Educational gaps among healthcare providers: An institution needs assessment to improve pain management for postsurgical patients

Marlís González-Fernández, MD, PhD; Hanan Aboumatar, MD, MPH; Deena Conti, RN, MS; Amit M. Patel, MD; Michael A. Purvin, MD; Marie Hanna, MD

doi:10.5055/jom.2014.0224

Authors

Marlís González-Fernández, MD, PhD
Hanan Aboumatar, MD, MPH
Deena Conti, RN, MS
Amit M. Patel, MD
Michael A. Purvin, MD
Marie Hanna, MD

DOI:

https://doi.org/10.5055/jom.2014.0224

Keywords:

acute pain management, knowledge and attitudes, analgesia, pain management education, quality improvement

Abstract

Objective: Nurses should be educated in pain management because they are more likely than other healthcare professionals to educate patients about their pain. The authors sought to identify the knowledge gaps in postoperative pain management among postsurgical nursing staff and the existence of institutional policies and educational programs to support them in delivering optimal pain management services.

Setting: Academic hospital.

Participants: Two hundred seventy-seven registered nurses, nurse practitioners, nurse managers, physician assistants, and other health professionals.

Interventions: Nurses participated in an online, anonymous survey that consisted of 43 questions in two broad categories: (1) knowledge and attitudes about pain management and (2) institutional pain management and assessment.

Main Outcome Measure: Knowledge base of surgical nursing staff regarding postoperative pain management.

Results: The overall mean knowledge score was 44.84 percent, with the highest percent of correct answers in the cancer pain category (54.03 percent). Recognition of signs and symptoms of pain had the lowest correct response rate (40.91 percent). Forty-nine percent of respondents reported that pain management protocols tailored to the specific population treated were available, 42 percent reported that patient pain education was always performed, 29 percent reported that they received regular training about pain management, and 17 percent had access to national pain management guidelines.

Conclusion: The survey results demonstrate general gaps in pain management knowledge among nurses, particularly in recognizing signs and symptoms of pain. This work may guide the development of programs that improve postoperative pain management by increasing the frequency of nurses' pain education and improving the availability of pain-related policies and protocols.

Author Biographies

Marlís González-Fernández, MD, PhD

Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Hanan Aboumatar, MD, MPH

Department of Medicine, Armstrong Institute for Safety and Quality, Johns Hopkins University, Baltimore, Maryland.

Deena Conti, RN, MS

Department of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland

Amit M. Patel, MD

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Michael A. Purvin, MD

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Marie Hanna, MD

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

References

Apfelbaum JL, Chen C, Mehta SS, et al.: Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97(2): 534-540. DOI: https://doi.org/10.1213/01.ANE.0000068822.10113.9E

Chung F, Ritchie E, Su J: Postoperative pain in ambulatory surgery. Anesth Analg. 1997; 85(4): 808-816. DOI: https://doi.org/10.1213/00000539-199710000-00017

Fortier J, Chung F, Su J: Unanticipated admission after ambulatory surgery—A prospective study. Can J Anaesth. 1998; 45(7): 612-619. DOI: https://doi.org/10.1007/BF03012088

Hadzic A, Karaca PE, Hobeika P, et al.: Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg. 2005; 100(4): 976-981. DOI: https://doi.org/10.1213/01.ANE.0000150944.95158.B9

Pavlin DJ, Rapp SE, Polissar NL, et al.: Factors affecting discharge time in adult outpatients. Anesth Analg. 1998; 87(4): 816-826. DOI: https://doi.org/10.1213/00000539-199810000-00014

Carroll NV, Miederhoff PA, Cox FM, et al.: Costs incurred by outpatient surgical centers in managing postoperative nausea and vomiting. J Clin Anesth. 1994; 6(5): 364-369. DOI: https://doi.org/10.1016/S0952-8180(05)80004-2

Gloth FM III: Pain management in older adults: Prevention and treatment. J Am Geriatr Soc. 2001; 49(2): 188-199. DOI: https://doi.org/10.1046/j.1532-5415.2001.49041.x

D'Alessio JG, Rosenblum M, Shea KP, et al.: A retrospective comparison of interscalene block and general anesthesia for ambulatory surgery shoulder arthroscopy. Reg Anesth. 1995; 20(1): 62-68.

Bardiau FM, Taviaux NF, Albert A, et al.: An intervention study to enhance postoperative pain management. Anesth Analg. 2003; 96(1): 179-185. DOI: https://doi.org/10.1213/00000539-200301000-00038

Mackintosh C, Bowles S: The effect of an acute pain service on nurses' knowledge and beliefs about post-operative pain. J Clin Nurs. 2000; 9(1): 119-126. DOI: https://doi.org/10.1046/j.1365-2702.2000.00345.x

Powell AE, Davies HT, Bannister J, et al.: Challenge of improving postoperative pain management: Case studies of three acute pain services in the UK National Health Service. Br J Anaesth. 2009; 102(6): 824-831. DOI: https://doi.org/10.1093/bja/aep066

Gleeson E, Carryer J: Nursing staff satisfaction with the acute pain service in a surgical ward setting. Nurs Prax N Z. 2010; 26(1): 14-26.

Chan SK, Chui PT, Lee A, et al.: Surgeons' attitudes and perception of an acute pain service. Hong Kong Med J. 2008; 14(5): 342-347.

Gordon DB, Dahl J, Phillips P, et al.: The use of “as-needed” range orders for opioid analgesics in the management of acute pain: A consensus statement of the American Society for Pain Management Nursing and the American Pain Society. Pain Manag Nurs. 2004; 5(2): 53-58. DOI: https://doi.org/10.1016/j.pmn.2004.04.001

Ferrell BR, McCaffery M: Knowledge and Attitudes Survey Regarding Pain. Available at http://prc.coh.org/Knowldege%20%20Attitude%20Survey%20-%20updated%205-08.pdf. Accessed November 4, 2010.

The Joint Commission: Effective pain management. Tips for undergoing a complex task. The Joint Commission: The Source. 2009; 7(6): 5, 8-9.

Castle NG, Brown J, Hepner KA, et al.: Review of the literature on survey instruments used to collect data on hospital patients' perceptions of care. Health Serv Res. 2005; 40(6 Pt 2): 1996-2017. DOI: https://doi.org/10.1111/j.1475-6773.2005.00475.x

Giordano LA, Elliott MN, Goldstein E, et al.: Development, implementation, and public reporting of the HCAHPS survey. Med Care Res Rev. 2010; 67(1): 27-37. DOI: https://doi.org/10.1177/1077558709341065

Hanna MN, Gonzalez-Fernandez M, Barrett AD, et al.: Does patient perception of pain control affect patient satisfaction across surgical units in a tertiary teaching hospital? Am J Med Qual. 2012; 27(5): 411-416. DOI: https://doi.org/10.1177/1062860611427769