Implementation And Effect Of A Pain Management Core Competency Training Course For Surgical Nurses

BackgroundSurgical nurses play an important role in postoperative pain management.In order to improve the quality of postoperative pain care,it is essential to strengthen the pain education of nurses.Competency-based education(CBE)is a framework for designing and implementing education that focuses on the desired performance characteristics of health care professionals,by establishing observable and measurable performance metrics that learners must attain to be deemed competent.The International Association for the Study of Pain(IASP)reached an interprofessional consensus on core competencies in pain assessment and management for health professional education in 2013.These competencies can serve as a foundation for developing,defining,and revising curricula.At present,there is no research attempt to conduct pain training for surgical nurses according to the expert consensus develop course of pain core competencies in China.ObjectivesTo evaluate surgical nurses' knowledge of core competencies for pain management,nursing practice behavior of postoperative pain management,and patients' postoperative pain intensity,before and after a pain management core competency training program.MethodsSubjects:Nurses working in the surgery departments and the medical records of patients undergoing elective surgery hospitalized in the corresponding department in a university-affiliated general hospital were selected as the research subjects.Nurses' inclusion criteria were:registered nurses working for at least three months(including probation period)on the surgical ward and informed consent were obtained to participate in the study.Student nurses,advanced training nurses,and nurses on vacation or in further training outside the hospital during the time of the study were excluded.Medical records of patients'inclusion criteria were:undergoing elective surgery,an expected hospital stay of at least one day after surgery.Those patients who were not back to the surgical ward after operation were excluded.Instruments:1.Clinical Pain Knowledge TestThe Clinical Pain Knowledge Test(CPKT)was developed by Bernhofer and Marie in 2017.It can be used to determine gaps in education and to evaluate knowledge after pain management education measures.It includes four pain management core competency aspects.The total score was calculated as a percentage of the total number of correct questions answered,and the scores of each dimension were calculated as a percentage of the total number of correctly answered questions divided by the total number of questions in that dimension.2.Knowledge and Attitudes Survey Regarding PainThe Knowledge and Attitudes Survey Regarding Pain(KASRP)was developed by Ferrell and McCaffery.It can be used to measure nurses' pain knowledge and attitude,and can also be used to evaluate the effect before and after pain education intervention.The most recent version was revised in 2014.It consists of 41 questions,one point was given for each correct answer,and the final score was calculated as a percentage of the total questions.3.Checklist for pain treatment and nursing records of surgical patientsDesigned by the reseachers,it includes the basic surgical information and postoperative pain treatment of surgical patients,nurses' pain management nursing practice behaviors,and the postoperative pain intensity score of patients.Study procedures:1.InterventionsA pain management core competency training course was developed for surgical nurses.Nurses were required to attend the two four-hour training sessions provided by a multidisciplinary pain management team.Learning materials were distributed and a Wechat group was established.Through online video learning and communication,postoperative pain management knowledge and skills were shared and disseminated.2.Data collectionBefore and after the theoretical teaching,the CPKT and the KASRP were distributed to surgical nurses who participated in the training,and pain knowledge data of nurses before and after the intervention were collected.The sample of medical records of patients undergoing elective surgery one week before and one week after the theoretical teaching was stratified and randomly selected.Patients' postoperative pain treatment,nurses' pain management practice,and patients' postoperative pain intensity scores were recorded.Results1.Nurses'scores of pain knowledgeOne hundred and thirty-five nurses and 107 nurses participated in the pre-and post-training tests,respectively.The scores of the CPKT of nurses increased significantly after intervention(45.6±12.3 vs.54.2±10.2,r=5.786,P<0.001).After training,the scores of four knowledge domains of nurses' pain management core competence significantly improved(34.1 vs.43.0,Z=-2.942,P=0.003;39.5 vs.50.6,Z=-3.981,P<0.001;47.2 vs.54.4,Z=-3.051,P=0.002;62.8 vs.70.3,Z=-2.252,P=0.024,respectively).The scores of the KARSP of nurses increased significantly after intervention(48.9±10.2 vs.61.6±12.1,t=8.880,P<0.001).The scores of the CPKT and the KASRP of nurses showed that Pearson correlation coefficient before intervention and after intervention were 0.423 and 0.465,respectively(P<0.001).2.Nurse' s pain management practiceTwo hundred and three patients' medical records were retrieved before and after intervention respectively.The nurses' practice behavior of postoperative pain management improved,with the percentage of recording postoperative pain management nursing increased from 59.6%(n=121)to 74.9%(n=152)(?2=10.746,P=0.001).The first time of pain assessment for patients was shortened form 494.3 min to 257.6 min(Z=-3.495,P<0.001).The use of pain intensity assessment tools increased from 81.8%(n=121)to 95.4%(n=152)(?2=13.079,P<0.001).The number of days with pain assessment documentation increased from an average of 4.0 days to 4.9 days(Z=-3.307,P=0.001),and the number of pain assessment times increased from an average of 7.7 to 9.2(Z=-3.086,P=0.002).3.Postoperative pain intensity of patientsAfter intervention,patients' average worst postoperative pain score significantly decreased from 2.1 to 1.7 on the day of surgery(Z=-2.486,P=0.013).The worst pain score significantly decreased from an average of 2.1 to 1.6 from the 1st to the 3rd postoperative day(Z=-2.172,P=0.030).ConclusionsImplementation of a pain management core competency training course for surgical nurses could increase nurses' knowledge of core competencies of pain management,change some pain management practices,and decrease patients'postoperative pain intensity.