<p>Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial</p>

Abstract

Purpose: Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016-2018). Participants: Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included. Intervention: In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses. Methods: Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10-30) using self-report instruments or observed (MMSE 0-9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatmentrelevant pain above cutoff (≥2) on the Pain Assessment in Advanced Dementia (PAINAD). Results: Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10-30) and logistic regression (n=222 residents, MMSE 0-9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=−0.07, p<0.001), and was lower when dementia diagnoses were present (B=−1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05). Conclusion: While no significant positive intervention effect was measured, findings suggest nurses' raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.

Identifying Frequently Used NANDA-I Nursing Diagnoses, NOC Outcomes, NIC Interventions, and NNN Linkages for Nursing Home Residents in Korea

“…Accordingly, impaired memory and chronic confusion are prevalent nursing diagnoses in this stimulation and were applied at high frequency for residents as an intervention for impaired memory. RNs can identify cognitive deficits through a mental status examination, and plan and provide cognitive-improvement programs for residents [ 37 ]. For example, RNs can provide one cognitive-stimulation intervention (enriched living environments that contain a wide array of personal memorable and memory-stimulating cues) to potentially support NH residents’ cognitive functioning [ 38 , 39 ].…”

Nurses knowledge, attitudes and education needs towards acute pain management in hospital settings: A meta‐analysis

“…Based on this, the accompanying low levels of positive attitude (25.76% 95% CI, 11.01 to 44.12) are unsurprising. The high levels of variability across the studies reduces their comparability and three studies (Brockopp et al, 2003(Brockopp et al, , 2004Schreiber et al, 2014) Kutschar et al, 2020). This study found that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.…”

Interviewer effects in a survey examining pain intensity and pain interference in nursing home residents

“…Survey data come from a registered cluster-randomised controlled trial (c-RCT; UTN: U111-1187-3174) in 15 German NHs, where effects of pain management nursing education interventions on NHR pain situation were evaluated in a sample of 879 NHRs with no, mild, moderate and severe CI. Details and results from the c-RCT have been published elsewhere [ 36 ].…”