A successful nursing education promotes newly graduated nurses' job satisfaction one year after graduation: a cross-sectional multi-country study.

BACKGROUND: Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction. METHODS: A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression. RESULTS: Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation. CONCLUSIONS: Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients.

Educational and personal burnout and burnout regarding collaborating with fellow university nursing students during COVID-19 in 2020-2021.

BACKGROUND: Knowledge is lacking about the effects of COVID-19 on nursing students' burnout symptoms. Burnout can lead to negative feelings and behaviours towards learning and poor mental health. AIMS: To describe and compare nursing/midwifery students' burnout, explore differences and detect predictors at two time points through COVID-19. METHODS: Students were offered participation in the spring semesters of 2020 and 2021 (N = 2046), during COVID-19. The response rate was 30-33%. By using reliable and valid instruments, the students' stress and burnout were analysed as well as the students' health and perceived support. RESULTS: Symptoms of academic burnout were higher among 1st and 2nd year BSc students in 2021. On the contrary, 3rd and 4th year students had higher academic and personal burnout than graduate students as well as than 1st and 2nd year students. Regarding academic burnout, 47% of the variability was explained by educational level, support, stress and the interactional effect of stress and support. Collaborational burnout, predicted by the students' educational level and support, explained 7% of the variability in the outcome. Additionally, educational level, and stress, predicted 52% of the variability in personal burnout. CONCLUSION: Educators or student counsellors need to facilitate effective learning practices and offer academic support, specifically during 3rd and 4th year to boost helpful coping strategies and handle uncertainty and stressors related to crises such as COVID-19.

Psychometric testing of the facilitative student-patient relationship scale within six EUROPEAN countries.

AIM: The aim of the study was to test the psychometric properties of the Facilitative Student-Patient Relationship (FSPR) Scale in clinical practicum in hospital settings within six European countries. DESIGN: A multi-country, cross-sectional survey design was applied. METHODS: A convenience sample of graduating nursing students (N = 1,796) completed the FSPR Scale. Psychometric testing was carried out through explorative factor analysis and confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha. RESULTS: Both validity and reliability of the scale were confirmed. The explorative factor analysis yielded a two-factor construct explaining 47.7% of the total variance, identifying two sub-scales: caring relationship and learning relationship. Confirmatory factor analysis confirmed the two-factor structure. The Cronbach alpha coefficients (0.8-0.9) indicated acceptable reliability of the scale.

Reviewing birth experience following a high-risk pregnancy: A feasibility study.

BACKGROUND: Complications during pregnancy and birth are known risk factors for negative birth experience. Women value the opportunity to review their birth experiences, but limited knowledge exists about appropriate interventions and the feasibility of providing this care for women following high-risk pregnancies. OBJECTIVE: To describe the construction and evaluate the feasibility and acceptability of a postpartum midwifery counselling intervention for women following high-risk pregnancies. DESIGN: A mixed-method study. SETTING: A high-risk antenatal outpatient clinic at Landspítali University Hospital in Reykjavík, Iceland. SAMPLE, RECRUITMENT AND DATA COLLECTION: Thirty women who experienced high-risk pregnancies were invited to write about and review their birth experience with a known midwife 4-6 weeks postpartum. Eight midwives working in a high-risk antenatal clinic provided the intervention after a special training. Data including birth outcomes, birth experience and experience of the intervention were collected by questionnaires from women at two time points before and after the counselling intervention. Midwives providing the intervention completed diaries and participated in focus group interview to explore their experiences of the process. DATA ANALYSIS: Descriptive and content analysis. FINDINGS: Women and midwives perceived the intervention positively and feasible in this context. Midwives evaluated the pre-training program as helpful. Most women would like to review their birth experience with a midwife they know, 4-6 weeks postpartum. Almost half of the women wrote about their birth experiences. KEY CONCLUSIONS: The findings indicate that women experiencing high-risk pregnancies might benefit from a follow up by a midwife they know. Women and midwives perceived the counselling intervention as an acceptable and feasible option in maternity care. The training program sufficiently prepared the midwives to provide the counselling intervention. IMPLICATIONS FOR PRACTICE: The findings provide an opportunity to offer the intervention on a larger scale to explore the effects further and subsequently implement into routine care after birth for high-risk women.

Patients' expectations and experiences of provided surgery-related patient education: A descriptive longitudinal study.

