Capstone Project PowerPoint Presentation

Capstone Project PowerPoint Presentation

Read the entire Capstone Project uploaded below and summarize it in a PowerPoint presentation at least 30 slides, APA Format. the PowerPoint should contain the same ideas as the capstone project. Capstone Project PowerPoint Presentation

Capstone Project

Nurses’ gap between Knowledge and Practice in Pain Management with Patients in Physical Rehabilitation

Abstract

Encompass Health Rehabilitation hospital provide care to patients that need intensive inpatient rehabilitation therapy. Such patients include those recovering from serious illnesses, injuries or surgeries, needing a high level of specialized care. Examples of varies conditions that may require care in a rehabilitation hospital include brain injury, spinal cord injury and stroke. Patients who are recovering from hip or knee replacement may also qualify for rehabilitation services.

Most patients in rehabilitation therapy suffer from acute or chronic pain. Effective pain management is a way to assure a better quality of life and to prevent unnecessary hospital stay and complications. Nurses play a vital role in relieving patient pain through adequate assessment and proper treatment.

The practicum course that I just completed, identified a gap between nurse’s knowledge and practice in pain management. Some nurses showed lack of knowledge in the pharmacological interventions as well as in non-pharmacological interventions to treat patients ‘pain.  Furthermore, other barriers have been identified as contributors to ineffective pain management. This capstone project will explore in depth these factors and make recommendations on the best ways to provide effective pain management.

Introduction

Background

One of the vital components of quality patient care is effective pain management, nurses play a key role in implementation of pain management. When nurses are equipped with the latest innovative skills, knowledge, and information, they are better placed to provide compassionate and safe care for patients after surgeries (Madenski, 2014). In modern day surgical practice, postoperative pain (POP) remains a global concern despite the fact that several preoperative, postoperative, and intraoperative management strategies and interventions have been put in place to manage and reduce pain. Most patients still go through acute pain after surgery, less than half of these patients report adequate pain relief (Menlah, Garti, Amoo, Atakro, Amponsah, & Agyare, 2018). Capstone Project PowerPoint Presentation

Nursing education today is evolving so as to meet the demands of technological advancement and healthcare that keep changing, when nurses have adequate knowledge on pain management, effective pain control for patients can be achieved. Nurses continually experience challenges when it comes to treating pain, this may be caused by their lack of knowledge regarding appropriate measures for pain management (Madenski, 2014). Nurses require effective attitudes, skills, and knowledge so as to address issues to do with pain and thus ensure the best quality of care for patients. An increased knowledge regarding the pain mechanism, assessment of pain effectively, and both non-pharmacological and pharmacological management would lead to positive outcomes for patients. Some of the research conducted in the past has attributed lack of knowledge on pain management,  communication gaps, organizational change issues, and increased nursing workloads as the main barriers to effective pain management (Glowacki, 2015; Meissner, Coluzzi, Fletcher, Huygen, Morlion, Neugebauer, … & Pergolizzi, 2015). Capstone Project PowerPoint Presentation

It is important that patients’ pain is relieved within reasonable time frames due to the negative effects it has on clinical outcomes. When pain is not adequately controlled, it brings about negative effects on the patient’s function, functional recovery, and quality of life. Furthermore, it may also result in persistent pain and other postsurgical complications (Menlah et al, 2018). For instance, patients are likely to develop chronic pain syndromes, pneumonia, delayed healing, infections, or deep vein thrombosis from acute pain (Meissner et al, 2015). It is extremely important to decrease pain in order to ensure patient comfort and satisfaction.

Patients continue to experience moderate or even severe pain after undergoing surgery (Aziato, & Adejumo, 2014). Nurses tend to underestimate the level of pain among patients, or may not believe that their patients are in pain, and are reluctant to administer prescribed narcotics dose because they fear patients may be addicted to the medication (Aziato & Adejumo, 2014). However it is important to note that ineffective management of postoperative pain has very negative impact on patients recovery. As a result, patients may remain admitted for longer periods of time, causing an inability of hospitals to admit more patients due to inadequate bed availability.

The World Health Organization (2016) advocates for successful strategies of pain management to be developed and utilized by nurses in surgical units. Pain management should involve activities such as commitment, caring, appropriate assessment, therapeutic communication, adequate knowledge, the use of evidence-based approaches, and properly evaluating interventions together with other variable factors present such as cultural factors (Menlah et al, 2018). The key priorities for improvement of pain management after surgery are: increasing patient involvement in making decisions regarding treatment options, this requires good communication between nurses and their patients; better professional training and education of nurses in charge of surgical patients so as to enhance their knowledge and skills and thus improve patient care; optimization of treatment; and employing organizational changes that are likely to provide benefits in pain management (Meissner et al, 2015).

