Indiana Partnership for Statewide Education Course Development Grant Proposal
Pain Management for Health Professionals
Indiana University

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Abstract In the last two decades, the knowledge base on providing adequate pain relief has been expanded, and successful elimination or control of pain is now possible. A large body of research supporting the efficacy of pain management strategies is currently available (Acute Pain Management Guideline Committee, 1992; American Pain Society, 1992; Jacox, Carr, Payne, et al., 1994; WHO Expert Committee, 1986) Despite these advances, patients still report inadequate pain relief (Cleeland et al., 1994; Firth, 1991; Paice, Mahon, & Faut-Callahan, 1991; Paice et al., 1995, Ward & Gordon, 1994; Ward & Gordon, 1996). This is due in part to inadequate pain management practices by health care professionals (HCPs) including nurses (Dalton, 1989; Ferrell, McGuire, & Donovan, 1993; McCaffery, Ferrell, 0 Neil-Page, & Lester, 1990; Vortherms, Ryan, & Ward, 1992). The purpose of this proposal is to develop a course offering to assist nursing and other HCPs learn practice changes that will improve the quality of pain management for all patients. This includes educating HCPs about 2000 Standards for Pain Assessment and Management (JCAHO, 1999) created by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and developing institutional commitments to meet these standards. The Indiana University-Purdue University Indianapolis (IUPUI) School of Nursing (SON) intends to develop an asynchronous course in pain management that is offered on the World Wide Web (WWW), using WebCT as the course management software. The modules developed for this course will be used for Continuing Nursing Education as well as to support instruction about this topic in undergraduate nursing courses.

Narrative

1. 2. Needs to be addressed and learners to be served.

Control of pain has become a national priority as pain relief is now being linked with patient rights and organizational ethics. Many institutes are working to establish pain relief. Beginning with the World Health Organization (WHO) in 1986 with its release of Cancer Pain Relief (WHO Expert Committee, 1986), the Oncology Nursing Service (ONS) with its position paper entitled Oncology Nursing Society Position Paper on Cancer Pain (Spross, McGuire, & Schmitt, 1990a, 1990b, &1990c), and the American Pain Society (APS) with its publication of Principles of Analgesic Use in the Treatment of Acute and Cancer Pain (APS, 1992), have all played a major role in addressing the need to improve pain management. This has culminated in the development and widespread dissemination of clinical practice guidelines issued in 1992 and 1994 by the Agency for Health Care Policy and Research (AHCPR), a government agency of the U.S. Department of Health and Human Services, entitled Acute Pain Management: Operative or Medical Procedures and Trauma. Clinical Practice Guidelines and Management of Cancer Pain: Clinical Practice Guideline Number 9. Following this, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) created and will be evaluating 2000 Standards for Pain Assessment and Management during its environmental assessment for promoting quality in health care organizations (JCAHO, 1999). The new standards for pain assessment and management consider the patients’ rights and organizational ethics required to ensure adequate pain relief that consider assessment, care, education, continuum, improving performance, and implications for the patient experiencing pain.

The health care professional is expected to provide high quality, safe pain management to all patients. The proposed course will be designed for HCPs and nursing students who provide care to patients experiencing pain and wish to update their skills and knowledge to reflect current pain management practices. It will serve as an informational tool to assist HCPs, hospitals, and other healthcare institutions in their development of an institutional commitment to meet JCAHO’s (1999) 2000 Pain Assessment and Management Standards. The course will serve a diverse geographical population of HCPs since the planned course will be delivered via the World Wide Web; thus, the potential audience for this course is sizable. This course will be offered through the Indiana University School of Nursing Center for Teaching/Life Long Learning as a continuing education offering and embedded in the curricula where appropriate. Continuing education units (CEUs) will be awarded for all licensed professional (RN) and technical nurses (LPN) and will be obtained for other HCPs from appropriate continuing education granting agencies.

