More than seven years ago a multidisciplinary team at Joseph Brant Memorial Hospital came together to focus on pain management, share ideas and develop strategies for addressing patient pain.
That proactive and progressive approach was manifested again in June 2006 when 24 nurses were recruited from across the patient care units at Joseph Brant to become part of a Pain Resource Nurse (PRN) team. Ildy Tettero, an Advanced Practice Nurse and Sue Clarkson, a Nurse Clinician, each with a specialty in palliative care, collaborated with hospital administration to plan and implement the PRN role.
To improve pain management at the bedside and in all care delivery areas, they determined team members would: function as nursing clinical experts; model evidence-based pain management; be a resource to the interdisciplinary team on their units; and act as change agents to prevent and manage physical, emotional and psychological pain, in collaboration with the interdisciplinary team, patients and their families.
Candidate nurses completed a pre-test to identify their knowledge gaps and learning needs with respect to pain management. Two full-day educational training sessions were held covering such topics as myths and barriers; pain assessment; pharmacological and non-pharmacological intervention; cancer pain; paediatric pain; and managing side effects.
The education was a success. Nurses reported they had gained knowledge in pain management they felt would help in their clinical practice. “The enthusiasm of the group during the training exceeded our expectations,” says Ildy. To maintain that enthusiasm and to support team members in applying their newly acquired knowledge, a plan for sustainability was critical.
They decided to hold paid four-hour education sessions for team members to attend once every two months. These sessions were taught and/or coordinated by Ildy and Clarkson and repeated for two months consecutively to encourage team members to attend. The sessions were delivered in a variety of formats. Sometimes outside speakers came to share their expertise. Lori Palozzi, an Advanced Practice Nurse (APN) from the Hospital for Sick Children presented a general overview and assessment of paediatric pain and pharmacology. Salima Ladak, an APN from University Health Network (UHN), offered her experience from UHN’s development of a PRN team. To mark National Pain Awareness Week in November 2007, Dr. Nadia Plach presented on geriatric pain. The PRN team included a poster presentation (pictured) during that week displaying personal research on various areas and techniques in pain management.
There were also case studies, peer reviews and inservices on such topics as opioid equivalencies, addiction, CADD pumps and adult pain assessment tools. Most education sessions included team members presenting briefly on a particular pain-related topic they had researched. The sessions also included “check-in and story-telling” allowing PRN team members to discuss issues on their units relating to pain.
“The ongoing education has helped keep everyone connected and integrate new members,” says Ildy. She notes the great resource and support that Sue Clarkson is as she visits the various units in her work as a palliative care nurse. “They see her regularly and know she’s available to answer questions.”
Post training evaluations have shown an increase in knowledge about pain related topics and reflect the benefit of the education.: “I feel empowered to advocate for patients with pain”; “There is value in sharing experiences with colleagues”; and “I learned so much.”
Team members have also become a resource for each other. Barb Dalla Riva, a nurse with Joseph Brant’s Acute Pain Service in the Post Anaesthetic Care Unit (PACU) and member of the PRN team, has been able to learn and share information about pain management. “We primarily treat acute pain in PACU, whereas Ildy and Sue often treat chronic pain,” she says. “That requires an entirely different kind of management.”
Ildy appreciates the hospital’s financial and professional support, noting the sustainability of the program depends on this support. “I believe the creation of the PRN team enhances our ability to deliver quality care to our patients. The enthusiasm of the recruits for the initiative was contagious, which strengthened my resolve to obtain and provide support for the development and operations of the team,” says Beverley John, Vice President Patient Care Services and Chief Nursing Executive.
Ildy also points out the managers’ willingness to release staff, making the scheduling changes necessary to allow members of the PRN team to attend ongoing education events.
A plan for sustainability, and a commitment to it, can be the life blood of success for innovative and fledgling programs. The need to share knowledge and expertise in pain management is critical to high quality patient care.