Online Learning to Improve Nurses' Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults.

BACKGROUND: Older adults undergoing total knee arthroplasty may develop chronic pain without effective postoperative pain management. Increasing nurses' knowledge, changing their attitudes, and developing their pain management self-efficacy could improve the effectiveness of pain management. AIM: To determine the effectiveness of an online learning program to help registered nurses to manage postoperative pain in older adults undergoing total knee arthroplasty. DESIGN: A quasi-experimental pre-test-post-test design with intervention and control groups. METHOD: Six inpatient units were randomly selected at a large tertiary care medical center. Sixty nurses were evenly divided between intervention and control groups to participate in online learning about postoperative pain management in patients undergoing total knee arthroplasty. The content was based on Kolb's experiential learning theory. Data were collected on nurses' knowledge and attitudes toward pain management and pain management self-efficacy at baseline and after completion. Data were analyzed using descriptive statistics, chi-square tests, paired t-tests, and independent t-tests. RESULTS: The knowledge and attitudes about pain management and pain management self-efficacy toward older adults undergoing total knee arthroplasty of nurses in the intervention group significantly improved compared to the baseline and were also significantly higher than in the control group. CONCLUSIONS: An online learning program improves nurses' understanding and ability to manage pain in older adults undergoing total knee arthroplasty. This was therefore an effective learning method.

Pain management education needs for nurses caring for older adults undergoing total knee replacement.

INTRODUCTION: Effective postoperative pain management is necessary to improve the outcomes of older adults undergoing total knee replacement (TKR). Discovering what registered nurses (RNs) need to know about pain management may be beneficial to improving the quality of care. AIM: The study aimed to identify the information needed to develop pain management education for RNs caring for older adults undergoing TKR. METHODS: A qualitative descriptive design was used in this study. Three focus groups were conducted with 22 staff RNs with experience caring for older adults undergoing TKR at a supra-tertiary care hospital in Bangkok, Thailand; one focus group was conducted with five members of the hospital's nursing pain management committee. Data were analyzed using content analysis. RESULTS: Two themes relevant to pain assessment education were pain assessment and pain management. Subthemes of pain assessment included challenges in cognitively impaired older adults, inadequate knowledge and misconceptions, and re-assessing pain. Three subthemes of pain management were created, including knowledge of pain medication, new trends in pharmacological pain management and devices, and non-pharmacological pain management using cold compression. CONCLUSIONS: RNs require current information about pain management to provide effective postoperative care for older adults undergoing TKR. The findings may be used in pain management education to update RNs' knowledge of pain management.

A cross-sectional study of factors associated with nurses' postoperative pain management practices for older patients.

AIM: The aim of the study was to identify factors associated with nurses' pain management practices in older patients undergoing surgery. DESIGN: A cross-sectional study. METHODS: The study sample was 85 Registered nurses working in inpatient surgical units in a tertiary care hospital, Thailand. Data were analysed using descriptive statistics, Pearson's and point biserial correlation coefficients, and stepwise multiple regression analysis. RESULTS: A positive correlation was found between practices and (a) pain management training and (b) perceptions related to collaboration with physicians. However, practices were negatively related to (a) the nurses' perception of their workload and (b) the number of years of nursing experience. The recent pain management training, the nurses' perceptions of both collaboration with physicians and their workload explained 24.40% of the variance in practices. Appropriate nursing workloads, regular pain management training and promoting collaboration among the healthcare team could all improve the quality of nurses' postoperative pain management.

A comprehensive health education plus monitoring support program for older adults with knee osteoarthritis coexisting with overweight and type 2 diabetes.

Objectives: To examine the patient outcomes of a comprehensive health education plus village health volunteer monitoring support program on older adults with knee osteoarthritis who are overweight and have type 2 diabetes. Methods: Quasi-experimental, two-group, pretest-posttest design was applied. Using random geographic cluster sampling, older adults who met the inclusion criteria were assigned to two groups, 62 in the intervention group and 71 in the control group. The intervention group received the comprehensive health education plus village health volunteer monitoring support program. The control group received only the comprehensive health education program. Study outcomes, including blood glucose level, knee pain and range of motion, body weight, physical ability (Timed Up and Go Test), fatigue, depressive symptoms, quality of sleep, and quality of life, were assessed at baseline, 3 months, and 6 months after enrollment and analyzed using descriptive statistics and multivariate analysis of variance. Results: One hundred and ten participants completed the study (55 participants in each group). Most patient outcomes in the two groups showed general improvement with statistical significance (P ≤ 0.001): pain decreased, physical ability improved, less depressive symptoms and fatigue, quality of life and sleep improved. The interaction effect (the group and time) demonstrated statistically significant differences between the intervention and control groups on pain, knee range of motion, and fatigue according to each time follow-up (P < 0.001). Conclusions: The comprehensive health education plus village health volunteer monitoring support program promotes good patient outcomes in this population. The integrated health education resource and support for older adults with knee osteoarthritis and type 2 diabetes is an effective, non-surgical treatment that highlights professional nursing roles and non-professional roles-village health volunteers. Nurses should consider implementing a health education plus monitoring support program to mitigate the effects of chronic diseases and improve patients' quality of life.

