Effectiveness of a Nurse-led Pain Management Training Program on Knowledge, Attitude and Practice of Nurses in Ilorin, Kwara State, Nigeria

Background: Effective pain management requires precise knowledge and competent skills in practice. Nurses should have a solid foundation of pain knowledge and develop good practice pain management. Little is documented towards nurse’s knowledge and practice of pain management among critical ill patients in the study area. Objective: To examine the level of knowledge, practice & associated factors of nurses towards critically ill patients pain management at federal hospitals, Addis Ababa, Ethiopia September to October 2020. Method: A cross-sectional study design was conducted among nurses, who work at federal hospitals of Addis Ababa, Ethiopia from September 15 to October 15, 2020. All intensive care unit nurses was participated in the study. Data was collected by using self-administered structured questionnaire and entered into Epi info version 7 and imported to SPSS version 23.0 software for analysis. Associations was analyzed by using bivariate and multivariate logistic regression model. The findings were expressed with 95% CI and odd ratio and P-value<0.05. Result: Knowledge of nurses towards pain management in the study area is 64.9%. Among many factors contributed to the nurses’ pain management knowledge in the Multivariate logistic regression: work load (AOR, 8.8, CI95%, 1.45-53.39), training related to ICU (AOR, 10.8, CI95%, 1.07-109.42), reading of guidelines (AOR, 10.11, CI95%, 1.36-75.22), educational status (AOR, 16.38, CI95%, 1.02-261.9), and practice of nurse towards pain management (AOR, 6.17, CI95%; 1.38-27.56) were associated with knowledge of pain management. Nurses’ practice of pain management in the study area is 56.5%. Similarly having a training related to intensive care unit (AOR, 19.95, CI95%, 3.03-130.9), and knowledge of nurse towards pain management (AOR, 5.30, CI95%; 1.3-21.68) were significantly associated with practice of nurses on pain management. Conclusion and recommendation: The overall nurses’ pain management knowledge in federal hospitals of Addis Ababa relative to Mekelle hospitals is good. Taking training, reading guidelines and level of education of nurses were significant predictors of nurse’s knowledge. Receiving a training related to intensive care unit and having adequate knowledge of pain management were also associated with practice of pain management. Therefore, the need to give trainings and prepare guideline regarding pain assessment and management might escalate to address pain management among nurses.

Aim: Nurses are the point of contact for patients admitted in hospital wards. Nurse's deal with all complaints of the patients, most common being pain. Hospitalised patients can suffer from pain due to various causes like post-operative, infection, malignancy, trauma, iatrogenic causes like i.v. cannulation, catheters etc. Proper management of pain in such patients improves patient experience and doctor-patient relationship. The knowledge and attitude of nurses regarding pain management affects the overall patient experience in hospital. We conducted a survey among nurses of tertiary care hospital (including government and private hospitals) in Pune regarding their knowledge, attitude and practices in pain management. Our questionnaire consisted of 20 questions relating to knowledge, attitude and practices of nurses in pain management. Material and Method: A survey was conducted among 248 nurses of tertiary care hospital (including government and private hospitals) in Pune regarding their knowledge (6 questions), attitude (5 questions) and practices (7 questions) in pain management using a questionnaire. Statistical Analysis: Questionnaire comprised all categorical answers hence descriptive statistics (percentage values) of all the individual categories was calculated. Results: Our survey revealed deficiency in nowledge, attitude and practices of nurses regarding basics of pain management, especially cancer pain and opioid use. Conclusion: This study has brought to light the deficiency in nursing curriculum or training regarding basics of pain management specifically cancer pain and opioid use.

