Using e-learning to enhance nursing students' pain management education

Nursing Students' Perceptions on a Pain Management E- Learning Module: An Exploratory Quantitative Study

BACKGROUND

Nursing students are graduating ill-prepared to assess and manage pain in older adults. To address this gap, we developed an e-learning module on the topic.

AIM

To examine nursing students' perceptions on a pain management e-learning module focused on older adults.

METHODS

Utilizing an exploratory quantitative design, we assessed nursing students' perceptions of the e-learning module. We used a feedback survey (four 5-point, Likert-type items) and one open-ended question to assess students' perceptions. Descriptive statistics were used to summarize students' perceptions and demographic characteristics. Responses to the open-ended question were content analyzed.

RESULTS

A total of 181 of 249 students completed the module, of whom two-thirds were female. Students perceived that the module enhanced their knowledge, confidence, and perception in working with older people. Students also found the method of instruction interactive and enjoyable.

CONCLUSIONS

The e-learning module on pain management was viewed by nursing students to be helpful and its interactive method of learning improved their knowledge, confidence, and perceptions of working with older adults in pain.

Teaching pain management to health professional students: A systematic review and meta-analysis

Background

Satisfactory pain management can have a significant impact on clients' activities of daily living. We questioned what types of pain management education might improve health professional students' knowledge, skills and perceptions?

Method

From inception until 30^th July 2020, we searched MEDLINE, EBM Reviews, CINAHL Plus, ERIC, EMBASE, Cochrane database and Monash University library. Inclusion criteria were controlled trials of health professional students' pain education compared to alternative education, usual curriculum or no intervention. Studies were limited to English. Data were synthesised using meta-analysis.

Results

Fourteen articles were included in this review. For continuous data, meta-analysis demonstrated a clear effect favouring the intervention for knowledge SMD 1.47 [95% CI 1.18, 1.77], skills 0.93 [0.58, 1.28] or perceptions 0.69 [0.31, 1.08]. For dichotomous data, results showed no effect for knowledge 4.21 [0.65, 27.41], skills 2.26 [0.47, 11.01] or perceptions 1.96 [0.66, 5.76]. However, the overall result showed an effect 2.82 [1.20, 6.59] favouring the intervention.

Conclusions

In summary, short theoretical interventions are sufficient to change students' knowledge and perceptions. Longer interventions incorporating interactivity improve skills. Further research is required to indicate the best method, outcome measure, length of intervention and follow-up in delivering these pain courses and assessing the cost and long-term retention of information.

A Systematic Review and Meta-Analysis of the Effects of Biopsychosocial Pain Education upon Health Care Professional Pain Attitudes, Knowledge, Behavior and Patient Outcomes

Pain is a significant health burden globally and its management frequently fails to comply with evidence based, biopsychosocial guidelines. This may be partly attributable to inadequate biopsychosocial focussed pain education for students and clinicians. We aimed to undertake a systematic review, using Cochrane methodology, of randomized controlled trials with meta-analysis to quantify the effects of biopsychosocial education strategies in changing student/qualified health care professionals (HCPs) pain related attitudes, knowledge, clinical behaviour or patient outcomes. A systematic search of the literature was undertaken using CINAHL, AMED, PEDro, Cochrane Central Library, MEDLINE, ScienceDirect, Rehabdata, SportDiscus, EMBASE, ASSIA, Dentistry and Oral Science, Psycinfo, Education Research Complete and OpenGrey from 1977 to November 2020. Pooled effect sizes were quantified in random effects meta-analyses for attitudes, knowledge, and clinical behaviors. From a sample of 1812 records, 6 were narratively analysed and 15 were included in the meta-analyses. These studies represented 3022 patients and 3163 HCPs and students. Education improved attitudes by 11.3% (95% confidence interval: 2.2-20.4%, P = .02), and knowledge by 18.8% (12.4-25.3%, P = .01). The effects of education on clinical behavior favoured a clinically relevant improvement (OR = 2.4, 0.9-5.9, P = .06). Narrative analysis of the effect of biopsychosocial education for student HCPs/HCPs upon patient outcomes was inconclusive. These findings demonstrate that biopsychosocial focussed pain education strategies can improve student/qualified HCPs' pain related knowledge and attitudes and increase the likelihood that they will behave more in keeping with evidence-based practice. This should result in improved patient outcomes, however, evidence to support or refute this is lacking. PROSPERO systematic review record number, CRD42018082251. Perspective: We outline the effectiveness of biopsychosocial pain education for health care professionals and students in improving pain knowledge, attitudes, and evidence-based behaviors. These improvements should enhance clinical outcomes in patients with pain but further evidence is needed to confirm this.

