Revisiting the Pain Resource Nurse Role in Sustaining Evidence-Based Practice Changes for Pain Assessment and Management.

BACKGROUND: Effective pain management is unlikely to occur without consistent and timely assessments. To improve assessment and management of pain, ward-based pain resource nurses were introduced in 2007 to facilitate hospital-wide evidence-based practice changes using three key targets. One-year post implementation of this quality improvement project, promising results were revealed. AIMS: The purpose of this study, 8 years post implementation, was to (a) evaluate sustained practice improvements in pain assessment and management, (b) assess current pain resource nurse knowledge and attitudes to pain, (c) explore characteristics of the pain resource nurse role, as well as (d) any perceived contextual changes regarding study findings. METHODS: A mixed-methods approach was used to address study aims. Quantitative data were collected from documentation audits and a "Knowledge and Attitudes Survey Regarding Pain." Qualitative interviews explored the characteristics of the pain resource nurse role, and a focus group discussion explored the context of change. RESULTS: Significant improvements were observed for the documentation of pain scores on admission and for each nursing shift. Survey results highlighted potential knowledge deficits in key practice areas, even though interview findings suggested that pain resource nurses provided a resource for peers, raised awareness of best practice, and imparted knowledge to other ward staff. An important facilitator for the pain resource nurse role was the ongoing collaboration and support from specific pain teams, and barriers to engage in the role were competing workload priorities, and limited awareness among other ward staff. LINKING EVIDENCE TO ACTION: Implementing and sustaining evidence-based practice change in clinical practice is challenging. Ongoing evaluation is necessary for identifying the long-term implications of practice improvement interventions and issues that influence the adoption of evidence-based practice. Strategies to address barriers, and to increase awareness and engagement of the pain resource nurse role with wider collaboration require further investigation.

A workforce survey of New Zealand medical oncologists.

AIM: There is wide recognition that the challenge of providing health care into the future requires planning for a sustainable workforce particularly in the context of increasing service demand. The Medical Oncology Work Group (MOWG) undertook a survey of vocationally registered medical oncologists which aimed to support future workforce planning and the development of models of care. METHODS: The survey was developed and carried out by the MOWG in conjunction with the Ministry of Health during 2009. Medical oncologists were sent the survey and forwarded unnamed completed responses to one of the authors (SB). RESULTS: A total of 33 out of 40 practising medical oncologists completed the survey, representing an 82% response rate. The survey found that there is an emerging movement from a male-dominated workforce largely working full time, to a workforce with a higher proportion of females and part-time workers. The median full-time medical oncologist in New Zealand was responsible for 220 first specialist assessments (FSAs) per annum, 40 more than the number considered reasonable by the surveyed practitioners. In qualitative responses, medical oncologists expressed frustration with lack of resources and high workloads that constrained their ability to appropriately deploy their skills and undertake teaching and research. Positive aspects included collegial collaboration and patient contact. Prominent suggestions for improving job satisfaction included use of skilled administrative staff or nurse specialists to free up time for oncologists to better use their skills. CONCLUSION: The survey highlights high clinical workload and frustration within the medical oncology workforce. In addition there is increasing service demand. This survey has formed the basis of work to develop new models of care in medical oncology.