Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: a mixed-methods approach

Knowledge and practical skills for cancer pain management among nurses on remote islands in Japan and related factors nationwide

OBJECTIVE

To clarify the knowledge and practical skills needed for cancer pain management among nurses on remote islands in Japan and related factors nationwide.

SETTING

Due to geographical factors, nurses working on remote islands in Japan have few opportunities to attend training programs, which makes it difficult to acquire the knowledge and practical skills needed to provide pain management for patients with cancer.

METHODS

We conducted a self-administered questionnaire survey regarding knowledge and practical skills in pain management for patients with cancer.

DESIGN

Cross-sectional study.

PARTICIPANTS

Nurses working in cancer pain care in medical facilities and home care on remote islands throughout Japan.

RESULTS

We analysed 128 responses. Regarding knowledge, the average accuracy level was 49.1%. Items with a low accuracy rate included selecting medicine according to the type of pain and the patient's condition. Regarding practice, the items with low scores included analgesics appropriate for the type of pain and relating physical pain to mental, social and spiritual aspects. The most common significant factor in both knowledge and practice was related to postgraduate training.

CONCLUSIONS

These findings suggest that to improve the knowledge and practical skills for cancer pain management among nurses on remote islands in Japan, it is necessary to incorporate clinical reasoning into basic education and establish remote education systems and consultation systems with other facilities.

What influences specialist palliative care nurses working in a community setting to engage with research?

AIMS

The aim of this research was to understand what influences specialist palliative care nurses working in a community setting to engage with research.

METHODS

Qualitative research using interviews with community based clinical nurse specialists (CNS).

FINDINGS

A total of five themes were identified: research negativity and enthusiasm, clinical focus, audits, organisational support and keeping up to date.

CONCLUSION

Except for audit activity, CNS do not view the research pillar as an integral part of their clinical role. Previous research education may not give the CNS the breadth of research skills that they require. The advance professional apprenticeship may resolve these education issues. Managers and organisations need to prioritise EBP skills; supporting nurses with both education and EBP mentors to develop these skills. Nurses require ongoing time to engage with research activity and use these skills to improve both their own clinical practice and those who use them as a research resource.

Effects of evidence-based nursing on surgical site wound infections in patients undergoing surgery for liver cancer: A meta-analysis

This study aimed to systematically evaluate the impact of evidence-based nursing (EBN) on perioperative wound infections and postoperative complications in patients undergoing surgery for liver hepatocellular carcinoma (LIHC). Randomised controlled trials (RCTs) on the application of EBN on patients receiving LIHC surgery were searched in PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure from the inception of each database to September 2023. Studies were screened and evaluated by two investigators based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 4.0 was used for data analysis. Overall, 15 RCTs involving 1374 patients with LIHC were included, with 687 in the EBN group and 687 in the conventional care group. The analysis revealed that the incidence of wound infections (odds ratio [OR] = 0.32, 95% confidence interval [CI]: 0.18-0.56, p < 0.001) and postoperative complications (OR = 0.22, 95% CI: 0.15-0.31, p < 0.001) was significantly lower in the EBN group than in the conventional care group. The available evidence suggests that nursing strategies for EBN applied in the perioperative period in patients with LIHC receiving surgery can effectively reduce the incidence of wound infections and postoperative complications and promote postoperative recovery.

Using mixed-methods in evidence-based nursing: a scoping review guided by a socio-ecological perspective

Background

Increased pressure for evidence-based practice in nursing necessitates that researchers use effective approaches. Mixed-methods research (MMR) has potential to improve the knowledge and implementation of evidence-based nursing (EBN) by generating outcome-based and contextually-focused evidence.

Aims

To identify methodological trends in how MMR is used in EBN research.

Methods

Searches were completed in PubMed, CINAHL, and Google Scholar using the terms "nursing", "mixed-methods", and "evidence-based". Seventy-two articles using MMR to address EBN and published 2000-2021 were reviewed across content themes and methodological domains of the Socio-Ecological Framework for MMR.

Results

Mixed-methods research has been used to study how EBN strategies are perceived, developed and assessed, and implemented or evaluated. A few studies provided an MMR definition reflecting the methods perspective, and the dominant MMR rationale was gaining a comprehensive understanding of the issue. The leading design was concurrent, and half of studies intersected MMR with evaluation, action/participatory, and/or case-study approaches. Research quality was primarily assessed using criteria specific to quantitative and qualitative approaches.

Conclusions

Mixed-methods research has great potential to enhance EBN research by generating more clinically useful findings and helping nurses understand how to identify and implement the best available research evidence in practice.

Adherence to evidence-based practice across healthcare professionals in Germany: results from a cross-sectional, nationwide survey

Background

Adherence to evidence-based practice (EBP) is considered a key competence to improve healthcare quality. In this study, we aimed to describe the EBP adherence of healthcare professionals working in Germany and to explore barriers and facilitators regarding the implementation of EBP in clinical practice.

