A Systematic Review and Meta-Analysis of the Effects of Biopsychosocial Pain Education upon Health Care Professional Pain Attitudes,Knowledge, Behavior and Patient Outcomes

Pain is a significant health burden globally and its management frequently fails to comply with evidence based, biopsychosocial guidelines. This may be partly attributable to inadequate biopsychosocial focussed pain education for students and clinicians. We aimed to undertake a systematic review, using Cochrane methodology, of randomized controlled trials with meta-analysis to quantify the effects of biopsychosocial education strategies in changing student/qualified health care professionals (HCPs) pain related attitudes, knowledge, clinical behaviour or patient outcomes. A systematic search of the literature was undertaken using CINAHL, AMED, PEDro, Cochrane Central Library, MEDLINE, ScienceDirect, Rehabdata, SportDiscus, EMBASE, ASSIA, Dentistry and Oral Science, Psycinfo, Education Research Complete and OpenGrey from 1977 to November 2020. Pooled effect sizes were quantified in random effects meta-analyses for attitudes, knowledge, and clinical behaviors. From a sample of 1812 records, 6 were narratively analysed and 15 were included in the meta-analyses. These studies represented 3022 patients and 3163 HCPs and students. Education improved attitudes by 11.3% (95% confidence interval: 2.2–20.4%, P = .02), and knowledge by 18.8% (12.4–25.3%, P = .01). The effects of education on clinical behavior favoured a clinically relevant improvement (OR = 2.4, 0.9–5.9, P = .06). Narrative analysis of the effect of biopsychosocial education for student HCPs/HCPs upon patient outcomes was inconclusive. These findings demonstrate that biopsychosocial focussed pain education strategies can improve student/qualified HCPs’ pain related knowledge and attitudes and increase the likelihood that they will behave more in keeping with evidence-based practice. This should result in improved patient outcomes, however, evidence to support or refute this is lacking.PROSPERO systematic review record number, CRD42018082251.PerspectiveWe outline the effectiveness of biopsychosocial pain education for health care professionals and students in improving pain knowledge, attitudes, and evidence-based behaviors. These improvements should enhance clinical outcomes in patients with pain but further evidence is needed to confirm this.     

Mock trials and web-based education using malpractice cases: A randomised controlled trial

BackgroundWeb-based education using malpractice cases is increasingly used as an effective program to improve nurses' patient safety competency, and education on legal obligations is vital for nursing students.AimTo evaluate the effectiveness of web-based education using mock trials of medical malpractice cases in improving nursing students' legal obligations, patient safety competency, and critical thinking.MethodsForty-three senior nursing students were randomly assigned to be exposed to blended learning of mock trials (4 weeks) and web-based education (4 weeks) in experimental group (n = 23), and web-based education (4 weeks) alone in control group (n = 20). Pre-test (before randomisation) and post-test (after intervention) data were collected at a university in Korea between October and December 2019.ResultsThere were statistically significant differences in patient safety competencies (t = 3.59, P = 0.001), including skills (t = 2.89, P = 0.006) and knowledge (t = 2.60, P = 0.013), as well as a significant difference in critical thinking disposition (t = 3.09, P = 0.004) between the two groups in the pre−post changes. The two groups had no difference in knowledge and cognition of legal obligation.ConclusionBlended learning of mock trials and web-based education can enhance nursing students' patient safety competency. In particular, mock trials are an active participatory learning method that helps nursing students develop critical thinking skills to ensure patient safety competency compared to web-based education alone. Incorporating mock trial education using medical malpractice cases into the curriculum could enhance nursing students' patient safety competency and critical thinking disposition.     

