A significant number of patients continue to experience unrelieved pain during hospitalization despite decades of research, improved therapeutic measures and advancement in technology. Delays in recovery, decreased patient satisfaction, decreased quality of life and increased healthcare costs are some consequences related to poor pain management.
Limitation in nurses’ knowledge about pain assessment and management contributes to poor pain management in hospitalized patients. Literature suggests concerns about addiction and respiratory depression as a likely cause of under treatment of pain (Lewthwaite et.al, 2011).
A study conducted to explore nursing opinions about pain revealed a tendency for personal opinion to influence the choice of opioid dose (Lewthwaite et.al, 2011).
The purpose of this study was to better understand the registered nurses’ level of knowledge of and attitudes toward pain management.
Where do nurses receive and update their knowledge about pain management? A 2007 survey of Canadian university undergraduate programs showed pain education virtually nonexistent in the curricula of health care professional faculties (Watt-Watson, McGillion, & Hunter, 2007).
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Providing adequate pain management depends on the level of knowledge of, skills, and attitudes of nurses. To address learning needs effectively, and prior to planning educational opportunities, it is essential to identify these knowledge gaps. Education alone may be insufficient to change practice, given limited improvement in pain management over the last three decades. Some suggest changing the entire culture within any given organization to one that designates and empowers nurses in areas of assessment and management of patients’ pain experiences , thereby giving the nurse greater influence over these areas (Lewthwaite et al., 2011).
Strong nursing leadership and support from clinical nurse specialists, educators, and administrators is needed to introduce and sustain practice changes.
Methods
Design and Sample
This descriptive quantitative study was conducted in an urban tertiary care hospital in Midwestern Canada. A convenience sample included 761 full and part-time registered nurses who administer analgesia as part of their practice. Clinical units included surgery, woman and child, cardiac sciences, medicine, family medicine, geriatric-rehabilitation, emergency, mental health, and the hospital float pool (Lewthwaite et al., 2011).
A self-administered one-page data survey was created for the study, which collected demographical information as well as years of experience and pain knowledge. The survey included the Ferrell and McCaffery (2008) Knowledge and Attitudes Survey Regarding Pain (KASRP) tool. The original KASRP tool would be thought of as too long to complete during working hours, so a revised survey using only the 22 true and false question on the KASRP tool was used (Lewthwaite et al., 2011).
The KASRP tool, developed in 1987 and revised in 2008, is used extensively as a pre and posttest evaluation measure for educational programs to assess nurses and other healthcare professionals. The content was reviewed and validated by pain experts, and content information was established through current pain management standards derived from organizations including the World Health Organization, American Pain Society, and the Agency for Health Care Policy and Research. Construct validity was established by comparing scores of nurses at various levels of expertise from students, to senior pain experts (Ferrell & McCaffery, 2008).
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Procedures
An alpha level of 0.05 would determine statistical significance. Construct validity was evaluated by comparing nurses scores with varying levels of expertise, from students to senior nurses and pain experts. Test-retest reliability was established (r > 0.80) and internal consistency was shown, with a coefficient alpha of 0.85 (Lewthwaite et al., 2011).
Results
Out of 761 nurses, 324 participated and returned the surveys, for a response rate of 43%. Years of experience ranged from 24% with more than 25 years of professional experience to 22% with five years or less of professional experience. The majority of nurses’ reported working in surgery, woman and child, and cardiac sciences. Almost half of the participants (48.8%) scored 80% or higher and 66% of the nurses rated their knowledge of pain management as good. Questions relating to pharmacology, in particular those involving knowledge of opioids, scored the lowest. As with similar studies on this subject, this study found knowledge gaps among acute care nurses. The findings of this study can be used to design continuing educational opportunities in the work place that include pharmacology information to meet specific needs in the workplace. The results also provide a benchmark to evaluate the effectiveness of enhancing pain education in the classroom setting.
Ethical Considerations
Ethics approval was obtained from the study hospital research review committee, and a university research ethics board. The list of potential participants was obtained from the human resources department. Hospital volunteers delivered the study packets to unit-based staff mailboxes. The package included a letter of invite to participate, the survey questionnaire, and a self-addressed return envelope. Participation was voluntary, and completion and return of the questionnaire indicated such. In this self-reporting study, participants may have taken the opportunity to discuss questions or seek answers from other sources, as well as answer questions in a professionally or socially desirable fashion.
Conclusion
The battle to achieve effective pain management despite years of research and efforts by all involved continues to be a challenge. Previous nursing studies, along with this study, cite a knowledge gap amongst nurses as one reason for poor pain management and identify areas such as pharmacology, where nurses in particular lack knowledge. Continuing education opportunities are essential to achieve improved pain management skills. Education alone will not improve pain management; optimal quality care is dependent not only on a culture of learning but also on a cohesive professional team with inter-professional collaboration to ensure effective, individualized pain management.
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References
Ferrell, B., & McCaffery, M. (2008).
Knowledge and attitude survey regarding pain. Retrieved December 12, 2012 from http://prc.coh.org/Knowldege%20%20Attitude%20Survey%20-%20updated%205-08.pdf
Lewthwaite,B.J., Jabusch, K.M., Wheeler, B.J., Schnell-Hoehn, K.N., Mills, J., Estrella-Holder, E., & Fedorowicz, A.(2011).
Nurses’ knowledge and attitudes regarding pain management in hospitalized adults. Journal of Continuing Education in Nursing, 42(6), 251-7. Retrieved December 12, 2012 from http://ehis.ebscohost.com.library.gcu.edu
Watt-Watson, J., McGillion, M., & Hunter, J. (2007).
A survey of pain curricula in pre-licensure health sciences facilities in Canadian Universities. Retrieved December 12, 2012 from http://www.pulsus.com/journals/pdf_frameset.jsp?jnlKy=7&atlKy=9192&isArt=t&jnlAdvert=Pain&adverifHCTp=&sTitle=A%20survey%20of%20prelicensure%20pain%20curricula%20in%20health%20science%20faculties%20in%20Canadian%20universities,%20Pulsus%20Group%20Inc&HCtype=Physician.
