Determinants of nurses' knowledge gap on pain management in Ghana

There are concerns about adequacy of nurses' knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses' inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses' inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required.     

疼痛教育项目对护士疼痛知识、态度及评估实践的效果研究

目的探讨实施疼痛教育项目对护士疼痛知识、态度和评估实践的影响。方法应用类实验研究设计评价疼痛教育项目对护士疼痛知识、态度及评估实践的影响。疼痛教育项目包括对护士进行疼痛相关知识培训和指导护士应用“长海痛尺”开展疼痛评估2部分内容。疼痛教育干预为期5周,由群体教育、小组活动和个别指导组成。根据入选条件确定2所三级甲等教学医院的研究对象196名护士,分为实验组106名和对照组90名,行基线调查后对实验组护士实施干预（疼痛教育项目）。在干预后的1个月和3个月收集资料,评价2组护士的疼痛知识、态度,并评估实践行为。结果接受疼痛教育项目后,实验组护士“疼痛知识和态度调查问卷”（NKAS）的平均得分从干预前的15．67分增加为26．13分（干预后1个月）和35．14分（干预后3个月）,其干预后的得分与基线和对照组护士相比均有显著差异;而且实验组护士正确应用“长海痛尺”评估患者疼痛强度的比较显著提高,与基线和对照组相比差异显著。结论疼痛教育项目可显著提高护士疼痛知识及态度,改善疼痛评估实践,是一种促进疼痛管理的有效措施,应被推广使用。     

Achieving consensus about pain content for child branch curricula

AIM: The aim of the study was to identify nurse educators' and nurse managers' perceptions of the educational needs of children's nurses in relation to pain management. RATIONALE: Children continue to suffer unnecessary pain during hospitalization. This has been attributed, in part, to inadequate education among paediatric nurses with a number of studies demonstrating that nursing curricula need re-evaluating with respect to the content relating to pain management. In order to equip nurses to manage pain within clinical practice nurse education needs to provide them with the knowledge and skills required. It is apparent that nurse education is currently failing students in this regard. In order to evaluate nursing curricula with respect to pain management it is necessary for there to be a degree of consensus, among paediatric nurses, regarding appropriate content. METHODOLOGY: A two-round Delphi study was used to ascertain the appropriate pain content for pre-registration child branch courses. When undertaking a Delphi study a number of 'experts' in the field are identified, who complete a series of questionnaires. The first round is used to generate ideas, which are reconsidered in subsequent rounds (Hicks 1999, Reid 1988). Following analysis of the responses to each questionnaire anonymous feedback is sent to the respondents together with the next questionnaire (Walker 1994). Participants were either senior nurse educators or senior nurse managers. RESULTS: Positive correlations were found within the two groups as well as between the educators' and managers' rankings for the 14 categories identified. CONCLUSIONS: The results of this study suggest that nurse educators and nurse managers have similar views about the pain management knowledge they would expect a newly qualified child branch nurse to have. The list of appropriate pain content derived from the results of this study provides a useful tool with which to evaluate the content of child branch curricula.     

Improving Patient Satisfaction With Better Pain Management in Hospitalized Patients

Pain is a common problem in hospitalized patients. Pain management needed improvement at an urban level 1 trauma hospital unit as evidenced by below benchmark pain management Hospital Consumer Assessment of Healthcare Providers and Systems scores. A quality improvement project was implemented that consisted of an evidenced-based nursing education program and the development and use of an evidenced-based pain management algorithm for nurses. After completion of the quality improvement project, nurses showed significantly improved knowledge regarding pain management and pain scores improved. A pain management quality improvement project improved staff knowledge and patient satisfaction with pain management.     

Recommendations for educating nurses in genetics

With the ongoing and increasingly rapid pace of genetic discoveries, nurses must be able to incorporate genetic knowledge into their everyday practices of promoting the genetic health of individuals, families, and communities. Although development of genetic health knowledge is in its infancy, nurses are currently expected to integrate information about genetic risks, testing, and treatments for clients throughout the clients' entire lifespan. All nurses must have an understanding of the relationship between genetics and health to appropriately identify and address genetic concerns in their clients. To fulfill these roles, nurses need to improve their knowledge base in genetics. This article provides recommendations for genetics curriculum in continuing and entry-level nursing education programs. These recommendations are outcomes of a research project involving genetics nurse experts as well as nurses new to the area of genetics, and a consensus workshop of nursing faculty involved in curriculum changes subsequent to an intensive genetics continuing education program. Nursing educators are beginning to recognize the importance of education of all nurses about genetics. If, however, all educators do not accept this responsibility, nurses will be left behind in designing and offering health care for the 21st century.     

