Journal Club

Alignment of Pain Reassessment Practices and National Comprehensive Cancer Network Guidelines

Cynthia Smith Idell

Marcia Grant

Christina Kirk

pain assessment, pain management, standards and guidelines
ONF 2007, 34(3), 661-671. DOI: 10.1188/07.ONF.661-671

Purpose/Objectives: To improve nursing pain reassessment practices using a research utilization model and advanced practice nurses (APNs).

Design: A pre- and postintervention one-group design.

Setting: A cancer hospital located in the western United States.

Sample: 42 oncology RNs from the inpatient staff of medical or surgical oncology units working at least 24 hours per week.

Methods: National Comprehensive Cancer Network clinical practice guidelines were adopted. Interventions included one-on-one feedback regarding reassessment practices and nursing pain rounds. Instruments used were Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP), Pain Reassessment Data Tool, and Pain Competency Evaluation (PCE).

Main Research Variables: Independent variables were pain rounds and one-on-one feedback. Dependent variables were PCE scores, percentage of pain reassessment documentation, and NKASRP test scores.

Findings: Changing staff pain practices requires more than education. Barriers may be overcome through careful planning, using a systematic change process such as a research utilization approach. NKASRP and PCE scores and a percentage of reassessment documentation reached statistically significant increases postintervention.

Conclusions: Adapting research recommendations allowed staff to create unit-specific solutions, evaluate practice changes, establish research partnerships, and use research in bedside care. Staff increased their proficiency in pain reassessment practices after the intervention.

Implications for Nursing: Research utilization models bring about desired practice changes under APN leadership. Aligning pain reassessment practices with clinical pain guideline recommendations promotes improved pain management through better reassessment documentation.

