A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design

Abstract

BackgroundPain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted.Methods/designA quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention.DiscussionNursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group's pain will be implemented more widely.Trial Registration NumberClinicalTrials.gov NCT01313234

Challenges to evaluating complex interventions: a content analysis of published papers

“…Drawing on previous studies, Borglin, Gustafsson and Krona [14] describe using the Theory of Planned Behaviour to develop a series of workshops for nurses to improve pain management for cancer patients. The Normalisation Process Model [15] was used as a theoretical framework in two RCTs in maternity care and was reported to be of value in understanding organisational contexts into which new models of care are introduced [16].…”

Knowledge and attitudes of nurses toward pain management

“…Modern programs have been implemented in Australia, the USA, and Sweden, suggesting that there is considerable room for local improvement. [ 36 37 ]…”

Knowledge and attitude towards pain management. A comparison between oncology and non-oncology nurses in Jordan

“…For instance, nurse stated 'Patients don't really know how to rate pain, some always rate the pain the same, but they are able to sleep' [10]. Borglin et al [34] argue that patients perceived the crucial role in increasing pain levels is that having their pain assessed incorrectly. The study was also consistent with Fothergill-Bourbonnais and Wilson-Barnett [28] who concluded that clinical experience is the most influential factor that promotes nurses knowledge and confidence in managing patient's pain.…”

“…The non-oncology nurses showed more confidence than oncology nurses in using aspirin and using analgesics in patients with acute abdomen (q 23 and 24). However, the most significant barrier to undertaking an effective pain management is nurses' reliance on their own subjective judgment [10,34]. To manage patient pain effectively, nurses must trust patient self-report, even if it appears incongruent with the patient's nonverbal behavior or the nurses' individual beliefs.…”