Evidence-based pain management: analyzing the practice environment and clinical expertise

Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies ( n = 68,278) was .922 ( p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

The Influence of Context on Utilizing Research Evidence for Pain Management in Jordanian Pediatric Intensive Care Units (PICU)

PURPOSE

The purpose of this study was to gain a beginning understanding of the contextual factors that influence the use of research for pain management in Jordanian Pediatric Intensive Care Units (PICUs).

DESIGN AND METHODS

A paper or online questionnaire was used to collect data on instrumental research use (IRU) and conceptual research use (CRU) and ten contextual variables from 73 registered nurses working in four Jordanian PICUs. The Pearson product-moment correlation coefficient was used to test the relationship between continuous (demographic and contextual) factors and IRU and CRU. One way ANOVA and independent t-test were used to examine the differences between sociodemographic variables and IRU and CRU. Generalized Estimating Equations (GEE) was used to determine the demographic and contextual factors that influenced research use. We modeled the significant variables identified by bivariate correlation, t-test, and ANOVA at (p≤0.10).

RESULTS

Nine of the contextual factors significantly and positively correlated with the IRU for pain assessment, eight with the IRU for pain treatment, and six with the CRU for pain management (including assessment and treatment). Hospital type (public) predicted the IRU for pain assessment. Social capital, structural, and electronic resources predicted the IRU for pain treatment. Social capital predicted the CRU for pain management.

CONCLUSION

Context influences Jordanian PICU nurses' use of research for pain management.

PRACTICE IMPLICATIONS

Concentrating on modifiable contextual factors may positively influence Jordanian PICU nurses' use of research for pain management. This influence may extend to reduce children's pain in Jordanian PICUs.

Psychometric Testing of the Smoking Cessation Counseling Scale Among Magnet® Hospital Nurses

Psychometrics of the Smoking Cessation Counseling Scale, which measures adherence to evidence-based smoking cessation counseling practice, were originally estimated among rural hospital nurses. The purpose of this study was to estimate the scale's reliability, convergent validity, and factor structure among 289 nurses from 27 acute care Magnet® hospitals. The scale demonstrated acceptable estimates for internal consistency (Cronbach's α = .95, 95% CI = [0.94, 0.96]). Convergent validity was supported by the association with comfort in conducting smoking cessation counseling (coefficient = 3.58, 95% CI = [2.80, 4.37]) and shared vision (coefficient = 0.72, 95% CI = [0.02, 1.42]). A four-factor structure (standard care, basic counseling, advanced counseling, and referral to services) was identified. Findings supported the scale's reliability and convergent validity among Magnet® hospital nurses. Further testing is needed to confirm the four-factor structure and accumulate psychometric evidence among different nursing providers and health care settings to expand the use of the instrument.

The influence of interpersonal relationships on nurse managers' work engagement and proactive work behavior

OBJECTIVE

This study tested the effects of interpersonal relationships on nurse managers' work engagement and proactive work behavior.

BACKGROUND

An engaged workforce may help healthcare organizations improve performance. In healthcare, nurse managers are responsible for creating motivating work environments. They also need to be engaged, yet little is known about what influences nurse managers' performance.

METHODS

A self-administered electronic survey was used to collect data from 323 nurse managers working in acute care hospitals. Instruments included the Relational Coordination Scale, Utrecht Work Engagement Scale, and Proactive Work Behavior Scale.

RESULTS

Interpersonal relationships with nurse administrators were most predictive of nurse managers' work engagement. Interpersonal relationships with physicians were most predictive of nurse managers' proactive work behavior.

CONCLUSION

Organizational cultures that foster quality interpersonal relationships will support the job performance of nurse managers.

Evaluation of pain management documentation

OBJECTIVES

Accurate and consistent documentation of pain management, including patient responses regarding improvement in pain scores, is essential for improving patient care. The objective of the project was to evaluate the current prescribing patterns and to review the current documentation for opioid-managed, chronic pain patients in an academic continuity of care medicine clinic.

METHODS

Retrospective data were extracted from currently managed adult, opioid patients to evaluate prescribing patterns and to review documentation processes.

RESULTS

Results reveal inconsistent to absent documentation with most patients receiving prescriptions from multiple providers. Oxycodone/acetaminophen was the most frequently prescribed analgesic.

CONCLUSION

The results of this evaluation highlight the opportunity for educational intervention and the development of a structured, institution-specific guideline for prescribing and documenting pain management.

Global use of the Practice Environment Scale of the Nursing Work Index

BACKGROUND

Although the Practice Environment Scale of the Nursing Work Index has been endorsed as a gauge of the quality of the nursing practice environment by several organizations in the United States promoting healthcare quality, there is no literature describing its use in different practice settings and countries.

OBJECTIVE

The purpose of this study was to inform research by describing the modifications and use of the scale in a variety of practice settings and countries.

METHODS

The Cumulative Index to Nursing and Allied Health Literature and the PubMed databases were searched for the years 2002-2010 to identify 37 research reports published since 2002 describing use, modification, and scoring variations in different practice settings and countries.

RESULTS

The scale was modified for 10 practice settings in five countries and translated into three languages. Composite scores ranged from 2.48 to 3.17 (on a 1-4 scale). The Staffing and Resource Adequacy subscale most often scored lowest. A new Nursing Information Technology subscale has been developed. New scoring methods to identify the favorability of practice environments are described. Over time, the nature of the research conducted using the measure has changed. Overall, most publications report significant associations between scale scores and multiple nurse, patient, and organizational outcomes.

DISCUSSION

Scale use is growing across different clinical settings and countries. Recommendations for future research use include reducing scale length, using consistent scoring methods, considering the impact of various modifications on the basis of cultural and clinical setting nuances, and using the measure in longitudinal and intervention research designs.