Using education to support pain management

Selecting tools to aid staff in teaching is crucial

Education is an important part of any pain management initiative. Health care facilities throughout the nation are working to identify the materials they need to enable them to teach patients about pain management.

Doris Doherty, BSN, RN, patient education coordinator at Franciscan Skemp Healthcare in LaCrosse, WI, worked with a small group of nurses, occupational therapists, and social workers to select patient education materials as part of a larger committee that was creating a pain management initiative. (To learn more about how an education subgroup fits into a pain management committee as a whole, see "Subgroups tackle pain management components," in this issue. To review a working pain management initiative, see "Pain initiative changes staff and patient mindsets," in this issue.)

"We ended up choosing quite a selection of materials, knowing that some people come in with chronic pain, some have acute pain, and then we have children with pain, and elderly people with pain who have dementia and oftentimes act out their symptoms," says Doherty.

During the selection process, the team kept certain content criteria in mind. They looked for materials that taught people how pain occurs and how pharmacological and nonpharmacological interventions assist people in relieving pain. They also looked for information that would help patients understand the need to be honest with hospital staff who were conducting pain assessments. Information that emphasizes the patient’s responsibility helps staff assess a patient’s pain level so that appropriate approaches to pain management can be implemented.

The new materials on pain will be incorporated into the existing patient education model, and their use will be documented the same as other materials. Pain education will be based on the assessment using a pain scale of zero to 10. The longevity of pain will play a factor in education as well, says Doherty.

Take stock of existing tools

The first project the subgroup on patient and family pain management education tackled at Children’s Hospitals and Clinics - Minneapolis was an inventory of all the tools that were already in place, says Casey Hooke, RN, MSN, APON, a clinical nurse specialist on the team. They found that many existing patient education programs had overviews of pain. For example, oncology had a family notebook with information about the cause of pain and how it is managed. There was also specific pain education around certain interventions such as an epidural catheter.

Once the inventory was completed, the team — which consisted of two clinical nurse specialists and the patient education coordinator — decided to create two education sheets for parents: one covering pain in children and the second for pain in infants. When creating content, team members reviewed Joint Commission standards to ensure that this education met that accrediting organization’s criteria.

The sheet for pain in children covers the health care institution’s commitment to pain management, identifies the causes of pain, and discusses how pain is assessed and how to identify pain in children. To help parents recognize pain, the sheet explains how children react according to their developmental stage (infants, toddlers, preschool children, school-age children, and adolescents). It also suggests pain interventions that parents can try, such as massage, and discusses pain medications, says Hooke.

The content in the sheet for infants is based on the information included in the children’s sheet. However, input from clinical nurse specialists in the neonatal intensive care unit and infant units were solicited to make the information more applicable to premature and full-term infants. For example, parents are told to watch their children’s behavior, because refusing to eat could be a sign of pain, says Hooke. The sheet on infant pain was just finalized.

"All families will receive the education sheet, and it will be reviewed with them and the teaching documented," says Hooke. If there are specific pain needs assessed, then the teaching would go beyond what’s covered on the initial sheet and address the intervention, but all patients’ families receive a minimum standard of teaching.

The patient education resources/materials group at Riley Children’s Hospital in Indianapolis is currently searching for resources and information so they can use the latest research when creating or evaluating for purchase written materials and videos on pain. Their plan includes revising some of the institution’s current handouts to update them, says Cindy Latty, BSN, RN, patient education coordinator/clinical educator at the hospital.

In their initial evaluation process, the group determined that most of what was presently available was in written format. "We feel we need to provide another medium for those whose learning styles differ and also to make pain education for our pediatric patients and their families more interesting," says Latty.

Information about pain management and resources pertaining to this issue has been gathered from conferences, literature, hospital staff, and web sites. (For a list of web sites the group has researched, see editor’s note at end of article.) Latty recommends using staff as resources during research. "Their knowledge of other resources can be invaluable," she explains. For example, a new professor of pediatric oncology nursing at the hospital provided information about a pain resource center for nursing research and education — The City of Hope Pain/Palliative Care Resource Center.

Addressing pain seems to be a simple matter, but it is not. There are various types of pain described in research, and as groups begin to discuss education, they begin to think about how to prepare a new mom for anticipated pain during labor or how to prepare a presurgical patient for anticipated pain post-op, says Doherty. "Each patient experiences pain differently, so we have a broad base of printed information that staff can select from. We will teach staff what the information covers so that they can easily pick and choose what they will share with the patients as they deal with their pain," says Doherty.

Need More Information?

  • Doris Doherty, BSN, RN, Patient Education Coordinator, Nursing/Patient Education, Franciscan Skemp Healthcare, LaCrosse, WI 54601. Telephone: (608) 785-0940, ext. 2193. E-mail: Doherty.Doris@mayo.edu.
  • Casey Hooke, RN, MSN, APON, Clinical Nurse Specialist, Children’s Hospitals and Clinics-Minneapolis. For information contact: Linda Broz, RN, MS, Patient/Family Education Coordinator, Children’s Hospitals and Clinics - Minneapolis and St. Paul, 345 N. Smith Ave. (MS 61245), St. Paul, MN 55103. Telephone: (651) 220-6107. E-mail: Linda.Broz@childrenshc.org.
  • Cindy Latty, BSN, RN, Patient Education Coordinator/Clinical Educator, Riley Children’s Hospital, Clarian Health Partners, Indianapolis. Telephone: (317) 274-8845. E-mail: Clatty@clarian.org.

Following is a list of web sites researched by the patient education resources/materials group at Riley Children’s Hospital in Indianapolis during the creation of the institution’s pain management initiative. The information was provided by Cindy Latty, BSN, RN, patient education coordinator/clinical educator at the hospital.