The effects of pain management education on knowledge, attitudes, and beliefs in nursing students in Turkey: A quasi-experimental study

PURPOSE

The aim of this study is to examine the effects of pain management education on nursing students' knowledge, attitudes, and beliefs concerning pain management in Turkey.

DESIGN AND METHODS

A quasi-experimental design with pretest/posttest measures was used. The study sample included 79 students.

FINDINGS

The nursing students were found to have enhanced knowledge, attitudes following the initial education, and at the 3-month evaluation, compared to their knowledge and attitudes about pain before the education. However, education had no influence on their organic and psychological beliefs as they did not change across time.

PRACTICE IMPLICATIONS

Pain management education improved the knowledge and attitudes of nursing students. Nurse educators could revise their teaching methods and adopt interactive education methods.

Learning outcomes of a flipped classroom teaching approach in an adult-health nursing course: a quasi-experimental study

BACKGROUND

New teaching strategies must be developed not only to enhance nurse's competence but also to allow nurses to respond to the complex health care needs of today's society. The purpose of this study was to explore the learning outcomes of a flipped classroom teaching approach in an adult-health nursing course for students in a two-year Bachelor of Science in Nursing program.

METHODS

The study had a quasi-experimental design. An 18-week flipped classroom teaching approach was applied in an adult-health nursing course. In total, 485 nursing students enrolled in the study, with 287 in the experimental group and 198 in the control group. The Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students, Self-Directed Learning Readiness Scale, and self-designed learning satisfaction questionnaire were used to evaluate the students' learning outcomes.

RESULTS

The experimental group showed a statistically significant increase in the overall scores for self-evaluated core competencies, the "self-modification" subscale of the Metacognitive Inventory for Nursing Students, and in overall self-directed learning readiness; further, they also showed high levels of course satisfaction.

CONCLUSIONS

A flipped classroom teaching approach had a positive impact on student's learning motivation and contributed to better learning outcomes in an adult-health nursing course. The flipped classroom combined with hybrid teaching methods is a suitable and effective learning strategy for a registered nurse (RN) to Bachelor of Science in Nursing (BSN) program to tackle today's complex revolution in nursing curricula, and may enhance nursing students' abilities to address numerous challenges.

The effect of pain management training in workshop on the knowledge, attitude and self-efficacy of pediatric nurses

Background and Aims

Pain is the fifth vital sign, and pediatric nurses plays a key role in the process of pediatric pain management. The present study aimed to determine the effect of pain management training on the knowledge, attitude and self-efficacy of pediatric nurses.

Methods

This is a quasi-experimental study including two groups of test and control. The experimental group received a workshop method with a content including (ethical aspect, physiology, assessment tools, and pharmaceutical and non-pharmacological pain management) and was not given in the control group. The PNKAS self-efficacy questionnaires was completed by the participants before and one month after the beginning of the study. The data were analyzed using descriptive statistics and independent T-test, Fisher exact, and Chi-square tests using SPSS version 20 software.

Results

The mean pre-test scores of knowledge and attitude in the control and experimental groups was 50.79-47.14, and after one month was 47.46-53.09, respectively, showed that, training was significantly effective in the knowledge and attitude of the experimental group (P value = 0.01). The mean pre-test score of self-efficacy in the control and experimental groups was (17.01-18.06), and one month later was 20.36-21.03 respectively. Although the self-efficacy score increased in both groups, training significantly increased the self-efficacy of pediatric nurses in the experimental group (P value <0.001).