Methods

A nationwide online survey was performed among healthcare professionals in Germany from January to April 2018 using the German version of the Evidence-based Practice Inventory (EBPI) questionnaire for a comprehensive assessment of adherence to EBP. Univariate logistic regression analyses were performed to explore the association between demographic and professional determinants and each EBPI dimension.

Results

We analysed data of 889 participants, including 318 physical therapists, 154 occupational therapists, 137 midwifes and 280 participants of six other healthcare professions. Approximately 70% of the participants generally demonstrated a positive attitude towards EBP and believed that EBP was useful in clinical practice. Broadly, 80% of the respondents evaluated themselves as being able to enact EBP behaviour in clinical practice. In contrast, less than 70% preferred to use quantitative information instead of their intuition to inform their habitual clinical behaviour. Still, 20 to 30% reported that EBP did not sufficiently account for their clinical experience and differences between patients.

The strongest facilitators to EBP adherence across at least three dimensions of the EBPI were the availability of ≥ 60 min for scientific literature at work (OR: 9.67; 95% CI: 5.86; 16.30), followed by a master or higher academic degree (OR: 9.09, 95% CI: 5.86; 14.28) and the involvement in ≥ 1 scientific publication (OR: 7.06, 95% CI: 5.10; 9.85).

Conclusions

This study showed that healthcare professionals in Germany in general had a positive attitude towards EBP although they currently do not consider EBP principles in its entirety. The most important determinant positively influencing a healthcare professional’s decision to perform EBP was the time available for scientific literature at work. German healthcare professionals experience similar barriers towards the implementation of EBP in clinical practice compared to other international healthcare settings. These barriers should be targeted by future research.

Trial registration

German Clinical Trials Register (DRKS00013792). Registered 19 January 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08682-z.

Effect of evidence-based nursing intervention on diet and pain after subtotal gastrectomy

OBJECTIVE

To understand the effect of evidence-based nursing on diet and pain after subtotal gastrectomy.

METHODS

From June 2014 to May 2016, 68 patients with gastric cancer undergoing subtotal gastrectomy were selected as the research group (RG) and 57 patients with routine nursing as the control group (CG). The incidence of complications and recovery time were compared between the two groups. The pain and sleep were evaluated by visual analogue scale (VAS) and Pittsburgh Sleep Quality Index (PSQI). The survival condition of the two groups after 3 years of prognosis was observed.

RESULTS

The incidence of complications and recovery time in RG were less than those in CG (P < 0.05), and the VAS and PSQI scores in RG were lower than those in CG on the 3rd and 7th day after operation (P < 0.01). However, the nursing satisfaction and 3-year survival rate of RG were higher than those of CG (P < 0.05).

CONCLUSION

Evidence-based nursing can effectively reduce postoperative complications and pain in patients with gastric cancer undergoing subtotal gastrectomy.

Nursing Insights on Delirium in the Intensive Care Unit: A Quality Improvement Study

Delirium is a common complication of critical illness. As frontline providers, nurses (registered nurses) are uniquely positioned to inform interventions to improve intensive care unit (ICU) patient outcomes. This article reports a study of attitudes and knowledge about ICU delirium assessment at an urban academic medical center. Findings suggest a knowledge deficit regarding the spectrum of delirium. ICU nurses also identified that a lack of effective collaboration within the treatment team was the biggest barrier to effective care for the patient with hypoactive delirium. The study findings indicate that both educational and management initiatives are needed to improve clinical practices for patients with manifestations of hypoactive and hyperactive delirium.

The factors affecting nurses' assessments toward pain management in Saudi Arabia

Background and Aims:

Pain assessment requires an extensive practice in diagnosis coupled with proficiency in recognizing health factors that lead to its occurrence. Nurses' education and training could be the main factor influencing pain perception and diagnosis. This study aims at comparing nurses' academic qualifications and relevant training courses that may impact their assessment skills toward patients in pain.

Methods:

A descriptive cross-sectional design using a Knowledge and Attitudes Survey Regarding Pain questionnaire was administered to a total of 247 nurses. In this survey, the nurses were asked to answer specific questions related to correctly diagnosing and assessing patients' pain, as well as answer questions about their previous training in pain assessment.

Results:

A total of 247 nurses answered the questionnaire, with an overall response rate of 82%. Questionnaires revealed that more than half (50.6%) of the nurses involved in this study have not received any pain education related to pain management in the 5 years following their initial nursing licensure or supervision under a nurse supervisor.

Conclusions:

The results of the paper show that nurses' experiential level has the highest impact on their knowledge of pain relief management and medications necessary for treating it. Also, nurses' pain education following their initial licensure and during their professional practice has the second highest impact on their pain relief management knowledge, whereas their primary nursing education had the lowest.