Improving postoperative pain management requires crucial changes involving nurses, patients and the organization in general. Patients need to be fully involved in their treatment procedure by being given all the information available regarding their treatment options, this makes up an important element of the patient-centered approach of treatment and pain management (Meissner et al, 2015). Nurses knowledge gap in pain management can be bridged by increasing awareness on pain medications among nurses involved in pain managing and by also having their skills regularly enhanced in the same area. A greater emphasis should be put on pain management during undergraduate and postgraduate training programs. Nurses should also be encouraged to take part in relevant Continuing Medical Education (CME); there should also be improved access to these courses to ensure that nurses are well equipped with knowledge and skills on pain management (Meissner et al, 2015). To achieve optimal pain management, there is a need to change nurses’ knowledge regarding pain management, beliefs, and attitudes.

Nurses’ levels of knowledge together with their attitudes have an impact on the quality of care received by patients. The foundational knowledge of nurses concerning pain correlates with better patient satisfaction levels and outcomes, on the contrary, any deficiencies in pain management are linked directly to nurses passively participating in the assessment and management of pain in patients (Kahsay, & Pitkäjärvi, 2019). By believing that patients exaggerate their reports on pain, nurses mistakenly underestimate the degree of suffering among patients (Kahsay, & Pitkäjärvi, 2019). In order to adequately manage patient suffering, it is important that nurses have a proper attitude and adequate knowledge concerning pain management.

Effective pain management is a universal and compelling requirement in provision of health care, despite the advancements that have been made in this field, adverse psychological and physiological effects of pain that is left unmanaged are substantially unresolved (Glowacki, 2015). Advanced treatments and research in improved protocols of practice have indicated improvements in managing postoperative pain, however, there is still little awareness on how effective best practices are. Making use of improved interventions is likely to enhance the perceptions and attitudes of patients regarding pain. A patient’s beliefs and understanding about pain is essential in influencing their reaction to pain therapies provided by nurses (Glowacki, 2015). Patients’ satisfaction, pain management, outcomes, and pain education can be greatly improved through the use of interdisciplinary teams for pain management (Leegaard et al, 2011). Capstone Project PowerPoint Presentation

Significance

Nurses have some knowledge on pain assessment and management in surgical units, however, their knowledge, in addition to being inadequate, is not used largely to effectively manage postoperative pain. This is partly due to resource constraints. This study intend to identify areas where there is inadequate knowledge on pain management and thus where there is need for additional training and resource provision in hospitals. The study identifies pain assessment tools that could be utilized by nurses in determining patient pain levels before administering medication, these are essential in proper and effective management of postoperative pain (Mahama, & Ninnoni, 2019).

Nurses who care for surgical patients need to be equipped with expertise in the use of advanced pain management techniques such as epidural analgesia, patient-controlled analgesia, ad other pharmacological or non-pharmacological measures that can be used for pain management after surgical procedures (Aziato & Adejumo, 2014). It is evident from research that pain management strategies employed by surgical nurses are a clear indication that they are not always adequately knowledgeable in postoperative pain management (Aziato & Adejumo, 2014). It is therefore important that the knowledge gap is filled to ensure that quality care is provided to post-surgical patients. Optimal pain relief is largely dependent on the understanding and knowledge of pain among nurses, this includes consistent and systematic pain assessment and regular documentation and observation of pain among the patients.

Justification

In modern times, healthcare has become a business, patient satisfaction is therefore key to sustaining the business. Ineffective pain management is likely to negatively affect the health system. Accurate pain assessment is usually dependent on the ability of a patient to verbalize or describe their pain, for this reason, it is often challenging for nurses to assess and manage pain effectively (Menlah et al, 2018). In the process of their recovery, patients may also not be unable to describe their pain and it may be challenging for nurses to observe any other internal discomforts which may be experienced as a result of pain. Nurses should be trained on how to utilize effective therapeutic approaches and assessment tools for managing pain (Menlah et al, 2018). Some of the therapeutic approaches that can be used will be explored in this study.

Purpose

The purpose of this study is to recognize nurses’ gab in pain management and the learning needs for nurses to bridge that gap and identify the best way to provide effective pain management for patients after surgery.

The goals of this capstone project are:

• Assesses the nurses’ knowledge of pain management in physical rehabilitation.
• Explore barriers that prevent nurses from providing effective pain management to patients in rehabilitation.
• Make recommendation through an educational intervention on the best ways to provide adequate assessment and treatment of patients ‘pain.
• Collect nurses’ evaluation of the educational intervention through a post-survey.

