Overcoming barriers to effective pain management: the use of professionally directed small group discussions.

Inadequate assessment and management of pain among critical care patients can lead to ineffective care delivery and an increased length of stay. Nurses' lack of knowledge regarding appropriate assessment and treatment, as well as negative biases toward specific patient populations, can lead to poor pain control. Our aim was to evaluate the effectiveness of professionally directed small group discussions on critical care nurses' knowledge and biases related to pain management. A quasi-experiment was conducted at a 383-bed Magnet(®) redesignated hospital in the southeastern United States. Critical care nurses (N = 32) participated in the study. A modified Brockopp and Warden Pain Knowledge Questionnaire was administered before and after the small group sessions. These sessions were 45 minutes in length, consisted of two to six nurses per group, and focused on effective pain management strategies. Results indicated that mean knowledge scores differed significantly and in a positive direction after intervention [preintervention mean = 18.28, standard deviation = 2.33; postintervention mean = 22.16, standard deviation = 1.70; t(31) = -8.87, p < .001]. Post-bias scores (amount of time and energy nurses would spend attending to patients' pain) were significantly higher for 6 of 15 patient populations. The strongest bias against treating patients' pain was toward unconscious and mechanically ventilated individuals. After the implementation of professionally directed small group discussions with critical care nurses, knowledge levels related to pain management increased and biases toward specific patient populations decreased.

Effect of a medication-taking behavior feedback theory-based intervention on outcomes in patients with heart failure.

BACKGROUND: Medication nonadherence contributes to hospitalization and mortality, yet there have been few interventions tested that improve adherence and reduce hospitalization and mortality in heart failure (HF). Our objective was to determine whether an education intervention improved medication adherence and cardiac event-free survival. METHODS AND RESULTS: A randomized controlled trial was conducted on 82 HF patients. The intervention was based on the theory of planned behavior (TPB) and included feedback of medication-taking behavior using the Medication Event Monitoring System (MEMS). Patients were assigned to one of three groups: 1) theory-based education plus MEMS feedback; 2) theory-based education only; or 3) usual care (control). Cardiac events were collected for 9 months. Patients in both intervention groups were more adherent over follow-up compared with the control group. In Cox regression, patients in either intervention group had a longer event-free survival compared with those in the control group before and after controlling age, marital status, financial status, ejection fraction, New York Heart Association functional class, angiotensin-converting enzyme inhibitor use, and presence or absence of a significant other during the intervention (P < .05). CONCLUSIONS: Use of an intervention based on the TPB improves medication adherence and outcomes in patients with HF and therefore offers promise as a clinically applicable intervention to help patients with HF to adhere to their prescribed regimen.