Measures of evidence-informed decision-making competence attributes: a psychometric systematic review

Background

The current state of evidence regarding measures that assess evidence-informed decision-making (EIDM) competence attributes (i.e., knowledge, skills, attitudes/beliefs, behaviours) among nurses is unknown. This systematic review provides a narrative synthesis of the psychometric properties and general characteristics of EIDM competence attribute measures in nursing.

Methods

The search strategy included online databases, hand searches, grey literature, and content experts. To align with the Cochrane Handbook of Systematic Reviews, psychometric outcome data (i.e., acceptability, reliability, validity) were extracted in duplicate, while all remaining data (i.e., study and measure characteristics) were extracted by one team member and checked by a second member for accuracy. Acceptability data was defined as measure completion time and overall rate of missing data. The Standards for Educational and Psychological Testing was used as the guiding framework to define reliability, and validity evidence, identified as a unified concept comprised of four validity sources: content, response process, internal structure and relationships to other variables. A narrative synthesis of measure and study characteristics, and psychometric outcomes is presented across measures and settings.

Results

A total of 5883 citations were screened with 103 studies and 35 unique measures included in the review. Measures were used or tested in acute care (n = 31 measures), public health (n = 4 measures), home health (n = 4 measures), and long-term care (n = 1 measure). Half of the measures assessed a single competence attribute (n = 19; 54.3%). Three measures (9%) assessed four competence attributes of knowledge, skills, attitudes/beliefs and behaviours. Regarding acceptability, overall missing data ranged from 1.6–25.6% across 11 measures and completion times ranged from 5 to 25 min (n = 4 measures). Internal consistency reliability was commonly reported (21 measures), with Cronbach’s alphas ranging from 0.45–0.98. Two measures reported four sources of validity evidence, and over half (n = 19; 54%) reported one source of validity evidence.

Conclusions

This review highlights a gap in the testing and use of competence attribute measures related to evidence-informed decision making in community-based and long-term care settings. Further development of measures is needed conceptually and psychometrically, as most measures assess only a single competence attribute, and lack assessment and evidence of reliability and sources of established validity evidence.

Registration

PROSPERO #CRD42018088754.

Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey

Objective:

to explore self-perception competence among Spanish nurses dealing with patient death and its relationship with work environment, evidence-based practice, and occupational stress.

Method:

a cross-sectional web-based survey collected information from a convenience sample of 534 nurses from professional Spanish Colleges who answered four validated questionnaires: Coping with Death Scale, Practice Environment Scale of the Nursing Work Index, Perception of Evidence-Based Practice (EBP) and Nursing Stress Scale.

Results:

a total of 79% of the participants were women, the average age was 40 years old, 38% had a postgraduate degree and 77% worked in public health settings. Many nurses evaluated their work environment as unfavorable (66%), reported high occupational stress (83.5±14.9), and had high scores on knowledge/skills in EBP (47.9±11.3). However, 61.2% of them perceived an optimal coping (>157 score). The multivariate logistic model indicated positive associations with work environment and EBP characteristics (OR: 1.30, p=0.054; OR: 1.04, p=0.007; OR: 1.13, p<0.001, respectively) but negative associations with occupational stress and short work experience (OR: 0.98, p=0.0043; OR: 0.74, p<0.002, respectively). These factors explained 23.1% of the coping variance (p<0.001).

Conclusion:

although most nurses perceived optimal coping, the situation could be enhanced by modifying several contextual factors. The identification of these factors would improve the quality of end-of-life care by facilitating nursing management.

Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review

OBJECTIVE

This systematic review aimed to evaluate the efficacy of CAM interventions for cancer-related pain in breast cancer patients.

METHODS

Databases (PubMed, Scopus, Web of Science, and EMBASE) were searched from January 1, 2000, up to April 31, 2019, using the keywords: Complementary and alternative medicine therapies and cancer related pain. Standard tools were used to evaluate the quality of the studies included.

RESULTS

Of the 3742 articles found, 46 articles comprising 3685 participants entered the final phase. Our results indicate that interventions including acupuncture/acupressure, tai chi/qi gong, hypnosis, meditation, music therapy, yoga, massage, reflexology, and Reiki improve cancer-related pain in breast cancer patients. However, aromatherapy had no effect on the same.

CONCLUSIONS

Despite the positive effect of various CAM interventions in reducing cancer-related pain, necessary precautions should be adopted to use them alongside other treatments to control cancer pain in the clinical setting.

