Nurses’ Knowledge and Attitudes about Pain: Personal and Professional Characteristics and Patient Reported Pain Satisfaction

Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar

BACKGROUND

Pain is a complex and challenging phenomenon. People have different pain experiences, but everyone has the right to effective pain management. Pain assessment and management are integral components of a nurse's role.

AIM

To assess the knowledge and attitudes of nurses in Qatar about adult post-operative patients' pain assessment and management, and the factors that may be associated with such knowledge and attitudes.

METHODS

Post-operative registered nurses from all peri-operative areas at Hamad Medical Corporation participated in a cross-sectional online survey using a self-administered questionnaire. A knowledge and attitudes (K&A) score was calculated. Associations between K&A and potential explanatory variables were assessed using t-tests and one-way ANOVA.

RESULTS

A total of 151 post-operative nurses participated in the study. The mean knowledge and attitudes (K&A) score was 19.6 ± 4.5 out of 41 (48%), indicating a large deficit in nurses' knowledge and attitudes about adult post-operative pain. There were no statistically significant differences in the mean K&A scores of participants based on gender, nationality, education level, marital status, workplace facility, current job designation, or hours of pain education.

CONCLUSIONS

There is a significant deficit in post-operative nurses' knowledge and attitudes about pain across the nursing workforce in post-operative care. Implications for nursing education and policy: Evidence-based, innovative nursing education courses are needed to improve nurses' knowledge and attitudes about pain assessment and management. Health service policy is required to ensure that evidence-based in-service education on pain management is compulsory for all nurses. This study was not registered.

Nursing students' knowledge of and attitudes towards pain management: An integrative review

OBJECTIVES

The objectives of this review were to appraise the available literature regarding nursing students' knowledge of and attitudes towards pain management; and secondly, to examine the instruments currently used to measure students' knowledge of and attitudes towards pain management.

DESIGN

This review was conducted using Whittemore and Knafl's five-stage framework for integrative reviews.

DATA SOURCES

A comprehensive search to retrieve relevant studies published in English between 1978 and 2022 was conducted using the databases: CINAHL, MEDLINE, Embase and Scopus databases. An updated search of the same databases was performed to identify studies published in 2023-2024.

REVIEW METHODS

The initial search located 558 articles. One more relevant article was identified from an updated search test. Total of 244 duplicated records were removed. The remaining 315 studies were eligible for screening. After screening and checking for eligibility, 29 included articles were critically appraised using the Joanna Briggs Institute critical appraisal tools.

RESULTS

Synthesis of the findings of the 29 included studies indicated that, internationally, nursing students have limited knowledge and often hold negative attitudes towards pain. Various instruments have been used to measure students' knowledge and attitudes towards pain. Most studies used true/false or multiple-choice questions and Likert-type scales. The validity and reliability of most of the tools were reported to be acceptable. The most commonly used instrument was the Knowledge and Attitudes Survey Regarding Pain.

CONCLUSION

The findings from this review suggest the need for refinement of pain education programs to improve nursing students' knowledge of and attitudes towards pain management. Future research should focus on understanding the personal and environmental factors that impact students' level of knowledge and attitudes so as to inform curriculum development and ultimately the quality of the care graduates provide.

Observed and Perceived Pain: Findings of a Cross-Sectional Study in Hospitalized Subjects

BACKGROUND

Pain constitutes a serious problem of a health, economic, ethical, and social equity nature affecting negatively quality of life. Its assessment is often subjected to overestimation or underestimation.

AIM

The aim of this study is threefold: (1) to estimate the prevalence of pain in hospitalized patients; (2) to assess the grade of correlation between the level of pain observed by the nurses and the pain perceived by the patients; and (3) to examine the level of scientific knowledge among the healthcare professionals.

DESIGN

Cross-sectional study.

METHODS

The intensity level of observed and perceived pain has been evaluated in 401 patients with validated scales. Analyzed data have been extracted from the electronic medical record and integrated into the data-collection sheet. A questionnaire has been submitted to nurses to investigate their level of knowledge on pain assessment and management.

RESULTS

The study included 350 patients out of 401; for 51 patients the "pain" data was missing. Prevalence of perceived pain was 40.15%. Nurses overestimated pain in 7.43% of cases and underestimated it in 24.9%. The majority of the nursing staff claimed to be aware of the pain topic, however, they showed some uncertainties in clinical practice.

CONCLUSIONS

The differential variation between the observed pain and the perceived one resulted in 43.71% of cases, highlighting the dependence on the two variables: "area of hospitalization" and "intensity level". The observation and monitoring of pain did not appear to be a consolidated practice, thus representing an important area for investments in the nursing profession.

