The Influence of Social Cognitive Domains on Pain Vignette Performance

Goebel JR, Sherbourne C, Asch S, Meredith L, Cohen AB, Hagenmaier E, Lanto A, Simon B, Rubenstein L, Lorenz K. The Influence of Social Cognitive Domains on Pain Vignette Performance. Poster session presented at: Western Institute of Nursing Annual Meeting; 2007 Apr 12; Portland, OR.

Related HSR&D Project(s)

• IIR 03-150 – Validation of Pain as a Vital Sign Among Veterans with Advanced Illness

Background: Progress in pain management requires a multidisciplinary approach with attention to improving the performance of multiple providers involved in patient care. Nurses play a pivotal role as the first contact with patients in pain and they have a profound potential to positively influence pain management. Research suggests that provider attributes and health care environment influence care for patients in pain. Purpose: The purpose of this study is to use social cognitive theory domains (nurse expectations, perceived environment and behavioral capacity) as a framework to investigate the performance of nurses on a pain vignette responding to patient/caregiver addiction concerns of an elderly patient in severe pain. Sample: Written consent was obtained from VA staff nurses (RNs, LVNs, health technicians) at 2 hospitals and 7 community clinics (Greater Los Angeles and Long Beach) in an ongoing study evaluating pain screening and treatment. The response rate was 95% and represented an ethnically diverse workforce (68.3% identified themselves as non-Caucasian/non-white). Forty-three percent of 100 respondents were registered nurses, 47% licensed vocational nurses, and 10% were health technicians. Work experience varied from 1-48 years (median 19.44 years), 86% of nurses were female, and 60% had attended one or more pain/palliative care lectures. Methods: Vignette-derived outcome was whether nurses were ‘very likely’ (on 5-point category scale) or not to educate the patient/caregiver about addiction concerns (0,1). Independent variables included peer attitudes about pain management, role (RN/LVN/health tech), years of experience, pain lecture attendance and responses to 2 scales - Confidence Related to Pain Care, and Negative Nurse Expectations of Pain Care Scales. We examined association of these factors with appropriate care using logistic regression. Results: Most nurses were very likely (vs. ‘somewhat likely’ to ‘very unlikely’) to provide education related to addiction risk and pain medication (61 out of 100). Vignette performance was higher among nurses with more years of work experience (OR: 1.133, CI: 1.057-1.216, p < 0.001) and higher pain management confidence (OR: 1.509, CI: 1.189-1.915, p < 0.001). Nurses who reported attending pain/palliative care lectures demonstrated higher performance scores (OR: 3.701, CI: 1.215-11.266, p < 0.021). Although not statistically significant, as skill level increased (from licensed vocational nurse to registered nurse) performance on the vignette improved (OR: 4.0208, CI: 0.91-19.22, p = 0.064). The influence of negative nurse expectations, gender, and environmental perceptions did not significantly influence vignette performance. Conclusions: Policies targeted to improve pain management may include retention and use of experienced nurses in clinical care, mentoring support for nurses entering practice, directed activities to improve nurses’ knowledge and confidence in pain management, and expanded opportunities to transition to higher levels of practice.