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    Agency for Health Care Policy and Research. (1994). Management of cancer pain, clinical practice guidelines [No. 94-0592]. Rockville, MD: Department of Health and Human Services.
    Aiken, L.H., Sochalski, J., & Lake, E.T. (1997). Studying outcomes of organizational change in health services. Medical Care, 35(Suppl. 11), NS6-NS18.
    American Pain Society. (2003). Principles of analgesic use in the treatment of acute pain and chronic cancer pain (5th ed.). Glenview, IL: Author.
    Asselin, M.E. (2001). Knowledge utilization among experienced staff nurses. Journal for Nurses in Staff Development, 17, 115-122.
    Baltic, T.E., Whedon, M.B., Ahles, T.A., & Fanciullo, G. (2002). Improving pain relief in a rural cancer center. Cancer Practice, 10(Suppl. 1), S39-S44.
    Bucknall, T., Manias, E., & Botti, M. (2001). Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context. International Journal of Nursing Practice, 7, 266-273.
    Cameron, G. (1998). Transformational leadership: A strategy for organizational change. Journal of Nursing Administration, 28(10), 3.
    City of Hope. (2006). Performance assessment tools: Position summary and annual competence assessment for a registered nurse. Retrieved April 16, 2007, from
    Cochrane Collaboration. (2006). Pain, palliative and supportive care. Retrieved September 26, 2006, from
    Cohen, M.Z., Easley, M.K., Ellis, C., Hughes, B., Ownby, K., Rashad, B.G., et al. (2003). Cancer pain management and the JCAHO's pain standards: An institutional challenge. Journal of Pain and Symptom Management, 25, 519-527.
    Dooks, P. (2001). Diffusion of pain management research into nursing practice. Cancer Nursing, 24, 99-103.
    Dufault, M.A., Bielecki, C., Collins, E., & Willey, C. (1995). Changing nurses' pain assessment practice: A collaborative research utilization approach. Journal of Advanced Nursing, 21, 634-645.
    Duncan, K., & Pozehl, B. (2001). Effects of individual performance feedback on nurses' adherence to pain management clinical guidelines. Outcomes Management for Nursing Practice, 5(2), 57-62.
    Ferrell, B.R., McGuire, D.B., & Donovan, M.I. (1993). Knowledge and beliefs regarding pain in a sample of nursing faculty. Journal of Professional Nursing, 9(2), 79-88.
    Francke, A.L., Luiken, J.B., de Schepper, A.M.E., Abu-Saad, H.H., & Grypdonck, M. (1997). Effects of a continuing education program on nurses' pain assessment practices. Journal of Pain and Symptom Management, 13, 90-97.
    Gelinas, C., Fortier, M., Viens, C., Fillion, L., & Puntillo, K. (2004). Pain assessment and management in critically ill intubated patients: A retrospective study. American Journal of Critical Care, 13, 126-135.
    Given, B., Beck, S., Etland, C., Gobel, B.H., Lamkin, L., & Marsee, V.D. (2004). Nursing-sensitive patient outcomes. Retrieved April 16, 2007, from
    Gordon, D.B., Dahl, J.L., Miaskowski, C., McCarberg, B., Todd, K.H., Paice, J.A., et al. (2005). American Pain Society recommendations for improving the quality of acute and cancer pain management. Archives of Internal Medicine, 165, 1574-1580.
    Hambleton, R.K., & De Gruijter, D.M.N. (1983). Application of item response models to criterion-referenced test item selection. Journal of Educational Measurement, 20, 355-367.
    Herr, K., Titler, M.G., Schilling, M.L., Marsh, J.L., Xie, X., Ardery, G., et al. (2004). Evidence-based assessment of acute pain in older adults: Current nursing practices and perceived barriers. Clinical Journal of Pain, 20, 331-340.
    Horsley, J.A., Crane, J., & Bingle, J. (1978). Research utilization as an organizational process. Journal of Nursing Administration, 8(7), 4-6.
    Idell, C.S. (2004). Clinical practice guidelines for pain management: An overview. Oncology Supportive Care Quarterly, 3(1), 30-41.
    Janken, J.K., & Dufault, M.A. (2002, January 24). Improving the quality of pain assessment through research utilization. Online Journal of Knowledge Synthesis for Nursing, 9, 2C. Retrieved October 23, 2006, from
    Jassak, P.F. (2001). Introduction: Evidence-based oncology nursing practice: Improving patient outcomes in the next millennium. Oncology Nursing Forum, 28(2, Suppl.), 3-4.
    Joint Commission on Accreditation of Healthcare Organizations. (2000). Pain assessment and management: An organizational approach. Oakbrook Terrace, IL: Joint Commission Resources.
    McCaughan, D., Thompson, C., Cullum, N., Sheldon, T.A., & Thompson, D.R. (2002). Acute care nurses' perceptions of barriers to using research information in clinical decision making. Journal of Advanced Nursing, 39, 46-60.
    Melnyk, B.M., & Fineout-Overholt, E. (2002). Putting research into practice. Reflections on Nursing Leadership, 28(2), 22-25, 45.
    Mercadante, S., & Fulfaro, F. (2005). World Health Organization guidelines for cancer pain: A reappraisal. Annals of Oncology, 16(Suppl. 4), iv132-iv135.
    National Comprehensive Cancer Network. (2004). Cancer pain: Clinical practice guidelines in oncology-v.1.2004. Retrieved April 1, 2004, from
    Rogers, E.M. (1995). Diffusion of innovations (4th ed.). New York: Free Press.
    Rousseau, D.M., & Tijoriwala, S.A. (1999). What's a good reason to change? Motivated reasoning and social accounts in promoting organizational change. Journal of Applied Psychology, 84, 514-528.
    Rutledge, D. (1995). Research utilization in oncology nursing. In S. Hubbard, M. Goodman, & T. Knobf (Eds.), Oncology nursing updates: Patient treatment and support (pp. 1-14). Philadelphia: Lippincott Williams and Wilkins.
    Rutledge, D.N., & Bookbinder, M. (2002). Processes and outcomes of evidence-based practice. Seminars in Oncology Nursing, 18, 3-10.
    Rutledge, D.N., & Donaldson, N.E. (1998). Pain assessment and documentation, part I. Overview and application in adults. Online Journal of Clinical Innovations, 1, 1-37. Retrieved October 23, 2006, from CINAHL at
    Thompson, C.J. (1997). Extent and factors influencing research utilization among critical care nurses. Unpublished doctoral dissertation, Texas Woman's University.
    Vallerand, A.H. (1997). Measurement issues in the comprehensive assessment of cancer pain. Seminars in Oncology Nursing, 13, 16-24.
    Willson, H. (2000). Factors affecting the administration of analgesia to patients following repair of a fractured hip. Journal of Advanced Nursing, 31, 1145-1154.
    World Health Organization. (1990). Cancer pain relief and palliative care [Technical report series 804]. Geneva, Switzerland: Author.