The Effect of Educational Strategies Targeted for Nurses on Pain Assessment and Management in Children: An Integrative Review

Nursing students' pain management self-efficacy and attitude towards patients with chronic pain: What can be done better in education? A cross-sectional study

AIM

This study has been conducted to determine nursing students' pain management self-efficacy and attitudes towards patients with chronic pain.

BACKGROUND

Pain is a significant phenomenon that often leads individuals to seek medical attention, influenced by various factors and commonly encountered by healthcare professionals. Adequate knowledge and positive attitudes among nurses play a crucial role in the thorough assessment and effective management of pain, resulting in favorable outcomes for hospitalized individuals.

DESIGN

This study used a descriptive cross-sectional design.

METHODS

The research was conducted with 322 undergraduate students who were continuing their education in the autumn semester of the 2023-2024 academic year at Aksaray University, Faculty of Health Sciences, Department of Nursing. Data have been collected by using Student Information Form, Pain Management Self-Efficacy Questionnaire (PMSEQ) and the Attitude of Healthcare Professionals towards Patients with Chronic Pain Scale. Mann-Whitney U, Kruskal-Wallis significance test and Spearman Correlation analysis have been used to evaluate the data.

RESULTS

The mean total score of the PMSEQ was 62.91 (SD 15.58) and the mean total score of the Attitude of Healthcare Professionals Towards Patients with Chronic Pain Scale was 3.94 (SD.52). Those students who willingly opted for the nursing profession, perceived themselves as proficient in managing chronic pain, administered care to patients experiencing pain during clinical placements, believed they received sufficient education in pain management throughout their studies and rated their overall health status as "very poor" demonstrated higher levels of self-efficacy in pain management (p<0.05). As a result of the analysis performed according to the mean scores of the Attitude of Healthcare Professionals Towards Chronic Pain Patients Scale and its sub-dimensions of the students participating in the study, a statistically significant difference has been found according to their gender, academic year and self-sufficiency in pain management (p<0.05). It has been determined that there is a weak positive correlation between the total mean scores of the participants' PMSEQ and the Attitude of Healthcare Professionals Towards Patients with Chronic Pain scale (r=.260; p<0.01).

CONCLUSIONS

In this study, as nursing students' self-confidence in pain management self-efficacy increased, their attitudes towards patients with pain also increased positively. In the nursing curriculum, there is a necessity for integrating pain management education and fostering awareness to adequately equip nursing students in addressing the pain requirements of patients.

Effect of Educational Interventions for Improving the Nurses' Knowledge, Attitude, and Practice of Pediatric Pain Management: A Aystematic Review and Meta-Analysis

OBJECTIVE

This study aimed to evaluate the effectiveness of educational interventions in improving nurses' knowledge, attitude, and practice regarding pediatric pain management.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A comprehensive search was conducted in MEDLINE, Scopus, Cochrane database, Google Scholar, and trial registries, supplemented by bibliography searches.

REVIEW/ANALYSIS METHODS

This review included randomized controlled trials, nonrandomized trials, and quasi-experimental trials with control groups. Eligible studies involved nurses (professionals or students) caring for pediatric patients and featured any form of educational intervention for pain management. Pooled effect estimates were calculated using a random effects model, and heterogeneity was assessed using the I-squared statistic.

RESULTS

The pooled results demonstrated a significant improvement in nurses' knowledge and attitudes toward pediatric pain management postintervention, with a Standardized Mean Difference (SMD) of 2.41 (95% CI: 0.58-4.23). Additionally, the pooled results indicated a higher likelihood of effective pain medication administration (OR = 1.98; 95% CI: 1.21-3.27). However, there was no significant difference in the utilization of pain assessment tools (OR = 19.85; 95% CI: 0.29-1352.98). Pooled OR was 3.42 (95% CI: 1.93-6.07), showing significantly higher odds of ability to administer nonpharmacological interventions. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

Educational interventions significantly improve nurses' knowledge, attitudes, and ability to administer both pharmacological and nonpharmacological pediatric pain management interventions.

Does Education Improve Nurses' Knowledge, Attitudes, Skills, and Practice in Relation to Pain Management? An Integrative Review

BACKGROUND

Pain is undertreated in both adults and children and a major factor linked to this is nurses' lack of knowledge as evidenced by studies undertaken globally.

OBJECTIVE

This review sought to explore the effects educational interventions can have on nurses' knowledge, attitudes, skills, and practice regarding pain management.

