Pain management competency evidenced by a survey of pediatric nurses' knowledge and attitudes

Nurses' knowledge and attitudes about pain management affect their capability to attend to children in pain. A modified version of the Pediatric Nurses' Knowledge and Attitude Survey (PNKAS--Manworren and Shriners Hospitals for Children Version, 2002) was used to evaluate nursing competency to manage pain at eight pediatric hospitals. A convenience sample of 295 nurses attained a mean individual test score of 74% correct. Scores were correlated with demographic data. The novice group with 0-2 years nursing experience had significantly (p<0.05) lower scores (fewer correct answers) than the other five groups with more than 2 years of nursing experience. The nurses who participated in professional nursing organizations or nursing committees had significantly higher scores than those who did not participate. Nursing education, professional activity, and years of clinical experience contribute to the knowledge necessary for competency in pain management, as evidenced by higher scores using this survey tool.     

Fever management: paediatric nurses' knowledge, attitudes and influencing factors

AIMS: This paper describes Australian paediatric nurses' knowledge of and attitudes toward fever and its management and the predictors of their intentions to administer paracetamol to a febrile child. BACKGROUND: Despite evidence-based support for the beneficial effects of fever over the past three decades, health professionals' negative attitudes toward fever and their reliance on antipyretics to reduce it have persisted and continue to be reported in the literature. METHODS: A self-report questionnaire was used. An instrument was developed, piloted by test-retest and revised prior to data collection. Fifty-one paediatric nurses working in medical wards of a metropolitan paediatric hospital in Australia participated. RESULTS: Nurses' mean knowledge score about the physiology of fever, general fever management and antipyretics was 62%, which was not as high as expected. Participants reported positive attitudes toward the benefits of fever, the necessity for its reduction in children with pre-existing cardiac or respiratory conditions and towards regular antipyretic administration masking the infective process. Negative attitudes included disbelief that temperature is often unrelated to illness severity. Conflicting attitudes toward febrile convulsions were highlighted by beliefs that antipyretic therapy prevents these and that antipyretics do not prevent initial febrile convulsions. Predictors of intentions to administer paracetamol were beliefs about the effectiveness of paracetamol and nurses' beliefs about the expectations of others in relation to paracetamol administration. Nurses reported strong intentions to administer paracetamol to the next febrile child they cared for. Limitations of the study include the use of a nurse manager for recruitment and collecting the data at only one site. CONCLUSIONS: Fever management is an integral aspect of paediatric nursing. For its consistent rational management, nurses must have appropriate knowledge and positive attitudes. This highlights the need for continuing education in fever management.     

Sexuality in early childhood: pediatric nurses' attitudes,knowledge, and clinical practice

This exploratory study assessed pediatric nurses' attitudes, knowledge, and patient care practices related to the sexuality of hospitalized preschool and early school-age children. Sexuality was defined as the sum of the physical, emotional, and psychologic attributes that are expressed in gender identity and behavior. For this study, a questionnaire containing 24 attitude, 20 knowledge, and 29 nursing practice Likert-scale items was used to survey 45 pediatric nurses in a southeastern tertiary care teaching hospital. Results indicated that, in general, the nurses surveyed had positive attitudes, sound knowledge, and appropriate practice with regard to the sexuality-related needs of their patients. However, there appeared to be some attitudinal biases and knowledge gaps that could adversely affect nursing practice. These findings were used to alter the content in pediatric nursing education at the study institution.     

Portuguese nurses' knowledge of and attitudes toward hospitalized older adults

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses′ education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross‐sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence‐based guidelines in their practice.     

Assessment of nurses' attitudes and knowledge regarding pain management

BACKGROUND: RNs in North Carolina were surveyed to determine their current knowledge and to determine if educational preparation, practice setting, or clinical specialty influenced their knowledge levels and attitudes. METHOD: A stratified random sample of 1,000 practicing RNs in North Carolina were surveyed using the Nurses' Knowledge and Attitudes Survey Instrument developed by McCaffery and Ferrell. RESULTS: The mean score was 64.58 based on the percentage of correct responses from the 260 subjects who participated. No statistically significant difference was found in scores based on educational preparation, practice setting, or clinical specialty. CONCLUSION: The findings of this study support the concern of inadequate knowledge and inappropriate attitudes regarding pain management. It reveals the need for intensive continuing education and staff development.     

