OUIDA CARR PICO

1. Nurse Education Enhancing
Pain Management
Ouida Carr
February 2019
NU560

2. PICOT: Pain Management and Nurse Education
The PICOT project focuses on nurse education to enhance pain management in clinical practice. Enhanced pain management is a
targeted effort to reduce hospitalization rates, a metric that can tracked and impacted at numerous levels.
The PICOT project will have a specific focus on nurse education as a medium of enhancing pain management. The purpose of the
project is to identify if more frequent opportunities for skill enrichment among nurses can lead to enhanced patient outcomes. The
training systems will target technology-based approaches for pain management and patient communication. Quantitative and
qualitative research design could be utilized to determine the effectiveness of the program design and weight of variable changes.

3. Description of Problem
Pain management involves a dynamic
communication between healthcare staff and the
patient.
Assessment may reveal straightforward methods
of dealing with patient pain, while certain aspects
may require abridged treatment based on
specialized understanding.
Reasons for Ineffective Management
● Gaps in Education
○ Lack of situational training, no previous
experience
○ Assumption of previous training and
certification
● Communication Gaps
○ Cultural barriers
○ Inability to communicate with body language or
common linguistics
● Over-reliance on pharmaceutical options

4. EBP and Literature
Knowledge to Action Framework
● Continual, cyclical pattern of learning,
assessment and application
● Nurse Leaders control the process but
all project members have a role in the
process
The knowledge creation process is curated by project
coordinators/management staff who communicate with staff
to ascertain their gaps in knowledge, then moves forward to
create relevant educational content to meet the needs of the
current skill mix (Canivet et al., 2014).

5. EBP and Literature
Barriers to Pain Management Noted in Research
***Organization leadership is a key factor identified
in the research as a solution to increasing the pain
management effectiveness.
**Staffing levels and availability of resources play
an important role in the nurse’s repertoire of
treatment options.
*Low staffing and low financial resources
Solutions?
● Education
● Tiered Scales for Assessment
● Patient Communication

6. Ethical Considerations
Pain Management solutions requiring
pharmaceutical regumens present risk for:
*drug resistance
*opioid abuse
*”default” care solutions
The patients undergoing pain management techniques that are new to
the practitioner are not under a particular risk as long as the
appropriate supervision and training is applied in context.
There will not be a particular device or experimental group of
patients, thus the application of nursing techniques for pain
management ranging from functional assessment to communication
do not present a specific risk in terms of ethics.

7. Change Model
Lewin’s Change Model
● Unfreeze
○ Awareness of Change
○ Informing staff and engaging in pre-assessment
● Change/Action
○ Tangible steps taken toward the target objectives
○ Nurse education program enacted and recorded
○ Project leadership conducting consistent assessment toward objectives
● Freeze
○ Organizational practice and culture adapts the new methodologies of care, training, education and
communication
○ The change becomes permanent
○ Results of project communicated to relevant audiences

8. Research Model
Methodology
Knowledge to Action Framework for education
● Leadership develops topic-specific content
for nurse practitioners to enhance their
care methodology
Pre-assessment of Gaps in Clinical Knowledge
and/or Patient Communication
Data Collection
Qualitative - Semi-structured interviews with
nurse managers and key subordinates (nurses),
post-implementation of education programs
Quantitative- Hospitalization rate for facility,
county and state

9. Project Target Outcomes
In Dekalb County Ga, the hospitalization rate, as
demonstrated within Cancer-related conditions,
represents nearly a quarter of the population.
Pain management has important implications for
oncological nursing and beyond.
A target of 5% decrease in hospitalization
results in a potential impact of 13 thousand
patients
(Source: Fulton-Dekalb Hospital Authority, 2019)

10. Funding Opportunities
Pain Consortium (National Institute of Health)
Translational Devices to Treat Pain (UG3/UH3 Clinical Trial Optional)
Early Phase Pain Investigation Clinical Network - Specialized Clinical Centers (U24 Clinical Trial Not Allowed)
Tissue Chips to Model Nociception, Addiction, and Overdose (UG3/UH3 Clinical Trial Not Allowed)
Early Phase Pain Investigation Clinical Network - Data Coordinating Center (U24 Clinical Trials Not Allowed)
Pragmatic Randomized Controlled Trial of Acupuncture for Management of Chronic Low Back Pain in Older
Adults (UG3/UH3 Clinical Trial Required)
Early Phase Pain Investigation Clinical Network - Clinical Coordinating Center (U24 Clinical Trial Required)

11. Conclusion
Organizations can support enhanced patient care with targeted training and supporting clinical staff with
adequate resources for diverse EBP implementation. The Lewin’s Change Model is recommended for
the project due to the distinct phases of change to adjust clinical practices of newly acquired skills. The
Knowledge-To-Action framework of education requires a close assessment of needs for patients and
practitioners, in a continual feedback loop supported by targeted education.
Good project management for this PICOT topic can help to identify a larger context of data trends from
the internal and external perspective. Shifting the practice model to targeted interventions instead of
generalized approaches helps to reduce potential issues of patient addiction to opioids, low satisfaction
and high costs related to long stays in the facility. Effective pain management through enhanced nurse
education presents a major opportunity for improving patient care.

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