Nursing 695: Independent Nursing Research Study

Introduction:
It is widely known that pain is often under-treated and under-documented in the clinical setting. It has been shown numerous times how a lack of education can influence how a nurse treats pain. Although one area that is lacking research is how factors such as religion, age, past experience with pain, degrees and educational background, units worked on and years as a nurse influence how the nurse treats pain. In a study done by Ooi Seow Yin, it was found that there is a significant association between educational level and a level of helplessness. Those with a degree were less likely to feel helpless compared to those with a diploma or advanced diploma (Yin 2007). Within the research, many articles looked into the influence of the patient’s culture and the nurse’s culture on the perception and expression of pain. It is mostly the articles on the cultural environment of the unit, and the nurses’s culture, where the gap in knowledge occurs. To better enhance the understanding of how nurses treat pain, the goal of our study is to examine a nurse’s culture based on what is lacking in the research.

Objectives:
- To determine how cultural factors such as religion, age, past experience with pain, degrees and educational background, units worked on, and years as a nurse influence how a nurse treats pain.
- To understand how a nurse’s past experience with pain can influence how she treats a patient’s pain.
- To utilize our research to educate nurses on how cultural and personal issues may influence how they treat pain in order to enhance patient satisfaction with pain management.

Setting:
A seacoast area hospice service and a medical-surgical unit with a focus on the care of oncology and end-stage disease management.
Source of Subjects: 20 RNs by convenience sampling (10 Medical -Surgical nurses and 10 Hospice nurses)

Investigator Experience:
Julianne St. Onge and Christina Nagel, both senior nursing students with 2 years of experience in the clinical setting along with prior experience working in nursing homes. Dr. Flores is a UNH faculty member with experience in qualitative research and hospice care (see attached letter).

Protocols:
After obtaining informed consent, the investigators will conduct focused interviews with participating nurses who provide end-of-life and end-stage-disease management care in the hospice and acute care settings. All responses will be kept anonymous while all names and identifiers will be removed. All interviews will be conducted in a private area such as a conference room or break room with only the interviewer and informant present. Interviews will be audio taped to ensure the accuracy of data transcription and analysis. Study participants will sign a form consenting to the recording, transcription, analysis and reporting of the data he or she provides. Study participants may request to have access to the recordings of their individual interviews. Analyzed data will be presented in an aggregated form on tables and figures that eliminates all identifiers of individual participants. All tapes and transcripts will be stored in a locked filing cabinet in Hewitt Hall. Researchers will honor requests to edit a subject from a presentation.

Consent:
Consent will be obtained using the written full form which will state that the interviewees are agreeing to take part in an audio taped interview. Both interviewer and interviewees will receive signed copies of the consent form (see attached consent form).

Data:
All subject identifiers will be removed from the interview transcripts prior to analysis. Data will be analyzed through qualitative methods such as coding, theme identification, and describing the varieties of categories within each theme using data management software. Our findings will be used to describe social and cultural factors that may influence the nurse-management of pain in end-of-life and/or end-stage-disease care. Data will be aggregated and reported in charts, graphs and anecdotal paragraphs, quotes or stories. Data will be stored in a locked filing cabinet in Hewitt Hall. Only researchers will have the ability to access the audio tapes. At the end of the study, all audio tapes will be destroyed.

Risks:
There is minimal risk to the subjects involved in this study. Researchers are taking all possible measures to ensure confidentiality of subjects.

Benefits:
Benefits include raising the subject’s awareness of how cultural and personal issues influence the management of pain at the end of life.


References
Camp, L.D., O’Sullivan, P.S. (1987). Comparison of medical, surgical and oncology patients’ descriptions of pain and nurses’ documentation of pain assessments. Journal of Advanced Nursing, 12, 593-598. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Dalton, J.A., Carlson, J., Mann, J.D., Blau, W., Bernard, S., Youngblood, R. (1998). An examination of nursing attitudes and pain management practices. Cancer Practice, 6, 115-124. Retrieved June 25, 2008, from the CINAHL database.
Fothergill-Bourbonnais, F., Wilson-Barnett, J. (1992). A comparitive study of intensive therapy unit and hospice nurses’ knowledge of pain management. Journal of Advanced Nursing, 17, 362-372. Retrieved June 24, 2008, from the CINAHL database.
Wilson, B., McSherry, W. (2006). A study of nurses’ inferences of patients’ physical pain. Journal of Clinical Nursing, 15, 459-468. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Wilson, B. (2007). Nurses’ knowledge of pain. Journal of Clinical Nursing, 16, 1012-1020. Retrieved June 24, 2008, from the MEDLINE (through EBSCOhost) database.
Yin, O.S., Xia, Z., Chia, D.T.C. (2007). Nurses’ perceptions towards caring for dying patients in oncology ward and general surgical ward. Singapore Nursing Journal, 34, 16-21. Retrieved on June 25, 2008, from the CINAHL database.
Young, J.L., Horton, F.M., Davidhizar, R. (2006). Nursing attitudes and beliefs in pain assessment and management. Journal of Advanced Nursing, 53, 412-421. Retrieved June 24, 2008, from the CINAHL database.