NHS Pain Education
This information is being requested as a freedom of information request. We are trying to find out what education is taking place in the workplace for staff who work directly with patients. Although this form is several pages long it should take less than 10 minutes to complete. Section 1
1. Name of your organisation Gloucestershire Health and Care NHS Trust
2. Do you provide education for your healthcare staff about pain management? Delete as appropriate – if NO please do not continue with the form and return it to a.swift@bham.ac.uk. Yes this FOI request has been completed considering the Nurse and AHP workforce, it has not been possible to gain information relating to our Medical workforce or Medical trainees. Section 2
3. Who do you deliver pain education to?
The following section is divided into staff groupings. Please add a cross in the relevant box to indicate who you provide pain management education to at least annually.
Mandatory Optional Mandatory for some but not all Not provided Not a staff group in this organisation Comment
Band 3 support worker nursing or midwifery. Pain and importance of assessment and management is referred to in the delivery of our face to face Care Certificate programme.
Nurses ü
Nursing Associates ü
Student Nursing Associates ü
Midwives ü
Health visitors ü
FY1/FY2
ST1/CT1
ST2/CT2
ST3-6
Consultant
Support worker therapy. ü
Physiotherapists ü
Occupational therapists ü
Speech and language therapists ü
Dieticians ü
Art therapists ü
Counselling team ü
Social workers ü
Dieticians ü
Chaplaincy ü
Psychologists ü
Pharmacists ü
Radiography and imaging team ü
Others please list.
Podiatrist ü
Paramedics ü
Students – Nursing ü
4. What percentage of each of the following staff groups attending at least one pain education event in the last 12 months.
Support workers nursing and midwifery. Data not available
Nurses Data not available
Doctors Data not available
AHPs Data not available
Other please list. Data not available
5. Who delivers pain education in your organisation?
Only: the Practice Development and Learning Team to Community Nurses associated to syringe driver training
The Professional Development and Clinical Skills facilitators within the care certificate as above Q3.
6. What methods do you use to deliver pain education to staff?
Face to face Online – asynchronous Online – synchronous Both F2F and online, participant chooses Method not used. Comment
Classroom or lecture theatre LT. -lecture didactic. Yes half day session which can be accessed by registered staff. Outsourced to external provider. Incorperated within End of Life session. About an hour is dedicated to pain relief . On line session to be completed pre face to face
Classroom or LT discussion/Q&A
yes
Case study presentation and discussion
Yes Video of past teaching sessions Available on Clinical Skills Net via Learning Management system
Video of expert giving lecture or being interviewed ü
Simulation lab- management of a lifelike scenario ü
Skills demonstration e.g. injections Syringe Driver training
Supervised skills practice Syringe Driver training
Role play ü
Supervision in clinical area supervised practice. Syringe Driver competence sign off
Specialist embedded in the ward – work alongside ü
One to one coaching on request ü
Pain ward rounds include ward staff ü
Posters in the clinical area ü
Pocket guides ü
Dashboard messaging ü
Audit feedback ü
Intranet guidelines ü
Smartphone or app ü
Guidance pop-ups in electronic patient management or prescribing system ü
Ask the expert sessions Incorporated within external training which is accessed
WhatsApp discussion groups ü
Pain meetings in clinical areas Potentially component part of MDT service user reviews
Schwarz rounds ü
QI programmes Although pain management not taught specifically the QI team align clinical scenarios to assist staff to understand QI methodologies and test interventions – so QI not seen as separate but what they do day to day.
If you have a virtual learning environment as part of your pain management education please describe what methods are used e.g. case studies, narrated powerpoints, quizzes, reading materials.
Are there any other methods that you use?
7. Content of pain education.
The EFIC core curriculum contains seven domains. Please indicate which aspects of the curricula you include in your pain education all or some of the time.