Literature Review

Pain management in patients remains a significant challenge for nurses. The main challenge which the past studies outlined as far as pain management revolves around the existence of a gap between the level of knowledge of nurses and practice which makes it hard to achieve maximum benefits in the long run. This section outlines the past findings and conclusions made by other experts. The literature analysis will help to outline some of the main factors responsible for the increased gap between knowledge and practice of nurses when it comes to pain management. Also, the literature will document the findings of the barriers responsible for achieving maximum pain management for patients. Finally, the literature analysis will document findings on the best approaches or tools that nurses may need to use to foster pain assessment and treatment for patients following surgery. Hence, to collect this information, this section will search various databases and online journals. The primary sources toe use include NCBI, and online, sagepub, PubMed Central, Imedpub and but not limited to BMC Nursing. These databases will offer a chance to retrieve the right articles which speak about the issues highlighted in the topic above and pain management. The role of these databases is that they form a foundation for documenting peer-reviewed and scholarly articles. On the same note, the study will use avenues such as ResearchGate and the internet to locate professional journals which will supplement the collected evidence about the topic in the context.

Collecting the right articles will require the creation of a pillar and framework using keywords. The following keywords act as the ultimate guide to the collection of the right evidence e.g. pain management after surgery, tools for patient pain management, nurse gaps in pain management and challenges to pain management. The keywords were typed on the search engines of the respective databases and avenues to obtain the relevant literature articles. The acceptance criteria of the articles followed the ability to provide data and findings which matched the three main areas of study which form the topic above. Searching the databases and sources yielded 20 valid and credible articles which the following explores outlining not only their content but also their role in supporting the project. Capstone Project PowerPoint Presentation

Nurses’ Gaps between Knowledge and Practice in Pain Management

According to a study completed by Aziato & Adejumo (2014), the healthcare sector offers a chance for the improvement and promotion of the wellbeing of the various populations. Nurses who exhibit the right knowledge and skills help in improving their abilities to deliver high-quality practices and services to patients. However, the industry reported a growing concern on the role of sufficient knowledge as well as skills on pain management aspects on the outcomes of patients. The witnessed gap creates a platform for reduced recovery trends, especially after surgery.

The role that this article plays reflects on the idea that it forms a foundation for understanding the problem of the growing gap of knowledge and practice on pain management. Samara, Toba & Sa’ed (2018) supplement the findings of the previous study. This study claims that the lack of accurate knowledge of pain assessment and documentation may undermine the recovery and treatment of the affected patients. The study focuses on the collection of data about the knowledge and practices of practitioners using cancer pain management incidents in Palestine. This study offers an insight into the main challenges which failure of nurses to exhibit the right knowledge and skills may bring to patients requiring pain management.

Similar, a study completed by Kahsay & Pitkäjärvi (2019) claims that pain management acts as a vital part of the healthcare sector. The importance of pain management reflects on the idea that it helps in the improvement of recovery time for the affected patients. For instance, this study gathered research on the effectiveness of emergency nurses in managing pain based on the assessment of their level of knowledge and skills. The study concludes that emergency nurses in the selected setting exhibited reduced knowledge and skills about pain management at a mean score of 49.5%. The nurses who attained a bachelor’s degree exhibited a higher level of knowledge on pain management, exposing a gap that could be rectified through the use of sufficient training practices. Subsequently, the findings of this study rhyme with the conclusions made by Manwere, Chipfuwa, Mukwamba & Chironda (2015). According to this study, most registered nurses reported poor knowledge about pain management. This study shows that with the current trends, patients suffering from various sensitive conditions like cancer may not receive the required level of treatment and interventions due to poor knowledge and skills by the practitioners.

Menlah et al. (2018) carried out a study that focused on the evaluation of the level of knowledge and skills which nurses in a selected Ghanian district exhibited. The motivation for the study came from the challenges witnessed in the country`s hospitals as well as the global industry on postoperative pain management. The study explored the perceptions of nurses through a cross-sectional survey on the issue of postoperative pain management. The study concluded that at least 48% of the respondents did not exhibit the required level of pain management knowledge. In addition, 97.6% of the respondents relied on the previous necessary skills of nursing in addressing pain problems.

Similarly, Issa, Awajeh & Khraisat, (2017) carried out a study that sought to evaluate the abilities of nurses to exhibit the right knowledge and attitude about pain management in a critical care unit at a tertiary hospital. The study claims that the ICU nurses need to learn more about pain management, primarily based on the areas where they work. The study documented a reduced level of knowledge and skills in pain management of the nurses who worked in intensive care units, especially in the King Saud Medical City facility in Saudi Arabia. The findings documented in this context reflect the conclusions made by Ufashingabire, Nsereko, Njunwa & Brysiewicz (2016) carried out in Rwanda. The two studies showed that intensive care unit nurses in the associated facilities exhibited a reduced level of knowledge on pain management.

