Abstract

The purpose of this study was primarily to identify the clinical judgement used by practicing nurses, who could manage cancer pain effectively, and secondly to compare the differences between nurses who could manage cancer pain ettectively and those who could not.

Data was collected from three cancer patients and 23 clinical nurses at one cancer center using participant observation, pain flow charts, questionnaires (including a knowledge test of cancer pain management), and interviews with the subjects. The study analyzed the data and evaluated the nurses' pain management both qualitatively and quantitatively.

Three categories were identified as the basis of the clinical judgement for effective pain management. There are “expertise”, “information gained by the assessment of patients”, and “nurse's experience”.

Nine of 23 nurses (group A) successfully brought cancer pain-relief to the patients during the course of the trial period and the others (14 nurses: group B) were not able to manage cancer pain effectively.

There were no significant differences in the demographic data between both groups of nurses. However the group A knowledge score was significantly higher than that of group B (p＜.01). When administering morphine to the patients, Group B especially expressed a significantly greater fear than Group A of the patients becoming psychologically dependent (p＜.05). The study suggests that appropriate knowledge about cancer pain management is needed for the clinical nurses.

Abstract

The purpose of this study was to identify the nursing knowledge which clinical nurses need for cancer pain management. The study consisted of two steps. The first step was implemented in order to make a “List of knowledge criteria needed for cancer pain management”, and the second step was done to identify the items an educational program (made by Computer Assisted Instruction: CAI) should contain.

Data was collected from 25 clinical nurses at one cancer center using a semi-structured questionnaire for the first study purpose. The study analyzed the data qualitatively and four major groups were identified by practicing nurses, as being those important for cancer pain management. These were: “Knowledge of disease”, “Knowledge of pain”, “Knowledge about the theory and concept of cancer pain”, and “Knowledge of collecting data and assessment”. Each major group consisted of categories and sub-categories. From 122 descriptions, approximately half of them fell into “Pharmacological care”, a sub-category of “Knowledge of pain”. The “List of 19 knowledge items needed for cancer pain management” was mainly taken from this “Pharmacological care” sub-category, and the second survey was implemented using this list. Data was collected from 227 clinical nurses at two cancer centers using a structured questionnaire and a knowledge test. The questionnaire asked subjects the improtance of and the familiarity with each item, whilst the knowledge test checked the expertise of each subject. Three items, “Side effects of opioids prescribed for severe pain (morphine) and care”, “Causes of cancer pain”, and “Factors that effect cancer pain” represented high importance and were most familiar to the nurses. All of the average importance scores nurses who had more than 5 years clinical experience of cancer nursing (group 1 nurses) marked were higher than those of the other nurses' (group 2 nurses) average scores. The average points of the knowledge test was 10.4 (out of 19 points), and the group 1 average (11.4 points) was significantly higher than that of group 2 (9.78 points, p＜.001). Two questions, regarding “Mechanism of pain” and “Conversion to different drugs (narcotics)” showed low percentages of correct answers. With these results, an educational program was made (from which clinical nurses can obtain nursing knowledge about cancer pain management).