Despite there being acknowledgement by the aged care industry of the presence of complex persistent pain in older people living in residential care facilities (RCFs), pain continues to be under-recognised and poorly managed. This is particularly the case for residents from culturally and linguistically diverse (CALD) groups and those living with dementia. Some initiatives in this area include the development of multiple assessment tools, advancement of pharmacological and non-pharmacological strategies, the development of best practice guidelines and increased education. However, little advancement has been made in establishing and sustaining best practice in this area of care. There is also a lack of research examining how knowledge and best practice, on a broader scale, are sustained within RCFs, through ongoing learning.Using a mixed methods approach, this research, conducted in two phases, aimed to identify what factors impact on organisational knowledge and the sustainability of evidence-based (EB) pain management practices in aged care. Phase One was conducted in an RCF that had previously implemented the Australian Pain Society’s (APS) best practice guidelines (Goucke et al., 2005) and it investigated what individual and organisational factors impact on the ability of the direct care staff (registered and enrolled nurse, allied health and care workers) to undertake EB pain management practices. Phase Two was conducted in two Registered Training Organisations (RTOs) in Queensland and it investigated, how current education practices for workers with Certificate III in Aged Care (the primary workforce), influence their ability to conduct EB pain management practices.Organisational learning theory (OLT) was utilised in this research, specifically the organisational learning theoretical framework as proposed by Argote and Miron-Spektor (2011). This framework provided the tool for analysing how factors from the external environmental context (e.g. government policy and legislation) and internal contextual factors (organisational and individual), influence the way in which knowledge about pain management practices is attained, retained and transferred (Argote & Miron-Spektor, 2011).The findings of this research indicate that, two years after implementation of EB pain management strategies, best practice was not sustained and a number of resident, staff, organisational and system factors, influenced the maintenance and utilisation of organisational knowledge. This research also found, that Certificate III care workers obtained only basic knowledge of pain identification and management practices in the course, through one hour of education, primarily provided in the palliative care module. They received limited education or mentoring in these practices and processes, once they were employed in a care worker role. Clinical Facilitators (CFs) involved in care worker training, typically had a Certificate III in care work only and had varying levels of experience and knowledge in pain management practices and processes. The teaching methods utilised in the workers’ education were didactic, with use of workbooks or a power point presentation.The results indicate there are significant individual and organisational factors that impact the sustainability of EB pain management practices in aged care. Inadequate maintenance of best practice, affects the older person’s quality of life and contributes to unnecessary suffering. Whilst many of these factors have previously been documented in the literature as impacting on pain management processes in RCFs, there appears to have been minimal advances in resolving the issues. Knowledge regarding pain identification, assessment and management, may be attained through education and the provision of guidelines. However, the utilisation, retention, and transference of this knowledge within aged care facilities, appears to decline after initial implementation. If best practice is to be sustained, managers and clinical leaders in RCFs, need to utilise a framework or model, such as provided in the organisational learning theoretical framework, to identify potential barriers and facilitators, consider what happens beyond the initial implementation phase and strategically plan how the RCF can sustain knowledge and best practice, given their current human and physical resources. The aged care industry, nursing as a professional body and the public at large, needs to pressure the government to improve staff ratios and skill mix. There also needs to be a pressure placed on the government and training providers, to improve the standard of education offered in the Certificate III/IV aged care training material. Improved education for care workers in pain management (and other clinical areas), would better equip them, for work in the current aged care environment, where care that is more complex is required for older people now being admitted to RCFs.If we do not make some considerable efforts to address the ongoing poor recognition and management of pain in RCFs, then we will continue to fail in our duty of care to one of the most vulnerable groups in our population. Older people have the right to have their pain managed appropriately.

#36889 Closing the gaps in postoperative pain management: challenges and future perspectives

Rapid assessment and treatment of pain is crucial when a patient first arrives in the emergency department (ED). Overcrowding and underassessment of pain can lead to inadequate management. There is also a paucity of literature on pain assessment and management practices in EDs. Hence, we decided to conduct a study to do a gap analysis on ongoing pain management practices in the ED and increase adherence to standard international pain management guidelines through a teaching program, with a vision for a "pain-free ED." This quasi-experimental study examined ED patients with pain. The study was conducted in three phases: pre-training, training, and post-training. Observing the ED pain assessment and management practices was the primary objective. Patient demographics, pain assessment method, door-to-analgesia time, and the analgesic prescribed were recorded, among others. Training of residents and changes in pain management practices were secondary objectives. Two hundred and forty-six patients were recruited in each of the pre-training and post-training phases. Before training, pain assessment was conducted in 19.5% of cases, primarily using the Numeric Rating Scale (NRS). Reassessment was done in only 22% of cases. Median door-to-analgesia time was 46.50 min, interquartile range (20-107). After training, pain assessment significantly improved from 19.5% to 59.8% (P = 0.0001). The rate of analgesic prescription at triage increased from 42.68% to 53.65% (P = 0.014). No significant change in door-to-analgesia time was observed (P = 0.091). This study highlights deficiencies in current pain management practices in the ED and underscores the necessity for a structured departmental pain protocol. Recommendations include emphasizing pain assessment, documentation, and early prescription of correct analgesics. Positive outcomes in our study underscore the potential benefits of educational initiatives in optimizing pain management in the ED.