Further, on the issue of pain management, Alkhatib, Al Qadire & Alshraideh (2019) evaluated the level of knowledge that nurses in seven medical facilities exhibited in the long run. The study obtained complementing results as the articles mentioned above. Out of the 56 physicians as well as 81 nurses included in the study, a mean of 45.26% and 50.6% reported poor knowledge about pain management when addressing various types of patients. This conclusion shows that there exists a gap in the level of knowledge and skills that the nurses and other practitioners exhibit on the issue of pain management. In this context, the studies above reflect on the determination of the gap which exists on the knowledge and practice abilities of practitioners in handling patients with various pain management challenges.

Failing to consider the implications of this gap may undermine the abilities of the nurses to deliver the right and required level of assistance to the associated patients. A study completed by Advani et al. (2019) focused on the extension of the available knowledge about the gap witnessed among nurses in handling patient challenges. The aim of the study focused on the extension of the existing information to show that there exists a gap that requires immediate attention to reduce further suffering for patients. For instance, the study explored the level of knowledge and practice that physicians exhibited when addressing catheterized patients. The study showed that a lack of knowledge and skills accounted for the high noncompliance to the IDSA guidelines. The main conclusion that the research articles given above may offer claims that the majority of nurses and practitioners exhibit a limited level of knowledge and skills as well as practices when it comes to the management of pain. The existence of this gap comes from diverse factors. The following part outlines the main barriers that limit effective pain management practices and knowledge for nurses in various health settings. Capstone Project PowerPoint Presentation

Barriers to Effective Pain Management

Diverse factors limit the abilities of nurses to provide the required and desired level of assistance to the patients suffering from diverse pain management problems. The existence of these barriers undermines the abilities of the nurses and practitioners to gain the desired level of knowledge and skills to handle their day-to-day duties. Factors such as but not limited to lack of skills and information or sufficient supplemental training act as the ultimate barriers to effective pain management for nurses and practitioners. This section outlines the main findings from multiple research articles that will form a foundation for determining the best interventions and approaches to use to bridge the witnessed gap, as mentioned above.

According to a study completed by Al-Mahrezi (2017), pain acts as one of the main problems which may affect the health outcomes of a given patient. Diverse factors have been associated with the reduction of the abilities to manage pain for the affected patients. Some of the barriers arise from the lack of the implementation of the right protocols in the underlying workplaces. Nurses who work in areas that do not operate with pain management protocols and systems stand in a position to reduce the health outcomes of the underlying patients. When it comes to the issue of pain management, failing to identify the underlying barriers may undermine the abilities to handle the arising problems facing patients. Cancer patients, for instance, may require specialized attention when it comes to the management of pain. The author in this context claims that some of the most common barriers to pain management include factors such:

1. System-related
2. Staff, Nurse, and Physician related

• Patient-related

In the study, Uysal (2018) claim that diverse barriers to the management of pain amongst patients usually lead to increased suffering while at the same time reducing the chances of the improvement of recovery of the patients. This study uses an example of the management of pain among cancer patients. According to the study, failing to adopt the right management practices may undermine the recovery of the affected populations. In this context, the main barrier that the article focuses on arises from the practitioners or staff. Staff oriented barriers may include the failure of the nurses among other practitioners to follow the right interventions, which, in the long run, would help to overcome the underlying problems. The study claims that sometimes, nurses fail to create a conducive environment for the management of pain exhibited by different types of patients. For example, managing pain for cancer patients requires the adoption of advanced approaches altogether. However, these approaches require additional skills and knowledge. Therefore, the leading nurse related problem revolves around the lack of sufficient skills and knowledge about pain management, especially for cancer patients.

The perceptions and attitudes of both nurses and patients may undermine the overall level of recovery and health outcomes, especially when it comes to pain management. Lou & Shang (2017) claim that maintaining the right attitude can help in the reduction of issues such as resistance to treatment, among others that the patients may exhibit. These challenges, in the long run, undermine the quality of care received by the patients based primarily on the negative attitudes. Therefore, other than the lack of sufficient skills and knowledge about pain management, another major barrier includes negative attitudes of patients.