Nursing students’ knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia

ObjectiveThe prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence. Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice. This study aimed to assess nursing students’ knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them.MethodsA cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022. Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care. The data were analyzed using a Chi-square test and multivariate logistic regression analysis.ResultsThe results show that 43.2% (171/396) of nursing students had inadequate knowledge of diabetic ulcer care. However, 88.9% (352/396) had a favorable attitude toward the topic. Nursing students lacked knowledge about the characteristics of diabetic ulcers, diabetic neuropathy, wound infection, and adjunctive therapy for diabetic ulcers, and many of them believe that diabetic ulcer care is too time-consuming to carry out. Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase (aOR = 9.99, 95% CI 4.96–20.08, P < 0.001). Male nursing students were significantly less likely to have positive attitude toward the topic than female students (aOR = 0.42, 95% CI 0.19–0.96, P = 0.048), and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not (aOR = 2.76, 95% CI 1.40–5.41, P = 0.003).ConclusionFindings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care. Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students’ knowledge and attitudes based on the factors discovered in this study.     

Nursing students' knowledge and attitudes toward urinary incontinence: A cross-sectional survey

BackgroundNurses must have adequate knowledge to manage the complexities of urinary incontinence. Nursing students are the nurses of the future, yet little is known about urinary incontinence education in undergraduate nursing programs.ObjectivesThe aim of this study was (a) to assess the knowledge and attitudes of urinary incontinence held by undergraduate nursing students in China and (b) to explore the relationship between knowledge, attitudes and socio-demographic characteristics.DesignA cross-sectional survey using cluster random sampling.SettingsUndergraduate departments of Nursing within the Faculty of Health Sciences at six Universities, located in different areas of China.ParticipantsA random selection of 6 faculties with a total of 1313 full time undergraduate nursing students completed the survey.MethodsSelf-reported data were collected using two validated questionnaires, the Urinary Incontinence Knowledge Scale and the Urinary Incontinence Attitude Scale, to access students' knowledge and attitudes toward urinary incontinence.ResultsOverall urinary incontinence knowledge was poor (49.9%, 15.0/30) and attitudes about urinary incontinence were generally positive (71.7%, 43.0/60). A high level of interest in learning more about urinary incontinence was found. There was a weak correlation between urinary incontinence knowledge and attitudes (r = 0.135, p < 0.01). There was also a significant positive correlation between urinary incontinence knowledge and attitudes and nursing students' year of study, urinary incontinence education and training, and formal clinical practicum experience in urology (p < 0.05).ConclusionsChinese nursing students showed poor urinary incontinence knowledge but generally positive attitudes toward urinary incontinence. This study suggests there is a need to examine urinary incontinence content throughout undergraduate nursing curricula in China.     

Stress and Perception of Procedural Pain Management in Chinese Parents of Children With Cancer

ObjectivesChildren with cancer are exposed to repeated painful and invasive procedures. This study examines Chinese parents' stress and perception toward their children's procedural pain control.MethodsWe recruited 265 parents of children (aged <18 years) diagnosed with hematological cancer (74.7%) and solid tumors (25.3%) from two major public hospitals. Parents used a scale (0–10) to rate perceived pain experienced by their child when undergoing lumbar puncture (LP), bone marrow aspirate, or/and biopsy. They reported their stress level and attitudes toward analgesics using the adapted Pain Flexibility Scale for Parents and Parental Medication Attitude Questionnaire. General linear modeling was used to identify factors associated with perception outcomes.ResultsParents (72.8% mothers, age 36.5 [6.8] years) expressed that they were worried (31.7%) and had difficulty with concentration (57.7%) when the child was in pain. Among parents whose children had undergone LP (n = 207), 39.1% perceived that their child still experienced severe pain (pain score >7) even with existing pain control measures. Parents reported concerns over side effects of analgesics (69.4%) and addiction (35.1%). Half of the parents (47.2%) perceived that analgesics should only be reserved for severe pain. Parents who were older (estimate = 2.07, SE = 0.87; P = 0.0054) and had lower education attainment (estimate = ?3.38, SE = 1.09; P = 0.0021) had a more negative attitude toward analgesics use. Higher parental distress was associated with avoidance of analgesics use (r_s = 0.17, P = 0.0052).ConclusionOur findings suggested that subgroups of Chinese parents demonstrated distress with their child's pain and harbored misconceptions over analgesics use. Future work includes devising targeted psychoeducation interventions for these parents.     