3. Rationale for choice of course and technologies to be used.

5. Instructional design and delivery plan.

6. Explanation of how the instructional design will serve the needs of the target audience.

This course is designed for the increasing numbers of HCPs who wish to obtain CEUs in a flexible, convenient, and individually paced learning environment via the WWW. In addition, the proposed course fills an educational gap as no other continuing education courses in pain management were found that were being offered on the WWW. The Internet technology will permit individuals or groups of individuals to access the on-line program at various times, accommodating shift personnel, orientation and in-service schedules, and other personal or institutional requirements. WWW delivery of the course offerings meets participants’ and students’ needs for flexibility and ease of access to the course. The course is designed to present core content with 6-8 independent modules focusing on definitions of pain, physiology of pain, pain assessment, pharmacologic management, postoperative pain, cancer pain, chronic nonmalignant pain, nonpharmacologic strategies to relieve pain, and information on addiction, tolerance, and dependence. In order to demonstrate relevancy of content to the learner, clinical scenarios will he used to illustrate the roles and responsibilities of healthcare personnel in pain management. A manual of related materials and references will be constructed as participants proceed through the course. Besides providing access to pain management specialists, multiple data bases, and libraries worldwide via the WWW, the course management software (WebCT) will permit many learning activities to promote critical thinking including discussion, case studies, guest lectures, and on-line testing. The format encompasses a variety of media rich digital/video/audio technologies. The course will be offered asynchronously during a two-week time frame, during which participants can complete modules independently with a few specified dates for participation in on-line discussions and chat interspersed.

4. Institution’s capacity and commitment to the course-development project.

There is solid commitment to distributed education within the university, the campus, and SON. This proposal is consistent with the Indiana University Information Technology Strategic Plan ( http://www.indiana.edu/~ovpit/strategic) and IUPUI Campus initiatives to support distributed learning.

This course will be offered through the Center for Teaching/Lifelong Learning at the School of Nursing. The School’s strategic plan, “Becoming a School of Nursing Without Walls”, calls for the development of academic and continuing education courses and provides the necessary support services from the School’s instructional support team (learning resource coordinator, multimedia developer, database manager, video conferencing coordinator, instructional designer, webmaster, and LAN manager) as well as campus team members from the IUPUI Library and Center for Teaching and Learning. This team will support the development and deployment of this proposed course. The SON has a four-semester experience of offering web-based courses using the course development team approach described above. Additionally, participant support services are also well developed. For example, the user’s guide for the course management software has been developed and posted on-line; there is a student database for gathering evaluation data; the campus bookstore has capability for mailing course materials; the library can offer full text on-line resources and electronic resources; and participants can register on-line through the SON CE Department. (See letter of support from the University Dean.)

7. Course evaluation plan.

Evaluation of the course will occur as follows:

1. Peer review of course and course materials prior to course offering.

2. Usability testing of the online functionality by course development and technical support teams prior to the course offering.

3. Testing of prior conditions contributing to the adoption of current pain management practices at beginning of course, completion, and 6 months after completion with statistical analysis of appropriate sections (Prior Conditions Instrument developed by course lead faculty.).

4. Testing of pain management knowledge at beginning of couse, completion, and 6 months after completion.

5. Online formative evaluation after completion of each module.

6. Summative evaluation using the current IUPUI SON Web-based evaluation instruments.

8. 9. Quality and/or transferability plans and/or strategies.

Information about how the course fits into other efforts in Indiana.

IUPUI faculty members whose expertise is in pain management or teaching, instructional design, product development, and distance learning will review each module. In addition to these faculty members, two practicing Registered Nurses, one pharmacist, and one physician pain specialist will review each module for accuracy, completeness, and currency.

This proposal meets a need for workforce development of Health Care Professionals who are caring for patients with pain. The letter of support from the Vice President for Nursing at the nation’s second largest health care corporation indicates how this proposal meets needs in Indiana.

10. Marketing Plans

The course will be marketed to institutions within IPSE, all healthcare agencies in Indiana, professional organizations with members requiring this content to comply with JCAHO accreditation, and to pain management and professional pain organization Web-sites. Marketing capabilities exist within the SON and will include posting course information on the SON Web site and using course announcement brochures. In Indiana and Nationwide, the timeliness of this proposed course and JCAHO’s new 2000 Standards for Pain Assessment and Management is advantageous in promoting adequate pain relief by HCPs and the health care organizations they represent.

11. Project Timeline.

January-March, 2000 Complete course design; develop learning activities; select on-line resources; prepare course guide.

April-August, 2000 Begin to market course to target audience.

April, 2000 Peer review course draft and revisions.

April-June, 2000 Technical specifications developed; course created in WebCT (course management software); course linked to the SON home page.

July-September, 2000 Technical usability testing by technical team, faculty colleagues, peer reviewer; develop/refine evaluation instruments.

July-September, 2000 Register and enroll students.

September, 2000 Offer course; formative evaluation. Summative evaluation by peer reviewer, participants, technical team, project course development personnel.

March, 2001 Six-month follow-up.

12. Key Course Development Personnel.

Cathy Greer, RN, MS, Case Manager, Lutheran Hospital of Indiana. Ms. Greer will develop and teach the course.

Michael Vaughn, MA, Director of Information Technology and Multimedia Developer, will design user interfaces and tutorials.

Dennis Dell, MS, Video conferencing Coordinator, will serve as instructional designer and develop video modules for case studies.