AIMS: The aim of this study was to explore the educational expectations and experiences of surgical patients. DESIGN: Prospective, longitudinal, descriptive and two-centre study. Data were collected with questionnaires at the hospital and 6 weeks and 6 months postsurgery. METHODS: Patients undergoing elective surgery and hospitalized overnight from January to July 2016 answered questions about the content of received pre-operative and pre-discharge education, topics they wanted more information on, sources of information, satisfaction with and usefulness of the information and if their recovery was as expected. RESULTS: Patients (N = 697, 49% male, mean age 64.1 [SD 12.6] years) perceived the provided education as useful and satisfactory but less so after discharge. Most common topics which they expected more education about were postoperative complications, pain management, fatigue, lack of stamina and expected recovery time. Most patients received information through face-to-face teaching (79.7%) and in writing (78.4%). Expectations on recovery were related to patients' satisfaction with the education and how useful they evaluated it.

Pain, Sleep, and Health-Related Quality of Life after Multidisciplinary Intervention for Chronic Pain.

Multidisciplinary pain-management programs have the potential to decrease pain intensity, improve health-related quality of life (HRQOL), and increase sleep quality. In this longitudinal prospective cohort study, the aim was to investigate the long-term effects of multidisciplinary pain rehabilitation interventions in Iceland. More precisely, we (a) explored and described how individuals with chronic pain evaluated their pain severity, sleep, and HRQOL at pre-treatment and at one-year follow-up and (b) examined what predicted the participants' one-year follow-up HRQOL. Seventy-nine patients aged 20-68 years, most of whom were women (85%), responded. The participants scored their pain lower at one-year follow-up (p < 0.001). According to their response, most of them had disrupted sleep, mainly because of pain. One year after the treatment, more participants slept through the night (p = 0.004), and their HRQOL increased. Higher pre-treatment mental component summary (MCS) scores and having pursued higher education predicted higher MCS scores at one-year follow-up, and higher pre-treatment physical component summary (PCS) scores predicted higher PCS scores at one-year follow-up. Sleep problems, being a woman, and having children younger than 18 years of age predicted lower MCS scores at one-year follow-up. These findings are suggestive that patients should be examined with respect to their mental status, and it could be beneficial if they received some professional support after completing the intervention.

Pain Rehabilitation's Effect on People in Chronic Pain: A Prospective Cohort Study.

Multidisciplinary long-term pain rehabilitation programs with a team of healthcare professionals are an integrated approach to treat patients with chronic non-malignant pain. In this longitudinal prospective cohort study, we investigated the long-term effects of multidisciplinary pain rehabilitation on the self-reported causes of pain, pain self-management strategies, sleep, pain severity, and pain's interference with life, pre- and post-treatment. Eighty-one patients, aged 20-69 years, with chronic pain responded. The two most frequently reported perceived causes of pain were fibromyalgia and accidents. The difference in average self-reported pain severity decreased significantly at one-year follow-up (p < 0.001), as did pain's interference with general activities, mood, walking ability, sleep, and enjoyment of life. At one-year follow-up, participants (21%) rated their health as good/very good and were more likely to state that it was better than a year before (20%). No change was found in the use of pain self-management strategies such as physical training at one-year follow-up. The intervention was effective for the participants, as reflected in the decreased pain severity and pain interference with life.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe-A longitudinal study.

AIMS: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. DESIGN: A longitudinal design with two data collections points (pre- and post-graduate). METHODS: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. RESULTS: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. CONCLUSION: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. IMPACT: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

The level of competence of graduating nursing students in 10 European countries-Comparison between countries.

AIM: To analyse graduating nursing students' self-assessed competence level in Europe at graduation, at the beginning of nursing career. DESIGN: An international cross-sectional evaluative design. METHODS: Data were collected in February 2018-July 2019 from graduating nursing students in 10 European countries. Competence was assessed with a validated instrument, the Nurse Competence Scale (NCS). The sample comprised 3,490 students (response rate 45%), and data were analysed statistically. RESULTS: In all countries, graduating nursing students assessed their competence as good (range 50.0-69.1; VAS 0-100), albeit with statistically significant differences between countries. The assessments were highest in Iceland and lowest in Lithuania. Older students, those with working experience in health care, satisfied with their current degree programme, with excellent or good study achievements, graduating to 1st study choice and having a nursing career plan for future assessed their competence higher.