Improving paediatric nurses' knowledge and attitudes in childhood fever management

AIM: This paper reports an evaluation of the effectiveness of a peer education programme in developing paediatric nurses' evidence-based knowledge and attitudes towards fever management and the sustainability of these changes. BACKGROUND: In general, paediatric nurses' fever management knowledge seems to be mediocre. They believe fever to be harmful, causing febrile convulsions and brain damage. Antipyretics are administered to prevent febrile convulsions and alternate antipyretics are given when temperatures are not reduced. METHOD: A quasi-experiment was conducted from August 2002 to March 2003. An experimental group of Registered Nurses received the peer education programme and peer support and education were promoted for those unable to attend the sessions. A control group continued its normal practices. Seventy-seven nurses were eligible to attend the programme; 74.0% attended at least one session, 52% two or more. Questionnaire data were collected 1 month before and 1 and 4 months after the peer education programme from 56.3% to 77.8% of eligible experimental and 40.9% to 51.6% of eligible control group nurses. FINDINGS: Interaction effects between group and time were found in overall knowledge (P = 0.01), specifically knowledge of the physiology of fever (P = 0.001), and attitudes towards evidence-based fever management (P = 0.05). In addition, experimental group nurses demonstrated statistically significantly more knowledge of general fever management principles at 4 months after the intervention than control group nurses (P = 0.01), and compared with their own knowledge at baseline (P < 0.001). CONCLUSIONS: Educational programmes targeting practice change must be theoretically based and target knowledge, attitudes and barriers to change. The programme tested here, which incorporated peer education and support and facilitated group change, is adaptable to other practices, groups and settings.     

Nurses' knowledge and attitudes in pain management practice

Nursing a patient in pain is a challenging task requiring up-to-date knowledge, skilled interventions and attitudes that convey trust, care and an honest belief in what the patient says (Carr, 1997). This study examined the knowledge and attitudes of nurses who have completed a knowledge and competency training programme within an orthopaedic centre (Group one) against a group of nurses who were attending a pain conference who had not completed this programme (Group two). The questionnaire used was the Nurse's Knowledge and Attitudes Survey Regarding Pain (Ferrell and McCaffery, 2002). Findings from the survey revealed that there was no significant difference in the total correct responses between the two groups and there was a severe deficit in knowledge relating to questions about non-pharmacological methods of treating pain and opioid use in chronic pain conditions. However Group one had a higher correct response rate (p=0.001) in the vignettes that are based on daily nursing practice.     

Long-term care personnel assess their attitudes and knowledge of the older adult

The purpose of this study was to compare long-term care employees' attitude and knowledge about myths of ageing and normal age changes, before and after exposure to formal educational sessions. The researchers investigated if there was a difference in knowledge level and change in attitudes of long-term care employees after educational sessions. The subjects for this study were defined as persons who had any contact with the residents at St Charles Care Center. The final data set used in the analysis contained 84 observations. Each participant attended three 1-hour classes which consisted of simulation of handicaps, normal age-related changes, and myths and realities of ageing. Overall, there was a significant increase in knowledge from the pre-test to the post-test. The study also tested for a negative (anti-aged) bias attitude and a positive (falsely pro-aged) bias attitude among the individuals. At the end of the study there was still a slight negative biased attitude towards ageing. The data suggest that continuing education is an effective means of influencing the knowledge and attitudes of personnel in long-term care facilities. Recommendation for future research should be that this study be replicated in another long-term care facility with the addition of a job satisfaction tool.     

A cluster analysis to investigating nurses' knowledge, attitudes, and skills regarding the clinical management system

Nurses' knowledge, attitudes, and skills regarding the Clinical Management System are explored by identifying profiles of nurses working in Hong Kong. A total of 282 nurses from four hospitals completed a self-reported questionnaire during the period from December 2004 to May 2005. Two-step cluster analysis yielded two clusters. The first cluster (n = 159, 56.4%) was labeled "negative attitudes, less skillful, and average knowledge" group. The second cluster (n = 123, 43.6%) was labeled "positive attitudes, good knowledge, but less skillful." There was a positive correlation in cluster 1 for nurses' knowledge and attitudes (rs = 0.28) and in cluster 2 for nurses' skills and attitudes (rs = 0.25) toward computerization. The study showed that senior and more highly educated nurses generally held more positive attitudes to computerization, whereas the attitudes among younger and less well educated nurses generally were more negative. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' computer knowledge and skills and improve their attitudes toward computerization.     