Proposal Budget and Budget Narrative

The total budget request for this proposal is $20,003. The request to the IPSE Course Development Grant Program is for $11,841 for salaries for the faculty and instructional design staff and an honorarium for peer review of the course.

The following salaries were derived as a percentage of salary and fringe benefits as follows:

1. Cathy Greer, Lead Faculty. Will develop and teach the course.Honorarium $6,000

2. Michael Vaughn, Director of Information Technology. Will design user interfaces; develop multimedia tutorials/case studies. Salary: $2,374 (6%) Fringe: $831 (35.02%) $3,205

3. Dennis Dell, Video conferencing Coordinator. Will develop examples of video- based instructional materials. Salary: $1,582.40 (4.5%) Fringe: $554.00 (35.02%) $2,136

4. TBA, Peer Reviewer. Will review course during development stages and provide formative evaluation; will also review on-line teaching and learning at the end of the course (using the on-line record of discussion, chats, collaborative learning activities, and so forth). $500

The following personnel, hardware and software are contributed by the School of Nursing:

1. School of Nursing Learning Resources Web Programmer (Louise Watkins) (Upload files to WebCT; enroll students into the course software; manage site.) Salary: $2,412 (12%) Fringe: $583 (24.18%) $2,995
2. School of Nursing LAN Manager (Novell Graves).Salary: $804 (3%) Fringe: $194 (24.18%) $998
3. File server, course management software (site license to IUPUI), Flashlight Current Student Inventory (site license to IUPUI), marketing (brochures, announcements, Web page).
4. Administrative Assistant Continuing Nursing Education (TBA). Will register participants, award certificates, CE coordination fees. Salary: $1,187 (4%) Fringe: $416 (35.02%) $1,603
5. School of Nursing Learning Resources Coordinator (Serena Novosel). Will identify appropriate on-line resources and Web sites.Salary: $791 (3%) Fringe: $277 (35.02%) $1,068
6. School of Nursing Database Manager (TBA). Will program database for on-line course evaluation and provide summary data and reports. Salary: $804 (3%) Fringe: $194 (24.18%) $998
7. IUPUI Libraries. Will assist with on-line course reserves. $500

Appendix A.
Biosketch : Cathy Greer, MS, RN is a Case Manager at Lutheran Hospital of Indiana in Fort Wayne. She has 4 plus years of teaching experience in nursing and 18 years of medical-surgical clinical practice. She is a 2^nd year Ph.D. student at Indiana University School of Nursing. Her program of research is in the area of health promotion through pain management. Currently, she is the principle investigator of two research studies on (1) prior conditions in nursing contributing to the adoption of pain management strategies and (2) behavioral responses to common types of pain. Both projects have been supported as an Indiana University Graduate Fellow and through Indiana University Research Incentive Fellowships.

Publications and presentations.

Greer, C. & Case, D. (1997). Perioperative Nursing. In G. Duncan.& L. White (Eds.), Medical Surgical Nursing: An Integrated Approach. Albany, New York: Delmar Publishers

“Agony is a Nursing Priority.” Pain Management Seminar. Fort Wayne, IN 3/6/98

Appendix B.

References

Acute Pain Management Guideline Panel. (1992). Acute Pain Management: Operative or medical procedures and trauma. Clinical Practice Guidelines. Publication no. 92-0032. Rockville, MD: Agency for Health Care Policy and Research, US Department of Health and Human Services.

American Pain Society, (1992). Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. (3rd ed.). Skokie, IL: American Pain Society.

Cleeland, C. S., Gonin, R., Hatfield,A. K., Edmonson, J. H., Blum, R. H., Stewart, J. A., & Pandya, K. J. (1994). Pain and its treatment in outpatients with metastatic cancer. The New England Journal of Medicine, 3 30(9), 592-596.

Dalton, J. A. (1989). Nurses’ perceptions of their pain assessment skills, pain management practices, and attitudes toward pain. Oncology Nursing Forum. 16(2), 225-31.

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.

Firth, F. (1991). Pain after day surgery. Nursing Times, 87(40), 72.74,76.

Jacox, A., Carr, D.B., Payne, R., et al. (1994). Management of Cancer Pain: Clinical Practice Guideline Number 9. Publication No. 94-0592. Rockville, MD: Agency for Health Care Policy and Research, US Department of Health and Human Services.

Joint Commission on Accreditation of Healthcare Organizations. (1999). Hospital Executive Preparation for 2000: Changes that Will Impact Accreditation Scores in 2000. Oakbrook, IL: Joint Commission on Accreditation of Healthcare Organizations.

McCaffery, M., Ferrell, B., 0’ Neil-Page, E., & Lester, M. (1990). Nurses’ knowledge of opioid analgesic drugs and psychological dependence. Cancer Nursing, 13(1), 21-7.