Koh et al. (2018) support the findings above about the need for the adoption of a reliable pain management approach for nurses. However, this study focuses on the problem created by the misconceptions about pain management by the patients. The patient-oriented problems usually undermine the abilities of the nurses and support staff to provide the required services as far as pain management is concerned. Misconceptions about pain management therapies among the patients usually arise as a result of a lack of sufficient knowledge about the effectiveness of each intervention. Lack of information plays a crucial role in that it undermines the abilities of patients to accept and follow the provided interventions or prescriptions to manage pain, lengthening the recovery process.

Goodman, Anitescu & Malik, (2018) on the other hand offer an insight into the main consequences that may arise from a clinical perceptive if nurses and the other practitioners fail to implement pain management therapies and approaches for the patients. Cancer patients who fail to receive the right pain management therapies and interventions stand at a high risk of lengthening the recovery process. On the same note, the cancer patients who do not receive the required pain management solutions usually report declining quality of life, which undermines the abilities to achieve positive outcomes in the long run.

Brown et al., (2016) claims that one of the main issues that reduce the abilities of nurses to deliver quality care services to patients as far as pain management is concerned includes the existence of inadequate systems and protocols. Some hospitals, as the author’s report, do not operate with reliable protocols as well as policies for pain management. In this context, the main weakness that the lack of a policy for pain management brings to the patients revolves round reduced quality of care received.

Also, the lack of a firm policy undermines the operations of nurses when attending patients requiring pain management interventions. While numerous measures have been suggested, the problem of system-based challenges top pain management persists. Diverse challenges may arise in the course of treatment, undermining the recovery time for the patients. Hospitals that operate with policies for the physicians, nurses and staff members to follow in pain management record improved quality of care and hence recovery period for the patients. Capstone Project PowerPoint Presentation

After looking at the past literature about the significant barriers to pain management and the identification of the gap that exists between knowledge and practice of nurses, the following section defines the ultimate interventions that may help to overcome the problems. The selection of the alternatives comes from the analysis of the nature of the problems listed and explored above while at the same time relating them to the primary gap identified in the topic of research. In recap, the main ideas that this section outlined include the ideas that there exist multiple types of barriers, which undermine pain management in a given facility or setting. For instance, these barriers fall under three main categories, such as patient, staff, and system-based issues. Addressing these barriers may require changes in the current policies and but not limited to provide external interventions to guarantee better outcomes for not only the patients but also the staff and nursing teams.

Tools for Pain Assessment and Treatment after Surgery

When addressing the issues of pain management, there exist multiple interventions that can help patients and nurses achieve maximum benefits from a health dimension. For instance, the selection of the desired interventions must come from the factors that could, in the long run, address the gaps identified in the previous section. Diverse factors can help to manage pain for the affected patients.

Providing Education to Nurses

Allen et al. (2018) offers an insight into the effectiveness of training and providing educational material to supplement the existing practices of nurses on pain management outcomes. The previous sections outlined that one of the main factors undermining the overall abilities to achieve maximum health benefits for patients revolves around the failure of the nurses to exhibit the right skills and knowledge. Many nurses, according to the articles above, fail to provide the ultimate platform for managing pain because of the lack of the necessary knowledge. The majority of nurse practitioners depend on the necessary skills that they learned during their training and college education about pain management. However, patient pain may change according to the arising trends in the industry and environment. Using the skills learned in school may make the strategies that the nurses employ obsolete in the management of pain for the affected populations. Therefore, this study concludes that to achieve better health outcomes, nurses should exhibit the right knowledge and skills. The best way that can help to improve the level of knowledge that nurses exhibit on pain management revolves around the implementation of training interventions.

Nurse education acts as an evidence-based practice and intervention, which in the long run helps to implement the right skills and hence knowledge on the improvement of pain management for the various types of patients. When addressing the issue of nurse education, the relevant stakeholders must ensure that they identify the missing gaps in knowledge and skills for the nurses. Identifying these gaps may help to create a platform for improved knowledge and hence the quality of care offered.

Changing or Introducing a Pain Management Framework

The previous studies identified one of the barriers to effective pain management as a system based. System based barriers can be overcome through the application of the right policies. Brant, Newton & Maurer (2017) offer an insight into the main challenges which may affect the quality of pain management for patients. The article supports the creation of a universal framework that would help to guide the operations carried out by nurses and other support staff when it comes to the management of pain for the various patients. In this context, failing to address the main problems that lack a reliable framework brings may undermine the abilities of the nurses and practitioners to understand the main barriers to pain management for the respective patients. This study supports the implementation of a pain management policy as a remedy for nurses and physicians to follow.