Pain as a biopsychosocial phenomenon impact on the individual and their family/carers showing understanding of the cognitive, sensory and affective dimensions
yes
The impact of pain on the patient and their family/carers yes
Pain as a multidimensional phenomenon with cognitive, sensory, and affective dimensions yes
The individual nature of pain and the factors contributing to the person’s understanding, experience and expression yes
Understand the importance of social roles, school/ work, occupational factors, finances, housing and recreational/leisure activities in relation to the patients’ pain yes
The importance of working in partnership with and advocating for patients and their families, yes
Promoting independence and self-management where appropriate
Prevalence of acute, chronic/persistent and cancer-related pain and the impact on healthcare and society yes
The characteristics and underlying mechanisms of nociceptive pain, inflammation, neuropathic pain, referred pain, phantom limb pain and explain nociplastic pain syndromes yes
The distinction between nociception and pain, including nociceptive, neuropathic and nociplastic pain yes
Mechanisms of transduction, transmission, perception and modulation in nociceptive pathways The relationship between peripheral/central sensitization and primary/secondary hyperalgesia
Mechanisms involved in the transition from acute to chronic/ persistent pain and how effective management can reduce this risk yes
The changes that occur in the brain during chronic/persistent pain and their possible impact including cognition, memory and mood. and cognitive-behavioural explanations such as fear-avoidance
The overlap between chronic/persistent pain and common co-morbidities, including stress, sleep, mood, depression and anxiety yes
The mechanisms underlying placebo and nocebo responses, and their relation to context, learning, genetics, expectations, beliefs and learning
The role of genetics and epigenetic mechanisms in relation to risk of developing chronic/persistent pain and pharmacotherapy
The importance of interprofessional working in pain management along with potential barriers and facilitators to team-based care yes
How to work respectfully and in partnership with patients, families/ carers, healthcare team members and agencies, to improve patient outcomes
yes
Team working skills communication, negotiation, problem solving, decision-making, conflict management.
yes
The professional perspectives, skills, goals and priorities of all team members
How to take a comprehensive pain history, an assessment of the patient across the lifespan and in care planning, consider social, psychological, and biological components of the pain condition
Person-centred care including how the following may influence the experience of illness, pain, pain assessment and treatment: Social factors, Cultural factors, Language, Psychological factors, Physical activity, Age, Health literacy, Values and beliefs, Traditional medical practices, Patients’ and families’ wishes, motivations, goals, and strengths
Patients’ and families’ different responses to the experience of pain and illness including affective, cognitive, and behavioural responses
The rationale for self-report of pain and the understand in which cases nurse-led ratings are necessary
At risk individuals for under-treatment of their pain e.g., individuals who are unable to self-report pain, neonates, cognitively impaired. and how to mitigate against this.
Using different assessment tools in different situations, using a person-centred approach
Valid, reliable and sensitive pain-assessment tools to assess pain at rest and on movement; tools that are appropriate to the needs of the patient and the demands of the care situation
Culturally sensitive and appropriate pain assessment for individuals who speak a different language to the language spoken by the healthcare professionals
Understand the rationale behind basic investigations in relation to serious pathology
What specialist assessment is, when it is needed, and how to refer.
Importance of accurate documentation
Assessment of pain coping skills and pain behaviours yes
Health promotion and self-management yes
Importance of non-pharmacological management yes
Discussed in session with external providers How to work with patients to develop goals for treatment yes
Referred to in session with external providers Evidence based complementary therapies for pain management e.g. acupuncture, reflexology. yes
Physical pain management strategies e.g. exercise, stretching, pacing, comfort, positioning, massage, manual therapies, heat/cold, hydrotherapy.. yes
Psychological pain management strategies e.g. distraction, relaxation, stress management, patient and family education, counselling, health promotion and self-management.. yes
Evidence based behavioural therapies e.g. CBT, mindfulness, acceptance and commitment, couple/family therapy, hypnosis/guided imagery, biofeedback.
Electrotherapies e.g. TENS, spinal cord stimulation.
Types of analgesics and potential combinations non-opioids, opioids, antidepressants, anticonvulsants, local anaesthetics.
Routes of delivery yes
Referred to but not in detailin session with external providers Risks and benefits of various routes and methods of delivery PCA, Epidural, Nerve blocks, Plexus blocks.. yes
Onset, peak effect, duration of effect. yes
Adverse events and management of these yes
Which drugs are appropriate to particular conditions and contexts yes
Side effects, detecting, limiting and managing these. yes
Long-term opioid use risks and benefits yes
Risk of addiction in different patient groups e.g. post-operative management, chronic pain management. yes
Addiction risk factors yes
Identification of aberrant drug use
Tapering opioid therapy yes
Preparation for discharge and ongoing pain management Yes not discharge.