Conclusion

Pain management training is required due to the poor knowledge of pediatric nurses and the importance of pain management in improving the quality of nursing care and the satisfaction of patients with the In addition, feeling high self-efficacy without sufficient knowledge of pain management can disrupt pediatric pain management.

Effect of e-learning on nurses' continuing professional development

BACKGROUND

E-learning can provide nurses with the opportunity to undertake lifelong learning and continuing professional development (CPD) in a flexible, practical and engaging manner. However, much of the research focuses on pre-registration nursing students' experiences of e-learning, despite nursing students not always experiencing the same clinical demands as registered nurses.

AIM

To explore the concept of e-learning and nurses' perception of its value for engaging with lifelong learning and CPD, as well as to determine attitudes towards e-learning, what influencing factors exist and how they affect the perceived value of e-learning.

METHOD

This study used a mixed-methods sequential explanatory design, in which there were two phases of data collection and analysis. In the first phase, 39 children's nurses completed questionnaires about e-learning and its flexibility, accessibility, value and contribution to CPD. Their responses were analysed and used to inform questions for the second phase, which involved semi-structured interviews exploring the findings and emerging themes from the completed questionnaires. Of the 39 questionnaire respondents, 12 agreed to participate in the interviews.

FINDINGS

More than half of the questionnaire respondents ( n =22/39) agreed or strongly agreed that e-learning aids their CPD, while 29 respondents valued e-learning that is specific to their practice area. Three main factors were identified that may influence the effect of e-learning on nurses' CPD: motivation to engage with CPD and e-learning; the perceived value of e-learning as a method for CPD; and challenges to effective engagement with e-learning.

CONCLUSION

Engagement with e-learning is influenced by the content of its modules and, while mandatory training is often provided through e-learning, this should not be its sole purpose. Nurses should take the opportunity to develop and engage with e-learning that is specific to their area of practice, which may increase its value.

Comparison of the effectiveness of teaching strategies for a pediatric pain management program for undergraduate nursing students: A quantitative evaluation using an objective structured clinical examination

Pain is a common experience for hospitalized children; however, nursing students are often not adequately trained in pediatric pain management. Innovative teaching strategies, such as e-learning, have been employed for instructing students, however success of these platforms has not been quantitatively measured. This study compared students' knowledge and skill performance following a researcher-designed pain management program administered with three teaching strategies: traditional face-to-face, e-learning, or blended learning. Undergraduate nursing students in Taiwan (N = 296) randomly assigned to one of the teaching strategies participated. Knowledge of pain management, and pain management skills were quantified. A subjective assessment of attitudes towards learning found no significant difference between groups. Knowledge of pediatric pain management did not differ significantly between groups (p = 0.36). A 15-item objective structured clinical examination (OSCE) measured the competency of pain management skills; scores were not significantly different, regardless of teaching strategy (p = 0.70). Traditional face-to-face teaching was as effective as both innovative strategies. Evaluating students' skills following a pain management program with an OSCE provided a quantitative assessment of competency. Innovative strategies for teaching pediatric pain management could be a cost-effective way to provide flexible learning opportunities for nursing students who are distant from educational institutions.

E-learning or lectures to increase knowledge about congenital heart disease in infants: A comparative interventional study

AIM

This project aimed to create, implement and evaluate an e-learning course on nursing infants with congenital heart disease (CHD) and to measure its efficacy compared with classroom learning.

DESIGN

This is a comparative interventional study with two groups.

METHODS

The study involved 15 postgraduate students and 13 newly employed nurses. The learning outcome was computed as the difference between pre-test and post-test knowledge scores and analysed using t tests and multiple regression.

RESULTS

Both learning groups scored significantly higher 1 week after training. The improvement did not differ significantly between the groups when controlling for the years of experience in CHD nursing and the baseline knowledge score. Participants with higher baseline knowledge scores improved their scores less. Neither learning method was proven more effective than the other. Participants reported experiencing traditional classroom teaching as more positive, but e-learning was more time effective.

