Can just-in-time, evidence-based "reminders" improve pain management among home health care nurses and their patients?
ABSTRACT The purpose of this randomized, controlled, home care intervention was to test the effectiveness of two nurse-targeted, e-mail-based interventions to increase home care nurses' adherence to pain assessment and management guidelines, and to improve patient outcomes. Nurses from a large urban non-profit home care organization were assigned to usual care or one of two interventions upon identification of an eligible cancer patient with pain. The basic intervention consisted of a patient-specific, one-time e-mail reminder highlighting six pain-specific clinical recommendations. The augmented intervention supplemented the initial e-mail reminder with provider prompts, patient education material, and clinical nurse specialist outreach. Over 300 nurses were randomized and outcomes of 673 of their patients were reviewed. Data collection involved clinical record abstraction of nurse care practices and patient interviews completed approximately 45 days after start of care. The intervention had limited effect on nurse-documented care practices but patient outcomes were positively influenced. Patients in the augmented group improved significantly over the control group in ratings of pain intensity at its worst, whereas patients in the basic group had better ratings of pain intensity on average. Other outcomes measures were also positively influenced but did not reach statistical significance. Our findings suggest that although reminders have some role in improving cancer pain management, a more intensive approach is needed for a generalized nursing workforce with limited recent exposure to state-of-the-art pain management practices.
Full-textDOI: · Available from: Liliana E Pezzin, May 30, 2015
SourceAvailable from: Deleise S Wilson[Show abstract] [Hide abstract]
ABSTRACT: Background: Application of research evidence in care delivery improves patient outcomes. Large gaps still exist, however, between recommended care and that used in practice. To increase the understanding of implementation studies, and dissemination of research findings, we present the perspective of investigators from seven Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded studies. Objective: To describe implementation strategies, challenges, and lessons learned from conducting 5 INQRI-funded implementation studies, and present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth. Research Design: Qualitative descriptive methods were used for the implementation studies. Case examples were set forth by in-vestigators using reflection questions. Results: Four of the 5 implementation studies focused on clinical topics and 1 on professional development of nurse managers, 4 were multisite studies. Common implementation strategies used across studies addressed education, ongoing interaction with sites, use of implementation tools, and visibility of the projects on the study units. Major challenges were the Institutional Review Board ap-proval process and the short length of time allocated for im-plementation. Successes and lessons learned included creating excitement about research, packaging of study tools and resources for use by other organizations, and understanding the importance of context when conducting this type of research. Case examples re-vealed that study findings have been disseminated to study sites and to the health care community through publications and presentations. The potential impact of all 7 studies is far reaching. Conclusions: This study captures several nuanced perspectives from 5 Principal Investigators, who were completing INQRI-funded implementation studies. These nuanced perspectives are important lessons for other scientists embarking on implementation studies. The INQRI case examples illustrate important dissemination strat-egies and impact of findings on quality of care. U se of research evidence to guide practice improves pa-tient outcomes. Large gaps still exist, however, between recommended, evidence-based (EB) care and what is applied in care of patients and populations. 1,2 The objectives of this study were to describe, as perceived by the Principal In-vestigators (PIs), the implementation strategies, challenges, successes, and lessons learned from conducting 5 im-plementation studies funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI), and to present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth.Medical Care 04/2013; 51(4):S41. · 2.94 Impact Factor
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ABSTRACT: The primary purpose of this study was to examine the effects of an intervention consisting of the four translation strategies of educational materials, educational meetings, reminders, and audit and feedback on nurses' adoption of an evidence-based bladder program for patients with stroke in an acute care setting. The secondary purpose was to evaluate the difference in incontinence episodes of patients with stroke before and after nurses received the intervention. Finally, the purpose was to evaluate the influence of nurses' attitudes and the demographic characteristics on the adoption and use of the evidence-based bladder program after receiving the intervention. This study was the first to provide empirical support for the influence of the combination of these four translation strategies and nurses' attitudes toward research on the adoption of evidence-based practice in a time-series design study. Thus, the combined use of the four translation strategies did have an impact on nurses' adoption of evidence-based practice.Journal of Neuroscience Nursing 08/2014; 46(4):218-226. DOI:10.1097/JNN.0000000000000069 · 0.91 Impact Factor
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ABSTRACT: Patient educational interventions can improve cancer pain management.•Patient benefits of cancer pain education for professionals are less clear.•All cancer pain educational interventions share common key components.•Key components are modelled to inform the development of future interventions.Patient Education and Counseling 11/2014; 98(3). DOI:10.1016/j.pec.2014.11.003 · 2.60 Impact Factor