| BackgroundAs China has entered the aging society, the proportion of the elderly hospitalized patients is increasing. Pain, a common complaint in older adults, is still undertreated. Unrelieved pain inflicts both physical and mental suffering, seriously affecting the older adult’s quality of life. Therefore, it is of vital significance to effectively treat the pain in older adults.Evidence-based practice can be used in guiding clinical nursing practice and improve the quality of pain management in older adult patients. Evidence-based practice guidelines geared for the pain of the elderly have been developed abroad. How to narrow the gap between the guidelines and nursing practice and facilitate the implementation of the guidelines into practice is a challenging issue.The current evidence-based practice in China mostly focuses on the knowledge and skills of, and attitude towards this branch on the part of the nurse, while research on nurses’ understanding of the elderly pain and on the evidence-based practice of acute pain assessment and management in older adults has been sparse. Therefore, a survey with the nurse as to the status quo of the evidence-based practice in terms of the acute pain assessment and management in older adults is of great importance.Objectives1. To learn about the knowledge of the elderly pain by the nurses in Guangdong Province;2. To analyze the status quo of the evidence-based practice in terms of acute pain assessment and management in older adults and the influencing factors;3. To explore the appropriateness of the evidence-based practice in the assessment and management of acute pain in older adults;4. To provide strategies to further improve the evidence-based practice in the acute pain assessment and management in older adults.MethodsSubjects:The study subjects were chosen, by convenience sampling, from the clinical nurses in the36hospitals where the members of the First Pain Management Nursing Committee of Guangdong Nursing Association were from. Criteria of inclusion: registered clinical nurses on the job; nurses who care for inpatients older than65years in their nursing unit; nurses with more than one year work experience; and those willing to take part in this survey.Instruments:1. Questionnaire on Nurses’ Knowledge of Pain in the Elderly. Designed by Sloman et al., this questionnaire comprises14true-or-false questions, covering pain assessment, pain management, analgesia and addiction. The score was based on the percentage of the correctly answered questions.2. Acute Pain Evidence-based Practice Questionnaire (APEBPQ). Designed by Suwanraj et al., this questionnaire is made up of two parts, consisting of53sub-items in six dimensions, with a total score of265. Each sections consists of six subscales: initial, rapid pain assessment; pain assessment of cognitively impaired older adults; pain management plan; pharmacological and non-pharmacological management; evaluation of effectiveness; and pain management discharge plan. The items of section A are scored based on how often their practice matches with the statements. The items of section B estimate how appropriate to use the statements in practice setting. A five-point Likert Scale scoring was used for both parts.3. Others:The demographic data included gender, age, educational background, professional title, years of work experience, work area, the proportion of the elderly patients in the nursing unit, and the level of the hospital, etc. The data concerning pain management nursing included the major ways of acquiring the knowledge of and skills for pain, participation in training in pain management nursing in recent two years, experience in managing pain in the elderly, confidence in correctly answering the questions in the survey, and the adequacy of the pain knowledge for the clinical work, and so on.In order to know about the major obstacles in nurses’ routine work to implement the evidence-based practice on assessment and management of acute pain in the elderly, the following were listed as obstacle factors:weak awareness of practice, inadequacy of the practice know-how, difficulty in reading literature, lack of confidence in the practice, absence of peer support, absence of manager support, lack of time owing to heavy workload, etc., in the form of multiple choices.Data Collection:Upon the inauguration of the First Pain Management Nursing Committee of the Guangdong Nursing Association, unified training of data collection were offered. Letters were attached to specify the objective, content and methods of the survey, for obtaining support, informed consent and assistance. The surveying personnel, taking back the questionnaires to each own hospital, were requested to conduct the survey in line with the procedures as was in the training and complete the survey within one month. The nursing units were selected from three medical departments, three surgical departments and one department of oncology. From each nursing unit, three to five nurses of various postions, professional titles and durations of professional work were randomly chosen. Before the survey, the purpose and requirement of the survey were detailed to the nurses to be surveyed for their understanding and support. After the survey, the collected questionnaires were express mailed back to the researcher. And after receiving the mails, the researcher would check the completeness of the questionnaires and number them.Data Analysis:Analysis was performed using the SPSS16.0. Descriptive analysis was used for the demographic data, knowledge about the elderly pain and the evidence-based practice on the assessment and management of acute pain in older adults. Non-parametric tests were conducted for two or multiple independent samples for determining the significance of the knowledge on the elderly pain between different nurse groups. And the one-way Analysis of Variance (ANOVA) was conducted for determining the significance