DESIGN

An integrative review DATA SOURCES: Systematic search of CINAHL, MEDLINE, AMED, EMBASE, and Psych INFO.

REVIEW/ANALYSIS METHODS

Five major databases were systematically searched from the year 2000-December 2019 with a total of 33 studies included in the final review.

RESULTS

The literature revealed that many nurses had inadequate knowledge and a poor attitude towards pain at baseline, which may be improved through educational intervention. However, misconceptions remained at post-intervention, particularly regarding pharmacological pain management.

CONCLUSIONS

Education is a possible means to enhance nurses' knowledge and improve attitudes and practices in pain management. However, there was some evidence that this may decline over time, and continuous professional updates are likely required.

Exploring outcomes from an innovative, pediatric-focused intervention with undergraduate nursing students

BACKGROUND

To adapt to COVID-19 restrictions, a virtual pediatric skills day was developed to provide nursing students with practical experience prior to entering the pediatric clinical setting. Student assessment before and after participation indicate a virtual skills day is helpful in building student confidence prior to pediatric clinicals.

METHODS

This mixed-method study involved a cross-sectional approach with a six-item survey administered before and immediately after the virtual pediatric skills day intervention to undergraduate junior nursing students. Outcome measures included comfort and preparation for pediatrics and families of pediatric patients.

FINDINGS

After exploring outcomes from 93 students complete pre and post intervention measures, we addressed comfort themes including excited, nervous, and readiness while preparedness themes highlighted concerns with parental interactions, upset children, and COVID-19 restrictions.

DISCUSSION

It is beneficial for nursing students to have clinical experiences with children prior to visiting a pediatric clinical setting. Such experiences decrease student stress and anxiety and allow meaningful opportunities to occur.

Predictors of nurses' attitudes and knowledge towards pain management in Italy. A cross-sectional study in the hospital settings

INTRODUCTION

Pain is multidimensional, and as such it is the chief reason patients require urgent health care services. If inadequately assessed and untreated, pain may negatively impact on the quality of life of the patient. Pain management is an essential part of Nursing. The aim to this study is to examine the level of knowledge and attitudes with regard to pain among Italian nurses who work in clinical settings.

METHODS

The Ferrell and McCaffery's Knowledge and Attitudes Survey Regarding Pain was distributed to 266 nurses employed in one specialized hospital in Rome, Italy. The staff in the survey work in three different settings: the intensive care unit, the sub-intensive care unit, and an ordinary ward. Descriptive statistics were employed and a logistic regression model was performed to evaluate the factors that may influence the attitude and knowledge of care providers.

RESULTS

49.6% of the sample correctly answered items about attitudes, 47.4% about knowledge, and 36.5% about assessment. The results show that the odds ratio of developing positive attitudes towards pain was 1.76 times higher in nurses employed in the sub-intensive care unit than in other settings. There are no statistically significant associations of knowledge between setting, sex or education.

CONCLUSIONS

Our survey revealed a limited overall level of knowledge and attitudes with regards to pain management among nurses. Implementing specific training for health professionals, starting with academic education, is therefore a priority. Further research is needed on a larger sample of Italian nurses.

Educational Intervention to Strengthen Pediatric Postoperative Pain Management: A Cluster Randomized Trial

BACKGROUND

Pediatric postoperative pain is still undertreated.

AIMS

To assess whether educational intervention increases nurses' knowledge and improves pediatric postoperative pain management.

DESIGN

Cluster randomized controlled trial with three measurement points (baseline T1, 1 month after intervention T2, and 6 months after intervention T3).

PARTICIPANTS/SUBJECTS

The study was conducted in postanesthesia care units at six hospitals in Norway. Nurses working with children in the included units and children who were undergoing surgery were invited to participate in this study.

METHODS

Nurses were cluster randomized by units to an intervention (n = 129) or a control group (n = 129). This allocation was blinded for participants at baseline. Data were collected using "The Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain: Norwegian Version" (primary outcome), observations of nurses' clinical practice, and interviews with children. The intervention included an educational day, clinical supervision, and reminders.

RESULTS

At baseline 193 nurses completed the survey (75% response rate), 143 responded at T2, and 107 at T3. Observations of nurses' (n = 138) clinical practice included 588 children, and 38 children were interviewed. The knowledge level increased from T1 to T3 in both groups, but there was no statistically significant difference between the groups. In the intervention group, there was an improvement between T1 and T2 in the total PNKAS-N score (70% vs. 83%), observed increase use of pain assessment tools (17% vs. 39%), and children experienced less moderate-to-severe pain.