Knowledge, attitudes and practices of general practitioners on peripheral neuropathies in Benin in 2021

PURPOSE

First healthcare actors in neurological diseases management, General Practitioners (GPs) still limited in the assessment of Peripheral Neuropathies (PN). This study assesses the knowledge, attitudes, practices (KAP) of GPs on PN in Benin in 2021 and identifying associated factors to low KAP.

MATERIALS AND METHODS

It was a cross-sectional study conducted from 20 November 2020 to 30 June 2021 which included GPs registered in the National Order of Physicians in Benin and interns in last year of medical studies (MS). An overall KAP score of 24 points was derived. KAP levels were low (score < 17), medium (17 to 19) and high (score ≥ 20). Multivariable regression models were performed to identify factors associated with low KAP.

RESULTS

645/1,066 participants (60.5%) were included in the study with median age 28 years [Interquartile range IQR: 26-30 years], and 442 (68.5%) were male. The KAP level was low in 70.1%. 16.7% had a low knowledge of polyneuropathy manifestations, 35% perceived PN as an incurable disease. Lack of knowledge on PN before MS (adjusted Odds-ratio aOR = 1.6 [95% confidence interval CI: 1.1-2.3]), and no postgraduate training on PN (aOR = 1.8 [95% CI: 1.--3.0]) were associated with low overall KAP level. Working in rural area (aOR = 0.4 [95%CI: 0.2-0.7]), and being an intern (aOR = 0.6 [95%CI: 0.4-0.9]) were associated with better overall KAP level.

CONCLUSION

This study highlights the need for better training with strong emphasis on PN during the MS and the organization of postgraduate training for GPs; the cornerstone for improving the management of PN in Benin.

Validation of the Danish version of the knowledge and attitudes survey regarding pain

OBJECTIVES

Pain management is critical for nurses; therefore, knowledge assessment is also critical. The Knowledge and Attitudes Survey Regarding Pain (KASRP), designed for testing pain management knowledge among nurses, finds widespread use internationally; yet, key validity evidence according to American Psychological Association standards is missing. Therefore, this study aimed to translate and test the psychometric traits of KASRP based on an item response theory model.

METHODS

Cronbach's α was included to assess internal consistency, and the Kolmogorov-Smirnov test was included to assess the total score normal distribution goodness of fit. KASRP was tested using the Kaiser-Meyer-Olkin (KMO) test for sphericity to examine its suitability for factor analysis and exploratory factor analysis to examine construct evidence. The Kruskal-Wallis H test was used to assess discriminant evidence. The correlation between KASRP and the Brockopp-Warden Pain Knowledge Questionnaire (BWPKQ) was included as a measure of convergent validity evidence, and correlation with self-assessed knowledge was tested as a divergent validity measure.

RESULTS

The questionnaire was translated using back-forth and parallel translation. The KMO test for sphericity was 0.49 for all items and 0.53 for the adjusted scale without items 30, 33, and 36, with factor analysis explaining 70.42% of the variation suggesting unacceptable construct validity evidence. Cronbach's α was 0.75, suggesting acceptable reliability evidence; the Kolmogorov-Smirnov test revealed an insignificant skewness of -0.195 and a kurtosis of 0.001, while the Kruskal-Wallis H test revealed a significance of p < 0.001. The correlation between KASRP and the BWPKQ was 0.69 (p = 0.0001), suggesting acceptable convergent validity evidence. A correlation between KASRP and self-assessed knowledge of -0.59 was also found, which suggests acceptable divergent validity evidence.

CONCLUSIONS

The translated KASRP passed six out of seven tests based on the given sample.

Organisational challenges of pain management in neonatal intensive care unit: a qualitative study

OBJECTIVES

Despite credible evidence, optimal neonates' pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing challenges vary depending on the context, and investigating them can help to improve the quality of care. The study aimed to explore organisational challenges to neonates' pain management in the NICU.

METHODS

This qualitative study included 31 nurses and physicians in the NICU of Children's Hospital, Tabriz, Iran. Data collection was done through individual and focus group interviews. For data analysis, we used conventional content analysis.

RESULTS

The identified challenges included organisational culture (poor interprofessional collaboration and low parental participation), organisational structure (lack of unified approach in relieving pain and limited supervision for pain management) and organisational resources (lack of time due to high workload and inadequate educational programmes).

CONCLUSIONS

Many organisational factors consistently affect neonatal pain management. Adopting some approaches to enhance the cooperation of treatment team members, holding educational programmes, proper organisational supervision and implementing a unified neonatal-based pain management programme could improve neonatal pain management.