Tasmanian nurses' knowledge of pain management

The aim of this research was to obtain information concerning knowledge of the pain management practices of Tasmanian nurses. We examined the knowledge of Tasmanian Registered Nurses in relation to pain management issues such as addiction, use of analgesics and the assessment of pain. In addition, we queried them about their satisfaction with information they had received about how to manage pain in both workplace programs and in their initial education. A total of 2768 registered nurses were mailed a 29-item survey examining knowledge of pain management practices. One thousand and fifteen valid surveys were returned. Mean scores on the knowledge questions (72% correct) of the survey revealed deficits in knowledge. Nurses specifically lacked up-to-date knowledge concerning the pharmacological management of pain, but displayed a more up-to-date knowledge concerning the effect of patient variables on pain perception. Nurses also rated the information they received about pain management during workplace programs as poor, feeling that they acquired significantly more in-depth information during their initial education. The results of this study have implications for institutions involved in both patient pain management and pain management education.     

Pain management skills of regional nurses caring for older people with dementia: a needs analysis

An exploratory survey of the pain management education needs of 197 nurses working with older people with dementia was undertaken in a regional area of Queensland, Australia. The analysis indicated that nurses in this setting might not have the knowledge base to manage pain effectively; and that respondents have essentially negative perceptions of the availability and appropriateness of current pain management education programs. Consistent with non-metropolitan nurses generally, respondents expressed a preference for pain management education that had a significant face-to-face component allied with ongoing mentorship and support on completion of the program. The obstacles to attending such programs were also typical of the problems facing regional and rural nurses throughout Australia. These were identified as: inability to pay for courses; lack of information on what is available; distance to travel to education; and a perceived lack of employer support due to an inability to replace those staff attending education. Positive aspects include the degree to which participants were responsive and interested in dementia pain management and their access to, and acceptance of, non-medical pain therapies. The findings suggest a definite need for a dementia pain management program for aged care nurses, specifically tailored to their needs and to the constraints of the regional practice setting.     

疼痛教育项目对护士疼痛知识、态度及评估实践的效果研究

目的 探讨实施疼痛教育项目对护士疼痛知识、态度和评估实践的影响.方法 应用类实验研究设计评价疼痛教育项目对护士疼痛知识、态度及评估实践的影响.疼痛教育项目包括对护士进行疼痛相关知识培训和指导护士应用"长海痛尺"开展疼痛评估2部分内容.疼痛教育干预为期5周,由群体教育、小组活动和个别指导组成.根据入选条件确定2所三级甲等教学医院的研究对象196名护士,分为实验组106名和对照组90名,行基线调查后对实验组护士实施干预(疼痛教育项目).在干预后的1个月和3个月收集资料,评价2组护士的疼痛知识、态度,并评估实践行为.结果 接受疼痛教育项目后,实验组护士"疼痛知识和态度调查问卷"(NKAS)的平均得分从干预前的15.67分增加为26.13分(干预后1个月)和35.14分(干预后3个月),其干预后的得分与基线和对照组护士相比均有显著差异;而且实验组护士正确应用"长海痛尺"评估患者疼痛强度的比较显著提高,与基线和对照组相比差异显著.结论 疼痛教育项目可显著提高护士疼痛知识及态度,改善疼痛评估实践,是一种促进疼痛管理的有效措施,应被推广使用.     

Knowledge and awareness concerning chemical and biological terrorism: continuing education implications

BACKGROUND: A survey on knowledge and awareness concerning chemical and biological terrorism was used to assess the knowledge base of health care providers at an urban medical center in preparation for developing a workshop on domestic terrorism preparedness. A second survey assessing domestic terrorism preparedness of infection control personnel and nurse educators also was conducted. METHOD: A total of 291 nurses, physicians, nursing students, and medical students completed the knowledge and awareness survey. A total of 24 infection control personnel and nurse educators completed the second survey on domestic terrorism preparedness. FINDINGS: The knowledge scores of the respondents were low, with less than one fourth of the knowledge questions answered correctly. In addition, less than 23% of the respondents reported confidence to provide health care in a hypothetical chemical terrorism situation. CONCLUSION: These findings indicate a need for nurses in continuing education and staff development to develop, implement, and evaluate innovative domestic terrorism preparedness programs.     

