Development and testing of four instruments to assess prior conditions that influence nurses' adoption of evidence-based pain management practices

Acute Postoperative Pain in Trauma Patients - The Fifth Vital Sign

AIM

To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment.

PATIENTS AND METHODS

The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain.

RESULTS

The average pain intensity at hospital admission was NRS median 7 (range 4-10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4-7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally.

CONCLUSION

Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn't ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment.

Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: a mixed-methods approach

PURPOSE/OBJECTIVES

To describe evidence-based practice (EBP) beliefs and behaviors of nurses who provide cancer pain management.

DESIGN

Descriptive, cross-sectional with a mixed-methods approach.

SETTING

Two inpatient oncology units in the Pacific Northwest.

SAMPLE

40 RNs.


METHODS

Data collected by interviews and web-based surveys.

MAIN RESEARCH VARIABLES

EBP beliefs, EBP implementation, evidence-based pain management.

FINDINGS

Nurses agreed with the positive aspects of EBP and their implementation ability, although implementation level was low. They were satisfied with their pain management practices. Oncology nursing certification was associated with innovativeness, and innovativeness was associated with EBP beliefs. Themes identified were (a) limited definition of EBP, (b) varied evidence-based pain management decision making, (c) limited identification of evidence-based pain management practices, and (d) integration of nonpharmacologic interventions into patient care.

CONCLUSIONS

Nurses' low level of EBP implementation in the context of pain management was explained by their trust that standards of care and medical orders were evidence-based.

IMPLICATIONS FOR NURSING

Nurses' EBP beliefs and behaviors should be considered when developing strategies for sustaining evidence-based pain management practices. Implementation of the EBP process by nurses may not be realistic in the inpatient setting; therefore, hospital pain management policies need to be evidence-based and reinforced with nurses.

Pain management and satisfaction in postsurgical patients

AIMS AND OBJECTIVES

To examine the relationship between patient satisfaction and the incidence of severe and enduring pain through a health board wide hospital satisfaction questionnaire.

BACKGROUND

The incidence and management of acute postoperative pain and its relationship to patient satisfaction have been of great interest to clinicians over the last 20 years. Evidence suggests that despite many moves to address this problem with the advent of acute pain nurse specialists and dedicated pain teams, severe and enduring pain continues to be a problem. However, patients appear to report high satisfaction levels.

DESIGN

The study design was a postal questionnaire the results of which were analysed statistically.

METHODS

The postal questionnaire was sent to patients who had been discharged from acute hospitals in one health board in the previous two weeks. A total of three large acute hospitals were included. The data were analysed to produce descriptive statistics for all patients on the pain questions and then for patients with severe and enduring pain on the variables of age, gender, ethnic group, responses to pain questions and type of admission.

RESULTS

Twenty-six percent of patients reported having pain all or most of the time. Patients suffering from severe and enduring pain were younger females.

CONCLUSION

Acute postoperative pain continues to be a problem, although patients continue reporting moderate satisfaction levels.

RELEVANCE TO CLINICAL PRACTICE

Acute postoperative pain is an ongoing issue for postsurgical patients. It is crucial to understand and recognise issues that can adversely contribute to increased pain severity.

Prior conditions influencing nurses' decisions to adopt evidence-based postoperative pain assessment practices

Over the past 30 years, postoperative pain relief has been shown to be inadequate. To provide optimal postoperative pain relief, it is imperative for nurses to use evidence-based postoperative pain assessment practices. This correlational descriptive study was conducted to identify factors, termed prior conditions, that influenced nurses' decisions to adopt three evidence-based postoperative pain assessment practices. A convenience sample of nurses who cared for adult postoperative patients in two Midwestern hospitals were surveyed, and 443 (46.9%) nurses responded. The previous practice and innovativeness of nurses were supportive of adoption of the three practices. Nurses felt that patients received adequate pain relief, which is unsupportive of adoption of the three practices because there is no impetus to change. Nurses who perceived the prior conditions as being supportive of adoption of pain management practices used multiple sources to identify solutions to clinical practice problems, and those who read professional nursing journals were more likely to have adopted the three practices and were more innovative. The number of sources used to identify solutions to clinical practice problems, previous practices, and innovativeness were predictive of nurses' adoption of the three evidence-based postoperative pain assessment practices. Nurses need to be encouraged to use multiple sources, including professional nursing journals, to identify solutions to clinical practice problems. Innovative nurses may be considered to be opinion leaders and need to be identified to promote the adoption of evidence-based postoperative pain assessment practices. Further exploration of the large unexplained variance in adoption of evidence-based postoperative pain assessment practices is needed.