Evaluation of the revised pain resource nurse training program pre/posttest

Purpose: To evaluate the 1) gains in pain knowledge from pre to posttest  and 2) number of questions and content of the questions that were answered incorrectly by > 50% the participants.

Background;There is evidence that pain management in hospitals is improving with routine pain assessment and the development and implementation of treatment strategies; however, pain is still inadequately treated.  The Pain Resource Nurse (PRN) program provides nurses with core knowledge in the nursing care of people with pain.  Research has reported that participation in the pain resource nurse program improves pain management at hospitals.

Description: A 2-day annual pain resource nurse conference is offered by the Puget Sound Pain Resource Nurse Education Cooperative and includes a 42 question pretest and posttest.  The pretest is part of the on line conference registration process and is completed 1-2 months prior to the conference.  The online posttest is available to participants immediately following the conference for three weeks. 805 nurses completed the pretest over the four years; 2011 (n=190), 2012 (n=162), 2013 (n=185), and 2014 (n=268).  655 nurses completed the posttest over the four years; 2011 (n=171), 2012 (n=112), 2013 (n=149), and 2014 (n=223). The pre/post test scores are analyzed using descriptive statistics and independent t-tests.    Descriptive statistics were used to identify the questions that > 50% of participants answered incorrectly on the pretest and posttest for each of the four years.

Outcomes Achieved: Examination of the test score means reveals that pre-test mean scores were consistently lower than posttest mean scores; 2011 (M_Pre =24.93, SD_Pre = 5.45; M_Post=33.12, SD_Post=4.36), 2012 (M_Pre =24.82, SD_Pre = 4.91; M_Post=33.19, SD_Post=3.96), 2013 (M_Pre =26.09, SD_Pre = 5.93; M_Post=33.00, SD_Post=3.19), and 2014 (M_Pre =26.49, SD_Pre = 5.22; M_Post=34.76, SD_Post=3.94).  Independent t-tests compared the pre/posttest mean scores and were significant; 2011 (t₍₃₅₉₎=-15.655, p<.001), 2012 (t₍₂₇₂₎=-14.985, p<.001), 2013 (t₍₃₃₂₎=-12.825, p<.001), 2014 (t₍₄₈₉₎=-14.712, p<.001). Sixteen to eighteen pretest questions were responded to incorrectly by > to 50% of participants and zero to four posttest questions were responded to incorrectly by > to 50% of participants for the four years evaluated.

Conclusions/ Implications for educational practices/ Recommendations: Nurses consistently improved their pain knowledge at posttest for each of the four years. In addition, 38%-43% of questions on the pretest and only 10% or 0% of the questions on the posttest were responded to incorrectly by >50% of participants. The posttest questions missed were related to pharmacologic topics (e.g. equianalgesia, side effects). Limitations include: 1) attrition rate of participants who took the pretest but did not take the posttest and 2) the pre/posttest are the same test.  We do not know if the posttest scores reflect the knowledge gain from the program or an effect of the pre-test.  Future research is needed to link nurse improvements in pain knowledge to patient outcomes.