Predictors of university nursing students burnout at the time of the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Little is known about the stress and burnout experienced by undergraduate and graduate nursing students during the COVID-19 pandemic. Academic burnout among nursing students can have an impact on students' learning ability, health, and wellbeing and on the quality of care and intention to leave the profession post-graduation. OBJECTIVES: Evaluate the predictors of nursing students' personal, academic, and collaboration-related burnout during the COVID-19 pandemic. DESIGN: Cross-sectional two-site study. SETTINGS: Icelandic universities offering nursing education. PARTICIPANTS: Graduate and undergraduate nursing students in Iceland (N = 1044) were asked to participate in the study, with a response rate of 32.7%. METHODS: An online survey was used to evaluate the students' stress and burnout in spring 2020. RESULTS: The main findings show that 51% of the variability in the students' personal burnout was explained by their perceived stress, mental health, and perceived support. Furthermore, the students' perceived stress, support, and educational levels predicted 42% of the variability in their academic burnout. Burnout related to collaborating with fellow-students was explained by the nursing students' physical health and by their educational level, explaining 6% of the variability in fellow-students burnout. CONCLUSION: University administrators might consider adding academic support facilities into their undergraduate nursing programs and teaching their students healthy coping skills.

Health related quality of life in patients having total knee replacement and associations with symptoms, recovery, and patient education: A six month follow up study.

AIM: To describe the symptoms, recovery, patient education, and health related quality of life (HRQOL) of patients having total knee replacements at three time points and to detect experiences and situations that predict HRQOL six weeks and six months post-surgery. METHOD: A prospective exploratory two-site study assessing 123 patients, while in hospital (T1), at six weeks (T2), and at six months (T3) post-discharge. HRQOL was measured using the SF-36v2 and symptoms were measured with the Hospital and Anxiety Scale. Two questions considered pain and two considered movement and tiredness while two questions addressed recovery and patient education. Linear regression models were used to calculate predictors of mental and physical HRQOL at T2 and T3. RESULTS: HRQOL improved from T1 to T3. The main predictors of higher physical scores at T2 were; being older, fewer symptoms of depression and little distress related to movement. At T3 the main predictors were; having resumed work, finding patient education very useful, experiencing no pain in the last 24 h and fewer symptoms of depression. The main predictors of higher mental scores at T2 were fewer symptoms of anxiety and depression and little distress related to movement while at T3 these were fewer symptoms of anxiety and depression and experiencing no pain last 24 h. CONCLUSION: Apart from pain, function and resumption of activities, the symptoms of anxiety and depression influence HRQOL. These symptoms should be assessed during the hospital stay.

The competence of nurse educators and graduating nurse students.

BACKGROUND: A nurse educator has an important role in promoting students' learning and professional development as well as in offering high quality nursing education. OBJECTIVES: To describe the competence of nurse educators and explore its connection with the self-evaluated competence of graduating nurse students. DESIGN: A cross-sectional survey design was used. PARTICIPANTS: A total of 1796 graduating nurse students in Finland, Germany, Iceland, Ireland, Lithuania and Spain participated in this study. METHODS: The data were collected with structured electronic or paper-and-pencil questionnaires. Graduating nurse students evaluated the nurse educators' competence using six items derived from the Tool for Evaluation of Requirements of Nurse Teacher (ERNT) and in addition, the students evaluated their own generic professional competence using the Nursing Competence Scale (NCS). The data were analysed statistically. RESULTS: On average, graduating nurse students evaluated the competence of nurse educators to be rather high. Icelandic and Irish students evaluated nurse educators' competence the highest. German and Finnish students were the most critical. The students also evaluated the level of their own professional competence as good. The higher graduating nurse students evaluated their own competence, the higher they also evaluated their nurse educators' competence. CONCLUSIONS: Students' evaluations of their educators' competence and their own competence seem to be aligned. However, educators' competence and its connection with students' competence warrants further studies.

Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study.

Aims: To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3. Design: Prospective, explorative two-site follow-up study. Methods: Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression. Results: The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.

Breaking the vicious circle: Experiences of people in chronic pain on the pain rehabilitation journey.

Aim: To explore the lived experience of individuals' in chronic pain of participating in a pain rehabilitation programme in Iceland. Design: Phenomenological research. Method: The Vancouver School of Doing Phenomenology. Eleven participants were interviewed. Results: The overarching theme was as follows: "the journey of breaking the vicious circle of chronic pain." Before the programme, the participants felt they were in survival mode, trying to survive each day; they were stuck in a vicious circle of chronic pain, simultaneously trying to ease and conceal the pain. Reaching out for professional help was a turning point. While attending the programme, participants began deconstructing their old ways of dealing with chronic pain. After completing the programme, they were still reconstructing their daily lives. In conclusion, pain rehabilitation programmes can be the first step towards breaking the vicious circle of chronic pain.

Processing birth experiences: A content analysis of women's preferences.

