Increasing Nurses’ Knowledge of an Evidence-Based Practice Pain Management Plan in the Intensive Care Unit

Abstract

Purpose: The purpose of this DNP project was to increase nurses’ knowledge of the “Assess and manage pain” component in working with adult critical care patients at Mercy Gilbert Medical Center. Evidence-based care practice content was included in the educational portion, with the ultimate goal of increasing compliance with the ABCDEF bundle at Mercy Gilbert Medical Center. Background: Approximately 77% of adult ICU patients have experienced pain during an intensive care unit (ICU) stay (Barr et al., 2013). Current clinical guidelines recommend using a pain, agitation, delirium (PAD) bundle to decrease delirium in the ICU by assessing pain first and screening for pain frequently (Barr et al., 2013; Devlin et al., 2018). The ABCDE bundle significantly decreases delirium (Devlin et al., 2018). Mercy Gilbert Medical Center serves a large population of adult ICU patients; therefore, the possibility of pain-related delirium among these patients is strong. Methods: This project used a pre-test/post-test quantitative design. Participants 1) completed a pre-test survey to evaluate knowledge and beliefs surrounding pain assessment and delirium; 2) viewed an educational presentation about pain assessment, delirium, and screening guidelines; and 3) completed a post-survey to evaluate any changes in knowledge and intention to screen for pain. Results were shared with ICU unit managers to help refine the education process for future testing cycles and other hospital sites. Results: A total final sample size of 11 ICU nurses completed the entire survey for a response rate of 14%. The highest proportion of respondents were ICU nurse females at 63.6%. The typical age range was 36-50 and years of practice were >10 years. The education level was 54% had Bachelor’s degrees in Nursing, 27% Associate’s degrees in Nursing and 18% Masters in Nursing. There were significant differences pre- and post-test for knowledge of pain assessment. (The Wilcoxon signed-rank test showed that five of the participants who completed the surveys and educational video demonstrated statistically significant improvement from pre- and post-testing [p < 0.01].) Conclusions: DNP quality improvement projects like this one help develop strategies to increase best practices, leading to improved patient outcomes. Results may be used to develop strategies to increase and align provider practices with the best standards for promoting early identification and treatment of pain-induced delirium.