Factors influencing health status in older people with knee osteoarthritis.

AIM: To examine a causal model of health status among older people with knee osteoarthritis. METHODS: A cross-sectional, correlational design was used with a convenience sample of 220 older Thai people with knee osteoarthritis (mean age 68.96 years; SD = 6.22). Participants were asked to complete a demographic questionnaire, the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia, The Medical Outcomes Study Social Support Survey, and the Arthritis Impact Measurement Scales 2-Short Form. Structural Equation Model was used to examine a hypothesized model. RESULTS: Using Chi-square, hypothesized model was statistically nonsignificant. A model of health status fitted with the empirical data and explained 19.2% of variance. Pain catastrophizing had negative direct effect on self-efficacy and health status. Pain catastrophizing also had negative indirect effect on health status through self-efficacy. Self-efficacy and social support had positive direct effects on health status. However, pain-related fear had no direct or indirect effect on health status. CONCLUSION: Lower level of pain catastrophizing can improve self-efficacy. Increasing of self-efficacy and social support can then lead to improvement on health status. This study highlighted the effect of psychosocial factors on health status. It is necessary to develop a program to minimize pain catastrophizing, improve social support, and promote self-efficacy to improve the health status of older people with knee osteoarthritis.

Path model of factors influencing health-related quality of life among older people with knee osteoarthritis.

Chronic illness has a significant effect on quality of life, and a critical measure of health outcomes. Correlations between pain, depressive symptoms, fatigue, and physical function and their direct and indirect effects on quality of life were determined among 200 Thai older population with knee osteoarthritis using the Numeric Rating Scale, the Multidimensional Assessment of Fatigue, and the Thai Geriatric Depression Scale-15. Physical function was investigated by using the Timed Up and Go test. Path analysis revealed significant negative direct paths from pain, depressive symptoms, fatigue, and Timed Up and Go test results to quality of life. Pain, fatigue, and the Timed Up and Go test results had indirect effects on quality of life, while depressive symptoms had no indirect effect on quality of life. Increases in pain, depressive symptoms, fatigue, and Timed Up and Go test results were associated with reductions in quality of life. An understanding of the complex relationship among these variables is beneficial for designing an appropriate intervention for improving quality of life among older people with knee osteoarthritis.

Theory of Planned Behavior Constructs Associated with Nurses' Pain Assessment and Pro Re Nata (PRN) Opioid Analgesic Administration: A Cross-sectional Study.

Little theory-based research has been performed to better understand nurses' perceptions of pain management. Framed by the theory of planned behavior, the aims of the study were to describe nurses' beliefs (behavioral, normative, and control) about pain management for hospitalized elderly patients with postoperative pain; to present an item analysis for beliefs, attitudes, perceived norms, perceived behavioral control, intentions, and behaviors (measured in case study vignettes) for nurses (a) with different durations of nursing experience, (b) working in university, public health, and military hospitals, and (c) who either had or had not received pain management training in the past six months; and to compare differences in the constructs across these three groups. A comparative descriptive cross-sectional design was used with a convenience sample of 140 Thai nurses working in three Bangkok hospitals. Participants responded to pain assessment and management questionnaires. Most nurses expressed fairly strong beliefs about pain assessment and pro re nata (PRN) opioid analgesic administration. Nurses with more than 10 years of experience had the highest scores for attitudes toward pain assessment and perceptions of others' expectations about PRN opioid analgesic administration. Responses of nurses working in different types of hospitals indicated significantly different pain assessment and PRN opioid analgesic administration behaviors. No significant differences were found for nurses who did and did not receive pain management training. The study highlighted the need for improved pain management education for nurses to enhance the quality of patient care.

Nurses' Pain Management for Hospitalized Elderly Patients With Postoperative Pain.

Using the theory of planned behavior, the study aim was to determine the relationships among nurses' beliefs, attitudes, perceived norms, perceived behavioral control, intentions, and behavior regarding pain management for hospitalized elderly patients with postoperative pain. A cross-sectional design was used with a convenience sample of 140 nurses working in adult surgical units at three hospitals. Based on path analyses, nurses' behavioral, normative, and control beliefs, respectively, had direct effects on their attitudes, perceived norms, and perceived behavioral control regarding pain management. Nurses' attitudes and perceived norms had direct effects on their pain management intentions. However, nurses' intentions had no direct effect on their behavior (measured by responses to questions about case study vignettes). This study highlights the need for education that enhances nurses' perceptions of pain management benefits, the influence of normative referents, and their ability to assess pain and administer pro re nata (PRN) opioid analgesics.