Paediatric pain education: A call for innovation and change

Pain management is an important issue which impacts the prognosis of neonates in neonatal intensive care units. Evidence has shown that professionals' knowledge and attitudes regarding pain management can impact the quality of their practice. The purpose of this study was to evaluate the knowledge, attitudes, and practices of neonatal professionals regarding neonatal pain management. A cross-sectional study was performed involving neonatal physicians and nurses, using a research questionnaire to investigate the knowledge and attitudes of professionals as well as to assess their practice of pain management. Research found an apparent discrepancy between the knowledge levels of neonatologists and nurses regarding pain assessment and management, with nurses displaying weaker professional knowledge and more negative attitudes toward pain management than did neonatologists. Additionally, research revealed a lack of knowledge and negative attitudes among participants regarding the provision of sufficient opioid analgesics to sick infants during invasive procedures and even for dying neonates. There is an urgent need for continuing education regarding neonatal pain management with the goal of empowering neonatal professionals; further research is needed into the question of how to translate education into more reliable practice.Conclusion: This research provides useful information regarding the knowledge, attitudes, and clinical practice of neonatal pain management among neonatologists and nurses and points out some differences in the knowledge levels of these two groups. What is Known: •Neonates can perceive and respond to pain stimuli by showing their biological signals similarly to children and adults. •Untreated or insufficient pain management for high-risk neonates has short-term. negative effects and may also induce long-term negative effects. What is New: •The level of knowledge, the attitudes, and the practices regarding neonatal pain in intensive care are different among neonatal professionals. •There is an urgent need to provide interdisciplinary continuing education to improve the knowledge of neonatal professionals and encourage them to more highly prioritize neonatal pain management.

BackgroundPain is a common phenomenon among emergency patients which may lead to chronic pain conditions and alteration of physiological function. However, it is widely reported that proper pain assessment and management, which is often accomplished by adequately trained nurses reduce the suffering of patients. Therefore, the aim of this study was to assess the emergency nurses´ knowledge, attitude and perceived barriers regarding pain management.MethodsA cross-sectional quantitative study design was applied to determine the nurses´ knowledge level, attitude and the perceived barriers related to pain management. Hundred twenty-six nurses from the emergency departments of seven referral hospitals of Eritrea participated in the study. Data were collected in August and September 2017. Both descriptive and inferential statistics were used to summarize and elaborate on the results.ResultIn general, the knowledge level and attitude of the emergency nurses was poor. The participants’ correct mean score was 49.5%. Nurses with Bachelor’s Degree had significantly higher knowledge and attitude level compared to the nurses at the Diploma and Certificate level of professional preparation (95% CI = 7.1–16.7 and 9.4–19.1; p < 0.001) respectively. Similarly, nurses who had previous training regarding pain scored significantly higher knowledge level compared to those without training (95% CI =1.82–8.99; p = 0.003). The highest perceived barriers to adequate pain management in emergency departments were measured to be overcrowding of the emergency department (2.57 ± 1.25), lack of protocols for pain assessment (2.45 ± 1.52), nursing workload (2.44 ± 1.29) and lack of pain assessment tools (2.43 ± 1.43). There was no significant difference in perceived barriers among nurses with different demographic characteristics.ConclusionThe emergency nurses’ knowledge and attitude regarding pain management were poor. Nurses with higher educational level and nurses with previous training scored significantly higher knowledge level. This indicates the need for nursing schools and the ministry of health to work together to educate nurses to a higher level of preparation for pain assessment and management.

There are no evidence-based guidelines on pain management in people with haemophilia (PWH), who may suffer acute, disabling pain from haemarthroses and chronic arthropathic pain. To review evidence and to investigate current clinical practice in pain assessment and management in PWH the European Haemophilia Therapy Standardisation Board undertook a literature review and a survey in 22 Haemophilia Treatment Centres (HTC), using a questionnaire and seven clinical scenarios. Consensus was sought on pain assessment and management in PWH. Few clinical studies on pain management in PWH were identified. The HTCs care for 1678 children (47% severe haemophilia, 84% on prophylaxis, 17% with arthropathy and 8% with chronic pain) and 5103 adults (44% severe haemophilia, 40% on prophylaxis, 67% with arthropathy and 35% with chronic pain). Analgesics are prescribed by HTCs in 80% of cases (median; range 0-100%) and in 10% (median; range 0-80%) are bought over the counter. Pain and analgesic use are assessed when reported by patients and at check-ups. Only eight centres use a specific pain scale and/or have specific pain guidelines. Two HTCs arrange regular consultations with pain specialists. For acute pain, the preferred first-line drug is paracetamol for children, and paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for adults. Children with chronic pain are treated with paracetamol or NSAIDs, whereas adults usually receive Cox-2 inhibitors. Second-line therapy is heterogeneous. There is little published evidence to guide pain assessment and management in PWH, and clinical practice varies considerably across Europe. General and specific recommendations are needed.