Pain and Pain Management Among University Students: Online Survey and Web-Based Education

Pain is common among university students. Unrelieved pain has adverse impacts on their quality of life. In this study, a pain management Web site was developed to distribute an online survey and provide Web-based pain education to university students. Participants were recruited from eight universities in Hong Kong using snowball sampling. The online survey included 37 items examining pain situations, pain management strategies, knowledge about self-medication, and demographic data of the participants. A total of 387 students participated and over 90 percent of them reported pain in the past 6 months. Around one-third of participants did not take any action to manage their pain. Pharmacological method was the most common strategy for students to relieve pain (37.2 percent). The use of over-the-counter (OTC) drug for pain relief was high (n = 214). However, OTC drug knowledge score was significantly higher among health-related group than nonhealth-related group (p < 0.001). There were 188 students who also read the Web-based pain education and completed the evaluation on its usefulness. Nonhealth-related students reported significantly higher scores of self-perceived usefulness for the online education than the health-related students (p < 0.001). Findings suggested the need to consider the service users' background when developing online education program in the future.

Conventional vs. e-learning in nursing education: A systematic review and meta-analysis

BACKGROUND

By and large, in health professions training, the direction of the effect of e-learning, positive or negative, strongly depends on the learning outcome in question as well as on learning methods which e-learning is compared to. In nursing education, meta-analytically generated knowledge regarding the comparisons between conventional and e-learning is scarce.

OBJECTIVES

The aim of this review is to discover the size of the effect of e-learning on learning outcomes in nursing education and to assess the quality of studies in which e-learning has been compared to conventional learning.

METHODS

A systematic search of six electronic databases, PubMed, Ovid MEDLINE®, CINAHL (EBSCOhost), Cochrane Library, PsycINFO, and ERIC, was conducted in order to identify relevant peer-reviewed English language articles published between 2011 and 2015. The quality of the studies included as well as the risk of bias in each study was assessed. A random-effects meta-analysis was performed to generate a pooled mean difference in the learning outcome.

RESULTS

Altogether, 10 studies were eligible for the quality assessment and meta-analysis. Nine studies were evaluated as good quality studies, but not without a risk of bias. Performance bias caused a high risk in nearly all the studies. In the meta-analysis, an e-learning method resulted in test scores that were, on average, five points higher than a conventional method on a 0-100 scale. Heterogeneity between the studies was very large.

CONCLUSIONS

The size and direction of the effect of a learning method on learning outcomes appeared to be strongly situational. We suggest that meta-regressions should be performed instead of basic meta-analyses in order to reveal factors that cause variation in the learning outcomes of nursing education. It might be necessary to perform separate meta-analyses between e-learning interventions aimed at improving nursing knowledge and those aimed at improving nursing skills.

Persuasive technology in teaching acute pain assessment in nursing: Results in learning based on pre and post-testing

BACKGROUND

Thousands of patients seek health services every day with complaints of pain. However, adequate pain assessment is still flawed, a fact that is partly related to gaps in professional learning on this topic. Innovative strategies such as the use of a virtual learning object mediated by persuasive technology in the learning of undergraduate nursing students can help to fill these gaps and to provide different ways of learning to learn.

OBJECTIVE

To evaluate the results in learning among undergraduate nursing students about assessment of acute pain in adults and newborns, before and after an online educational intervention.

DESIGN

This is a quasi-experimental, non-equivalent study using pre-and post-testing.

SETTING

Federal University of Santa Catarina, Brazil.

PARTICIPANTS

75 undergraduate nursing students.

METHODS

Our study was conducted in three steps (pre-test, education intervention, post-test). Data were collected from November 2013 to February 2014. The educational intervention was performed using online access to virtual learning object about acute pain assessment, which students accessed on their mobile devices.

CONCLUSION

A significant difference was seen in student learning (p<0.001) in the post-test compared with the pre-test results. The students understood the importance of the topic, and were satisfied and motivated by the technology and method applied. The use of persuasive technology such as small mobile devices as mediators of online educational interventions broadens learning spaces in an innovative, flexible, motivational, and promising manner.

The utility and impact of information communication technology (ICT) for pre-registration nurse education: A narrative synthesis systematic review

OBJECTIVES

To evaluate and summarise the utility and impact of information communication technology (ICT) in enhancing student performance and the learning environment in pre-registration nursing.

