study strategies varied widely among the included articles. These articles used multivariate interventions without systematization or sufficient opportunity to transfer the study protocols. It can be concluded that versatile pain nursing education interventions, as well as auditing of pain nursing and its documentation combined with feedback, can be effective to nurses in adapting pain management and assessment practices and increasing patient satisfaction. However, further research is required in this regard. In addition, well-designed, implemented, and reproducible evidence-based pain education intervention is required in the future.

Are nurse`s needs assessment methods robust enough to recognise palliative care needs in people with dementia? A scoping review

BACKGROUND

People with dementia are most at risk of experiencing serious health related suffering, if they do not have a palliative care approach introduced early enough in the illness. It can be challenging for nurses to assess experienced needs of people, who are thought no longer able to self-report such as people with dementia. Assessment help to understand the care the patient and their family need promptly. It is unknown how nurses recognise holistic palliative care needs in people with dementia during routine care.

METHODS

Scoping review where EMBASE, MEDLINE, CINAHL, PsycInfo databases, and references were searched with an advanced search strategy, which was built on three concepts (nurses, dementia, and nursing assessment) using corresponding Medical Subject Headings. Data were charted in a piloted extraction form, based on the assessment domains within the nursing process followed by summarise and synthesise results narratively.

RESULTS

37 out of 2,028 qualitative and quantitative articles published between 2000 and 2021, and relating to 2600 + nurses, were identified. Pain was sole focus of assessment in 29 articles, leaving 8 articles to describe assessment of additional needs (e.g., discomfort). Nurses working in a nursing home assess pain and other needs by observing the persons with dementia behaviour during routine care. Nurses in the acute care setting are more likely to assess symptoms with standard assessment tools at admission and evaluate symptoms by observational methods. Across settings, about one third of pain assessments are supported by person-centred pain assessment tools. Assessments were mostly triggered when the person with dementia vocalised discomfort or a change in usual behaviour was observed. Nurses rely on family members and colleagues to gain more information about needs experienced by people with dementia.

CONCLUSION

There is a scarcity of evidence about techniques and methods used by nurses to assess needs other than pain experienced by people with dementia. A holistic, person-centred screening tool to aid real-time observations at the bedside and used in conversations with health care professionals and families/friends, may improve need recognition other than pain, to ensure holistic needs could then be addressed timely to improve care in people with dementia.

Effects of a web-based education program for nurses using medical malpractice cases: A randomized controlled trial

BACKGROUND

Education on legal obligations in healthcare related to medical malpractice is insufficient, which has the potential to reduce patient safety. Nurses need to improve their understanding of legal obligations in order to enhance patient safety. However, no easily accessible education program has been developed that covers both the concepts of legal obligations and patient safety.

OBJECTIVE

This study sought to develop a web-based education program using medical malpractice cases and to evaluate the effectiveness with regard to legal obligations and patient safety competency of nurses.

DESIGN

The study design was a randomized controlled trial evaluating the effectiveness of a newly-developed web-based education program.

PARTICIPANTS AND SETTING

Seven experts and 19 learners evaluated the developed program. One hundred eighteen nurses working in three hospitals were randomly assigned to the intervention group (N = 59) and the control group (N = 59).

METHODS

The web-based program was developed using the analysis-design-development-implementation-evaluation model and evaluated by experts and learners. Data were collected from January to May 2019. The intervention was the five-week web-based education program. The post-test was conducted five weeks after the pre-test in the control and intervention groups.

RESULTS

The web-based program consisted of two modules on theoretical knowledge and seven modules on medical malpractice cases. The findings demonstrated significant differences in knowledge and cognition of legal obligations and patient safety competency between the control and intervention groups after the five-week intervention.

CONCLUSION

A web-based education program on medical malpractice cases enhanced nurses' awareness of legal obligations and patient safety competency. Therefore, this web-based educational program should be organized as an online continuing education program for clinical nurses. It will improve awareness of patient safety by clearly specifying the relationship between legal obligations and root causes of medical errors from various perspectives.