Sammanfattning
Aim: The purpose of this review is to provide a comprehensive overview and evaluation of experimental studies, testing the efficacy of interventions aimed at nurses, or the multidisciplinary health care team, to improve pain management.
Background: Pain is a prevalent problem, and has been found to be inadequately assessed, documented and managed. Barriers to pain management have been identified at multiple levels, including the systems level, among health care professionals and among patients and their family members. Continuing education and training aimed at nurses and other health care professionals has been a commonly used strategy to improve pain management.
Methods: Computer searches were conducted to identify experimental studies, either randomized controlled trials (RCTs) or quasi experiments with a control group, where the efficacy of interventions aimed at nurses or the multidisciplinary health care team, to improve pain management were tested. Articles were included if they were published between 1990 and 2010.
Findings: Few experimental studies have been conducted to evaluate the efficacy of continuing educational programs aimed at health care professionals to improve pain management. Eleven studies were found that fit the inclusion criteria, nine RCTs and two quasi experiments with control groups. The patient populations, settings, target of the interventions, content, delivery method and duration varied greatly, as did outcome measures. In only six studies, effects on patient outcomes were reported. Three interventions were found to positively affect clinical patient outcomes; a brief, focused intervention aimed at staff nurses with individualized feedback, a comprehensive intervention utilizing role models to implement change plus an implementation of an evidence based pain algorithm; and a comprehensive intervention with over 30 hours of education aimed at nursing staff.
Conclusion: In only a few studies, the effects of continuing education programs to improve pain management have been assessed, and in only a handful of studies, direct patient outcomes have been measured. Continuing education programs are both time consuming and costly. Since they are among the most used strategies to improve pain management in health care settings, it is vital to test their efficacy in randomized controlled trials, to identify their key components and to test their effects on direct patient outcomes.