Alley, Linda G, PhD, RN

Baker, Kathy, MPH, RN

Etchason, Jeffrey, MD

Flores, Michelle D

Foltz, Carol A, PhD

Paxton, Hannah D, RN, MPH

Wike, Jen, MPH, MBA

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Community Health and Health StudiesExamining Nurses' Knowledge and AttitudesAbout Pain Management Using an Online SurveyLinda G. Alley PhD, RNLehigh Valley Health Network, Linda_G.Alley@lvhn.orgMichelle D. FloresLehigh Valley Health Network, Michelle_D.Flores@lvhn.orgHannah D. Paxton RN, MPHLehigh Valley Health Network, Hannah_D.Paxton@lvhn.orgKathy Baker MPH, RNLehigh Valley Health Network, Kathy.Baker@lvhn.orgCarol A. Foltz PhDLehigh Valley Health Network, Carol_A.Foltz@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/community_health_and_health_studiesPart of the Anesthesia and Analgesia Commons, Community Health and Preventive MedicineCommons, and the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtAlley, L., Flores, M., Paxton, H., Baker, K., Foltz, C., Wike, J., & Etchason, J. (2013, April). Examining nurses' knowledge and attitudesabout pain management, using an online survey. Poster presented at: The Eastern Nursing Research Society Annual Meeting in Boston,MA.AuthorsLinda G. Alley PhD, RN; Michelle D. Flores; Hannah D. Paxton RN, MPH; Kathy Baker MPH, RN; Carol A.Foltz PhD; Jen Wike MPH, MBA; and Jeffrey Etchason MDThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/community_health_and_health_studies/3Lehigh Valley Health Network, Allentown, PennsylvaniaExamining Nurses’ Knowledge and Attitudes About Pain Management,Using An Online SurveryL.G. Alley, PhD, RN; M.D. Flores, BSN, RN; H.D. Paxton, MPH, RN; K. Baker, MPH, RN; C. Foltz, PhD; J. Wike, MPH, MBA; J. Etchason, MDBackground/Purpose: 	 •	 	Past	studies	suggest	that	healthcare	providers’	decisions	about	pain	management	are	influenced	more	by	their	own	attitudes	and	beliefs	about	pain	than	by	a	thorough	assessment	of	their	patients’	current	status.		 •	 	Acknowledging	the	well-established	notion	that	knowledge	and	attitudes	guide	behaviors,	the	project	team	sought	to	examine	the	pain	management	knowledge	and	attitudes	of	nurses	working	in	the	Lehigh	Valley	Health	Network	and	use	the	results	to	implement	education	and	quality	improvement	(QI)	initiatives	to	improve	pain	management	for	Network	patients.		 •	 	Published	literature	indicates	that	web-based	surveys	offer	unique	advantages	that	more	traditional	survey	methods	lack.	Thus,	the	project	team	designed	a	web-based	pain	management	nurse	survey	tool.	 •	 	The	theoretical	framework	was	a	healthcare	network	adaptation	of	Michael	Harrison’s	model	of	an	organization	as	an	open	system,	providing	a	broad	organizational	context	in	which	pain	management	can	be	examined.	© 2013 Lehigh Valley Health NetworkMethods: The	project	was	reviewed	by	the	Network’s	IRB	and	deemed	to	be	QI.		 •	 	Population and setting:		The	study	population	for	the	survey	QI	project	was	all	registered	and	licensed	practical	nurses	working	on	inpatient	units	in	the	Network’s	three	hospitals.	 •	 	Designing the web-based survey: 	The	survey	was	comprised	of	the	40-item	Knowledge	and	Attitudes	Survey	Regarding	Pain	(Ferrell	&	McCaffery,	2008),	the	8-item	Accountability	for	Pain	Management	Questionnaire	(Alley,	2001),	and	10	demographic	items.		SelectSurvey	version	4.01,	an	online	software	tool	(ClassApps.com,	Overland	Park,	Kansas),	was	used	to	design	the	web-based	survey.	 •	 	Survey pilot testing:		The	survey	was	pilot	tested	with	a	separate	group	of	nurses	at	LVHN	who	were	not	part	of	the	final	sample.		The	survey	was	revised	based	on	pilot	subjects’	feedback,	resulting	in	the	final	survey.		Average	expected	time	to	complete	the	final	survey	was	20	minutes.	 •	 	Procedures:		To	maximize	the	visibility	of	and	interest	in	the	online	nurse	survey,	the	project	team	partnered	with	Network	Nursing	leadership	to	raise	awareness	of	the	study	and	encourage	participation.		The	Nurse	leaders	e-mailed	their	nursing	staff	members,	explaining	the	survey’s	purpose	and	how	results	would	be	used;	they	also	assured	staff	that	participants’	responses	would	be	anonymous.	