8. Do you include anything else in your pain education that has not been captured so far?
Syringe Pump Training Yes 9. Is there anything else that you would like to tell us about?
We have utilised our Nurse & AHP CPD funding to enable colleagues to access role appropriate training provided by external training providers.
This includes:
ESCAPE-pain facilitator training
ESCAPE – pain for knees / hips
Abilitee – Cranio-Mandibular: Learn the missing piece for treating neck pain, headaches, and orofacial pain
Health Development and Performance Network- Anterior Knee pain
Jonathan Bell Ltd- Patellofemoral Pain Uncovered
James Davis Physio- Cognitive Functional Therapy – An person-centred behavioural approach for people with disabling back pain
NCORE – Study Day on Chronic Pain Management
NCORE – Advanced study Day on Chronic Pain Management
NCORE – Explain pain
UWE- Complexities of Supportive and End of Life Care
Society of Musculoskeletal Medicine – Theory and Practice of Injection Therapy
Sue Ryder – Assessment and Medication administration for End of Life Care
– End of Life Care Masterclass: Assessment of symptoms
– End of Life Care Masterclass: Pain Management
– Pain Management in Palliative Care and General overview
FOI Request
I appreciate that you may not be able to use the MS Forms link. I have a word version of the form which I append. I also include the data fields requested below.
NHS Pain Education
This information is being requested as a freedom of information request. We are trying to find out what education is taking place in the workplace for staff who work directly with patients. Although this form is several pages long it should take less than 10 minutes to complete. Section 1
1. Name of your organisation
2. Do you provide education for your healthcare staff about pain management? Delete as appropriate – if NO please do not continue with the form and return it to a.swift@bham.ac.uk.
Yes No
Section 2
3. Who do you deliver pain education to?
The following section is divided into staff groupings. Please add a cross in the relevant box to indicate who you provide pain management education to at least annually.
Mandatory Optional Mandatory for some but not all Not provided Not a staff group in this organisation
Band 3 support worker nursing or midwifery.
Nurses
Midwives
Health visitors
FY1/FY2
ST1/CT1
ST2/CT2
ST3-6
Consultant
Support worker therapy.
Physiotherapists
Occupational therapists
Speech and language therapists
Dieticians
Art therapists
Counselling team
Social workers
Dieticians
Chaplaincy
Psychologists
Pharmacists
Radiography and imaging team
Others please list.
4. What percentage of each of the following staff groups attending at least one pain education event in the last 12 months.
Support workers nursing and midwifery.
Nurses
Doctors
AHPs
Other please list.
5. Who delivers pain education in your organisation?
6. What methods do you use to deliver pain education to staff?
Face to face Online – asynchronous Online – synchronous Both F2F and online, participant chooses Method not used.
Classroom or lecture theatre LT. -lecture didactic.
Classroom or LT discussion/Q&A
Case study presentation and discussion
Video of past teaching sessions
Video of expert giving lecture or being interviewed
Simulation lab- management of a lifelike scenario
Skills demonstration e.g. injections
Supervised skills practice
Role play
Supervision in clinical area supervised practice.
Specialist embedded in the ward – work alongside
One to one coaching on request
Pain ward rounds include ward staff
Posters in the clinical area
Pocket guides
Dashboard messaging
Audit feedback
Intranet guidelines
Smartphone or app
Guidance pop-ups in electronic patient management or prescribing system
Ask the expert sessions
WhatsApp discussion groups
Pain meetings in clinical areas
Schwarz rounds
QI programmes
7. If you have a virtual learning environment as part of your pain management education please describe what methods are used e.g. case studies, narrated powerpoints, quizzes, reading materials.
8. Are there any other methods that you use?
9. Content of pain education.
The EFIC core curriculum contains seven domains. Please indicate which aspects of the curricula you include in your pain education all or some of the time.
