Date of Conferral

2021

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Ann Hubbard

Abstract

Current evidence-based research shows that pain in hospice patients is a growing problem. A gap in practice was identified as the current clinical practice guideline (CPG) in a hospice center in South Carolina was outdated and not being employed. A literature review revealed that updated CPGs provide better outcomes in pain management for end-of-life care. The project answered the practice-focused question: In the context of hospice, what are current evidence-based strategies for managing pain. The Stettler model and Kolcaba’s comfort theory guided the development of the CPG. Three nurse case managers and two physicians participated in the creation of CPG. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to critically appraise the evidence selected for inclusion in the CPG. Only articles which scored a high or moderate on the GRADE scale were used in the final determination. Twenty scholarly articles were originally reviewed, and ten of those met the inclusion criteria. The updated CPG was developed using the Appraisal of Guidelines and Evaluation (AGREE) II tool consisting of six domains. Using the AGREE II Instrument and the scoring checklist, the CPG was reviewed by an expert panel of hospice physicians. Of the six domains, all domains exceeded the threshold of 70%, indicating acceptance of the domain. In addition, the final domain scored a 100%, which also indicated acceptance of the content of the CPG. It is recommended that the hospice nurses, clinicians, and practitioners implement this updated evidence-based pain management guideline to prescribe pain medications. This CPG has the potential to influence social change by providing adequate pain management for patients at end of life.

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