EDUCATING NURSES--MANAGING CANCER PAIN IN RURAL PATIENTS

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The aims of the proposed educational program are to (1) increase nurses' understanding of cancer pain assessment, pharmacologic and nonpharmacologic therapies, and ethical and regulatory issues, and (2) teach them to use a coordinated care program, adapted from the Memorial Sloan-Kettering Supportive Care program, for rural areas. The program will be targeted to nurses in rural areas, who often lack access to the most up-to-date information on cancer pain management and the opportunity to receive ongoing consultation from cancer pain experts. Thirty nurses who work in rural areas (3 cohorts of 10 each) will travel to UNC Hospitals 1 day/week x 6 weeks to participate in the program (the project will conduct 3 6-week programs). Nurses, physicians, pharmacists, a psychologist, and a discipline consultant for the Board of Nursing will constitute the faculty for the program. The program uses the androgogical approach to learning, presenting content at a teachable moment, providing repetition, using a variety of teaching/learning strategies, and providing opportunities for practice. Nurse trainees will learn how to assess and evaluate patient problems, understand the clinical pharmacology of pain management, establish guidelines for non-pharmacologic therapy, learn about ethical and regulatory issues affecting patients and families in rural areas, and will be taught to use a coordinated supportive-care program. In the supportive-care portion of the program, the nurse trainees will learn how to consult with a team of pain management experts, assist in establishing guidelines for pharmacologic and nonpharmacologic therapy, and teach patients how to use cognitive-behavioral therapies such as education, relaxation, distraction and massage. As the nurse learns to use the supportive care model she/he will implement the same model in her home setting. A follow-up telecommunication conference will be implemented 1 year later to convey the latest developments in cancer pain management. The effectiveness of the program in improving the knowledge, attitude, and behavior of nurses, and improving patient satisfaction with pain management and quality of life will be evaluated, using a self-control quasi-experimental lag design in which nurses and patients act as their own controls. Five weeks prior to the beginning of the educational program, baseline data will be collected from each nurse entering the program and from 10 patients cared for by that nurse (30 nurses x 10 patients each). The same data will be collected from patients and nurses at the time the nurse enters the educational program and at the completion of the program. Additional follow-up data will be collected from the nurses at 6 months and 12 months after completion of the educational program and from patients at 5 and 10 weeks after the end of the program. If the program is successful in improving nurses' knowledge, attitude, and behavior and patient satisfaction and quality of life, efforts will be made to have future dissemination of the educational program supported by AHEC and to offer follow-up telecommunication conferences on a yearly basis.