Create an Interactive Environment

From another dimension, the creation of an interactive working environment would help to improve the level of collaboration and communication between the practitioners and the patients. Eaton, Meins, Zeliadt & Doorenbos (2017) explain that nurses who apply the principles of evidence-based practices when addressing pain management create an appealing environment that promotes better outcomes. One of the main pillars associated with evidence-based practices includes the consideration of the affairs of the patients. Using this approach helps to reduce the risks associated with poor communication and collaboration with the patients.

Adopting a Variety of Complementary Pain Management Approaches

The final approach that this section suggests includes the adoption of complementary pain management practices (Nahin et al. (2016)). According to a study by Brewer, Turrise, Kim-Godwin & Pond Jr, (2019) nurses who incorporate both the scientific and complementary pain management practices create a platform for the consideration of the role of culture in treatment approaches. In this context, the study shows that complementary pain management helps to shift the strategy used by nurses to treat patients making it easy to provide a client-centred framework. The study concludes that using these approaches may help to improve the perception of the patients and nurses, leading to improved quality of care.

Method

Choice of Research Methodology

Cross-sectional study was my choice of research methodology. The choice was informed by the fact that in medical research, in biology or in any other science, the research design is highly recommended due to its characteristic observational study that provides for analysis of data from a representative subject or a population at a particular point in time (Levin, 2006). Other than this beneficial characteristic of the research design, another reason that informed the choice of the method is its minimal expense in comparison to other methodologies (Levin, 2006). In fact, one may end up at no expense in the application of the methodology which is a result of data that is collected routinely which enables intensive cross-sectional studies to be achieved in the most economical way. In this type of study, a particular group is studied to establish whether there is an interrelation between a certain activity and the case being investigated. It must also be mentioned that most critical scientific studies across the world, as mentioned earlier they were achieved through the application of this type of research design. However, the argument does not rule out or undermine other types of research designs such as case-control studies as they are an option and they have as well been widely applied. Most important therefore in making the choice of the research design is the consideration of the scope of study and the effectiveness of the method regarding the scope of coverage. That being the case, an investigation on The nurses’ gap between knowledge and practice in pain management, the barriers to pain management and best ways to provide pain assessment and treatment in a patient in physical rehabilitation could only be largely accomplished through a cross-sectional survey. Capstone Project PowerPoint Presentation

Data Gathering and Analysis Process

This part provides details on the description of the study population, the type of research design used, the reason for justification and exclusion of content, development of instrument or tool of data collection as well as the identification of themes and categories.

Description of Study Population and Setting

The study was conducted in my practicum course in a rehabilitation hospital. This facility is a 90 bed hospital that treat patients who are recovering from surgeries, major injuries or accidents. The main concern encountered by these patients is pain. In the last six months, this hospital has been scoring low in patients’ satisfaction. And the main area of concern in patients’ feedback is pain.  In this study, the participating population was restricted to nurses taking care of the patients in this rehabilitation hospital. In total, 14 nurses made up the study population for pain management in a physical rehabilitation center.

Type of Design

A descriptive research design was entirely applied in the cross-sectional survey. The design was important in answering key questions such as what, when, where, and how with deliberate exclusion of why. In this design, a survey questionnaire was widely used in the collection of data. The mode of the collection entailed the distribution of 14 questionnaires in the physical rehabilitation center to the respective participants after which they were given a time span of one week to respond to the questions. The structuring of the questionnaire was deliberately focused on the relevance of the study as well as structured to examine the inner details of the study. The language, the content were kept simple and brief in order to achieve easy understanding as well as an interesting activity.

On one hand, a descriptive research design was very crucial in the analysis of the collected data regarding this particular type of research. Besides, if the need arises for the integration of quantitative and qualitative types of data, descriptive research design still effectively provides the opportunity not mentioning the less time-consuming factor of this type of research design in comparison to many other designs like quantitative experiments (Lambert & Lambert, 2017). On the other hand, a questionnaire being a key tool of data collection in the descriptive research design, it allowed a relatively easy data analysis, familiarity to the responding nurses, simple administration given that it’s just a matter of distributing them to the respective nurses, standardization of the data collected owing to the fact that all questions in the questionnaire were similar and structured to generate information with regard to specific segments of the research.

In summing up the details of the research design, the cross-sectional study was critical in collecting the broader view of the research topic with regard to the wider nursing personnel working in the physical rehabilitation center (Levin, 2006). It is also of importance to recognize that the research topic is composed of various components. In particular, the topic is composed of four parts which entail ‘The nurses’ gap between knowledge and practice in pain management’ being the first part, ‘the barriers to pain management’ being the second part, while the third and fourth parts being ‘best ways to provide pain assessment’ and ‘treatment inpatient in physical rehabilitation’ respectively. Covering such a broad or diverse topic in research is ultimately favored by a cross-sectional approach to study for the purpose of diversity in feedback and analysis. In this case, this design enabled us to prove or disapprove assumptions regarding pain management, containing several variables in data collection while at the same time capturing the specific response in time.