An Update: Institutional Quality Improvement Initiative for Pain Management for Pediatric Cancer Inpatients, 2007–2010

Background: Critically ill patients have challenges reporting pain given their physical state. The complex nature of critical illness and diverse needs of patients may impact on the effectiveness of pain assessment and management in the intensive care units (ICU). Effective pain assessment culminates in effective pain management and nurses play an important role in ensuring effective pain management. Existing literature has shown gaps in the practice of pain assessment and management and efforts have ben made to try to mitigate the inefficiencies among nurses, yet their knowledge, attitudes and practices (KAP) in this domain variable and impact patient outcomes. This study therefore, sought to assess the nurses knowledge, attitudes and practices towards pain assessment and management in ICUS at Kasama General Hospital. Methods: A quantitative study using a cross sectional analytical study design guided the study. The study was conducted on a population of 53 nurses selected using census sampling method. A self administered questionnaire was used following approval from local ethics committee. Written consents were obtained before commencement of the study. Data was analyzed using SPSS version 26 and Binary Logistic regression and Chi square were employed. Results: The results revealed significant associations (p&lt;0.05) between Gender (p=0.014), years of experience (p=0.046), attitude (p=0.002) and practice of pain assessment and management. Binary Logistic regression revealed that females (AOR: 6.247, p=0.030), nurses with more than 10 years of experience (AOR: 3.962, p=0.002) and nurses working in the Pediatric Intensive care unit (AOR: 3.504, p=0.019) and Neonatal Intensive care unit (AOR; 6.098, p=0.002) had significantly higher odds of good practice. In addition, positive attitude (AOR: 2.007, p=0.0160 and possessing knowledge (AOR: 3.267, p=0.004) about pain assessment and management was significantly associated with higher odds of good practice. Conclusion: The study revealed that pain assessment and management practices among nurses is influenced by knowledge and attitudes. Therefore, there is need for intensifying professional development programs and increasing educational opportunities for nurses working in the ICUS.

Clinicians’ Practices In Pain Assessment And Management For Elderly With Heart Failure

What’s New in the Management of Pain in Children

To describe the pain assessment and management practices documented by health professionals within a tertiary-level Children's Cancer Centre and to evaluate how these practices were compared with international recommendations. Children with cancer are vulnerable to pain due to the intensity of antineoplastic therapy. Therefore, it is imperative to ensure that current pain management practices provided to paediatric oncology inpatients are of a high quality. A single-site cross-sectional audit. A 24-hour period of documented pain-related care in randomly selected inpatients of an Australian tertiary-level Children's Cancer Centre was examined. The current pain management practices were audited over a two-month period resulting in 258 episodes of pain-related care being reviewed. Pain related to medical treatment for cancer was common (n=146/258, 57%) and persistent. The presence of pain was not consistently recorded by health professionals (n=75/146, 51%). Pain was mild (n=26/75, 35%) and opioids were the mainstay of pain management interventions (n=63/112, 56%). Adjuvants were an important component of pain management (n=47/112, 42%), and nonpharmacological methods of managing pain were under-represented in this audit (n=38/146, 26%). According to the Pain Management Index, pain was appropriately managed for the majority of children (n=65/76, 87%). Pain management practices did not fully reflect the recommendations of contemporary paediatric pain management. Due to limitations in the documentation of children's pain, it was difficult to determine the effectiveness of pain management interventions. This study highlights the ongoing problem of pain for children receiving antineoplastic therapy. It is recommended that health professionals routinely screen for the presence of pain during hospitalisation and assess the efficacy of pain-related care.

Karol Mathews DVM DVSc DACVECC (Canada) Peter W Kronen Dr Vet Med, DVM DECVAA (Switzerland) Duncan Lascelles BSc BVSc PhD DSAS DECVS DACVS MRCVS (USA) Andrea Nolan MVB DVA PhD DECVAA DECVPT MRCVS (UK) Sheilah Robertson BVMS (Hons) PhD DACVAA DECVAA DECAWBM (WSEL) DACAW MRCVS (USA) Paulo VM Steagall MV MS PhD DACVAA (Brazil/Canada) Bonnie Wright DVM DACVAA (USA) Kazuto Yamashita DVM MS PhD DJCVS (Japan)