Cancer pain education: A structured clinical instruction module for hospice nurses

The learning experience with the Cancer Pain Structured Clinical Instructio n Module (SCIM), a highly structured skills training course for medical stu dents, has been reported favorably. The purpose of this study was to presen t the Cancer Pain SCIM to registered nurses employed in a hospice setting. The goal of the study was to pilot test a structured cancer pain educationa l program for hospice nurses and to determine the perceived effectiveness o f this course on the participants' cancer pain assessment and management sk ills. A multidisciplinary Cancer Pain SCIM was presented to 25 hospice nurses to improve their understanding of the management of cancer pain. The developme nt group identified essential aspects of cancer pain management and then de veloped checklists defining specific station content. During the 2-hour Can cer Pain SCIM, nurses rotated through 8 stations in groups of 3, spending 1 5 minutes at each station. Eight instructors and 6 standardized patients, 5 of whom were survivors of cancer, participated in the course. All particip ants (students, instructors, and patients) evaluated the course, using a 5- point Likert scale (1 = strongly disagree; 5 = strongly agree). Nurses prov ided self-assessments of their perceived competence on important aspects of cancer pain management both before and after the SCIM. The self-assessment items used a 5-point scale ranging from 1 (not competent) to 5 (very compe tent). Twenty-five hospice nurses, averaging 4.1 years (range 1-30 years) postgrad uation, participated in the Cancer Pain SCIM. Overall, nurses agreed that t hey improved on each of the 8 teaching items (P < 0.001). The average (SD) pretest score of 2.8 (0.72) improved to 3.8 (0.58) on the post-test (P < 0. 001). Nurses believed that their mastery of specific clinical skills, taugh t in all 8 stations, improved as a result of participation in the course. N urses strongly agreed (mean +/- SD) that it was beneficial to use patients with cancer in the course (4.6 +/- 0.82). Faculty members enjoyed participa ting in the course (4.9 +/- 0.35) and indicated a willingness to participat e in future courses (4.7 +/- 0.49). Significant perceived learning among hospice nurses took place in all aspec ts of the Cancer Pain SCIM. Participating nurses, instructors, and patients with cancer appreciated the SCIM format. Nurses and faculty considered the participation of actual patients with cancer highly beneficial. The SCIM f ormat has great potential to improve the quality of cancer pain education.