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Evidence-Based Pain Management: Analyzing the Practice Environment and Clinical Expertise


doi: 10.1097/NUR.0b013e3181b20745

Purpose/Objectives: Evidence regarding pain and pain control has been available for more than 30 years. Implementation of evidence-based pain management (EBPM) is impacted by both individual and organizational factors. Clinical nurse specialists, responsible for EBPM implementation need information to help target interventions. Using the Theory of Planned Behavior, the purpose of this study was to analyze the effect of the perception of the practice environment and clinical expertise on the adoption of EBPM.

Design: A descriptive, retrospective study took place in 2006.

Sample: A convenience sample of 85 nurses from 2 teaching hospitals and 3 surgical units in the Northeast volunteered to participate.

Methods: Nurses completed the Practice Environment Scale of the Revised Nursing Work Index and the Clinical Nursing Expertise instruments to measure the independent variables. The researcher then reviewed 4 of their pain management documentation entries. Each entry was scored using the Samuels' Pain Management Documentation Rating Scale and averaged to compute an individual rating score for each nurse. Data were analyzed first descriptively, then with multiple regression.

Findings: Results showed that the perception of the practice environment did not contribute to pain management documentation, whereas clinical expertise explained 4.4% of the variance. The more clinically expert practitioners had relatively poorer documentation scores.

Conclusions: Expertise may impact the implementation of evidence especially in areas where practice patterns are well established.

Implications: Adapting implementation strategies to target expertise levels are warranted.

Author Affiliations: University of New Hampshire, Durham.

Corresponding author: Joanne G. Samuels, PhD, RN, Hewitt Hall 243, 4 Library Way, Durham, NH 03824 (

© 2009 Lippincott Williams & Wilkins, Inc.