DESIGN

A systematic review of empirical research across a range of themes in ICT health-related education.

DATA SOURCES

Science Direct, Cinahl, AMED, MEDLINE, PubMed, ASSIA, OVID and OVID SP (2008-2014). Further date parameters were imposed by theme.

REVIEW METHODS

Evidence was reviewed by narrative synthesis, adopting Caldwell's appraisal framework and CASP for qualitative methods. Selection and inclusion was grounded in the PICOS structure, with language requirements (English), and further parameters were guided by theme appropriateness.

RESULTS

Fifty studies were selected for review across six domains: reusable learning objects, media, audience response systems, e-portfolios, computer-based assessment and faculty adoption of e-learning. Educational ICT was found to be non-inferior to traditional teaching, while offering benefits to teaching and learning efficiency. Where support is in place, ICT improves the learning environment for staff and students, but human and environmental barriers need to be addressed.

CONCLUSION

This review illuminates more advantages for ICT in nurse training than previously. The key advantage of flexibility is supported, though with little evidence for effect on depth of learning.

Workplace wellness using online learning tools in a healthcare setting

The aim was to develop and evaluate an online learning tool for use with UK healthcare employees, healthcare educators and healthcare students, to increase knowledge of workplace wellness as an important public health issue. A 'Workplace Wellness' e-learning tool was developed and peer-reviewed by 14 topic experts. This focused on six key areas relating to workplace wellness: work-related stress, musculoskeletal disorders, diet and nutrition, physical activity, smoking and alcohol consumption. Each key area provided current evidence-based information on causes and consequences, access to UK government reports and national statistics, and guidance on actions that could be taken to improve health within a workplace setting. 188 users (93.1% female, age 18-60) completed online knowledge questionnaires before (n = 188) and after (n = 88) exposure to the online learning tool. Baseline knowledge of workplace wellness was poor (n = 188; mean accuracy 47.6%, s.d. 11.94). Knowledge significantly improved from baseline to post-intervention (mean accuracy = 77.5%, s.d. 13.71) (t(75) = -14.801, p < 0.0005) with knowledge increases evident for all included topics areas. Usability evaluation showed that participants perceived the tool to be useful (96.4%), engaging (73.8%) and would recommend it to others (86.9%). Healthcare professionals, healthcare educators and pre-registered healthcare students held positive attitudes towards online learning, indicating scope for development of further online packages relating to other important health parameters.

Understanding factors that facilitate the inclusion of pain education in undergraduate curricula: Perspectives from a UK survey

BACKGROUND

Studies in Europe, North America and Australasia suggest that one in five adults suffer from pain. There is increasing recognition that pain, particularly chronic pain, represents a global health burden. Many studies, including two national surveys exploring the content of undergraduate curricula for pain education, identify that documented pain education in curricula was limited and fragmentary.

METHODS

The study design used a questionnaire which included an open text comment box for respondents to add 'further comments' as part of larger study previously published. The sample consisted of 19 UK universities that offered 108 undergraduate programmes in the following: dentistry, medicine, midwifery, nursing (adult, child, learning disabilities and mental health branches), occupational therapy (OT), pharmacy, physiotherapy and veterinary science. An inductive content analysis was performed, and the data were managed using NVivo 10 software for data management.

RESULTS

A total of 57 participants across seven disciplines (dentistry, medicine, midwifery, nursing, pharmacy, physiotherapy and OT) completed the open text comment box (none were received from veterinary science). Analysis revealed two major themes of successes and challenges. Successes included expansion (extending coverage and/or increased student access), multidimensional curriculum content and diversity of teaching methods. Challenges included difficulties in identifying where pain is taught in the curriculum, biomedical versus biopsychosocial definitions of pain, perceived importance, time, resources and staff knowledge, and finally a diffusion of responsibility for pain education.

CONCLUSION

This study identifies new insights of the factors attributed to successful implementation of pain education in undergraduate education. Many of the challenges previously reported were also identified. This is one of the first studies to identify a broad range of approaches, for pain education, that could be deemed as 'successful' across a range of health disciplines.

