Discussion
The questionnaire considered the nurses’ knowledge of pain
using questions that embraced a broad knowledge base
related to pharmacology, theories of pain and general pain
management. The difference noted between the specialist
nurses and general nurses’ knowledge scores suggests that the
specialist nurses had a more comprehensive knowledge base
than the general nurses. This study used the same pain
knowledge test as Hamilton and Edgar (1992), which
identified that the mean score for both groups of nurses
was 63Æ9%. They cited lack of pain control knowledge as the
main influencing factor in nurses’ managing pain ineffectively.
It was concluded that a score of 63Æ9% or lower
constitutes a poor knowledge score, therefore, it is reasonable
to propose that the general nurses demonstrated a poor knowledge of pain management. Equally, it is argued that the
specialist nurses mean score of 79Æ4% indicated a ‘good’
knowledge of pain. The difference in knowledge scores
identified between the two groups was expected, because of
the specialist nurses’ educational and clinical experiences.
However, this observation begs the question as to whether it
is the working environment or the educational experience of
the specialist nurse that determines their superior knowledge
base.
On first inspection, it would appear that the difference
between the pain control knowledge scores is attributable to
the educational differences that exist between the two groups
of nurses, rather than the clinical experiences. All of the
specialist nurses participating in the study had attended at
least one postregistration course or study day devoted to the
subject of pain management. Whilst the specialist nurses
had the advantage of postregistration education on pain,
the general nurses’ formal education appeared to be restricted
to their preregistration programme. Sofaer (1998) and
Ferrell et al. (1993) argue that there is a lack of comprehensive
coverage of pain and pain management within
the preregistration curriculum. Fothergill-Bourbonnais and
Wilson-Barnett (1992) and King (2004) identified how nurses
were not confident about their knowledge of analgesia
and suggested that their basic nurse education had not
adequately prepared them to care for patients in pain. All the
participants had a minimum of three years postregistration
experience within their field of expertise, hospice/oncology
or district nursing, and no significant difference in the
participants’ nursing experience in terms of years was
established. This would lend support to the proposal that
the knowledge scores are influenced by the nurses’
educational experience and strengthens the argument that
education leads to an increase in knowledge scores.
In contrast, Harrison (1991) argues that experienced
nurses are more accurate at pain assessment, an indication
that training and work experience has made them more
skilful at interpreting the relevant cues that lead to effective
pain management. Fothergill-Bourbonnais and Wilson-Barnett
(1992), proposals support this suggestion that the
working environment and clinical experience following
qualification is the most influential factor in contributing to
pain care knowledge, with the hospice environment proving
the most influential. Evidence to support Harrison (1991) and
Fothergill-Bourbonnais and Wilson-Barnett (1992) is found
in the positive correlational relationship between the knowledge
scores and experience when the nurses were considered
as one group. However, when the nurses were considered as
separate groups, it was noted that the relationship existed for
the general nurses’ experience and knowledge scores, rather
than the specialist nurses (Table 5). The educational and
clinical experience should reinforce each other; with the
academic experience offering opportunity to increase a
nurse’s knowledge base and the clinical environment allowing
them to consolidate academic learning and establish the
links between theory and practice. This could explain the
correlation between the experience and knowledge score for
the general nurses who may have received ‘ad-hoc’ education
from various sources such as drug companies or peers.
However, there may be something within the specialist
nurses’ clinical experience that disrupts this development,
thus offering explanation as to why a practice theory gap is
evident in the management of pain. Evidence as to why a
theory practice divide exists is beyond the scope of the limited
findings of this small study. However, analysis of the results
in conjunction with previous research findings, may offer an
explanation for the data obtained and allow an exploration
of the proposed theory practice divide