Pain Monitoring Program Raises Nurses’ Pain Knowledge

AMSTERDAM—A pain monitoring program for nurses implemented at three Dutch hospitals not only raised the nurses’ knowledge of pain and its treatment but also led to improvements in nurses’ attention to patients’ pain complaints.

The key to the program was its inclusion of a twice-daily pain assessment by nurses, using a numeric rating scale, in addition to a 3-hour educational program about pain management and the use of the assessment tool, said Marlies E.J. de Rond, RN, MS, of The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, and her colleagues.

Just before the start of the pain monitoring program and 6 months after, nurses completed a questionnaire regarding their pain knowledge (eight items) and attitudes (nine items).

At pretest, a majority of the nurses said they had received little or no training in pain management during their basic nursing education. Only 31.4% indicated they had taken any courses that included information on pain management after their basic education.

The pretest analysis included 175 nurses, and the post-test analysis involved 144 nurses. After the educational intervention, the mean score on the knowledge test improved from 69.1% to 75.8% (P < .001) (J Pain Symptom Manage 19:457-467, 2000). Analysis of individual items on the knowledge test showed significant improvements on several important items (see Table).

“A 7% increase on the knowledge test may seem rather moderate,” the authors said, “ but it should be noted that summary scores of 8 items can be misleading. On important issues [shown in the table], there was a substantial increase in knowledge.”

The attitudes test showed that “more nurses felt they had sufficient knowledge and skills to relieve pain” after the intervention, the authors said. At pretest, 78% of the nurses said they felt that nurses pay enough attention to patients’ complaints of pain. Six months after completion of the program, 85% agreed with the statement (P < .05).

Analysis of the pretest scores showed that age and additional pain courses were significant predictors of pain knowledge.

The authors noted that previous work by De Wit et al (Pain 73:55-69, 1997) showed that cancer patients with chronic pain and nurses tend to score lowest on the same items (“Giving the lowest amount of medicine possible,” “patients are often overmedicated,” “psychological addiction is inevitable over time”) and highest on the same item (“treatments other than medications can be effective”).

“Because patients and nurses have the same deficits in knowledge, educating nurses is very important in order to address misconceptions and myths about pain management,” the Dutch researchers pointed out.