Conclusion. Whilst educational programmes contribute to an increase in knowledge,
it would appear that the working environment has an influence on the
development and use of this knowledge. It is suggested that the clinical environment
in which the specialist nurse works can induce feelings of reduced self-efficacy and
low personal control. To ease tension, strategies are used that can result in nurses
refusing to endorse their knowledge, which can increase patients’ pain.
Relevance to clinical practice. Clinical supervision will serve to increase the nurses’
self-awareness; however, without power and autonomy to make decisions and affect
change, feelings of helplessness, reduced self-efficacy and cognitive dissonance can
increase. This may explain why, despite educational efforts to increase knowledge, a
concomitant change in practice has not occurred.