Abstract
BackgroundDespite substantial research on pediatric pain assessment and management, health care professionals do not adequately incorporate this knowledge into clinical practice. Organizational context (work environment) is a significant factor in influencing outcomes; however, the nature of the mechanisms are relatively unknown. The objective of this study was to assess how organizational context moderates the effect of research use and pain outcomes in hospitalized children.MethodsA cross-sectional survey was undertaken with 779 nurses in 32 patient care units in 8 Canadian pediatric hospitals, following implementation of a multifaceted knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ). The influence of organizational context was assessed in relation to pain process (assessment and management) and clinical (pain intensity) outcomes. Organizational context was measured using the Alberta Context Tool that includes: leadership, culture, evaluation, social capital, informal interactions, formal interactions, structural and electronic resources, and organizational slack (staff, space, and time). Marginal modeling estimated the effects of instrumental research use (direct use of research knowledge) and conceptual research use (indirect use of research knowledge) on pain outcomes while examining the effects of context.ResultsSix of the 10 organizational context factors (culture, social capital, informal interactions, resources, and organizational slack [space and time]) significantly moderated the effect of instrumental research use on pain assessment; four factors (culture, social capital, resources and organizational slack time) moderated the effect of conceptual research use and pain assessment. Only two factors (evaluation and formal interactions) moderated the effect of instrumental research use on pain management. All organizational factors except slack space significantly moderated the effect of instrumental research use on pain intensity; informal interactions and organizational slack space moderated the effect of conceptual research use and pain intensity.ConclusionsMany aspects of organizational context consistently moderated the effects of instrumental research use on pain assessment and pain intensity, while only a few influenced conceptual use of research on pain outcomes. Organizational context factors did not generally influence the effect of research use on pain management. Further research is required to further explore the relationships between organizational context and pain management outcomes.
Highlights
Despite substantial research on pediatric pain assessment and management, health care professionals do not adequately incorporate this knowledge into clinical practice
Our previous research in 32 patient care units in eight Canadian pediatric hospitals determined that a multifaceted knowledge translation (KT) intervention, Evidence-based Practice for Improving Quality (EPIQ) [3, 4] improved pain assessment and management practices of healthcare professionals, and decreased pain intensity in hospitalized children compared to standard care [5]
Taking into account the same mean differences and similarities as instrumental research use (IRU), there was a significant difference in the effect of conceptual research use (CRU) and pain assessment (Moderation Test CRU and Valid Pain Assessment, Table 2)
Summary
Despite substantial research on pediatric pain assessment and management, health care professionals do not adequately incorporate this knowledge into clinical practice. The objective of this study was to assess how organizational context moderates the effect of research use and pain outcomes in hospitalized children. Despite a growing body of research on effective pain assessment and management strategies, health care professionals are not consistently using this evidence to achieve best practice [2]. There was substantial variation in outcomes across hospital units To address this variability, our current study aimed to determine the influence of organizational context in moderating the effect of research use and pain outcomes
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