Phillips Jane L, Heneka Nicole, Hickman Louise, Lam Lawrence, Shaw Tim
University of Technology Sydney, Centre for Cardiovascular and Chronic Care, Sydney, Australia.
University of Technology Sydney, Centre for Cardiovascular and Chronic Care, Sydney, Australia.
Pain Manag Nurs. 2017 Apr;18(2):75-89. doi: 10.1016/j.pmn.2017.01.003.
Unrelieved cancer pain has an adverse impact on quality of life. While routine screening and assessment forms the basis of effective cancer pain management, it is often poorly done, thus contributing to the burden of unrelieved cancer pain. The aim of this study was to test the impact of an online, complex, evidence-based educational intervention on cancer nurses' pain assessment capabilities and adherence to cancer pain screening and assessment guidelines. Specialist inpatient cancer nurses in five Australian acute care settings participated in an intervention combining an online spaced learning cancer pain assessment module with audit and feedback of pain assessment practices. Participants' self-perceived pain assessment competencies were measured at three time points. Prospective, consecutive chart audits were undertaken to appraise nurses' adherence with pain screening and assessment guidelines. The differences in documented pre-post pain assessment practices were benchmarked and fed back to all sites post intervention. Data were analyzed using inferential statistics. Participants who completed the intervention (n = 44) increased their pain assessment knowledge, assessment tool knowledge, and confidence undertaking a pain assessment (p < .001). The positive changes in nurses' pain assessment capabilities translated into a significant increasing linear trend in the proportion of documented pain assessments in patients' charts at the three time points (χ trend = 18.28, df = 1, p < .001). There is evidence that learning content delivered using a spaced learning format, augmented with pain assessment audit and feedback data, improves inpatient cancer nurses' self-perceived pain screening and assessment capabilities and strengthens cancer pain guideline adherence.
未缓解的癌症疼痛会对生活质量产生不利影响。虽然常规筛查和评估是有效癌症疼痛管理的基础，但往往做得很差，从而加重了未缓解的癌症疼痛负担。本研究的目的是测试一种基于证据的在线综合教育干预对癌症护士疼痛评估能力以及对癌症疼痛筛查和评估指南的依从性的影响。澳大利亚五个急性护理机构的专科住院癌症护士参与了一项干预措施，该措施将在线间隔学习癌症疼痛评估模块与疼痛评估实践的审核及反馈相结合。在三个时间点测量了参与者自我感知的疼痛评估能力。进行了前瞻性、连续的病历审核，以评估护士对疼痛筛查和评估指南的依从性。记录的干预前后疼痛评估实践的差异进行了基准对比，并在干预后反馈给所有机构。使用推断统计分析数据。完成干预的参与者（n = 44）增加了他们的疼痛评估知识、评估工具知识以及进行疼痛评估的信心（p < .001）。护士疼痛评估能力的积极变化转化为在三个时间点患者病历中记录的疼痛评估比例的显著线性增加趋势（χ趋势 = 18.28，自由度 = 1，p < .001）。有证据表明，采用间隔学习形式并辅以疼痛评估审核和反馈数据的学习内容，可提高住院癌症护士自我感知的疼痛筛查和评估能力，并增强对癌症疼痛指南的依从性。