Nurses' and Nursing Students' Knowledge and Attitudes regarding Pediatric Pain

Nursing staff spend more time with patients with pain than any other health staff member. For this reason, the nurse must possess the basic knowledge to identify the presence of pain in patients, to measure its intensity and make the steps necessary for treatment. Therefore, a prospective, descriptive, analytical, and cross-sectional study was conducted to investigate the knowledge and attitudes regarding pediatric pain in two different populations. The questionnaire, Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain (PKNAS), was applied to 111 hospital pediatric nurses and 300 university nursing students. The final scores for pediatric nurses and nursing students were 40.1 ± 7.9 and 40.3 ± 7.5, respectively. None of the sociodemographic variables predicted the scores obtained by the participants (P > 0.05). There was a high correlation between the PKNAS scores of pediatric nurses and nursing students (r = 0.86, P < 0.001). It was observed that the degree of knowledge about pain and its treatment was very low in both groups. Due to this deficiency, pain in children remains inadequately managed, which leads to suffering in this population. It is necessary to increase the continued training in this subject in both areas.

Nursing students' assessment of pain and decision of triage for different ethnic groups: An experimental study

BACKGROUND

Pain management is a priority in nursing care but little is known about the factors that affect nursing students' assessment of pain expressed by patients of different ethnic backgrounds.

OBJECTIVES

This study examined undergraduate nursing students' assessment of pain and decision of triage when pain was expressed in different languages and their relation to students' empathy and social identity. Comparison between students with and without clinical experience was also carried out.

DESIGN

This is a cross-sectional quantitative design.

SETTING

This study took place at a university in Hong Kong.

PARTICIPANTS

74 female undergraduate nursing students.

METHODS

Students listened to eight audio recordings in which an individual expressed pain in one of the two dialects of Chinese, either Cantonese or Putonghua. For each dialect, two recordings depicted mild pain and two depicted severe pain. After listening to each recording, students rated the pain level and indicated their decision of triage. Subsequently, students completed a questionnaire that measured their empathy and social identity and reported their demographics. The data were analyzed by descriptive statistics, correlational analyses, and t-tests.

RESULTS

Severe pain described in Putonghua was rated as more intense than that described in Cantonese but it was not classified as more urgent. Students with clinical experience tended to perceive mild pain as less painful and less urgent than those without clinical experience. For mild pain described in Cantonese, students with clinical experience evaluated it as more urgent than those without such experience. The empathy level of students with and without clinical experience was comparable. Students with more empathy, especially those without clinical experience, reported heightened perceived intensity of severe pain described in Putonghua.

CONCLUSIONS

Nurse educators should note that empathy, social identity, and clinical experience may alter students' pain assessment of patients from different ethnicities. Pain education needs to be reinforced.

Secondary prevention of chronic pain: can internet help?

Chronic pain is common and strongly impacts the individual and society as a whole. Although there are effective multidisciplinary treatments available, they are often not easily accessible and designed for people with severe long-lasting problems. The main aim of this paper is to propose and stimulate debate about how the internet can help to increase accessibility and promote a shift toward secondary prevention. Specifically, internet can help by providing access to educational websites containing information for professionals and the general population. Internet can also be useful for creating accessible interventions designed to reduce risk factors for the development of long-term disability. The involvement of society in general and the professionals working in the field is fundamental for advancing in this direction.

Agreement between veterinary students and anesthesiologists regarding postoperative pain assessment in dogs

OBJECTIVE

To determine the levels of agreement among first- and second-year veterinary students and experienced anesthesiologists in assessing postoperative pain in dogs from video-recordings.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

Twenty-seven veterinary students, five anesthesiologists and 13 canine clinical patients.

METHODS

Prior to their enrolment in a core anesthesia course, veterinary students volunteered to watch 13 90 second videos of dogs. Dogs were hospitalized in an intensive care unit after a variety of surgical procedures. Students were asked to score the level of the dogs' pain using the Dynamic Interactive Visual Analog Scale and the Short Form of the Glasgow Composite-Measure Pain Scale. The same videotapes were scored by five board-certified anesthesiologists. The differences and agreement between the ratings of anesthesiologists and students, and first- and second-year students were determined with Mann-Whitney U-tests and Fleiss' or Cohen's kappa, respectively.