How Theory Can Help Facilitate Implementing Relaxation as a Complementary Pain Management Approach

Complementary therapies provide cancer survivors and clinicians with options for managing chronic pain. Recent published clinical guidelines and research findings support the use of relaxation therapy for managing chronic pain in cancer survivors. However, translating research findings into clinical practice remains a challenge. Using theory to guide implementation of a new practice can increase the likelihood of successful adoption. This article uses relaxation therapy for cancer survivors to describe how clinicians could use Rogers' Diffusion of Innovation Theory and the related Collaborative Research Utilization Model to implement a complementary therapy and ensure that it becomes standard practice.

The effect of a coix seed oil injection on cancer pain relief

BACKGROUND

Pain is one of the most commonly reported symptoms in patients with advanced cancer, but is still less than optimally treated. The effect of traditional Chinese medicine in cancer pain treatment is nowadays getting more and more attention.

OBJECTIVE

To investigate the effect of a coix seed oil injection on cancer pain relief in a cancer center in a tertiary hospital in China.

METHODS

Patients in the treatment group received a coix seed oil injection for 2 weeks, while patients in the control group received equivalent 0.9% saline. The numeric rating scale was used to assess the pain level. The Quality of Life Questionnaire-Core 30 was used to assess life quality. The adverse drug reactions during the treatment process were observed.

RESULTS

Patients in the coix seed treatment group had significantly superior efficacy on pain control over those in the control group. Coix seed therapy significantly improved patients' scores reflecting by the Quality of Life Questionnaire-Core 30 (QLQ-C30) scale. In addition, the occurrence of adverse reactions such as constipation and nausea in the treatment group was significantly lower than that in the control group.

CONCLUSION

The coix seed oil injection effectively reduced the pain level of cancer patients, significantly improved their life quality, and had no obvious adverse effects.

Knowledge and attitudes of nurses toward pain management

Background:

Pain control is a vitally important goal because untreated pain has detrimental impacts on the patients as hopelessness, impede their response to treatment, and negatively affect their quality of life. Limited knowledge and negative attitudes toward pain management were reported as one of the major obstacles to implement an effective pain management among nurses. The main purpose for this study was to explore Saudi nurses’ knowledge and attitudes toward pain management.

Methods:

Cross-sectional survey was used. Three hundred knowledge and attitudes survey regarding pain were submitted to nurses who participated in this study. Data were analyzed with the Statistical Package for the Social Sciences software (SPSS; version 17).

Results:

Two hundred and forty-seven questionnaires were returned response rate 82%. Half of the nurses reported no previous pain education in the last 5 years. The mean of the total correct answers was 18.5 standard deviation (SD 4.7) out of 40 (total score if all items answered correctly) with range of 3–37. A significant difference in the mean was observed in regard to gender (t = 2.55, P = 0.011) females had higher mean score (18.7, SD 5.4) than males (15.8, SD 4.4), but, no significant differences were identified for the exposure to previous pain education (P > 0.05).

Conclusions:

Saudi nurses showed a lower level of pain knowledge compared with nurses from other regional and worldwide nurses. It is recommended to considered pain management in continuous education and nursing undergraduate curricula.

Evidence-Based Practice Beliefs and Implementation in Doctor of Nursing Practice Students

BACKGROUND

Doctors of Nursing Practice focus on leadership in evidence-based practice (EBP). EBP is influenced by one's beliefs in and implementation of EBP. Little is known to date about the EBP beliefs and implementation of Doctor of Nursing Practice students and outcomes of Doctor of Nursing Practice education.

AIMS

Guided by the Advancing Research and Clinical practice through close Collaboration (ARCC) Model, the Evidence-Based Practice Beliefs (EBPB) and Implementation (EBPI) tools were used to assess the impact of EBP as a program pillar, curricular thread, and content area on EBPB and EBPI of Doctor of Nursing Practice-Family Nurse Practitioner students.

METHODS

Five cohorts who completed the same curriculum were studied. Fifty-four of the 89 students across the five cohorts began and completed the study.

RESULTS

Paired t-test for group effects showed statistical significance from pre- to post-measure in students overall EBPB, t = 4.4 (52), p < .001, and EBPI, t = 8.4 (52), p < .001. A large effect size of .75 standard deviation (SD) gain above the mean for EBPB, and a very large effect size of 1 SD gain above the mean for EBPI were observed. Repeated measures ANOVA showed that all cohorts made gains across the curriculum. Effect sizes for EBPB ranged from .25 to 1 SD above the mean, and .75 to 1.5 for EBPI.

LINKING EVIDENCE TO ACTION

DNP students who are educated to be EBP leaders must have a curriculum that supports them in the knowledge and skill-set needed to translate evidence into practice. The ARCC Model can guide faculty in EBP curriculum development. EBPB and EBPI are valid and reliable measures to assess for gains across a curriculum. Through educational outcomes, educators can assess desired student outcomes for EBP across a curriculum and can build an evidence base for ongoing curriculum development.