Assessing Nurses' Knowledge and Attitudes towards Cancer Pain Management in Oman

Cancer care in the Gulf Cooperation Countries, including Oman, faces challenges due to increasing incidence and late-stage diagnoses. Cancer patients at later stages suffer complex symptoms, pain being a prominent one. Access to adequate pain relief is a global problem, including in the Middle East, where palliative care is lacking. Nurses play a crucial role in pain assessment and management but often lack the necessary training, resulting in inadequate relief and prolonged hospital stays. This study aims to examine the knowledge and attitudes of nurses in a national cancer center toward the management of cancer pain, with the goal of identifying any gaps in their knowledge. This is a cross-sectional descriptive study conducted among nurses at the national cancer center in the Royal Hospital. The Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) was used to determine the pain-related knowledge and attitudes of the nurses. Out of 150 registered nurses, 118 participated in this study (78% response rate). The mean NKASRP score was 49.6%. Half of the participants (50%) had a poor level of knowledge and attitude, 46% had fair knowledge and attitude, and only five participants (4%) had a good level of knowledge and attitude. A statistically significant association existed between knowledge and education level, years of experience caring for cancer patients, and prior pain management training (p < 0.05). A low level of knowledge and attitude among nurses in cancer pain management is a significant challenge in providing comprehensive cancer care. Adequate training of nurses in cancer pain management is essential to providing effective pain management and improving the quality of life of cancer patients.

A cross-sectional study of factors associated with nurses' postoperative pain management practices for older patients

AIM

The aim of the study was to identify factors associated with nurses' pain management practices in older patients undergoing surgery.

DESIGN

A cross-sectional study.

METHODS

The study sample was 85 Registered nurses working in inpatient surgical units in a tertiary care hospital, Thailand. Data were analysed using descriptive statistics, Pearson's and point biserial correlation coefficients, and stepwise multiple regression analysis.

RESULTS

A positive correlation was found between practices and (a) pain management training and (b) perceptions related to collaboration with physicians. However, practices were negatively related to (a) the nurses' perception of their workload and (b) the number of years of nursing experience. The recent pain management training, the nurses' perceptions of both collaboration with physicians and their workload explained 24.40% of the variance in practices. Appropriate nursing workloads, regular pain management training and promoting collaboration among the healthcare team could all improve the quality of nurses' postoperative pain management.

The impact of a 12-hour educational program on nurses' knowledge and attitudes regarding pain management: a quasi-experimental study

BACKGROUND

Proper pain assessment is fundamental to effective pain management. Training nursing staff is critical for improving pain assessment competence and patient clinical outcomes. However, there is a dearth of research examining interventions that can enhance nurses' knowledge and attitudes toward pain management, especially in Saudi Arabia. Thus, this study aimed to evaluate the effectiveness of a structured education program on nurses' knowledge and attitudes towards pain management.

METHODS

A quasi-experimental design was used. The study sample included 124 registered nurses working in intensive care or inpatient units in Saudi Arabia. Data were collected between March and September 2021 using a knowledge and attitudes survey regarding pain, satisfaction with and self-confidence in learning, and the learning self-efficacy scale for clinical skills.

RESULTS

Nurses showed moderate levels of knowledge and attitudes regarding pain before (M = 20.3, SD = 4.80) pain management education, which were significantly higher after the intervention (M = 22.2, SD = 5.09, t = 2.87, p < .01). Before the intervention, nurses with a baccalaureate degree had more knowledge and better attitudes regarding pain management than diploma nurses (t = 3.06, p < .01). However, there was no significant difference between the two groups after the intervention (p > .05), indicating that the education was effective in enhancing nurses' knowledge and attitudes, regardless of nursing education level. Nurses in this study had high mean scores for self-confidence in learning (M = 35.6, SD = 4.68, range = 18-40), self-learning efficacy (M = 52.9, SD = 7.70, range = 25-60), and satisfaction with learning (M = 22.2, SD = 3.24, range: 10-25).

CONCLUSION

Regular pain education programs can improve nurses' knowledge and attitudes. Increasing the breadth and depth of educational courses, alongside appropriate training, competency-based assessment, and pain education programs, is also recommended. Future research should consider the subjectivity and individualized nature of nursing by including patient satisfaction surveys to measure the improvement in nurses' knowledge and attitudes from the patient perspective.

Nurses' Perceptions of the Management of Acute Pain in Emergency Departments: Cross-sectional Study

AIM

This study aimed to describe registered nurses' perceptions of acute pain management in emergency departments.

DESIGN

The study design was a cross-sectional survey carried out in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. One hundred one nurses from 5 different emergency departments participated in the survey.

METHODS

Data were analyzed using descriptive methods, nonparametric tests, and principal component analysis.

RESULTS

Continuing education was significantly related to pain management. Nurses who had received continuing pain management education thought more often that challenges in pain management impact patients' acute pain management than those who had not received education. Nurses reported that patients received inadequate pain medication. The most used nonpharmacological methods were ice therapy and postural care. The nurses reported that music and conversation with the patient ameliorated the patients' acute pain. Nurses stated that their lack of knowledge concerning pain management and workload affected their acute pain management.