Pain as a biopsychosocial phenomenon impact on the individual and their family/carers showing understanding of the cognitive, sensory and affective dimensions
The impact of pain on the patient and their family/carers
Pain as a multidimensional phenomenon with cognitive, sensory, and affective dimensions
The individual nature of pain and the factors contributing to the person’s understanding, experience and expression
Understand the importance of social roles, school/ work, occupational factors, finances, housing and recreational/leisure activities in relation to the patients’ pain
The importance of working in partnership with and advocating for patients and their families,
Promoting independence and self-management where appropriate
Prevalence of acute, chronic/persistent and cancer-related pain and the impact on healthcare and society
The characteristics and underlying mechanisms of nociceptive pain, inflammation, neuropathic pain, referred pain, phantom limb pain and explain nociplastic pain syndromes
The distinction between nociception and pain, including nociceptive, neuropathic and nociplastic pain
Mechanisms of transduction, transmission, perception and modulation in nociceptive pathways The relationship between peripheral/central sensitization and primary/secondary hyperalgesia
Mechanisms involved in the transition from acute to chronic/ persistent pain and how effective management can reduce this risk
The changes that occur in the brain during chronic/persistent pain and their possible impact including cognition, memory and mood. and cognitive-behavioural explanations such as fear-avoidance
The overlap between chronic/persistent pain and common co-morbidities, including stress, sleep, mood, depression and anxiety
The mechanisms underlying placebo and nocebo responses, and their relation to context, learning, genetics, expectations, beliefs and learning
The role of genetics and epigenetic mechanisms in relation to risk of developing chronic/persistent pain and pharmacotherapy
The importance of interprofessional working in pain management along with potential barriers and facilitators to team-based care
How to work respectfully and in partnership with patients, families/ carers, healthcare team members and agencies, to improve patient outcomes
Team working skills communication, negotiation, problem solving, decision-making, conflict management.
The professional perspectives, skills, goals and priorities of all team members
How to take a comprehensive pain history, an assessment of the patient across the lifespan and in care planning, consider social, psychological, and biological components of the pain condition
Person-centred care including how the following may influence the experience of illness, pain, pain assessment and treatment: Social factors, Cultural factors, Language, Psychological factors, Physical activity, Age, Health literacy, Values and beliefs, Traditional medical practices, Patients’ and families’ wishes, motivations, goals, and strengths
Patients’ and families’ different responses to the experience of pain and illness including affective, cognitive, and behavioural responses
The rationale for self-report of pain and the understand in which cases nurse-led ratings are necessary
At risk individuals for under-treatment of their pain e.g., individuals who are unable to self-report pain, neonates, cognitively impaired. and how to mitigate against this.
Using different assessment tools in different situations, using a person-centred approach
Valid, reliable and sensitive pain-assessment tools to assess pain at rest and on movement; tools that are appropriate to the needs of the patient and the demands of the care situation
Culturally sensitive and appropriate pain assessment for individuals who speak a different language to the language spoken by the healthcare professionals
Understand the rationale behind basic investigations in relation to serious pathology
What specialist assessment is, when it is needed, and how to refer.
Importance of accurate documentation
Assessment of pain coping skills and pain behaviours
Health promotion and self-management
Importance of non-pharmacological management
How to work with patients to develop goals for treatment
Evidence based complementary therapies for pain management e.g. acupuncture, reflexology.
Physical pain management strategies e.g. exercise, stretching, pacing, comfort, positioning, massage, manual therapies, heat/cold, hydrotherapy..
Psychological pain management strategies e.g. distraction, relaxation, stress management, patient and family education, counselling, health promotion and self-management..
Evidence based behavioural therapies e.g. CBT, mindfulness, acceptance and commitment, couple/family therapy, hypnosis/guided imagery, biofeedback.
Electrotherapies e.g. TENS, spinal cord stimulation.
Types of analgesics and potential combinations non-opioids, opioids, antidepressants, anticonvulsants, local anaesthetics.
Routes of delivery
Risks and benefits of various routes and methods of delivery PCA, Epidural, Nerve blocks, Plexus blocks..
Onset, peak effect, duration of effect.
Adverse events and management of these
Which drugs are appropriate to particular conditions and contexts
Side effects, detecting, limiting and managing these.
Long-term opioid use risks and benefits
Risk of addiction in different patient groups e.g. post-operative management, chronic pain management.
Addiction risk factors
Identification of aberrant drug use
Tapering opioid therapy
Preparation for discharge and ongoing pain management
10. Do you include anything else in your pain education that has not been captured so far?
11. Is there anything else that you would like to tell us about?