CONCLUSIONS

No significant difference was observed between the groups after intervention, but a positive change in knowledge and practice was revealed in both groups. Additional studies are needed to explore the most potent variables to strengthen pediatric postoperative pain management.

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

BACKGROUND

Although 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.

AIMS

To 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.

METHODS

Design; 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.

RESULTS

A 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.

CONCLUSIONS

Despite 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.

Use of artificial intelligence and virtual reality within clinical simulation for nursing pain education: A scoping review

OBJECTIVES

To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses.

DESIGN

A scoping review of published and unpublished research from 2009 to 2019.

DATA SOURCES

Nine electronic databases and hand-searching of reference lists.

REVIEW METHODS

Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis.

RESULTS

The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement.

CONCLUSION

Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.

Continuing nursing education: use of observational pain assessment tool for diagnosis and management of pain in critically ill patients following training through a social networking app versus lectures

BACKGROUND

Nursing staff training in using observational pain assessment tools is highly important to improve the assessment of pain. The present study was conducted to examine the effect of two different training methods (lectures vs. a social networking app) on the diagnosis and management of pain in mechanically-ventilated patients.

METHODS

This quasi-experimental study was conducted on 70 nurses working in two Intensive Care Units (ICU) in Mashhad, Iran. The nurses were trained in the application of observational pain assessment tools by lectures or through a social networking app. Before and after the intervention, the nurses' performance was evaluated in both groups using a checklist based on Critical-Care Pain Observation Tool (CPOT).

RESULTS

In the pre-intervention phase, the nurses' performance scores in the domains of pain diagnosis and pain management were not significantly different between the two groups (P > 0.05). Following the intervention, the mean score of pain diagnosis was 82 ± 19 in the lecture group and 97 ± 8 in the social networking app group (P < 0.01), and the mean pain management scores were 30 ± 17 and 90 ± 18 (P < 0.01), respectively.

CONCLUSION

This study showed that learning through a social networking app led to improved diagnosis and management of pain in mechanically-ventilated patients when compared with lectures. Training through social networking applications can therefore be considered as a feasible instructional method for developing nurses' pain management skills.

Pain management in children has significantly improved in the Italian emergency departments

AIM

Pain in children is often poorly assessed and treated in Italian emergency departments (EDs) as found in a survey conducted among the centres of the "Pain in Pediatric Emergency Room (PIPER)" Study Group in 2010. Our aim was to evaluate the changes in pain management in Italian EDs in the last years.

METHOD

A structured questionnaire about pain assessment, protocols, use of local anaesthetics before venipuncture, opioids and adjuvants was mailed to 46 Italian EDs between November 2017 and April 2018.

RESULTS

Pain was always assessed at triage in 34 centres (73.9%). Algometric scales were used in over 90% of EDs. Triage protocols were available in 37 centres (80.4%). Local anaesthetics before venipuncture were always used in six centres (13.0%). Protocols included opioids and adjuvants in 73.0% and 47.2%, respectively. Triage pain assessment was always done in 91.0% of the centres joining the PIPER Study Group up to 2015 and 56.5% in ones that joined the Group after 2015 (P = .017). Local anaesthetics before venipuncture were given in 39.1% of the centres joining until up to 2015 and 13.0% in ones that joined the Group after 2015 (P = .003).

CONCLUSION

Paediatric pain management has significantly improved in Italian EDs in the last 8 years. The centres joining the PIPER Study Group for longer time have shown better results for the indicators considered in the survey.

Exploring the educational needs of nurses on children's pain management: A descriptive qualitative study

Aim

To explore the educational needs of nurses on children's pain management.

Design

A descriptive qualitative study.

Methods

Individual and group interviews were conducted among 28 nurses and four nurse managers at four hospitals in the Ashanti region of Ghana. The recorded interviews were later transcribed verbatim and thematically analysed based on a conceptual interest in the educational needs on paediatric pain management.

Results

Nurses were acquainted with pain assessment of children who can verbally communicate. They mainly used drugs in treating pain and were familiar with the use of some non-pharmacological interventions. Notwithstanding, they desired to know more about pain assessment for children with non-functional speech. Additionally, they were interested in learning more about both drug and nondrug pain relief methods for children. The sampled nurses and nurse managers indicated diverse preferences on the nature of the paediatric pain educational programme based on their personal choices and working dynamics.