Factors Related to Nurses’ Knowledge and Attitudes Toward Pain in Hospitals in Low-Income Areas

BackgroundEffective pain management is closely related to nurses' knowledge and attitudes toward pain. Limited studies have been performed related to nurses’ knowledge and attitudes toward pain in hospitals in low-income areas.AimsThis study surveyed the knowledge and attitudes of nurses toward pain management in county hospitals from low-income areas in Hunan Province, China.Setting and participantsThe study included 4,668 registered nurses working in 48 county hospitals in low-income areas in China.MethodsA cross-sectional study examined the knowledge and attitudes of nurses with regard to pain using the Chinese version of the Knowledge and Attitude Survey Regarding Pain (KASRP) via the WeChat application.ResultsThe 4,668 registered nurses completed the survey; of these, 43.6% indicated they had never received continuing education for pain. The mean percentage score for KASRP was (40.3 ± 7.95), and none of the respondents achieved a percentage score of >80%. Further, of the 40 items, only two had a correct rate of >80%. Continuing pain education did not significantly affect KASRP. Multiple stepwise linear regression showed that education level, ethnicity, professional title, position, and department were independent influencing factors for KASRP scores.ConclusionAlmost all nurses in county hospitals of low-income areas had deficiencies in various aspects of pain management knowledge. Better educated nurses with higher professional title or management position, those from the Han ethnicity, and those from the oncology department had higher mean KASRP scores. Current continuing education programs for pain did not improve the pain management capability of the nurse. High-quality and standardized pain educational programs should be implemented to improve pain management.     

The challenge of caring for patients in pain: from the nurse’s perspective

Aim. To increase understanding of what it is like for nurses to care for patients in pain. Background. Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses’ relations with patients and doctors, it may be fruitful to study nurses’ experience of caring for patients in pain to increase understanding of the above problem. Design. A phenomenological study involved 20 dialogues with 10 experienced nurses. Results. The findings indicate that caring for a patient in pain is a ‘challenging journey’ for the nurse. The nurse seems to have a ‘strong motivation to ease the pain’ through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are ‘reading the patient’, ‘dealing with inner conflict of moral dilemmas’, ‘dealing with gatekeepers’ (physicians) and ‘organisational hindrances’. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse. Conclusions. Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses’ knowledge in this respect may hitherto have been too narrowly defined. Relevance to clinical practice. The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses’ clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge.     

Emergency nurses' knowledge of perceived barriers in pain management in Taiwan

Aims and objectives. To explore knowledge of and perceived barriers to pain management among emergency nurses in Taiwan. Background. Pain is the most common patient complaint in emergency departments. Quality care of these patients depends on the pain knowledge and pain management skills of emergency nurses. However, no studies have explored emergency nurses’ knowledge of and perceived barriers to pain management in Taiwan. Design and methods. Nurse subjects (n = 249) were recruited from nine hospitals chosen by stratified sampling across Taiwan. Data were collected using the Nurses’ Knowledge and Attitudes Survey‐Taiwanese version, a scale to assess perceived barriers to pain management and a background information form. Results. The overall average correct response rate for the knowledge scale was 49·2%, with a range of 4·8–89·2% for each survey question. The top barrier to managing pain was identified by these nurses as ‘the responsibility of caring for other acutely ill patients in addition to a patient with pain. Knowledge of pain management had a significant, negative relationship with perceived barriers to pain management and a significant, positive relationship with extent of clinical care experience and total hours of prior pain management education. In addition, scores for knowledge and perceived barriers differed significantly by the nursing clinical ladder. Perceived barriers also differed significantly by hospital accreditation category. Conclusions. Our results indicate an urgent need to strengthen pain education for emergency nurses in Taiwan. Relevance to clinical practice. The pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese emergency nurses.     

烧伤科护士疼痛认知状况调查

目的了解烧伤科护士对疼痛相关知识的掌握状况和在临床中的实践能力,为提高疼痛控制水平提供参考.方法对15所医院253名烧伤科护士进行问卷调查,用SPSS 11.0软件包进行统计处理.结果学历与职称是疼痛知识得分的主要影响因素;对疼痛的评估和疼痛控制方面的知识掌握较好,而对药物的作用、药物成瘾性和护理干预方面的知识掌握较差.结论烧伤科护士疼痛知识欠缺,建议从在校护士教育抓起,将疼痛知识的课程纳入护理学课程体系,同时面向在职护士,为临床护士提供多种形式的有针对性的疼痛知识继续教育,使护士在临床实践中积极参与疼痛管理.     

The Henry street consortium population-based competencies for educating public health nursing students

The Henry Street Consortium, a collaboration of nurse educators from universities and colleges and public health nurses (PHNs) from government, school, and community agencies, developed 11 population-based competencies for educating nursing students and the novice PHN. Although many organizations have developed competency lists for experts, the Consortium developed a set of competencies that clearly define expectations for the beginning PHN. The competencies are utilized by both education and practice. They guide nurse educators and PHNs in the creation of learning experiences that develop population-based knowledge and skills for baccalaureate nursing students. Public health nursing leaders use the competencies to frame their expectations and orientations for nurses who are new to public health nursing. This paper explains the meaning of each of the 11 population-based competencies and provides examples of student projects that demonstrate competency development. Strategies are suggested for nurse educators and PHNs to promote effective population-based student projects in public health agencies.     