CONCLUSION

Study results emphasize the need to develop ongoing pain management education for registered nurses and in addition to further research of nonpharmacological alleviation method in emergency departments.

Factors Associated With Knowledge and Attitude Among Vietnamese Nursing Staff Regarding Pain Management in a Vietnam National Hospital

ABSTRACT

BACKGROUND: Nurses play an important role in providing holistic care and effective pain management, which is significantly associated with their knowledge and attitudes. Limited evidence is available from Vietnamese nursing studies evaluating the knowledge and attitudes of nurses toward pain management. The objectives of this study were to evaluate the knowledge and attitudes of Vietnamese nurses and identify factors associated with pain management. METHODS: This study used a descriptive and cross-sectional design and was conducted at a national hospital in Vietnam from May to June 2021. Nurses working in all clinical units were surveyed to collect demographic data and assessed using the structured Knowledge and Attitudes Survey Regarding Pain (KASRP) scale. Multiple linear regression analysis was conducted to identify factors associated with knowledge and attitudes. RESULTS: Two hundred seventy-nine nurses completed the survey, including 152 (54.5%) who read books or journals about pain, 25 (9.0%) who reported the use of unit-based pain guidelines, and 77 (27.6%) who used a numeric rating tool. The mean number of correct answers on the KASRP was 23.34 (mean KASRP correct percentage of 54.9%), and only 16 nurses (5.7%) had passing scores. Having a bachelor's degree or higher, reading books or journals about pain, using a numeric rating tool, and using unit-based pain guidelines were significantly associated with higher KASRP scores (P < .01) among nurses. CONCLUSIONS: The knowledge and attitudes of nurses regarding pain management were far from satisfactory. Regular pain management training, access to pain-related reading materials, and the frequent use of a numeric tool to assess pain intensity are recommended to enhance the quality of care for patients provided by clinical nurses.

Nurses' Knowledge and Attitudes Regarding Pain Assessment and Management in Saudi Arabia

Inadequate pain management affects the patient outcome. Pain assessment and management are fundamental in nursing care, and nurses must be equipped with adequate knowledge and a positive attitude toward pain assessment and management. This study aims to evaluate nurses’ knowledge and attitudes regarding pain assessment and management at King Fahad Hospital, Al-Madinah, Kingdom of Saudi Arabia. A quantitative, cross-sectional survey, using a self-administered questionnaire, was conducted from January to February 2020 with 660 registered nurses working in the Emergency Department, critical care units, inpatient and outpatient departments at King Fahad Hospital in Al-Medinah, Kingdom of Saudi Arabia. The data were analyzed with descriptive and inferential statistics. Of the 660 nurses, 291 responded, resulting in a response rate of 44.09%. The participants’ scores ranged from 17.7% to 100%, with a mean score 45.29%. The majority of the participants (70.1%) had a poor level of knowledge and attitudes (score < 50%). Nurses working in the outpatient department scored significantly higher than the group working in the Emergency Department and inpatient wards. Deficient knowledge and negative attitudes were found and nurses continue to underassess and undertreat pain. Nursing school curricula and in-service continuous education must equip nurses with the required knowledge and attitudes to enable them to manage pain effectively.

Exploring factors affecting the facilitation of nursing students to learn paediatric pain management in Rwanda: A descriptive qualitative study

Nurse educators and nurse preceptors play a fundamental role in facilitating nursing students' acquisition and utilization of professional competencies. Previous studies about key elements for teaching and learning about pain in nursing education programs include students' personal characteristics and previous experiences; educators' knowledge, skills, and beliefs; learners' exposure to leaders in pain education; and curricular pain content and delivery approaches. These studies were mainly carried out in developed countries, with a context of educational and health care systems different from those of developing countries. The current study explores academics', clinical nurse preceptors', and nursing students' perceptions about factors influencing the facilitation of nursing students' competency for paediatric pain management in Rwanda. A qualitative descriptive exploratory design was used in this study that utilized in-depth interviews with six nurse educators and eight nurse preceptors, and focus group discussions with nineteen senior year nursing students. The study setting included five sites: two academic institutions and three clinical settings. Narratives from participants were transcribed verbatim and analysed using thematic analysis. The analysis yielded six themes describing factors that affected the facilitation of students' learning about paediatric pain management. The themes included student motivation, facilitators' attributes, collaboration between academics and clinicians, nurses' limited autonomy for decision-making regarding PPM practices, shortage of human and material resources, and educational qualification. Knowing these factors is essential as it provides an opportunity to design targeted interventions aimed to enhance the capacity of nurse educators and clinical nurse preceptors involved in teaching nursing students about paediatric pain management.

