Nurses' knowledge and attitude regarding pain assessment and interventions in nursing home patients: evaluation of a pain management program

Purpose of Project: The purpose of this quality improvement project implementing a pre-post design was to evaluate the effectiveness of a well-structured in-service education program on comprehensive pain management to improve nurses’ knowledge, attitude and documentation skills in a long term care facility. This project focused on pre and post educational program testing utilizing the Knowledge and Attitude Survey Regarding Pain (KASRP) and a short demographic survey and chart audits to assess knowledge retention and practice change in the participants. Methodology Setting: The setting chosen for the project was a skilled nursing facility located in central New Jersey. The organization is a large, for profit, 283 bed nursing home with facilities to provide both long term and short-term care. Study Population: The population for this project was all Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) employed by the organization who have been employed for at least one year, working on a full- or part-time basis, communicate using the English language , and are able to read and write in the English language. Study Intervention: The chart audit of 60 charts was completed on the designated unit prior to the pain educational program for RNs and LPNs. An educational program was developed based on national guidelines and the facility pain policy and was administered to all RNs and LPNs on the designated unit. Prior to the educational program, all participants were asked to review and sign an informed consent and complete the pre-test which is the Knowledge and Attitude Survey Regarding Pain (KASRP) and a short demographic survey. The post-test 1 (KASRP) was given immediately after the educational program. Post-test 2 (KASRP) was given one month after the educational program. The pre and post tests could document change in knowledge and retention of knowledge. After the educational program, another chart audit was done on 60 charts in the designated unit to evaluate for change in documentation and change in practice. Data Analysis: The Statistical Package for the Social Science (SPSS) was utilized for the statistical analysis of the data collected. Results: Pre-knowledge scores ranged from 11 to 25 (M = 18.00, SD = 3.69). Post 1 knowledge scores ranged from 30 to 37 (M = 34.86, SD = 1.93) and post 2 scores ranged from 21 to 35 (M = 30.05, SD = 3.48). Post 1 and 2 scores were greater than pre-scores. But the data shows a decrease in knowledge from post-test 1 to post-test 2. The decrease in knowledge scores in post-test 2 from post-test 1 indicates poor knowledge retention among nurses. Normality was assessed by performing Shapiro-Wilk’s tests of normality. The test was significant for post 1 knowledge scores (p = .024), indicating that post 1 scores were not normally distributed. Shapiro-Wilk’s tests were non-significant for post 2 (p = .245) and pre-knowledge (p = .343) indicating that those scores were normally distributed. Implications for Practice: An alarming number of older people experience poor pain management despite numerous pain management guidelines worldwide . Nurses’ knowledge and efficiency to accurately assess pain and provide appropriate interventions on time are critical to achieving effective pain management. Nurses play a vital role in the accurate assessment of pain and its effective treatment. Nurses should be knowledgeable regarding the up-to-date best practices in pain management. Hence it is crucial to consider incorporating pain management education to the nursing school curriculum so that nurses will be adequately prepared to practice evidence based pain management. All nursing programs should include a practicum to teach and evaluate accurate pain assessment and proper clinical documentation. Thus, an effective pain management educational program for nurses to foster adequate knowledge and attitudes toward pain management for the elderly. Though many national organizations have provided guidelines for pain assessment and management, there is no single guideline available for the nursing home residents. Considering the increasing aging population, the percentage of elderly with unrelieved pain and its overall impact on the quality of life of older people, it is imperative to have a unified state policy regarding pain management in the elderly. Available standardized clinical practice guidelines should be a part of state survey quality metrics of statewide long term care facilities. . The implementation of the state health policy on pain assessment and management for the elderly population should include four major steps: recognition, assessment, implementation and monitoring. A well-developed health policy, if followed, will help to ensure that pain among elderly people in the long term care facilities is adequately recognized, assessed, treated, and monitored. By implementing this guideline, healthcare providers can meet the expectations of patients, their families, advocates and policy makers for adequate, compassionate management of pain in the long term care settingDNPIncludes bibliographical reference