Transcript View Poster - pantherFILE - University of Wisconsin–Milwaukee

Gustavo Medrano1, Susan Heinze1, Michelle Czarnecki2, MSN, RN-C, CPNP; Katherine Simon1, MS; Helen Turner3, MSN, RN, PCNS-BC;
Sharon Wrona4, RN, MS, PNP-BC
University of Wisconsin-Milwaukee1,Children’s Hospital of Wisconsin2, Milwaukee, WI; Doernbecher Children's Hospital3, Portland, OR;
and, Nationwide Children’s Hospital4, Columbus, OH
Tables I and II: Demographics
Background
Acute pain in children has been shown to have numerous
negative effects, including longer postoperative recovery
times, decreased activity and poorer sleep. Despite many
advances, optimal management remains elusive
(American Pain Society, 2003). There have been
numerous studies that have examined the barriers to
optimal pain management in the adult population, although
few have looked into the pediatric population (Vincent,
2005). Vincent (2005) found that the six most common
barriers in pediatric nursing population were:
1.
2.
3.
4.
5.
6.
Inadequate or insufficient physician medication
orders.
Children’s reluctance to report pain.
Parents’ reluctance to have children receive
medications.
Children’s reluctance to take pain medications.
Nurses’ own concern over medication side effects.
The low priority given to pain management by
medical staff.
Hypothesis: There are significant differences in the
nurses’ perception of barriers to optimal pain
management, dependent on years of pediatric nursing
experience.
Methods
For the current study, 808 nurses from three pediatric
hospitals (two Midwestern, one West Coast) completed an
online survey on barriers to optimal pain management,
adapted with permission from Vincent (2004).
• The Adapted Barriers to Optimal Pain Management
Questionnaire is a 30-item measure that asks nurses to rank
how much each barrier interferes with their ability to provide
optimal pain management on a 10 point scale; with 0
meaning “not at all a barrier” and 10 meaning “a major
barrier.”
• Response rates ranged from 11% (1 Midwestern) to 41%
(West Coast).
• The top three departments reported were ambulatory
(10.0%), PICU (8.7%), and day surgery/PACU/UR (7.9%).
•The demographics of the participants are presented in
Tables I and II. As the demographics from the three sites
were similar, data was compiled in subsequent analysis.
•As hypothesized, significant differences were found between nurses’ perceptions
of barriers to optimal pain management according to years of pediatric nursing
experience.
Children’s
Hospital of
Wisconsin
N = 442
Doernbecher
Children’s
Hospital
N = 123
Nationwide
Children’s
Hospital
N = 243
Across all 3
hospitals
N = 808
Gender
(Female)
97.8%
95.8%
99.2%
97.9%
•Specifically, barriers having to do with nurses’ beliefs and biases were found to be
ranked higher by nurses with less pediatric nursing experience (p<.01).
Ethnicity
(Caucasian)
96.8%
92.2%
97.0%
96.2%
•Also, barriers having to do with the patient or his/her parent were found to be
ranked higher by nurses with less pediatric nursing experience (p<.05).
Highest
Education
Level
(Baccalaureate)
75.7%
60.7%
41.7%
62.9%
Role
(Staff Nurse)
88.4%
95.9%
63.0%
81.8%
Current Study
Purpose: While it is helpful to know which barriers need
to be addressed, the relationship between nurses’ years
of experience and the barriers they perceive needs to be
explored. Developing appropriate methods to decrease
barriers may depend on the experience of the nurse.
Discussion
Years of
Pediatric
Nursing
Experienceα
αM=3.75,
Less
than 2
N= 102
13.1%
2 to 5
N=125
5 to10
N=165
10 to 15
N=78
15 to 20
N=91
16.0%
21.2%
10.0%
11.7%
Greater
than 20
N=219
28.1%
•Post-hoc analysis showed that a majority of the significant differences between
experience groups were between the least experienced (less than 2 years and 2-5
years) and the rest of the sample (5 to10 years, 10 to 15 years, 15 to 20 years and
greater than 20 years). All significant differences were of the lesser experienced
nurses ranking barriers higher than more experienced nurses.
•In developing protocols to optimize pain management, nurses’ experience needs
to be considered since lesser experienced nurses were shown to significantly rank
certain barriers higher than more experienced nurses.
•Future research is needed addressing why less experienced nurses differ from the
rest of the population when it comes to their perceptions of barriers having to do
with the patient /their parent and of their own beliefs and biases. This difference
could be due to differences in content knowledge and experience or generational.
Elucidation on this matter could lead to more effective training designed to optimize
pediatric pain management.
Selected References
SD= 1.79
American Pain Society (APS). (2003). Principles of analgesic use in the treatment of acute pain and
cancer pain. (5th ed). Glenview, IL: Author.
Results
Per Czarnekci et al. (under editorial review), the items on The Barriers to Optimal Pain
Management were divided into three factors: Institutional Barriers, Patient Barriers, and
Beliefs and Biases. An ANOVA was conducted with the Pain Barrier factors as the
dependent variable and Years of Pediatric Nursing Experience as the independent variable
(Table III). Post-hoc analysis was conducted to determine which experience groups were
significantly different from each other with regard to their responses to the three Pain
Barrier factors.
Czarnekci, M et. al.(under editorial review). Barriers to Pediatric Pain Management. Pain
Management Nursing .
Van Hulle, Vincent, C. (2005). Nurses’ knowledge, attitudes, and practices: Regarding children’s
pain. MCN, 30(3), 177-183.
Table III
Analysis of Variance for Years of Pediatric Nursing Experience
__________________________________________________________________________________________________________________________________________________
Barrier Factor
<2 yrs
2 -5 yrs
5-10 yrs
10-15 yrs
15-20 yrs
>20 yrs
F
__________________________________________________________________________________________________________________________________________________
Beliefs and Biasesα
10.78 (5.26)
10.62 (4.88)
9.24 (4.50)
8.5 (4.55)
8.19 (4.27)
8.25 (4.04)
F(5)= 8.07
p<.01
Institutional Commitmentb
34.74 (12.22)
35.02 (12.35)
35.86 (12.06)
35.42 (14.02)
35.82 (14.38)
32.98 (13.22)
Patient/Parent Barriersc
12.81 (5.61)
12.08 (5.89)
11.73 (5.78)
11.40 (5.37)
12.22 (6.32)
10.57 (5.52)
F(5)=1.10
p=.36
F(5)= 2.68
p=.02
__________________________________________________________________________________________________________________________________________________
αExamples
of Beliefs and Biases include nurses’ concerns over drug addiction and side effects.
bExamples of Institutional Commitment include low priority given to pain management by medical staff and insufficient resources.
cExamples of Patient Barriers include patients’ reluctance to take medication and report pain.
The authors would like to acknowledge the nursing staff that participated at all three locations.
Without their support, many things would not be possible.
For information, please contact Gustavo Medrano at [email protected]