Prescribing and Administering Opioid Doses Based Solely on Pain Intensity: Update of A Position Statement by the American Society for Pain Management Nursing

The foundation of safe and effective pain management is an individualized, comprehensive pain assessment that includes, but is not limited to, the intensity of pain if the patient is able to report it. An unforeseen consequence of the widespread use of pain intensity rating scales is the practice of prescribing specific doses of opioid analgesics based solely on specific pain intensity ratings. Many factors in addition to pain intensity influence opioid requirements. To date there is no research demonstrating that a specific opioid dose will relieve pain of a specific intensity in all patients or even in the same patient at different times. The official position of the American Society for Pain Management Nursing (ASPMN) maintains that the practice of prescribing doses of opioid analgesics based solely on pain intensity should be prohibited because it disregards the relevance of other essential elements of assessment and may contribute to untoward patient outcomes.

Factors Relating to Nurses' Knowledge and Attitudes Regarding Pain Management in Inpatients

PURPOSE

To describe factors associated with nurses' attitudes or lack of knowledge regarding pain management in adult inpatients.

DESIGN

Transverse descriptive survey-based study.

METHODS

This was a transverse descriptive survey-based study. The population was obtained through nonprobabilistic convenience sampling. The Knowledge and Attitudes Survey Regarding Pain was made available to 470 nurses at a tertiary level hospital. Associations were sought with the unit where assigned, years of experience, specific training on pain, and postgraduate education.

RESULTS

The sample included 134 nurses with a mean age of 41.6 ± 10.8 years; 87% were women, 64% worked rotating shifts, 64% had more than 10 years of experience, and 31% had specific training in pain management. The greatest number of correct responses was obtained from nurses with specific training in pain management (p = .001) and nurses who worked in units of surgical hospitalization (p = .004). The lack of training was associated with a deficit in knowledge and inadequate attitudes about pain management. In nurses with less than 10 years of experience, worse results were observed in knowledge, whereas the unit of work was decisive in the results about attitude (p < .05).

CONCLUSIONS

Among the nurses surveyed, some knowledge gaps were detected, as were certain inappropriate attitudes, associated with lack of training, lack of experience, and being assigned to specific hospitalization units.

The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center, Controlled before-after Study in China

BACKGROUND

Effective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown.

AIMS

The current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients.

DESIGN

A single-center, propensity score-matched, controlled before-after study.

METHODS

The patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses' pain knowledge and attitude between group A and group B.

RESULTS

A total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X² = 38.926, p < .05; vomit: X² = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05).

CONCLUSION

Our study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.

Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital

This study examined the postoperative pain management practices among registered nurses in an urban hospital in Vietnam. Data of 90 nurses about postoperative pain management practices and pain management at the department were collected. Results indicated that 83.3% of nurses reported that they regularly assessed the degree of pain for postoperative patients. Only 32.2% used assessment tools such as the numeric rating scale to measure pain. Experience in pain management and having guidelines in the department were associated with a higher score in pain management practice. Findings suggested that facilitating the use of pain instruments and developing pain management guidelines should be prioritized.

Impact of a pain management program on nurses' knowledge and attitude toward pain in United Arab Emirates: Experimental-four Solomon group design

BACKGROUND

Lack of knowledge about pain is a common barrier to effective pain management. Educational pain management programs directed to health care professionals can improve knowledge and attitudes about pain. However, changing practice is more challenging, but can be achieved with more targeted educational interventions within the clinical setting.

OBJECTIVES

The main objective of this study was to examine which of four separate pain management educational designs improved nurses' knowledge and attitudes toward pain over time. Secondary objectives were to compare and contrast nurse's knowledge and attitudes toward pain before and after the educational intervention.

DESIGN

This randomized controlled trial using a four Solomon group design.

SETTING

This study took place in Dubai Hospital, Dubai Health Authority, in United Arab Emirates between January 2019-April 2019.

PARTICIPANTS

The sample consisted of 200 registered nurses who were randomly selected and assigned into four separate educational groups. Participants had at least one year of experience in Dubai hospital prior to data collection.

RESULTS

paired t-test has shown the experimental group scored significantly higher than the control group (p < 0.01). One-way ANOVA revealed significant post-test score differences between groups p < 0.001. A repeated measures ANOVA with a Greenhouse-Geisser correction determined that mean scores over three months was not statistically significant. Indicating that the level of knowledge did not change over time within any of the groups.

CONCLUSION AND RECOMMENDATIONS

The most important findings were the relatively low pre-test knowledge scores among staff nurses, and the significant improvement in knowledge for most test items following the educational intervention. Moreover, the level of knowledge and attitudes were maintained over three months. The pain management program proved to be effective in improving nurses' pain knowledge, attitudes, and assessment practices. Nurses in the experimental group increased their pain score significantly after the pain management program. Registration number: NETUBR.

Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: a knowledge, attitudes and practices survey

Background

Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between healthcare providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care.

Methods

A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey.

Results

Responses of 100 participants were included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD 8.13) years and the mean years’ experience 10.02 (SD 6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last 2 years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD 15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%.

Conclusion

Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.

Effect of an end-of-life gerontological nursing education programme on the attitudes and knowledge of clinical nurses: A non-randomised controlled trial

AIMS

To evaluate how a structured interactive two-day education programme for clinical nurses on end-of-life (EOL) care for older people affects nurses' attitudes and knowledge.

DESIGN

Non-randomised controlled trial.

METHODS

Nurses were recruited separately for intervention and control groups. The intervention group assisted older patients with EOL care and recruited patients for the programme. To prevent sampling bias, control group nurses were recruited from a facility with numerous EOL care opportunities. The intervention was a two-day educational programme. Using valid and reliable scales, we evaluated the attitudes (total score range: 26-130) and knowledge (total score range: 0-51) of the intervention group four times (pretraining, post-training, 3 months, 6 months) and the control group three times (baseline, 3 months, 6 months) between January 2016 and April 2017. Analysis of covariance examined both groups' score changes at 3 and 6 months while adjusting for confounding factors.

RESULTS

Participants were 338 nurses caring primarily for older people (intervention group: 164; control group: 174); 142 responded at all measurement points. The change in mean value of the attitude scale from baseline to 3 months (differences in the groups' attitude scores = 7.33; 95% CI = 2.43-12.24; p = .004) and 6 months (differences in groups' attitude scores = 5.77; 95% CI = 0.17-11.37; p = .044) was greater in the intervention group. Moreover, the mean knowledge scale score change from baseline to 3 months was greater in the intervention group (differences in groups' knowledge scores = 5.74; 95% CI = 4.07 to 7.39; p < .001). There was no evidence of a change in this score between baseline and 6 months.

CONCLUSION

The programme improved nurses' medium- to long-term attitudes and knowledge. Thus, it may help nurses enhance the quality of care they provide.

IMPLICATIONS FOR PRACTICE

A two-day educational program improves nurses' medium- to long-term attitudes and knowledge on end-oflife care. For quality end-of-life care for older people, a structured and evidence-based educational program should be provided to nursing staff.

Congruence between nurses' and patients' assessment of postoperative pain: a literature review

Postoperative pain remains poorly managed for many patients. Effective pain management begins with accurate pain assessment, with patient self-reporting considered the most accurate measure of pain. This literature review aimed to identify how congruent nurses' assessments of pain were with patients' self-reporting. A search identified six observational studies and one quasi-experimental study that met the inclusion criteria. The findings from these studies were summarised under two themes: nurses' underestimation of patients' pain and nurses' knowledge and understanding of pain assessment. Some nurses' pain management knowledge was deemed inadequate, with evidence of negative attitudes towards managing pain in certain groups of patients. Educational interventions have so far had limited impact on correcting the ethical and professional problem of inadequate pain relief in many patients postoperatively. Randomised controlled trials are required to identify effective education interventions that can contribute to ending this avoidable suffering.

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

Public hospitals in Catalonia, Spain, have recommended assessing pain in non-communicative inpatients by means of the Spanish version of the Pain Assessment in Advanced Dementia scale (PAINAD-Sp) since 2010; a modification for patients with neurologic disorders and cancer, PAINAD-Sp_Hosp, has also been validated. However, nurses are not routinely trained in the use of the scales. The aim of this study was to assess knowledge on pain assessment in nurses following an online training course. We surveyed participants prior to the course to determine baseline knowledge of pain and pain assessment. Course material included conceptual content on pain and practical videos demonstrating the scoring system for the PAINAD-Sp_Hosp scale. After completing the course, participants took a multiple choice quiz to test understanding of course content and a satisfaction survey to determine acceptability. Of the 836 nurses invited, 401 participated in the training course; 37.7% reported having no previous specific training on pain, and just 32.2% used the PAINAD-Sp scale regularly. Following the course, virtually all (99%) of the participants passed the quiz. Overall satisfaction among nurses with regard to the training received was 8.6/10. Thus, the e-learning course was effective and acceptable for training nurses on pain assessment using validated tools.

Knowledge, attitude and practice regarding nursing interruptions among Chinese nurses: A nationwide cross-sectional survey

Objectives

To explore the knowledge, attitude and practice of Chinese nurses regarding nursing interruptions and related factors.

