Exploration of contextual factors and the use of evidence-based nonpharmacological pediatric pain management practices in emergency departments

Exploration of contextual factors and the use of evidence-based nonpharmacological pediatric pain management practices in emergency departments. 1 ABSTRACT The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices in healthcare settings may improve patient conditions such as pain and decrease the cost of healthcare. A wealth of literature can be found describing barriers and facilitators of evidence-based practice (EBP), and a movement in research has begun to focus on what influences the use of EBP. This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPP) using an existing data set of nurses and providers, defined as Doctors of Medicine and Osteopathy, Nurse Practitioners, and Physician Assistants, caring for children in the Emergency Department. Initial analysis found several significant correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and Magnet Status and EBNPP for nurses or providers. Nurse regression analyses showed knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the nurse and provider models. A pooled regression analysis with Registered Nurses and providers found nurses had a significant increased use of EBNPP when compared to providers. Regression analyses found that while overall context is a significant predictor of EBNPP, no single element was significant when all three were added to the model. The effect of context on EBNPP did not differ by profession in this sample. Results of this study indicate that while context is important in the uptake of EBNPP, one area does not have more influence than another. The variables explored in this study account for 13% of the variance in EBNPP. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP. ii To my family iii Life is a dream, realize it. Life is a challenge, meet it. Life is a duty, complete it. Life is a promise, fulfill it. Life is a song, sing it. Life is struggle accept it. Life is life, fight for it. Mother Teresa iv ACKNOWLEDGMENTS