Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion

Annette Bird, Marianne Wallis
Journal of Advanced Nursing 2002, 40 (5): 522-31

BACKGROUND: In Australian hospitals, epidural infusions are commonly used for the management of post-operative pain in maternity and surgical patients, with little research evidence to indicate the efficacy of the educational preparation of nurses undertaking pain management.

AIMS: To describe nurses' assessment skills and knowledge related to the management of a patient with an epidural infusion and to explore relationships between these variables and the levels of education/clinical experience of the nurses.

METHODS: This descriptive correlational study used a convenience sample of surgical and obstetric unit registered nurses to explore relationships between the knowledge and skill in epidural management and the educational preparation of the nurse. Data were collected via survey and observation, using instruments developed by the research team.

RESULTS: The nurses had a good knowledge base for the performance of sensory blockade assessment but scored less well in motor blockade assessment and clinical decision-making. Nurses who had clinical experience, had completed a self- directed learning package and who worked in surgical areas scored higher on the survey than other nurses. Observation scores revealed a range of performance outcomes. There was only a weak correlation between knowledge and skill performance. There were no differences in scores for the observation exercise for different groups of nurses.

CONCLUSION: The results of this study indicated that the nurses' theoretical knowledge outweighed their clinical skill performance and clinical decision-making. Education for nurses regarding the management of epidural infusions needs to be comprehensive, context specific and have the capacity to develop the nurse's autonomous critical thinking and clinical decision-making skills. Strategies for this include self-directed learning packages best supplemented by a demonstration of clinical skills and supervised practice.

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