Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods

Abstract

Objectives: To examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to healthcare behavior-change theory. Methods Results:The twelve eligible studies used varied didactic and interactive teaching methods.Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. Studies did not explicitly reference theory underlying design of their interventions. No studies made reference to behavior change theory in their design. Eight of the twelve studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention.Discussion: Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual and emotionally demanding nature of nursing pain management in hospital settings.

Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

“…Work-related factors also influence the quality of process outcomes. It has been suggested that aspects like emotions, professional recognition, and work load do have an influence [48]. While emotions depend on the individual's situation and hospitals as employers might provide programs to cope with such conditions, the nursing profession suffers a lack of attractiveness with impact on motivation [49].…”

Rethinking pain education

“…Drake and Williams9 conducted a systematic review of educational interventions used in acute hospital settings to improve pain management. The studies (n=12) they appraised gave unhelpfully brief descriptions of the educational intervention, but these included web-based evidence guidelines, teaching sessions, audit and feedback, a pocket pain assessment guide and a computer decision-support system.…”

“…In Drake and Williams’ systematic review,9 the outcome measures included completion of pain assessment documentation, use of a pain assessment tool, mean pain rating of a patient group and reduction in the percentage of patients reporting moderate to severe pain as well as one study that used pre-knowledge and post-knowledge scores. One of the criticisms of evaluation of teaching interventions is an over-reliance on pre-knowledge and post-knowledge testing, which does not reflect any changes in practice.…”

Do surgical patients' characteristics and behaviours affect nurses' pain management decisions? A qualitative inquiry

“…Recent studies report that patient characteristics (eg, age and gender) and perceived cultural stereotypes can affect pain management (Alabas, Tashani, Tabasam, & Johnson, ; Koren et al, ; Kvachadze, Tsagareli, & Dumbadze, ; Samulowitz, Gremyr, Eriksson, & Hensing, ). Thus, nurses' attitudes and views to pain management warrant exploration within the context of the social workplace (Drake & Williams, ). This is especially true for the postsurgical setting to ensure patients' pain is adequately treated.…”