Nurses	were	invited	to	participate	through	a	link	to	the	online	survey.		 •	 	During	the	survey	collection	period,	the	project	coordinator	sent	updates	to	Nursing	leadership,	reporting	response	rates	of	the	units	and	answering	survey-related	questions.	Nurses’	survey	responses	were	captured	in	an	Excel	database.		Data	were	analyzed	in	SPSS.	Results: 	 •	 	The	survey	was	conducted	during	June	through	August,	2012.	 •	 	The	survey	was	distributed	to	1763	Network	nurses,	of	whom	675	completed	the	entire	survey	(response	rate	=	38%).	 Knowledge and Attitudes About Pain Management	 •	 	Sixty	percent	(n=408)	scored	correctly	on	50-74%	of	the	knowledge/attitudes	items.		 •	 	Another	39%	(n=265)	answered	75-100%	of	the	items	correctly,	and	0.3%	(n=2)	answered	25-49%	correctly.		 •	 	Items	addressing	general	pain	management	concepts	received	the	highest	scores.		 •	 	Items	related	to	analgesics	and	to	pharmacology	concepts	received	the	lowest	scores.	 •	 	One-way	ANOVAs	were	used	to	test	differences	in	the	Knowledge	and	Attitudes	scores	by	nurses’	formal	education	level	(<4	years,	4	years,	>4	years)	and	years	of	nursing	experience	(<10	years,	11-20	years,	21-30	years,	>30	years).		 	 	 -	 	Nurses’	pain	management	Knowledge	and	Attitudes	scores	significantly	varied	by	education	level,	F	(2,	672)	=	6.23,	p	=	.002.		Nurses	with	more	than	4	years	of	education	had	significantly	higher	Knowledge	and	Attitudes	scores	compared	to	nurses	with	4	or	fewer	years	of	education.		 	 	 -	 	Nurse	Knowledge	and	Attitudes	scores	also	varied	by	years	of	nursing	experience,	F	(3,	671)	=	3.77,	p	=	.01.		Nurses	with	more	than	30	years	had	significantly	higher	nurse	Knowledge	and	Attitudes	scores	than	nurses	with	10	or	fewer	years	of	experience.		Scores	did	not	differ	among	any	other	groups.		 •	 	Spearman	correlational	coefficients	suggested	significant	relationships	between	nurses’	education	level	and	accountability	for	helping	patients	achieve	pain	relief,	evaluating	how	well	opioids	relieved	patients’	pain,	and	completing	an	initial	assessment	of	patients’	pain.		 	 	 -	 	Nurses	with	more	education	felt	more	accountable	for	helping	patients	achieve	pain	relief	(r[675]	=	.09,	p<.05),	evaluating	how	well	the	ordered	opioids	relieved	patients’	pain	(r[675]	=	.10,	p<.05),	and	completing	an	initial	assessment	of	patients’	pain	(r[675]	=	.09,	p<.05).		 •	 	Spearman	correlational	coefficients	also	suggested	significant	relationships	between	years	of	nursing	experience	and	accountability	for	limiting	a	patient’s	daily	amount	of	opioids	and	accountability	for	preventing	addiction.		 	 	 -	 	The	less	experience	a	nurse	had,	the	more	accountable	the	nurse	felt	for	limiting	a	patient’s	daily	amount	of	opioids,	regardless	of	the	intensity	of	pain	(r[675]	=	-.11,	p<	.01),	and	the	more	accountable	the	nurse	felt	for	preventing	addiction	in	patients	who	need	opioids	for	pain	relief	(r[675]	=	-.08,	p<.05).		 		 •	 	Most	respondents	believed	themselves	to	be	accountable	(i.e.	responsible)	for	basic	actions	consistent	with	good	pain	management	practices,	including:		helping	patients	achieve	relief	(n=459;	68%),	assessing	pain	(n=656,	97%),	and	initiating	care	plan	changes	(n=643;	95%).		 •	 	However,	a	considerable	number	of	nurses	also	felt	responsible	for	outdated	actions	that	are	inconsistent	with	good	pain	care:		preventing	drug	tolerance	(n=379,	56%),	determining	real	versus	imaginary	pain	(n=201;	30%),	and	preventing	addiction	(n=214,	32%).		Conclusions: 	 •	 	Given	nurses’	24-hours	a	day	presence	in	hospitals,	nurses	can	be	the	most	influential	force	in	improving	pain	care	and	developing	relevant	policies	to	guide	and	improve	healthcare	providers’	clinical	pain	practices.		Thus,	we	believe	that	learning	about	Network	nurses’	pain	management	knowledge	and	attitudes	is	a	key	step	toward	identifying	nurses’	educational	needs,	designing	relevant,	focused	pain	management	programs,	and	determining	how	to	make	Network	pain	policy	and	clinical	guidelines	useful.				 •	 	Overall,	Network	nurses’	survey	responses	indicate	a	fair	level	of	baseline	knowledge	about	general	pain	management	topics.		Pain	education	programs	will	be	developed	to	reinforce	general	concepts	and	address	in	depth	the	pain	content	areas	in	which	improvements	are	most	needed,	e.g.	knowledge	about	the	use	of	analgesics	and	about	pharmacology	concepts,	understanding	state-of-the-art	principles	related	to	addiction	and	drug	tolerance.	 •	 	Our	experience	has	demonstrated	that	obtaining	current	information	about	pain	management-related	knowledge	and	attitudes	of	on-duty	nurses	working	in	busy	healthcare	settings	can	be	done	efficiently	and	effectively	using	an	online	survey.		After	improving	our	survey	processes,	we	plan	to	conduct	similar	surveys	with	other	Network	healthcare	provider	groups	(e.g.,	pharmacists,	physicians,	etc.).		Educational	programs	can	then	be	tailored	to	the	needs	of	the	various	provider	groups.		 •	 	The	response	rate	of	38%	is	lower	than	we	had	expected,	yet	the	online	methodology	was	advantageous	for	several	reasons,	including:		 	 	 -	 	Quick,	easy	access	to	1700	Network	nurses,	many	of	whom	would	have	been	challenging	to	reach	using	more	traditional	survey	formats;	and	 	 	 -	 	The	financial	savings	of	using	an	electronic	survey	format.	 •	 	There	are	many	ways	to	improve	the	response	rates	for	future	surveys:	 	 	 -	 	Allow	project	team	members	to	directly	contact	nurses	in	order	to	monitor	and	facilitate	completion	of	the	surveys	in	“real	time”;	 	 	 -	 	Include	more	interaction	between	the	project	team	and	staff	RNs,	management,	and	nursing	leadership	in	order	to	improve	communications	and	understanding	of	the	project	and	respond	to	questions	directly	about	how	to	complete	the	survey;	 	 	 -	 	Consider	providing	incentives	to	reinforce	the	importance	of	receiving	responses	from	the	survey	recipients;	and	 	 	 -	 	Improve	the	survey	technology	so	that	it	allows	for	better	access	and	improved	ease	of	use,	to	overcome	some	of	the	barriers	that	respondents	encountered	in	completing	the	survey	in	a	timely	manner.*Mean and standard deviationDemographicsSources most often listed by respondents used to inform their clinical practice in managing patients’ painTable 1. Demographics of Nurse Respondents (n=675)            N %Age 39* 12*Number of years at Network 9* 10*Number of years in nursing 12* 12*Nursing Education      BSN 373 55     Associates degree 207 31     Bachelor’s degree, non-nursing 87 13     Diploma 85 13     MSN 28 4     Master’s degree, non-nursing 11 2     LPN 6 1     Post Master’s Nursing degree 2 0.3     Post Master’s degree, non-nursing 1 0.1Nursing roleStaff Nurse 609 90Other 66 10Table 2. Accountability for Pain ManagementDisagree Agree            I am Accountable for: N % N %Helping patients achieve pain relief 216 32 459 68Preventing patients from developing drug tolerance to a given dose level of opioids 296 44 379 56Evaluating how well the opioids ordered for patients relieve their pain 28 4 647 96Determining real versus imaginary pain in a patient who reports pain 474 70 201 30Limiting a patient’s daily amount of opioids, regardless of the intensity of pain 538 80 137 20Beginning efforts to change a patient’s plan of care when the current treatment is not working 32 5 643 95Doing a complete initial assessment of patients’ pain 19 3 656 97Preventing addiction in patients who need opioids for pain relief 461 68 214 32Table 3. Sources        Sources   N %Policy, procedure manuals, or practice guidelines 192 28Hospital personnel,  including physicians, pharmacists, pain management specialists 179 27Pain scales 158 23KRAMES On-Demand, a patient education system 112 17Internet or Intranet 45 7Accountability for Pain Management

Examining Nurses\u27 Knowledge and Attitudes About Pain Management Using an Online Survey

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1002&context=community_health_and_health_studies

Examining Nurses\u27 Knowledge and Attitudes About Pain Management Using an Online Survey

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