of the scores by different nurse groups in the evidence-based nursing practice in terms of the assessment and management of acute pain in older adult patients.ResultsA total of1700questionnaires were distributed to nurses from36hospitals in16prefectures and municipalities in Guangdong Province, and1515were collected from35hospitals in16prefectures and municipalities, with a response rate of89.1%. Of those collected,1272were valid, accounting for74.8%.The study subjects were mainly nurses in Level3hospitals (92.0%), with females being the majority, accounting for96.6%. Their ages ranged from18to54years (averaging29.72±6.80). Those with the college education and the primary professional title accounted for53.0%and73.3%, respectively. The duration of work ranged from1to35years (averaged8.98±7.32). In the ward where61.6%of the subjects work, patients aged65or above accounted for over30%.13.5%of the nurses thought that their pain knowledge could meet the demand of the clinical work,29.1%reported they had experience of elderly pain management, while38.2%participated in pain related training over the past two years. The routes through which the subjects acquired pain knowledge were diverse:clinical practice (90.1%), continuing education (46.8%), learning at the college (41.5%), personal experience (28.6%), and learning on the Internet (13.1%).The maximum correct answers to the questionnaire on elderly pain knowledge were13, and the minimum,1, with the average being7.31. The highest correct rate was92.9%, and the lowest,7.14%, with the average being52.2%. The rate of correct answer to the fifth item of "Cultural factors influence the expression of pain symptoms" reached the highest of85.9%, and that to the tenth item of "It is best to avoid giving strong opioids for pain to frail elderly patients because it can cause respiratory depression" was the lowest, being15.7%. Of the14items, only5were correctly answered over60%. Those items with a low rate of correct answers were drug analgesia and addiction. The differences in the scores for the elderly pain knowledge between the nurses of different ages, educational backgrounds, professional titles, years of work experience,, and with different proportions of elderly patients had no statistical significance (P>0.05). However, the nurses from the department of oncology scored higher than those from non-oncology department (P<0.001), and those who had participated in pain related training scored higher than those had no training (P<0.001).The highest score for the evidence-based nursing practice on the assessment and management of elderly acute pain reached259, and the lowest,87(averaged192.49±27.58), with the average score for each item3.63±0.52. Among the various dimensions, the score for the evaluation of analgesic effectiveness was the highest (3.81±0.63), and the scores for plan for discharge planning and analgesic treatment were in the lower end, being3.40±0.77and3.51±0.64, respectively. Of all the items, there were only three items with average score higher than4, i.e.,"I obtain a self-report of pain from the older adult patients if at all possible","I consult with the patient’s physician or nursing staff if pain relief is not adequate", and "I ask about pain and observe nonverbal pain related behaviors during transfers or patient care activities". The differences in the scores for the evidence-based practice on the assessment and management of acute pain in the older adult patients between the nurses of different hospital ranks, genders, positions, proportions of the elderly patients in the ward, groups in terms of the rate of correct answers about elderly pain knowledge were not statistically significant (P>0.05). The differences between the nurses of different ages, educational backgrounds, professional titles, work fields, years of work, participation in pain related training over the past two years, experience in managing the elderly pain had statistical significance (P<0.05). Inadequate practice know-how and lack of time owing to heavy workload were major obstacles to the nurses’ evidence-based practice on the assessment and management of acute pain in older adults.The average total score for the appropriateness of the evidence-based practice on the assessment and management of acute elderly pain in the work unit of the nurse surveyed were183.21±29.95, with the average scores for the sub-items being3.51±0.94. The score for none of the53sub-items was over4.ConclusionNurses’ elderly pain knowledge, analgesics in particular, is inadequate, and cannot meet the demand of the older adult patients in pain. In the future, education in elderly pain should be strengthened, and the content and means of the education be improved to increase nurses’ knowledge in elderly pain and lay a sound foundation for the practice in geriatric pain management nursing.Nurses’ability of evidence-based practice for acute elderly pain needs to be improved, especially the ability in analgesic treatment and patient discharge planning. Managers should create a sound environment to facilitate the evidence-based pain management practice, including reasonable and appropriate staffing, improving the nurses’ knowledge and skills for evidence-based practice, playing the managers’ important role in implementing the evidence-based practice, introducing evidence-based practice model to facilitate the translation of knowledge to practice, and thus improving the quality of pain management nursing for older adult patients.The appropriateness of the evidence-based practice on the assessment and management of acute elderly pain remains to be improved. It is suggested that institutions and organizations develop geriatric pain management nursing guidelines tailored to China’s current status based on the existing clinical practice guidelines, to promote the dissemination and application of the practice guidelines. |
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