Methods

A total of 6,400 nurses from 31 hospitals in China were investigated by using the Knowledge, Attitude and Practice (KAP) Questionnaire of Nursing Interruptions. The questionnaire consists of three dimensions, knowledge, attitude and practice, containing 10, 9 and 7 items, with full score of 50, 45 and 28, respectively.

Results

The mean overall KAP score regarding nursing interruptions of Chinese nurses was 74.05 ± 16.65 (range: 26–123), with scores for the knowledge, attitude, and practice component being 21.74 ± 9.80, 34.83 ± 6.98, and 17.49 ± 4.97, respectively. Among the nurses, 70.8% of them experienced an average level of KAP toward nursing interruptions while 15.5% were at a poor level. The knowledge, attitude, and practice of nursing interruptions were better in chief nurses, managers, nurses with a master degree or above, nurses ever received training, and nurses with a strong agreement to leadership compared to nurses in other groups (P < 0.05). In addition, employment type, professional title, position, standardized training and leaders’ attention were predictors of KAP in nurses.

Conclusion

Chinese nurses have a moderate level of KAP regarding nursing interruptions. Leaders’ attention, standardized training, position, professional title and employment type could predict nurses’ KAP state of nursing interruptions. Thus, a targeted training program should be implemented for clinical nurses by nursing leaders, with a particular focus on feasibility and professionalism.

Faculty Perspectives of Teaching Pain Management to Nursing Students

BACKGROUND

Pain management education is threaded through prelicensure nursing education. However, the perspectives of faculty teaching pain assessment and management within the context of the opioid crisis are not addressed in the literature. Pain assessment and management is a complex process requiring critical thinking and clinical reasoning. The current opioid crisis has brought new challenges to health care professionals who provide pain management, and this is a concern for nurses.

AIMS

The purpose of the study was to discover the perspectives of nursing faculty on teaching pain management content in prelicensure nursing programs.

DESIGN

Following a systematic review to determine gaps in knowledge, a qualitative study was conducted using nursing faculty as participants.

PARTICIPANTS

The sample consisted of 17 faculty members from 15 nursing programs on the East Coast.

METHODS

The qualitative descriptive approach allowed for a rich, detailed exploration of faculty perspectives. Qualitative content analysis of the participant narratives indicated the need to approach pain management education from a perspective of relieving suffering and preventing harm to patients rather than focusing on the opioid crisis.

RESULTS

Participants perceived the opioid crisis as distinct from the legitimate use of pain medication. The findings indicate that nursing curricula includes only the basics of pain management.

CONCLUSIONS

Participants' teaching practice was based on experiential learning rather than formal education and often was heavily influenced by a seminal event in their own nursing practice. The findings support the need to improve the education of undergraduate nursing students about pain management in the context of the current opioid crisis.

Registered Nurses’ Perception about Pain Management of Hospitalized Patients in One of the Governmental Hospitals in Dubai, UAE: A Cross-Sectional Study

<b><i>Background:</i></b> Chronic and acute pain are highly prevalent, especially among hospitalized surgical patients, patients with cancer, and general medical inpatients. More than 50% of patients experience significant pain. Health professionals’ knowledge and attitude concerning pain management have often been referred to as insufficient. This study explored the attitudes and knowledge of nurses working in one of the government hospitals in the UAE, with regard to pain management. <b><i>Methods:</i></b> A quantitative, descriptive, cross-sectional design was used to examine nurses’ perception (knowledge and attitude) about pain using the Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP). We targeted the nursing field in order to assess nurses’ perceptions of pain management. A convenience sample of 200 nurses working at one of the government hospitals in the UAE participated in this study. <b><i>Results:</i></b> Participants who scored &#x3c;75% were considered to have poor knowledge and a nonstandard attitude. Participants who scored &#x3e;75% were considered to have adequate knowledge and a positive attitude. The study revealed that the knowledge and attitude percentage means of correct answers about pain management was 61% (SD: ±11.97%; 95% CI 59.33–62.6%). Inadequate knowledge and attitude featured in 89.5% and adequate knowledge and attitude in 10.5% of all participants. Previous pain management education experience was statistically significant <i>p</i> &#x3c; 0.05. <b><i>Conclusion and Recommendation:</i></b> This study showed that nurses reflected an inadequate knowledge and attitude regarding pain management. Nurses’ perception about pain management was higher among younger staff than those with longer experience. Pain management education has an impact on knowledge and attitude. There is a need to follow innovative approaches in training. Pain management education is an essential part of the nursing orientation program and should be conducted throughout the year to target all nurses. New evidence-based approaches to pain management among nurses should be explored and tested, using the NKASRP as a baseline and follow-up measure.

Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes

BACKGROUND

Previous approaches to measuring and improving nursing-sensitive, patient-centered metrics of pain quality and outcomes in hospitalized patients have been limited.

