Drake, GF; (2015) Barriers and potential solutions to effective pain management on a gastro-intestinal ward: an action research study in a university hospital. Doctoral thesis , UCL (University College London).

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Abstract

Aims: The current review examined the effects of nursing educational interventions on clinical outcomes for acute pain management in hospital settings, with emphasis given to the teaching methods used. The review also aimed to map these teaching methods onto known domains involved in healthcare behaviour-change, with reference to constructs developed by Michie and colleagues (2005). Methods: Three databases, Embase, Medline and CINAHL, were searched for experimental, quasi-experimental and observational studies, published between 2002 and 2015, that investigated nursing educational interventions in acute hospital settings and reported clinical outcomes. Included studies were appraised for quality using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies (EPHPP). Results: Twelve studies were reviewed. A range of didactic and interactive teaching methods were used in the studies. These mapped onto many domains theorised to be involved in healthcare behaviour-change, though the studies did not explicitly reference the theory underlying the design of their interventions. All except four studies investigated nursing documentation of pain assessment as the main clinical outcome, with the majority finding positive effects of educational interventions on nursing pain assessment. Of the remaining studies, one used patient satisfaction with pain management as the main outcome, two included patient self-report of pain scores as the key measure and one study measured changes in nurses’ delivery of a relaxation intervention for pain after an educational intervention. These findings were more mixed with some positive outcomes in patient satisfaction and reductions in self-reported pain scores following nursing interventions. Conclusions: More needs to be done in the design of nursing educational interventions to factor in existing theory on behaviour-change as well as to give emphasis to the relational, contextual and emotive nature of nursing pain management in hospital settings.

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