BACKGROUND: Negative birth experiences may have adverse effects on the wellbeing of women and babies. Knowledge about useful interventions to assist women in processing and resolving negative birth experiences is limited. OBJECTIVE: To explore women's experience and preferences of reviewing their birth experience at a special midwifery clinic. DESIGN: The study is a qualitative content analysis of women's written text responses to semi-structured questions, included in a retrospective study. SETTING: A special counselling clinic, 'Ljáðu mér eyra', at Landspitali University Hospital in Reykjavik, provides women with an opportunity to review their birth experience and discuss their fears about an upcoming birth with a midwife. SAMPLE, RECRUITMENT AND DATA COLLECTION: A questionnaire was sent to all women attending the clinic from 2006-2011 (n = 301). Of the 131 women completing and returning the questionnaire, 125 provided written responses to the open-ended questions. The questionnaire consisted of demographic and reproductive characteristics of women, questions about why they attended the clinic, whether their expectations were fulfilled, helpful components of the interview and open-ended questions about women's views of the process. DATA ANALYSIS: Data on participant characteristics, the reason for attending the clinic, whether the interview fulfilled their expectations and helpful components were analysed using quantitative descriptive data, while written responses to semi-structured questions were analysed using content analysis. FINDINGS: The main reasons for attending the clinic were a previous negative birth experience, anxiety about the upcoming birth, and/or loss of control during a prior birth. Two themes and three subthemes were identified. The overarching theme was 'on my terms' with the subthemes of 'being recognised', 'listening is paramount' and 'mapping the unknown'. The final theme was 'moving on'. KEY CONCLUSIONS: Women want to be recognised and invited to review their birth experience in a tailored conversation on their terms. By fulfilling their expectations of reviewing the birth experience, they regained control and strength to move on. IMPLICATIONS FOR PRACTICE: Findings support the importance of recognising women's need to review their birth experiences and offer an intervention to reflect on their perceptions. A discussion of the birth experience should be a routine part of maternity services.

Contraindications in planned home birth in Iceland: A retrospective cohort study.

OBJECTIVES: Icelandic national guidelines on place of birth list contraindications for home birth. Few studies have examined the effect of contraindication on home birth, and none have done so in Iceland. The aim of this study was to examine whether contraindications affect the outcome of planned home birth or have a different effect at home than in hospital. METHODS: The study is a retrospective cohort study on the effect of contraindications for home birth on the outcome of planned home (n = 307) and hospital (n = 921) birth in 2005-2009. Outcomes were described for four different groups of women, by exposure to contraindications (unexposed vs. exposed) and planned place of birth (hospital vs. home). Linear and logistic regression analysis was used to evaluate the effect of the contraindications under study and to detect interactions between contraindications and planned place of birth. RESULTS: The key findings of the study were that contraindications were related to higher rates of adverse maternal and neonatal outcomes, regardless of place of birth; women exposed to contraindications had higher rates of adverse outcomes in planned home birth; and healthy, unexposed women had higher rates of adverse outcomes in planned hospital birth. Contraindications significantly increased the risk of transfer in labour and postpartum haemorrhage in planned home births. CONCLUSION: The defined contraindications for home birth had a negative effect on maternal and neonatal outcomes in Iceland, regardless of place of birth. The study results do not contradict the current national guidelines on place of birth.

Predictors of women's positive childbirth pain experience: Findings from an Icelandic national study.

BACKGROUND: Pain in childbirth has been identified as one of the major components in the childbirth experience and an important topic that needs to be addressed during pregnancy, birth and the after-birth period. AIM: The aim of the study was to describe women's childbirth pain experience and to identify predictors of women's positive childbirth pain experience. METHOD: A population-based cross-sectional cohort study design was implemented, with convenient consecutive sampling, stratified according to residency. Pregnant women were recruited through 26 health care centers. Participants were sent a questionnaire by mail during early pregnancy and another one five to six months after childbirth. A multiple regression analysis was done, with women's childbirth pain experiences as the dependent variable. FINDINGS: Altogether 726 women participated in the study, with a response rate of 68%. The strongest predictors for women's positive childbirth pain experience were positive attitude to childbirth during pregnancy; support from midwife during childbirth; use of epidural analgesia and low intensity of pain in childbirth. DISCUSSION: The majority of the women in the study experienced childbirth pain as a positive experience, which is in line with studies that have demonstrated that pain in childbirth is different from other kinds of pain. In addition to epidural use as a predictor for positive childbirth pain experience, many other strong predictors exist and must be acknowledged. CONCLUSION: When planning pregnancy and childbirth services, predictors of positive experience of childbirth pain should be considered and investigated further.

The content of nurse unit managers' work: a descriptive study using daily activity diaries.