Pain management in the older adult: The relationship between nurses' knowledge,attitudes and nurses' practice in Ireland and Jordan

BackgroundResearch studies regarding nurses' knowledge attitudes and practice in the older adult are limited. Furthermore, none of these studies attempted to investigate the relationship between knowledge attitudes and practice. Furthermore, little studies compared nurses' knowledge, attitudes and practice between Eastern and Western countries.AimTo describe the factors associated with nurses' acute pain management practice in the context of caring for older adult patients.MethodA quantitative, correlational, comparative and cross-sectional survey approach.Data collectionData were collected using survey questionnaire.SampleA sample of 267 registered nurses from Ireland and Jordan (one private hospital in each country).ResultsA multiple linear regression analysis revealed that nurses' general knowledge and attitude towards pain management was associated with their pain management practice, with a regression coefficient of 0.14 (p = 0.002). However, knowledge of pain in the elderly failed to reach a statistically significant relationship with pain management practice. In regards to country and gender, Irish nurses had an average score that was 2.61 points higher than Jordanian nurses (p < 0.001), female nurses had an average score that was 0.67 points higher than male nurses (p = 0.025). The overall regression model was significant (p < 0.001) with an R² value of 43.2%, indicating that 43.2% of the variation in scores was explained by knowledge, attitude and practice.ConclusionMore research studies combining the three concepts (knowledge, attitude and practice) are recommended in the area of pain management.     

Alcohol education revisited: Exploring how much time we devote to alcohol education in the nursing curriculum

IntroductionThis study examines student nurses knowledge, attitudes and educational preparation to work with patients who misuse alcohol. The study begins to quantify how much time is devoted to alcohol education at one Scottish University.MethodThe study modified the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) and incorporated three case vignettes to examine the student nurses knowledge, attitudes and experience of working with patients who have an alcohol problem. The questionnaire was hand delivered to a convenience sample of third year nursing students.ResultsThe results show that the student nurses exhibit positive attitudes and beliefs about working with patients who have an alcohol misuse problem. A series of significant associations was found between the adult nursing cohort and their ability to include a comprehensive alcohol history in their nursing assessments (χ² = 19.82, df = 4, p < 0.0005); recognise signs of acute alcohol withdrawal (χ² = 52.26, df = 16, p < 0.000); and the psychological signs associated with alcohol misuse (χ² = 41.81, df = 16, p < 0.000). A baseline figure of 2.5 h of alcohol education is noted at this university.ConclusionsAlcohol education strongly features in three out of the five nursing programmes surveyed. Nurse education needs to focus on strategies that extend to teaching nurses how to respond, provide brief interventions and identify when to refer the patient for specialist intervention. These approaches should be universal to all areas of nursing practice.     

Predictors of Intervention Session Completion in a Randomized Clinical Trial of a Behavioral Cancer Pain Intervention

