- Describe collaborative interventions used to improve orthopedic patient satisfaction with pain management
- Discuss methods used to develop BSN student knowledge regarding pain assessment and management
Undermanaged post-operative pain is one of the biggest challenges for orthopedic patients, their families and nurses (Pasero and McCaffery, 2007). These patients can experience high pain levels and do not always perceive their pain needs are being heard or met which can lead to decreased satisfaction. Despite advances in pain management, nurses and practitioners receive very little formal education (Cordts, et. al.,2011) in analgesic and non-analgesic therapy for hospitalized orthopedic patients.
The orthopedic unit was chosen as one of three pilot units for the UM Hospital and School of Nursing (SON) Exemplar Unit Initiative (EUI). Over the past year, this unit noted a gradual decline in Press Ganey scores related to patient satisfaction with pain management. Therefore, “Improving patient satisfaction with pain management” was identified as the project focus. The group also wanted to facilitate student knowledge with patient pain assessment and management and strengthen the interaction between the nurse mentor and the student.
The purpose of the EUI collaboration between the Orthopedic unit and the School of Nursing was to:
- Improve orthopedic patients satisfaction with pain management
- Increase nursing students’ knowledge in pain assessment and management
- Improve staff nurse engagement and communication with students
A method to increase student nurse involvement in patient pain assessment and management was developed. An in-depth interview survey “Improving Patient Pain Satisfaction” was designed to be completed by the BSN nursing students.
The goals of this intervention were to:
- Provide structure for improved communication between patients and nursing
- Integrate a framework for clinical education
- Define mutually beneficial partnerships to improve patient care
- Improve student clinical experience through well-defined goals and responsibilities
- Increase student involvement and understanding of quality and evidence based practice
Over a nine month period, the EUI intervention was implemented in an acute care orthopedic unit. BSN sophomore students conducted patient pain management interview surveys, performed patient pain assessments, and wrote the patients’ current pain score and pain ‘goal for the day’ score on the patients’ whiteboard. These focused interventions were in addition to the students’ direct patient care responsibilities with their assigned staff nurse mentor and attending post-clinical conferences with the embedded clinical faculty.
BSN students completed a Pain Management and Communication Pre and Post-Survey to assess individual and aggregate knowledge. Students were surveyed on the first day of clinical—prior to pain management education and on the last day of clinical. Two forums for orthopedic staff nurse mentors were held to provide feedback related to the EUI intervention, mentor role clarification and suggestions for student and mentor improvements.
Data was collected on the following:
- Patient whiteboard pain goals
- Student “Pain Management and Communication” pre- and post- surveys
- “Improving patient pain satisfaction” surveys
- Press Ganey patient satisfaction scores
The SON clinical faculty obtained whiteboard pain goal data (key process measure) and scored the students’ Pain Management and Communication Pre- and Post-Surveys (student outcomes). Patient pain management interview survey data was reviewed by the unit’s Clinical Nurse Specialist then entered into a spreadsheet by a SN assistant (key process measure). The Press Ganey Patient Satisfaction scores were obtained from the unit’s Clinical Nurse Manager (patient outcomes).
Patient Outcome Measures: Press Ganey survey scores improved for five items in June 2014 vs. baseline June 2013:
- How well was your pain controlled? (score 88.2; improved 3.8 points)
- Caregivers response to concerns/complaints? (score 86; improved 4.0 points)
- Staff worked together to care for you? (score 89.9; improved 2.5 points)
- Attention to special/personal needs? (score 88.8; improved 1.2 points)
- Nurses attitude toward requests? (score 90.8; improved 1.3 points
Key Process Measures:
- Acceptable pain goal documented on patient’s whiteboard (55.5%)
- Patient interviews completed by BSN students ( N=176)
- Number of times whiteboard documentation complete compared to number of patient interviews completed (54.5%)
- Number of times patients’ acceptable pain goal for the day was met (55.3%)
Student Outcomes from Pain Management & Communication Survey:
- Knowledge at baseline (pre-intervention survey) 60.8% N=31
- Knowledge attained (post-intervention survey) 67.1% N=31
Staff outcomes—Qualitative results:
BSN students reported the nurse mentors increasingly asked and discussed pain goals and pain management with the patient. More patient education opportunities were noted and some changes in analgesic medication regimes occurred. Staff nurse mentors listened to students’ information related to patients’ pain concerns and addressed issues in a timely manner. Staff mentors’ forums were held the second month of the interventions and staff commented that students needed more education about patients’ realistic pain goals—especially those with chronic pain history. The staff mentors were surveyed in the sixth month of the interventions and demonstrated 100% of mentors were aware the students were interviewing patients about their pain satisfaction (n=4). Seventy-five percent of mentors reported the student’s interview with the patient ‘Sometimes’ or ‘Usually’ improved that patient’s satisfaction with their pain management (n=4). When asked whether the student wrote the patient’s pain goal on the whiteboard, mentors responded equally among ‘Rarely’, ‘Sometimes’. ‘Usually’ and ‘Always’ (n=4).
Since implementing this project, we have seen the following:
- Improved student nurse knowledge in listening to the patient’s story and performing a pain assessment
- Patients perceived increased collaboration and attentiveness to their individual needs
- Clinical staff nurse mentors were more engaged in student learning
- Increased student engagement in improving patient outcomes and experiences were noted by both nursing staff and students
- Improved Press Ganey patient satisfaction scores in five key areas r/t pain management
In summary, the EUI collaborative relationship and intervention was perceived as very valuable to patients, nursing staff and BSN students despite the time requirements. School of Nursing and Health System leaders were very pleased with the process and patient satisfaction outcomes. The group will continue to work improving patient satisfaction with pain management and increasing student and staff knowledge in providing safe and effective pain measures. This project is being repeated on the orthopedic/trauma unit within the hospital.
Chow, K.M., Chan, J.C.Y., Pain knowledge and attitudes of nursing students: A literature review. Nurse Educ Today (2014), http://dx/doi.org/10/1016k/medg/2014/10/1019
Cordts, G.A., Grant, M.S., Brandt, L.E., Mears, S.C. (2011). A qualitative and quantitative needs assessment of pain management for hospitalized orthopedic patients. Orthopedics (34) 8.
Mackintosh-Franklin, C. (2014). The impact of experience on undergraduate preregistration students nurses’ responses to patients in pain: A 2-year qualitative longitudinal study. Pain Management Nursing (15) 1.
Pasero, C. and McCaffery, M. (2007) Orthopaedic postoperative pain management. Journal of Perianesthesia Nursing (22) 3 pp 160-174.
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