METHODS

In this translational research study, we disseminated and implemented pain quality indicators in 1611 medical and/or surgical, step-down, rehabilitation, critical access, and obstetrical (postpartum) units from 326 US hospitals participating in the National Database of Nursing Quality Indicators. Eligible patients were English-speaking adults in pain. Trained nurses collected patients' perceptions via structured interview including 9 pain quality indicators, demographic, and clinical variables; these patient experience data were merged with unit and hospital level data. Analyses included geographic mapping; summary statistics and 3-level mixed effects modeling.

RESULTS

Hospitals in 45 states and District of Columbia participated. Of 22,293 screened patients, 15,012 were eligible; 82% verbally consented and participated. Pain prevalence was 72%. Participants were 59.4% female; ages ranged from 19 to 90+ (median: 59 y); 27.3% were nonwhite and 6.5% were Hispanic. Pain intensity on average over the past 24 hours was 6.03 (SD=2.45) on a 0-10 scale. 28.5% of patients were in severe pain frequently or constantly. Race (nonwhite), younger age, being female and nonsurgical were associated (P<0.001) with greater pain. Care quality indicators ranking lowest related to discussion of analgesic side effects and use of nonpharmacologic approaches.

CONCLUSIONS

Unrelieved pain remains a high-volume problem. Individual factors and unit type were significantly associated with pain outcomes. Hospitals can employ these quality indicators to direct continuous quality improvement targeting pain care quality.

Nurses' Knowledge and Attitudes Regarding Pediatric Pain Management in Western Australia

BACKGROUND AND AIM

Despite clinical guidelines, suboptimal pediatric pain management persists. A local audit found poor guideline compliance. Inadequate knowledge is a recognized barrier to the delivery of evidence-based care. The aim of the study was to investigate nurses' knowledge and attitudes regarding pain management at an Australian tertiary pediatric hospital. Design, Setting, Participants and Method: A cross-sectional, descriptive study using the Pediatric Pain Knowledge and Attitudes Questionnaire (Revised) was distributed to 590 nurses in an Australian pediatric hospital.

RESULTS

The mean knowledge score (n = 201) was 77.56 out of 100 (range 49.82-94.16, standard deviation [SD] 8.55); mean attitude score (n = 229) was 72.46 out of 100 (range 33.33-93.33, SD 11.76). Significant differences in mean knowledge scores were found between nurses' designations (p = .018), with the greatest mean difference (MD) between clinical nurses and enrolled nurses (10.5; p = .002). Nurses with experience in critical care had significantly higher mean knowledge scores (MD 3.1; p = .012). Senior registered nurses had the most positive mean attitude score (82.4, SD 6.2), which was significantly higher than clinical nurses (73.77, SD 10.0), registered nurses (71.64, SD 12.6), and enrolled nurses (68.89, SD 8.8) (p < .05). Nurses with specialist pediatric qualifications had significantly more positive attitude scores (mean 75.65, SD 11.6) than those without (mean 70.86, SD 11.7; p = .005). However, 51% of respondents believed that children tolerate pain better than adults do.

CONCLUSION

Although nurses' overall knowledge and attitude toward pediatric pain were among the highest reported, areas for targeted education using in-service education and workshops were identified alongside a need for exploration of the impediments to providing best care.

Prevalence, pain management and registration in Internal Medicine units

OBJECTIVE

To analyze the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalization units in a third level public hospital of the regional health service of Castilla y León.

METHOD

A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analyzed as recorded in the clinical records.

RESULTS

83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale.

CONCLUSIONS

There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management.

Postoperative Pain Management: A Bedside Perspective

PURPOSE

Postoperative pain management is an ongoing challenge in surgical care, during which inadequate relief can contribute to postoperative complications, and nurses are key figures in this process. The aim of the present study was to gain knowledge of how nurses provide postoperative pain management for women undergoing major surgery for endometriosis.

DESIGN

An ethnographic field study, consisting of semi-structured interviews and participant observations, was conducted in a setting of 2 gynecological units within a large Scandinavian university hospital.

METHOD

The participants were mainly nurses and patients. The overall focus for the field observations and interviews was on how the participants interacted and made care decisions concerning pain. The analysis focused on nurse-patient interaction in postoperative bedside care. A principal theme, pain-related nursing practice emerged, together with the sub-themes nurse-patient interaction, interpretation and assessment of pain and pain management, which represented a circular process, identified in bedside practice.

CONCLUSIONS

To some extend the postoperative pain management was influenced by unexpressed health beliefs and routine actions, and patient involvement was not prominent. Furthermore, the existing guidelines for pain management did not seem useful to the nurses.

CLINICAL IMPLICATIONS

There is a need to develop a new and more practice-oriented postoperative pain management, in ways that also integrate the patient experience.