ContextSome patients with cancer are able to complete psychosocial pain management intervention sessions, and others find it difficult to do so.ObjectivesConduct a secondary analysis of a randomized clinical trial (N = 178) that compared delivery formats (in-person vs. videoconference) of a pain coping skills training (PCST) intervention for patients with cancer to examine if intervention session completion predicts postintervention outcomes of pain severity and interference, psychological distress, physical well-being, and pain self-efficacy; and identify predictors (i.e., demographics, medical characteristics, baseline outcome scores) of session completion.MethodsSession completion (i.e., completing all four sessions vs. missing at least one session) was tested as a predictor of postintervention outcomes. Predictors of session completion were then examined.ResultsIn both study conditions combined, PCST session completion predicted improvement from baseline to postintervention in pain severity (β = −0.27; P = 0.03), pain interference (β = −0.25; P = 0.048), and pain self-efficacy (β = 0.23; P = 0.07). Participants in the videoconference condition were significantly more likely than those in the in-person condition to complete all sessions (83% vs. 65%; P = 0.006). Participants with at least some college education (odds ratio [OR] 4.36; P = 0.04), a diagnosis of breast cancer (OR 6.73; P = 0.04), and higher levels of pain self-efficacy (OR 2.32; P = 0.02) were more likely to complete videoconference sessions. Participants who lived closer to the medical center (OR 0.64; P = 0.07), had early stage cancer (OR 3.82; P = 0.07), and fewer medical comorbidities (OR 0.59; P = 0.04) were more likely to complete in-person sessions.ConclusionCompleting PCST sessions is important for improving pain outcomes. Efforts to increase session completion (e.g., videoconference delivery) should be considered.     

Development of Knowledge and Attitudes Survey on Pain Management for Korean Long-term Care Professionals

PurposeInappropriate knowledge and attitude toward pain management of professionals has been pointed to be major obstacles to effective pain management in long-term care setting. The purpose of this study was to develop the knowledge and attitudes survey on pain management for Korean long-term care (LTC) professionals (KASP-K).MethodsTo develop the KASP-K, the knowledge and attitudes survey regarding pain developed by Ferrell and McCaffery in 2014 was amended after a review of broad literature and the latest pain management standards. A rigorous validation process of the KASP-K was performed by testing the content validity, item difficulty and discrimination index, construct validity, test–retest reliability, and internal consistency.ResultsThe KASP-K consisted of 22 items and showed a content validity index of >0.7. The average difficulty of the KASP-K was 0.56 and the discrimination index was >0.2. The construct validity of the KASP-K was verified because of the differences in the sum scores depending on pain education (t = 2.30, p = .024). The test–retest reliability was r = .79 (p < .001) and the Cronbach's alpha was 0.73.ConclusionThis preliminary evaluation of the KASP-K demonstrated acceptable validity and reliability. The KASP-K will be able to provide scientific and empirical data regarding the knowledge of and attitude toward pain management by LTC professionals.     

Sources of Palliative Care Knowledge Among Patients With Advanced or Metastatic Gynecologic Cancer

ContextA minority of patients with advanced or metastatic gynecologic cancer utilize palliative care and lack of knowledge may be a barrier to receiving palliative care services.ObjectivesTo identify sources used by patients with advanced or metastatic gynecologic cancer to learn about palliative care and evaluate for differences in knowledge about palliative care and palliative care utilization by knowledge source.MethodsPatients with gynecologic cancer receiving treatment for advanced or metastatic gynecologic cancer at a single academic medical center were surveyed about their awareness of and knowledge about palliative care. Medical chart review was conducted.ResultsOf the 111 women surveyed, 70 had heard of palliative care (63%). Sixty-eight specified from where they learned of palliative care: cancer care (n = 28; 41.2%), word of mouth (n = 26; 38.2%), work (n = 6; 8.8%), self-education (n = 4; 5.9%), personal experience (n = 2; 2.9%), or do not know (n = 2; 2.9%). Knowledge about palliative care (P = 0.35) and palliative care utilization (P = 0.81) did not differ by awareness of palliative care.ConclusionMost women receiving treatment for advanced gynecologic cancer have heard of palliative care from sources other than their cancer care providers. Knowledge about palliative care and source of knowledge about palliative care were not associated with palliative care utilization. Awareness of palliative care and palliative care utilization may be improved by increasing the low rate of health provider-based education and engaging cancer patients' social networks.     