Justification for Exclusion or Inclusion of Content

The criteria for inclusion strictly demand that participating nurses must be active participants in physical rehabilitation. On the other hand, the exclusion criteria ruled out unregistered nurses such as students and those in training in addition to nurses not actively involved in pain management. Other participants that were excluded are those that submitted incomplete questionnaires. The key focus concerning these particular restrictions was based on the need to collect the most relevant data that lead to high accuracy and minimal errors. At most times, correct processes in research lead to the right conclusion.

Development of an Instrument for Obtaining Feedback

A questionnaire was developed on tools that had widely been applied in similar research. Meanwhile, Demographic and occupational questions composed the first section for the purpose of establishing the involvement and interaction of the participants. Six true or false questions formed the second section for testing the knowledge of participants in pain management. The third section consisted of views on barriers to pain management while the last section dealt with the best ways to provide pain assessment and treatment of patients in physical rehabilitation.

Identification of Themes and Categories

In order to identify the themes and categories in the collected data, conceptual, relationship and participant perspective codes were applied. Conceptual code specifically established the nurses ’gap between knowledge and practice by using the first section of the questionnaire to determine whether the participants understand the concepts of pain management and their application (DeSantis & Ugarriza, 2015). The participant’s perspective code was used in determining the participant’s viewpoint on barriers to pain management while the relationship codes were applied in drawing and classifying the relationships developed by participants between pain assessment and treatment of patients in physical rehabilitation.

Discussion and Recommendation

Data Analysis

Descriptive analysis was utilized in describing the participants’ characteristics as well as their answers to questions associated with knowledge, practices, and their perception of barriers in pain management. Another relationship obtained was between the participants’ characteristics and their knowledge score on pain management in physical rehabilitation. In this case, SPSS was applied in accomplishing statistical analysis. Percentages, frequencies, and mean were the statistical elements used to present the data in the study.  Capstone Project PowerPoint Presentation

Sample characteristics

A survey containing 10 questions was distributed to 14 participants. 88 percent of participants, which translates to 12 participants, successfully responded to the survey. The participants mean age stood at 33 years while their average practice experience in pain management, was 5 years. 48 percent of participants were male while 52 percent were females.

As such, the table below illustrates the relationship between the knowledge score and the characteristics of the study sample.

Fig 1.0: Characteristics of the study sample 

Characteristics	Number of nurses (%)	Knowledge score
Age
Below 35 years	83	4
Above 35  years	17	4
Gender
Male	48	5
Female	52	4
Work Experience
Below 7 Years	68	4
Above 7 Years	32	4

Mean score 4.2

0-10 is the range for knowledge score where the highest number indicates more knowledge in pain management.

Fig 1.1: Rate of correctness of answers in relation to knowledge of pain management

No.	Question	Number of nurses (%)
1.	You should discredit subjective reports of pain by patients (F)	48
2.	You should note the difference in specific causes of pain which require particular treatment (T)	73
3.	The risk of addiction is high in opioid analgesics (F)	15
4.	The assessment of the effect of immediate release of oral opioid can be achieved within one hour after administration (T)	38
5.	There is absence of the ceiling effect in opioid analgesics (T)	19
6.	The development of opioid-induced sedation occurs within a few days (T)	41
7.	Respiratory Suppression of the opioid-induced is common (F)	20
8.	The equivalence of opioid rescue dose to basal daily requirement of opioid is 25 percent (F)	10
9.	The fastest onset of action occurs at the IV route in opioid administration (T) Capstone Project PowerPoint Presentation	77
10.	Decreased adverse effect and increased analgesic efficacy results from prescription of NSAIDs of different types (F)	31

 

The two tables above illustrate the relationship between the knowledge score and the characteristics of participants.

Knowledge of pain management 

Figure 1.1 indicates the correct response rate according to the administered questions for assessing the knowledge score of the study sample. According to the calculation in figure 1.0, 4.2 is the mean knowledge score, an indication of a significant knowledge deficit among participants in pain management in physical rehabilitation. The questions about the opioid dose requirement (The equivalence of opioid rescue dose to the basal daily requirement of opioid is 25 percent) and the addiction risk of the opioids (The risk of addiction is high in opioid analgesics) reflected the highest knowledge gap as their percentage score ranged between 10 to 15 percent, respectively. However, the participants scored the highest knowledge in questions about the administration of opioids (The fastest onset of action occurs at the IV route in opioid administration) and treatment of pain (You should note the difference in specific causes of pain which require particular treatment) by scoring 77 and 73 percent, respectively.