The effect of postoperative pain management program on improving nurses' knowledge and attitudes toward pain

Effective postoperative pain treatment is an essential component to good quality of care. The purpose of this study was to explore nurses' knowledge of and attitudes toward pain in surgical wards before and after implementation of a postoperative management program at a university hospital in Jordan. The program consisted of an education program for nurses, and its effect was evaluated by using a pre- and post-intervention design. Sixty five registered nurses were asked to respond to a 21 items questionnaire, and a total of 240 patients' records were audited. After implementation of the program, the mean scores for all the questionnaire items were found to increase to 75%, with an average of 16/21 for the correct answers. There was a statistically significant difference (p < 0.05) between the number of correct answers between nurses' responses in the pre-intervention phase and their responses in the post-intervention phase for most of the questionnaire items. Also, there was a statistically significant improvement in the documentation of patients' care in 85% of the audited patients' records. It was recommended to introduce an acute pain services (APS) using a well established and safe pain management routines to increase the quality of care.     

重症监护室护士对身体约束相关知识、态度和行为的调查分析

目的了解重症监护室护士对患者身体约束相关知识、态度、行为的状况。方法对北京市某三级甲等医院4个重症监护室的121名护士进行患者身体约束相关知识、态度、行为的调查。结果重症监护室护士身体约束知识得分为(12.69±1.84)分,答对率为79.29%,态度得分为(33.46±3.05)分,行为得分为(49.33±6.46)分。不同性别、科室及监护室工作年限的护士在身体约束知识、态度、行为得分差异具有统计学意义(P0.01或P0.05)。结论重症监护室护士身体约束知识整体呈中等偏上水平,但身体约束适应知识存在不足;对身体约束呈中性态度,且有较恰当的身体约束行为。     

The effects of a well older adult clinical experience on students' knowledge and attitudes

Is a planned learning experience with well older adults a positive influence on a nursing student's attitude, level of gerontological knowledge, and willingness to work with older adults after graduation? Students in a baccalaureate program were divided into treatment or control groups based on their attitudes on the Kogan's Attitude Toward Old People Scale. Knowledge was measured by the Palmore's Facts on Aging Quiz (Palmore, 1977). Half of the students were given experiences with well elderly while the other group had no experience with this population. Differences in pre- and post-test scores were compared by analysis of variance. All students, regardless of planned experience with older adults, increased their knowledge. Students who initially had negative attitudes significantly improved their attitudes regardless of the type of clinical experience. The investigation failed to support the idea that experiences with well elderly would make a difference on attitude and knowledge base. This project suggests knowledge and attitude changes are not dependent upon a particular type of clinical learning activity.     

Student nurses' knowledge, attitudes, and self-efficacy of children's pain management: evaluation of an education program in Taiwan

The purpose of this study was to examine the effectiveness of a pediatric pain education program (PPEP) for student nurses. The sample consisted of 181 licensed student nurses who were enrolled in a nursing school in Taiwan. Student nurses attended a 4-hour PPEP that involved case scenario discussion, video, and lecture. Data were collected by an extensive questionnaire that assessed student nurses' knowledge of, attitudes toward, and self-efficacy in pediatric pain assessment and pharmacological and nonpharmacological pain management. The results demonstrated that student nurses gained significant knowledge of pediatric pain, expressed more appropriate attitudes, and reported greater self-efficacy in children's pain management after attending PPEP. Their knowledge of analgesic pharmacotherapy did not significantly improve. These results suggest that PPEP should be integrated into pediatric nursing curricula to enhance knowledge and skills regarding children's pain management during the early stage of a nursing career.     

The relationship between knowledge, attitudes and degree of contact with AIDS and HIV

This study examined the relationship between knowledge, attitudes, and degree of contact with AIDS and HIV for three groups of people: nurses, psychology students and design students using a standardized questionnaire. The questionnaire differentiated between the groups on all three dimensions with nurses having most knowledge but least positive attitudes. There was no relationship between knowledge and attitudes for the three groups although contact and knowledge were related for the design students and attitudes and contact were related for the psychology students. For all groups the strongest relationship was between attitudes and contact. The implications of the results for training courses are discussed.     

The impact of training program on nurses' attitudes toward workplace violence in Jordan

BackgroundNurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence.ObjectiveTo study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan.MethodsOne group before–after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. “The Framework Guidelines for addressing workplace violence in the health sector”, was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire.ResultsA total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t = 6. 62, df = 96, p = 0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%).ConclusionThe study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.