1. Rich, Kathleen PhD, RN, CCNS, CCRN-CSC, CNN

Article Content


Nursing has a primary responsibility in pain management, including educating, using pain assessment tools, writing policies, and developing quality indicators to meet this measure. A potential exists for nursing pain activities to have a very narrow focus, concentrating on pain relief, primarily through opioid administration, while neglecting or omitting assessments on the potential for injurious medication side effects. The purpose of this presentation was to discuss how the clinical nurse specialist utilized the Iowa Model of Evidence-Based Practice to Promote Quality Care in changing a limited scope pain management practice within a facility.



The CNS identified problem and knowledge-focused triggers including risk management data findings along with a knowledge deficit by nursing. These included omission of physiologic assessments and lack of medication knowledge by the nursing staff along with equipment deficiencies. The identified triggers resulted in the institution acknowledging pain management to be a priority issue.



The CNS assembled and led a multidisciplinary team consisting of administration, nursing staff, managers, education, pharmacy, risk management and quality improvement in reviewing the evidence-based pain guidelines. A member of the medical staff acted as liaison.



Current practices and policies were examined. In addition, at the committee's request, the CNS conducted several additional studies including an analysis of rapid response team (RRT) calls and a medication administration cost breakdown to support the need for change.



Multiple nursing practice revisions were recommended and implemented by the team in 2 stages over a 9-month period. These included equipment purchase, policy revisions, developing patient literature, nursing staff education, documentation modification, and new physician orders.



Evaluation of these evidence-based practice changes has resulted in a significant reduction in opioid-related RRT calls, a negligible change in cost, and improvement in both staff and patient satisfaction.


Implications for Practice:

Updating any clinical practice to conform to the current evidence is not a static process; it is dynamic and ongoing. The Iowa Model of Evidence-Based Practice to Promote Quality Care was the framework utilized by the CNS in this pain initiative. The CNS-led multidisciplinary team successfully implemented evidence-based practice changes in the nursing care of patients with pain while subsequently improving outcomes.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.