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BACKGROUND/RATIONALE:
Estimates of pain in hospitalized cancer patients are as high as 73 percent. Research indicates that patients continue to experience pain. Research suggests that nurses lack the knowledge to adequately manage pain and harbor attitudes that interfere with successful pain management behaviors.
OBJECTIVE(S):
To improve knowledge, attitudes, and behaviors of nursing staff related to pain management and to decrease patient pain, and constipation and increase functional status among hospitalized veterans with cancer through the use of Pain Resource Nurses.
METHODS:
The study settings are James A. Haley VAMC in Tampa and Bay Pines VAMC in nearby Pinellas county. Twelve registered nurses from the experimental hospital (JAHVAMC) received training in pain assessment and management. The Pain Resource Nurses serve as role models in pain management while education and consultation to the staff nurses. No intervention was provided to the control hospital. Outcome evaluation includes measurement of nurses’ pain-related knowledge, attitudes, and management behaviors, as well as patients’ pain intensity, constipation, and functional status. Measures are being taken from all nurses (n=124, excluding PRNs) and from patients (n=50) at each institution at five time periods; pre-, mid-, and immediately post-intervention, and six months and one year after the completion of the intervention. The five data collection periods will allow determination of the long-term effect of the intervention for both nurses and patients. Data analysis will be conducted to examine each hypothesis using t-tests, repeated measures ANOVA and ANCOVA as well as descriptive statistics.
FINDINGS/RESULTS:
Pre-training data confirms the need for this study, raw knowledge scores ranged from 26 percent to 77 percent with a mean of 60 percent. Attitudes toward patients in pain ranged from 0 (most negative) to 18 out of 25 questions with a mean of 1.0 (SD-4.3). Attitudes toward pain management ranged from 62 to 81 out of 100. Mean was 71.8. Pain ratings varied from 1 to 99 with a mean of 32.5. Approximately one-third of patients reported daily pain intensity at levels above mid-point. The mean activity interference score on the Brief Pain Inventory was 30 out of a possible 60. The greatest interference was with walking and sleeping. Data from the second wave showed a significant improvement in attitude at the experimental hospital. Patient data is still being evaluated. Data was used to evaluate the validity and reliability of the Brief Pain Inventory in the Immediate Post-operative Period. The Cronbach’s alpha for the surgical patients was .97 for the surgical patients compared with .95 for the medical patients. The correlation was comparable for every item except average pain over 24 hours. Qualitative interviews were conducted with the Pain Resource Nurses to evaluate the strengths, weaknesses and possible suggestions for the future of the program at the VA.
IMPACT:
Our study will provide important insight into both the current knowledge and attitude of VA nurses and their current practice in pain management. In addition, it will evaluate a possible intervention to improve pain management for cancer patients, which is a major priority for the VHA at this time. This insight will help VA providers deliver improved pain management for our veterans.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Communication and Decision Making, Treatment
Keywords:
Behavior (provider), Cancer, Pain
MeSH Terms:
Pain, Neoplasms
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