Nursing Students' Use of Guidelines for Pain Management in Clinical Practice: Context and Influencing Factors

Abstract

Purpose To understand the factors that influence nursing students’ use of evidence-based pain management guidelines in their clinical placements. Methods/Design Guided by educational and knowledge translation theory, multiple approaches were used: 1. A scoping review of the literature to identify and describe educational strategies to promote evidence-based practice (EBP) by nursing students in the clinical setting, along with associated barriers and facilitators from the literature. 2. A process to develop indicators of the use of pain guidelines in clinical practice. 3. A descriptive case study to determine the gap between evidence-based guideline recommendations and actual practice and to understand the clinical and educational contextual factors that influence nursing students’ use of pain management practice guidelines. Findings The scoping review identified 37 papers in total, 14 descriptive and 23 evaluation studies. Commonly identified barriers were lack of EBP knowledge and skills and lack of support in the clinical setting. EBP projects were the most frequently evaluated educational interventions, alone, or in combination with workshops or journal clubs. During the indicator development process, eleven guidelines were reviewed for quality, resulting in three quality guidelines. From these three guidelines, 12 recommendations were extracted. Quality indicators were then identified by a consensus process, resulting in 24 discrete indicators for the chart audit. For the descriptive case study, fifty-four charts were audited, and interviews were conducted with nine students, seven nurses, one professor, and one clinical instructor. Multiple documents were reviewed, and a site visit was conducted. There are gaps between pain guideline recommendations and practice in the clinical setting. Examples of barriers include the perception that guidelines are not applicable for the clinical setting, lack of knowledge regarding guidelines and an emphasis on task completion in the clinical setting. Facilitators included access to resources, curriculum changes, and the integration of guidelines in policies and procedures. These findings can inform the development, implementation and evaluation of evidence based educational strategies that take into account the multiple actors that impact nursing students’ experience, namely, in-class professors, clinical instructors, and staff nurses. Future education and research approaches should be rooted in knowledge translation and education theory.