Landspítali-The National University Hospital of Iceland, Iceland; University of Iceland, Iceland.
University of Wisconsin, Madison, United States.
Int J Nurs Stud. 2017 Oct;75:83-90. doi: 10.1016/j.ijnurstu.2017.07.009. Epub 2017 Jul 16.
The Pain Resource Nurse program is a widely disseminated, evidence-based, nursing staff development program, designed to improve pain management in hospitals. The program has shown promising results, but has never been tested with a rigorous research design.
Our objective was to test the effectiveness of the Pain Resource Nurse program. Hypothesized outcomes included improvements in nurses' knowledge, attitudes, and assessment practices, and in patients' participation in decision-making, adequacy of pain management, pain severity, time spent in severe pain, pain interference, and satisfaction.
Cluster randomized controlled trial.
A 650-bed university hospital in Iceland Participants: The sample consisted of a) patients ≥18 years of age, native speaking, hospitalized for at least 24h, alert and able to participate; and b) registered nurses who worked on the participating units.
Twenty three surgical and medical inpatient units were randomly assigned to the Pain Resource Nurse program (n=12) or to wait list control (n=11). The American Pain Society Outcome Questionnaire and the Knowledge and Attitudes Survey were used to collect data from patients and nurses respectively. Baseline data (T1) for patients were collected simultaneously on all units, followed by data collection from nurses. Then randomization took place, and the Pain Resource Nurse program was instituted. Ten months later, follow up (T2) data were collected, after which the nurses on the control group units received the Pain Resource Nurse program.
At baseline, data were collected from 305 of the 396 eligible patients and at follow up from 326 of the 392 eligible patients, a 77% and 83% response rate respectively. At baseline, 232 of 479 eligible nurses responded and at follow-up 176 of the eligible 451 nurses responded, a 49% and 39% response rate, respectively. A nested mixed model analysis of covariance revealed that the intervention was successful in changing pain assessment practices, with pain assessment using standardized measures increasing from 13% to 25% in the intervention group while decreasing from 21% to 16% in the control group. None of the other hypothesized improvements were found.
The Pain Resource Nurse program was successful in improving nurses' use of standardized measures for pain assessment. No effects were found on patient outcomes; pain was both prevalent and severe at both time points. Only minimal improvements were noted in response to this evidence-based staff development program. Changes in pain management practices remain a challenge in clinical settings.
疼痛资源护士计划是一个广泛传播的、基于证据的护理人员发展计划，旨在改善医院的疼痛管理。该计划已显示出有希望的结果，但从未经过严格的研究设计测试。
我们的目的是测试疼痛资源护士计划的有效性。假设的结果包括改善护士的知识、态度和评估实践，以及患者参与决策、疼痛管理的充分性、疼痛严重程度、处于严重疼痛中的时间、疼痛干扰和满意度。
整群随机对照试验。
冰岛的一家 650 床位的大学医院。
样本包括 a）年龄≥18 岁、母语为英语、住院至少 24 小时、意识清醒且能够参与的患者；和 b）在参与单位工作的注册护士。
23 个外科和内科住院单位被随机分配到疼痛资源护士计划（n=12）或候补名单对照（n=11）。美国疼痛协会结局问卷和知识与态度调查分别用于收集患者和护士的数据。对患者进行基线数据（T1）收集，同时在所有单位进行，然后收集护士的数据。然后进行随机分组，并实施疼痛资源护士计划。10 个月后，进行随访（T2）数据收集，之后对照组单位的护士接受疼痛资源护士计划。
在基线时，从 396 名符合条件的患者中收集了 305 名患者的数据，在随访时从 392 名符合条件的患者中收集了 326 名患者的数据，应答率分别为 77%和 83%。在基线时，从 479 名符合条件的护士中收集了 232 名护士的数据，在随访时从 451 名符合条件的护士中收集了 176 名护士的数据，应答率分别为 49%和 39%。嵌套混合模型协方差分析显示，干预成功地改变了疼痛评估实践，干预组使用标准化措施进行疼痛评估的比例从 13%增加到 25%，而对照组从 21%下降到 16%。没有发现其他假设的改善。
疼痛资源护士计划成功地改善了护士对疼痛评估的标准化措施的使用。对患者结局没有影响；在两个时间点，疼痛都既普遍又严重。对这一基于证据的员工发展计划仅注意到了最小的改进。在临床环境中，疼痛管理实践的改变仍然是一个挑战。
