Prófun á áhrifum starfsþróunaríhlutunar fyrir hjúkrunarfræðinga til að bæta verkjameðferð - verkefni lokið

Fréttatilkynning verkefnisstjóra


The purpose of the study was to test the effectiveness of an evidence-based staff development program, aimed at nurses, called the PRN program to improve nurses' knowledge, attitudes, and practices (e.g. documentation) and to improve patients' experience of pain management (e.g. time spent in severe pain). In addition, the goal was to evaluate the epidemiology of pain at a university hospital and to assess the quality of pain management. 

Heiti verkefnis: Prófun á áhrifum starfsþróunaríhlutunar fyrir hjúkrunarfræðinga til að bæta verkjameðferð
Verkefnisstjóri: Sigríður Gunnarsdóttir, Háskóla Íslands/Landspítala-háskólasjúkrahúsi

Tegund styrks: Verkefnisstyrkur
Styrkár: 2011-2013
Fjárhæð styrks: 19,976 millj. kr. alls
Tilvísunarnúmer Rannís:  110409

Two nurses from each of the 23 participating surgical and medical units at Landspitali-The National University Hospital of Iceland (LSH) were selected to participate in the PRN-program. The program consisted of a three day course in pain management with a structured follow up. After a baseline measurement (T1), the units were randomized to either receive the intervention or to serve as a wait-list control. The control group received the intervention following a second data collection 10 months from baseline (T2). Data on knowledge and attitudes regarding pain management were collected from nurses, but patient data were collected with the American Pain Society Patient Outcome Questionnaire and from medical records. Patients had to be ≥18 years old, hospitalized for ≥24 hours, alert and able to participate. Descriptive statistics were used to describe pain variables and demographic data. A mixed model, hierarchical (nested) ANOVA was used to analyze treatment effects. Significance level was set at p < 0.05.

At baseline, pain was found to be prevalent as 83% of patients hospitalized for 24 hours or more experienced pain and 35% had experienced severe pain (≥7 on 0-10 scale) during that same timeframe. Participation in decision making and patient satisfaction were related to less time in severe pain and better pain relief (p<0.01). The majority of patients (85%) were prescribed analgesics, but 36% of patients were not administered adequate treatment. Pain assessment was documented for 57% of patients, but use of standardized scales to measure pain severity was rare (15%). Patients who were assessed with standardized scales were more likely to be administered adequate pain treatment (OR 3.44; 95% CI 1.38-8.60). Assessment of the effectiveness of the program showed that pain assessment using standardized scales to measure pain severity increased significantly (p<0.05), but no differences were found for patient outcomes or in nurses' knowledge and attitudes.

The project has resulted in one doctoral thesis and three BS theses. Six peer reviewed articles have been published or accepted for publication so far and two more are in the final stages of preparation before submission to peer review. In addition it has produced 11 congress lectures and 12 poster presentations. The study has increased knowledge on the effectiveness of the PRN program, knowledge which has international significance. In addition it has increased knowledge on the epidemiology of pain and the quality of pain management at LSH and has lead to improvements in structural aspects of pain management at the hospital. The implementation of the PRN program has resulted in increased awareness of pain management and increased numbers of trained professionals in pain management at the hospital.

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