A Nonrandomized Pretest Posttest Study on the Impact of an Educational Pain Management Program on Nurses’ Knowledge and Attitudes Regarding Pain in a Middle Eastern Country

BackgroundAlthough nurse's knowledge and attitudes regarding pain management has been sufficiently studied worldwide, the impact of an educational intervention program in improving such attitudes and knowledge has not been likewise researched, especially in Middle Eastern countries.AimsTo examine nurses’ knowledge and attitudes regarding pain at a university hospital in Lebanon before and after the introduction of a pain management educational program. And to assess the relationship between the characteristic of nurses and their pain knowledge.MethodsDesign; A nonrandomized pretest posttest study design was used. Setting; A university hospital in Lebanon. Participants; Included 183 nurses using the Nurses' Knowledge and Attitudes Survey Regarding Pain questionnaire. The pain educational intervention was based on the principles of Ajzen's theory of planned behavior.ResultsA significant difference between the pre and post test scores was noted (p = .016). Questions answered correctly by 80% of participants were related to questions about pain, pain assessment and management, and questions related to medications, such as correct dosages and opioid side effects were not answered correctly by the majority of nurses. There were significant associations between test scores and the nurses’ educational level, their age, and their years of experience. Nurses who worked in critical care units, the emergency department and oncology had higher scores than nurses who worked on general units.ConclusionsDespite the intensive pain education provided at our institution, the pain knowledge of nurses remains below that recommended level which indicates a dire need for more intensive and continuous education in order to provide a pain free environment.     

Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study

AimTo evaluate the impact of video education on critical care nurses’ knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses’ experiences with video education.MethodsForty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients’ pain assessment between nurses and the researcher was determined to examine nurses’ skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis.ResultsThe knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction.ConclusionsVideo education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.     

What are the risks and knowledge deficits for prescribing and administering opioids in the ward environment? A quality project on assessing and improving knowledge

Investigations into Medical Emergency Team (MET) calls and related clinical incident reviews at a large district teaching hospital provided evidence that over sedation can be a significant issue post opioid administration and that safe and effective pain management requires accurate opioid knowledge and patient assessment skills.The aim of the study was to develop education that was directed at identified knowledge deficits, and to evaluate the impact of this tailored education program on knowledge of safe prescribing and administration of opioids.Knowledge levels were explored using a structured questionnaire in a pre and post-test design. A convenience sample of 34 nurses and 5 junior medical officers across three surgical wards in a tertiary referral hospital had their knowledge assessed.Results showed significant improvement when repeat questionnaires were given two weeks post-delivery of education. Mean scores were 68% at baseline and 89% two weeks post completion of the education program. The greatest improvement in scores was recorded for drug knowledge including dose, half-life and administration.The findings from this study suggest that the opioid education program is effective in improving the knowledge of safe prescribing and administration of opioids, however further studies are required.     

Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7-86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education.     

Nurses' knowledge of pain

Aim. The aim of this study was to establish if postregistration education and clinical experience influence nurses’ knowledge of pain. Background. Inadequacies in the pain management process may not be tied to myth and bias originating from general attitudes and beliefs, but reflect inadequate pain knowledge. Design. A pain knowledge survey of 20 true/false statements was used to measure the knowledge base of two groups of nurses. This was incorporated in a self‐administered questionnaire that also addressed lifestyle factors of patients in pain, inferences of physical pain, general attitudes and beliefs about pain management. Method. One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample, 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data were analysed using SPSS. Results. The specialist nurses had a more comprehensive knowledge base than the general nurses; however, their knowledge scores did not appear to be related to their experience in terms of years within the nursing profession. Conclusion. Whilst educational programmes contribute to an increase in knowledge, it would appear that the working environment has an influence on the development and use of this knowledge. It is suggested that the clinical environment in which the specialist nurse works can induce feelings of reduced self‐efficacy and low personal control. To ease tension, strategies are used that can result in nurses refusing to endorse their knowledge, which can increase patients’ pain. Relevance to clinical practice. Clinical supervision will serve to increase the nurses’ self‐awareness; however, without power and autonomy to make decisions and affect change, feelings of helplessness, reduced self‐efficacy and cognitive dissonance can increase. This may explain why, despite educational efforts to increase knowledge, a concomitant change in practice has not occurred.