RESULTS

Pain scores assigned by students and anesthesiologists differed significantly (p < 0.01). Students assigned higher pain scores to dogs that were given low pain scores by anesthesiologists, and lower pain scores to dogs deemed to be in more pain by anesthesiologists. On average, students assigned higher scores on both scales.

CONCLUSIONS AND CLINICAL RELEVANCE

Veterinary students early in their training assigned pain scores to dogs that differed from scores assigned by experienced anesthesiologists.

Pain knowledge and attitudes of nursing students: a literature review

BACKGROUND

Pain management is a priority in nursing care but nursing students often find it a challenge. To prepare nursing students adequately, nurse educators need to understand nursing students' pain knowledge and attitudes and design interventions to enhance their readiness for pain management.

OBJECTIVES

The objective of this literature review is to identify, summarize and critically appraise current evidence on (i) pain knowledge and attitudes of nursing students and (ii) pain education programs for nursing students.

DESIGN

A thorough analysis of the literatures on the topic of pain and nursing students was done. Data sources were as follows: MEDLINE, CINAHL, PsycINFO, British Nursing Index and GoogleScholar. Review methods were as follows: A systematic search was conducted in the named data sources from 2004 to 2014 to identify English-language articles with the two keywords "nursing student" and "pain." Two authors assessed all identified articles independently for inclusion into review.

RESULTS

A total of 11 studies were included in the review: seven of these studies focused on the assessment of pain knowledge and attitudes, and four of them aimed at evaluating pain education programs. The findings indicated that nursing students worldwide had inadequate pain knowledge and misconceptions on pain management. Pain education programs, in general, were found to be effective in improving nursing students' pain knowledge and attitudes.

CONCLUSIONS

Studies consistently revealed the inadequacy of pain knowledge and inappropriate pain management attitudes of nursing students. Pain education programs are limited in number, but they demonstrated effectiveness in improving nursing students' pain knowledge and attitudes. Implications for research on pain knowledge and attitudes, and the implementation of pain education programs for nursing students are discussed.

A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education

AIM

To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing.

BACKGROUND

The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited.

DESIGN

Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5.

DATA SOURCES

Computerized searches of five databases were undertaken for the period 1995-August 2013.

REVIEW METHODS

Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results.

RESULTS

Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies.

CONCLUSION

The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.

Knowledge and attitudes regarding pain management among Jordanian nursing students

BACKGROUND

The presence of pain is one of the main reasons why people seek health care, however pain is often undertreated. Inadequate treatment has been linked to health care professionals' failure to assess pain and to intervene appropriately. It may also result from the limited attention given to pain management in nursing curricula.

OBJECTIVES

The objectives of this study were to explore the current knowledge and attitudes regarding pain management among baccalaureate nursing students and the factors that might influence such knowledge and attitudes, and nursing students perceived barriers to adequate pain management during clinical practice.

METHODS

The descriptive design included a sample of 240 baccalaureate nursing students in three nursing schools in three governmental universities in Jordan. The Knowledge and Attitudes Survey Regarding Pain scale was used to measure knowledge and attitudes regarding pain management. Data were analyzed by descriptive statistics and independent sample t test. Data were collected over a period of three months from April 2012 to June 2012.

RESULTS

Of the 340 distributed questionnaires; 240 completed questionnaires were returned. The data showed that nursing students were found to have inadequate knowledge and attitudes related to pain and its management. The mean correct score for the entire scale was 34.1%. (SD=9.9). Findings revealed that there were significant differences found in the students' scores related to pain management training and frequency of using pain assessment tools (p<0.05).The most frequently identified barriers were lack of knowledge and training regarding pain management followed by not using pain assessment tools by nurses who are working in the clinical areas.

CONCLUSION

The study findings demonstrated that nursing students have insufficient knowledge and attitudes regarding pain and its management and could benefit from additional education and training on that issue.