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Penn Nursing News

Interprofessional Pain Science and Practice

In the University’s first large interprofessional course, 140 students from Penn Nursing, Penn Dental, and the Perelman School of Medicine united for an intensive 5-day intersession academic course on pain, which is a major health problem that is under-addressed in the United States.
The course, “Pain Science and Practice,” is designed to bring the latest advances in the bio psychosocial aspects of pain and pain management from the perspectives of individualized pain care, scientific discoveries, evidence-based guidelines  and cross-disciplinary learning. Through problem-based and directed learning, classroom simulation, and interactive discussions with national leaders in pain management, students acquired a strong scientific and practice foundation in team-based pain care and were introduced to core competencies for interprofessional collaboration.  
“Pain is an interdisciplinary specialty, patients experiencing pain require the attention of numerous different healthcare professionals,” said course co-director, Rosemary Polomano, PhD, RN, FAAN, associate professor of pain practice. “By engaging students from different disciplines in one classroom with faculty from multiple disciplines, students experience diverse interprofessional perspectives and cutting-edge science that will enable the delivery of quality health services to patients with pain and their families.” The ultimate goal of the course is prepare future clinicians for to address the challenges in pain care and to intervene to prevent or minimize the occurrence of both acute and chronic pain.
Throughout the course, students were introduced to national and international pain standards, policies, guidelines and agendas to address issues related to pain. Content included clinical assessment and measurement of pain, the influence of genetics on pain susceptibility and response to pain treatments, and models for interprofessional care delivery for acute pain, chronic pain, and palliative care.
Professors from Penn Dental, Penn Medicine and Penn Nursing presented general topics on the pathophysiology of pain, pharmacology of analgesics, acute pain, pain treatment disparities, chronic pain syndromes, the mounting problem of substance abuse among patients with pain, and care coordination, spiritual care and ethical issues in pain care.
“ Patients with chronic pain often present with multiple problems, for example a chronic lower back pain patient may also have neglected their dental needs because it is too painful for them to sit on a dental chair,” said course co-director Elliot Hersh, DMD, PhD, professor in the department of Oral & Maxillofacial Surgery/Pharmacology at Penn Dental Medicine. “In addition they may be experiencing depression from a result of their pain and may be taking multiple medications in a desperate attempt to relieve their pain; therefore a multidisciplinary approach is optimal to treat this patient.”
On the final day of the course, students engaged in small group work to translate evidence-base guidelines into practice and demonstrate core competencies for collaboration through various case scenario simulations played out in multiple care settings including inpatient oncology units, a hospital operating room with a discussion of post-anesthesia care, community-based dental practice office and an inpatient surgical unit nurses’ station. Groups were assigned a specific scenario and assumed the roles of other health care professionals outside of their discipline. These simulation exercises were critiqued by fellow students and expert pain faculty, and provided students with face-to-face interactions to educate peers, resolve discourse in opinions and bring about positive changes in practice. Students encountered real-life practice situations and interactions that cannot be experienced with online independent learning.
 “Pain Science and Practice is one of the first interprofessional education courses developed by experts at Penn and took multidisciplinary simulation case studies to teach students how to improve patient care and outcomes,” said Y. Kevin Zeng, BSN, RN an adult-gerontology acute care nurse practitioner candidate at Penn Nursing. “The simulations had an innovative approach which students acted in the roles of other healthcare professions than their own and learned about the roles of colleagues and how to best deliver team-based pain care.”
Interprofessionalism is the cornerstone of health professional education and is a priority for the University. Penn Nursing’s Dean Afaf I. Meleis, PhD, DrPS (hon), FAAN, has advocated for interprofessional care. In 2010, Dean Meleis co-authored a report from The Lancet and the Institute of Medicine calling on the crucial need for interprofessional education and practice in healthcare. More recently in 2012, Dean Meleis advocated for system-wide changes in healthcare delivery during a meeting between the Association of Academic Health Centers, the Institute of Medicine, The Lancet, the Perelman School of Medicine and Penn Nursing. 
An identified major challenge to interprofessional education is the ability to engage the academic community, but Penn has overcome this national challenge through the support of its top academic leaders and faculty. The success of the course would not have been possible without the enthusiastic support of leaders across the three schools: Dean J. Larry Jameson, Dr. Gail Morrison, and Dr. Stanley Goldfarb of the Perelman School of Medicine; Dean Denis Kinane and Dr. Uri Hangorksy of Penn Dental Medicine; and Dean Afaf Meleis and Dr. Kathleen McCauley of Penn Nursing. Over 20 Penn pain faculty participated in the course, and Penn’s Teaching and Learning Center experts brought innovation to the teaching and learning strategies used to promote interprofessional education.    
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