Relationships Between Advanced Cancer Patients' Worry About Dying and Illness Understanding,Treatment Preferences,and Advance Care Planning

ContextPatients with advanced cancer often worry about dying. Less is known about the role of worry in decision making regarding future care.ObjectivesTo explore relationships between patients' worry about dying and their illness understanding, treatment preferences, and advance care planning (ACP).MethodsThis cross-sectional study used baseline data from a primary palliative care intervention trial. All participants had metastatic solid tumors. Using patients' response to I worry about dying from the Functional Assessment of Chronic Illness—Palliative Care survey instrument, univariate and multivariate analyses assessed associations with illness understanding, treatment preferences, and ACP.ResultsOf 672 patients, 47% reported worrying about dying not at all, whereas 9.7% worried quite a bit or very much. In regression analysis, compared with patients who reported not worrying about dying, those who reported high levels of worry were more likely to describe themselves as terminally ill (adjusted odds ratio [AOR] = 1.98; 95% CI = 1.10–3.54; P = 0.021) and prefer life-extending therapy over symptom-focused care (AOR = 2.61; 95% CI = 1.30–5.22; P = 0.007). They were less likely to have completed an advance directive (AOR = 0.49; 95% CI = 0.25–0.94; P = 0.032). The same relationships were seen using patients' response to I feel scared about my future from the Herth Hope Index.ConclusionPatients with advanced cancer who worry about dying are more likely to identify as terminally ill and desire life-extending treatment and are less likely to engage in ACP. Understanding how patients cope with worry and make medical decisions is important in providing quality care to these patients.     

Family Factors Affect Clinician Attitudes in Pediatric End-of-Life Decision Making: A Randomized Vignette Study

ContextConflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children.ObjectivesWe hypothesized that family factors might influence clinician decision making in these circumstances.MethodsWe presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed.ResultsThree hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the “involved family” vignette were more likely to agree to continue medical care indefinitely (P < 0.0005). Respondents were marginally more likely to pursue a court-appointed guardian for those patients whose families had nonreligious objections to withdrawal (P = 0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI = 0.6–0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided “futile” care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7–1).ConclusionIn this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves.     

The effect of a peer education program on combating violence against women: A randomized controlled study

BackgroundStudent nurses in Turkey need to be exposed to appropriate undergraduate training if they are to acquire the required knowledge, attitudes and skills that will help them to fight the issue of violence against women (VAW).ObjectivesThe aim of this research study was to assess the effect of a peer education program about combating VAW on the knowledge, attitudes and skills of nursing students.DesignThe study was designed as a randomized controlled trial.SettingsThe participants in the intervention group received peer education on combating VAW.Participants136 nursing students (intervention group: n = 63, control group: n = 73) were included in the study.ResultsParticipants in both the intervention and control groups were assessed at pre-training and at two months post-training. Pre-training and post-training knowledge and attitudes were significantly different in the intervention group (p < 0.001). Moreover, the intervention group displayed a statistically significant difference in their ability to explain the correct interventions in a case study about VAW (p < 0.001).ConclusionsOur results indicate that peer education should be used as a part of undergraduate nursing education on VAW.     

Assessing attitudes toward elderly among nurses working in the city of Ilam

ObjectiveSeveral factors affect the quality of care in the elderly, such as nurses' attitudes. This study aimed to assess nurses' attitude toward elderly in the city of Ilam.MethodThis cross-sectional study was conducted among 230 nurses working at public hospitals in the city of Ilam. Participants were selected using simple random sampling from the list of staff. The Kogan's attitude questionnaire was used to measure nurses' attitudes toward the elderly.ResultsThe mean age of respondents in this study was 32.65 (SD = 7.67), and the score of attitudes toward the elderly was 144.96 (SD = 51.75) in average. More than half (54.3%) of the nurses had negative attitudes toward the elderly. The results of ANOVA analysis showed significant differences (P < 0.05) were observed in the attitudes toward the elderly among the nurses as their ages, marital status, work experiences, and ward types differed.ConclusionIn conclusion, nurses in this study have marginally negative attitudes toward the elderly. Therefore, promoting nurses' attitudes toward the elderly is important to provide high-quality care.