Facilitators and Barriers to Evidence-Based Cancer Pain Management
Eaton, Linda H,
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Evidence-based pain management (EBPM) is essential in relieving cancer pain. This dissertation explores nurse-level and organization-level factors for adopting, implementing, and sustaining EBPM practices. A descriptive cross-sectional mixed methods design involving two inpatient oncology units was used for this study. The first paper describes nurse evidence-based practice (EBP) beliefs and behaviors. Nurses (n=40) completed the EBP Beliefs and Implementation Scales, and Carlson's Prior Conditions Instruments. Nurses agreed with the positive aspects of EBP and their implementation ability, although their implementation level was relatively low. Nurses supported adopting EBPM practices and were satisfied with their practices and that of others in their unit. Oncology nursing certification was associated with perceived innovativeness (r = .46, p = .003), and innovativeness was associated with EBP beliefs (r = .48, p = .002). Four themes were identified from qualitative interviews: (a) limited definition of EBP, (b) EBPM decision making varies, (c) limited identification of EBPM practices, and (d) nonpharmacologic interventions are integrated into patient care. The second paper reports barriers, facilitators, and strategies for sustaining EBPM implementation. Staff nurses, nurse managers, advanced practice nurses, and chief nursing officers participated in semi-structured interviews. Lack of time to access and use EBPM was the most common barrier. The most common facilitators were computer systems and advanced practice nurses. Strategies were posters, one-to-one teaching and patient rounds. The third paper explains the development of a mixed model to explore predictors of nurse EBPM behavior. Data used to develop the model were the questionnaire data and 403 nurse documentation encounters with 58 patients. Hospital was the significant predictor for EBPM behavior (â = -0.377, se = .042, p < .001). Results from these papers suggest that nurses believe in the value of EBP. Their low EBP implementation level in the context of EBPM was explained by their trust that standards of care were evidence-based and by the nature of pain management, which requires medical orders for analgesic therapy. Organization-level factors such as pain management clinical nurse specialists, pain resource nurses, and Magnet recognition are important to consider in sustaining EBPM in the oncology inpatient setting.
- Nursing - Seattle