BACKGROUND: NUMs' job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities. AIM: To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self-documented and reflected in their job description. DESIGN: Prospective exploratory study. METHOD: The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: 'management and planning' (seven activities), 'staff responsibility (seven activities), 'direct clinical work' (five activities), 'service' (12 activities) and 'other' (nine activities). RESULTS: The managers' spent most of their time within the 'other' domain (32% of their time), then the next significant amount of time on 'management and planning' and 'clinical nursing' (19%), and the least amount of time on 'service' (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly. CONCLUSION: The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description.

Menstruation, objectification and health-related quality of life: A questionnaire study.

AIMS AND OBJECTIVES: To explore young women's health-related quality of life (HRQOL) and investigate whether menstrual and menarche experiences and objectification predict mental and physical health components of HRQOL. BACKGROUND: Menstruation plays a fundamental role in female biology, in women's relationship to their bodies and consequently in women's health and their HRQOL. DESIGN: Cross-sectional explorative survey design. METHOD: A questionnaire that included the SF-36v2, the Self-objectification Questionnaire (SOQ), the Body Surveillance and Body Shame subscales of the Objectified Body Consciousness Scale, the Belief and Attitudes Towards Menstruation Questionnaire (four subscales), and questions on menarche and menstruation was administered at the end of 2013 to 319 Icelandic women who represented the population by age. The SF-36v2 includes eight dimensions addressing the mental and physical components of HRQOL. Scores are presented as raw data scores and scores based on standardised score of American women and range from 0 to 100 with higher scores indicating better HRQL. A hierarchical multiple linear regression model was employed to calculate significant predictors of mental and physical health components of HRQOL. RESULTS: Mean raw data scores on SF36-v2 dimensions ranged from 54.7 to 91.5. The participants scored below the standardised, mean norm-based score for all dimensions. Secrecy of menstruation, experience of body shame and pain during menstruation predicted worse mental HRQOL. To believe in the proscriptive role and the unpleasantness of menstruation, experience of body shame, medication for menstrual pain and not holding a university education predicted worse physical HRQOL. These two models explained 30% and 22% of the variance of the mental and physical components of SF36-v2, respectively. CONCLUSION: Young women's mental and physical HRQOL is influenced by the specific context of their lives. RELEVANCE TO CLINICAL PRACTICE: Women's health education should take into account the various relationships women may have with their bodies.

The effectiveness of the Pain Resource Nurse Program to improve pain management in the hospital setting: A cluster randomized controlled trial.

BACKGROUND: The Pain Resource Nurse program is a widely disseminated, evidence-based, nursing staff development program, designed to improve pain management in hospitals. The program has shown promising results, but has never been tested with a rigorous research design. OBJECTIVES: Our objective was to test the effectiveness of the Pain Resource Nurse program. Hypothesized outcomes included improvements in nurses' knowledge, attitudes, and assessment practices, and in patients' participation in decision-making, adequacy of pain management, pain severity, time spent in severe pain, pain interference, and satisfaction. DESIGN: Cluster randomized controlled trial. SETTING: A 650-bed university hospital in Iceland Participants: The sample consisted of a) patients ≥18 years of age, native speaking, hospitalized for at least 24h, alert and able to participate; and b) registered nurses who worked on the participating units. METHODS: Twenty three surgical and medical inpatient units were randomly assigned to the Pain Resource Nurse program (n=12) or to wait list control (n=11). The American Pain Society Outcome Questionnaire and the Knowledge and Attitudes Survey were used to collect data from patients and nurses respectively. Baseline data (T1) for patients were collected simultaneously on all units, followed by data collection from nurses. Then randomization took place, and the Pain Resource Nurse program was instituted. Ten months later, follow up (T2) data were collected, after which the nurses on the control group units received the Pain Resource Nurse program. RESULTS: At baseline, data were collected from 305 of the 396 eligible patients and at follow up from 326 of the 392 eligible patients, a 77% and 83% response rate respectively. At baseline, 232 of 479 eligible nurses responded and at follow-up 176 of the eligible 451 nurses responded, a 49% and 39% response rate, respectively. A nested mixed model analysis of covariance revealed that the intervention was successful in changing pain assessment practices, with pain assessment using standardized measures increasing from 13% to 25% in the intervention group while decreasing from 21% to 16% in the control group. None of the other hypothesized improvements were found. CONCLUSIONS: The Pain Resource Nurse program was successful in improving nurses' use of standardized measures for pain assessment. No effects were found on patient outcomes; pain was both prevalent and severe at both time points. Only minimal improvements were noted in response to this evidence-based staff development program. Changes in pain management practices remain a challenge in clinical settings.