Purpose/Objectives:
This program evaluation was completed to determine the effectiveness of the Pain Resource Nurse (PRN) Program for reducing barriers to optimal pediatric pain management and to describe what behaviors PRNs use to influence changes in practice as they enact their role as local pain experts.
Significance:
Children are identified as a vulnerable population at risk for undertreatment of pain. Poorly treated pain can lead to impaired healing, delayed recovery, prolonged hospitalization, exacerbation of illness or injury, and even death.
Background/Rationale:
Barriers to optimal pain management generally cluster into 3 areas: patients and families, healthcare providers, and healthcare systems. The impact of the PRN Program on these barriers has not been measured. Understanding how the PRN role is enacted will allow organizations to better plan, implement, and support PRNs. The following questions were used in the evaluation: (1) Does the PRN Program decrease nurses' perceptions of barriers to pain management? (2) What behaviors do PRNs use to influence change in practice as they enact their role as pain experts? (3) Does the PRN Program improve family pain satisfaction scores?
Description:
Measures used were the Barriers to Optimal Pain Management Survey, content analysis of feedback from PRNs, and Press Ganey pain satisfaction results. Comparisons of perceived barriers and mean patient satisfaction scores were carried out pre- and postimplementation of the PRN Program.
Outcome:
Barriers related to nurses' beliefs and biases were decreased, institutional commitment/systems barriers were increased, and there was no change in patient/family barriers. PRNs used role enactment behaviors similar to those reported in the literature (resource, change agent, role model, and advocate). The PRN Program did not improve patient satisfaction with pain management.
Interpretation/Conclusion:
The PRN Program can be used effectively to decrease barriers and improve pain care.
Implications for Practice:
Clinical practice involves maintaining and improving gains, expansion of the program to other units, engagement of physicians in decreasing systems barriers and increasing institutional commitment, and efforts to decrease patient and family barriers. Future research will include regular monitoring of barriers and satisfaction and a cost-effectiveness analysis.
Section Description
The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.
A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.
The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.
Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.