Figure 1.3: Perceived barriers in pain management

Barriers	No. of nurses (%)
Barriers associated with nurses
Inadequate pain control experience	60
Inadequate pain examination	77
Inadequate pain control knowledge	62
Inadequate communication with the patient	67
Reluctance to opioid prescription	61
Barriers related to patient
Patients’ failure to report pain	64
Failure to take opioid	57
Inadequate communication with the nurse	64
Financial limitation	65
Inadequate pain control knowledge	71
Barriers associated with the system of healthcare
Stringent opioids regulations	70
Inadequate personnel	66
Limited opioids for different types of pains	60
Cost of medication and intervention	60

 

According to the analysis of perceived barriers in pain management, inadequate pain evaluation was viewed as the primary barrier at the medical staff category by scoring a frequency of 77 percent. In the patient category, insufficient knowledge of pain control was the significant barrier scoring a rate of 71 percent. On the other hand, concerning barriers associated with healthcare systems, the top frequency was 70 percent and was associated with strict opioids regulation. Capstone Project PowerPoint Presentation

Figure 1.4: Pain evaluation and documentation practices

Type of practice	Number of nurses (%)
Pain assessment occasion
Every round	58
On occasions selected	33
On occasions which are rare	7
Check-items during pain management
Location	70
Quality	58
Related factor	49
Severity	78
Timing	39
Pain assessment documentation	87

 

According to the analysis of pain evaluation and documentation practices, 58 percent of the nurses performed pain assessment every round. Although most nurses reported checking all aspects of pain during pain examination, severity and location of pain were the highly assessed aspect. On the other hand, 87 percent of nurses said that they documented pain assessments.

Discussion of findings 

The study centered its focus on the assessment of pain management concerning knowledge, practices as well as perceived barriers among nurses. As a result, the developed questionnaire was distributed and received a response rate of 88 percent, which directly translated to 12 participants. Attaining this degree of success at this level of study was attributed to factors such as the short time required to complete the questionnaire besides the nature of the request for participation in the study on the spot, which simplified the whole process of data collection.  Capstone Project PowerPoint Presentation

The analysis, however, reflects moderate knowledge of nurses in pain management. A mean score of 4.2 out of 10 in the knowledge of pain control indicates enormous knowledge gaps primarily on the calculation of opioid dose, the risk of opioids addiction, the opioids ceiling effects, and opioid-induced respiratory suppression. The results from the study add to the consistency of previous studies, which have equally pointed out nurses’ knowledge deficit in the administration of opioids as well as their (opioids) physical dependency. It is, however, important to note that although there was a close comparison between this study and other studies conducted outside the United States, the knowledge scores were significantly higher in this particular study than the latter. Perhaps this indicates a gradual improvement of knowledge in pain management. Another notable factor in this analysis is the higher knowledge score of male nurses in comparison to female nurses.

The study also highlights the critical barriers to adequate pain management. Some of these barriers are such as inadequate pain assessment on the part of the nurse highly associated with the deficit in knowledge of pain control and lack of critical consideration of complaints by patients. Given the criticality of the two barriers, it is easy to predict inconsistencies not only in the assessment practices but also in the documentation of pain management. On the same note, other studies have tied inadequate knowledge of pain control to pain-associated barriers and even strict policies on the usage of opioids to obstacles associated with healthcare systems.

Lastly, the study indicated that participants seemed to be keen on documenting pain assessment regularly, a trend that matches the findings of other studies previously conducted.

Strengths and limitations

The strength of this study was largely based on the clarity of the study objective, especially in the data collection process. However, one of the significant limitations of this study was the use of a small sample size of 14 participants limited in one health institution. Essentially, small sample sizes and limited coverage puts the accuracy of the study at stake. Besides, achieving more accuracy requires closer monitoring of nurses in practice to monitor their actual practice of which the study did not provide for. Also, given the cross-sectional nature of the study, it was impossible to ascertain the casual relationship with the determinants.  Capstone Project PowerPoint Presentation

Recommendation

The study analysis presents a clear case of knowledge deficit in pain management among nurses in the United States. The knowledge gap signifies the great need for improvement and promotion of nursing education to ensure that all stakeholders who include patients, nurses, and policymakers are more aware and knowledgeable about effective pain management in physical rehabilitation. As such, this study will be valuable in the future as one of the reference points in monitoring the progress of nursing knowledge and awareness in pain management.

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