Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness‐Implementation Study

Abstract

OBJECTIVES To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions. DESIGN An implementation science pilot study using a quasi‐experimental effectiveness‐implementation (hybrid II) design. SETTING Four NHs in Switzerland. PARTICIPANTS All consenting long‐term residents aged 65 years and older with pain at baseline (N = 62) and all registered and licensed practical nurses (N = 61). INTERVENTION Implementation of a contextually adapted pain management guideline, interactive training workshops for all care workers, and specifically trained pain champions. MEASUREMENTS Interference from pain, worst and average pain intensity over the previous 24 hours; proxy ratings of pain with the Pain Assessment in Advanced Dementia scale; and care workers' appraisal of the guideline's reach, acceptability, and adoption. RESULTS Pain‐related outcomes improved for self‐reporting residents (n = 43) and residents with proxy rating (n = 19). Significant improvements of average pain from baseline to T1 (P = .006), and in worst pain from baseline to T1 (P = .003) and T2 (P = .004). No significant changes in interference from pain (P = .18). With regard to the implementation efforts, about 76% of care workers indicated they were familiar with the guideline; 70.4% agreed that the guideline is practical and matches their ideas of good pain assessment (75.9%) and treatment (79.7%). CONCLUSION Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary. J Am Geriatr Soc 67:2574–2580, 2019

Use of Pain Management Champions to Enhance Guideline Implementation by Care Workers in Nursing Homes

“…Self‐reported adherence to guideline components ranged between 44% and 73% depending on the component; detailed results were reported in an earlier paper (Brunkert et al, 2019). Associations between self‐efficacy items and adherence to corresponding core components were significant for components I (comprehensive assessment) and II (PAINAD scale).…”

“…To describe the adoption of the core components, we built several sub‐samples and only considered data from respondents who indicated having experienced the relevant situations corresponding to the core component. Further, for the indicators “comprehensive pain assessment” and “use of PAINAD,” we excluded data from nursing assistants since these components are not part of their scope of practice (Brunkert, Simon, Ruppen, & Zúñiga 2019). In a next step, we determined associations between adherence to guideline components and self‐efficacy items by calculating several simple logistic regressions based on these sub‐samples.…”

Pain Diary in Bands Based on SBAR Communication Mode Application of Nursing Management in Patients with Postherpetic Neuralgia

“…Patients should play a more active self-assessment of pain during hospitalization 15 . Among the various pain assessment methods, pain self-reporting is emphasized as the most reliable method 16 . Pain diary is a dynamic and continuous method of patient self-reporting 17 .…”

Implementation science in the nursing home

“…However, a number of recent studies in nursing home residents have employed implementation science methodology, often built on an effectiveness trial. For example, there have been process evaluations of an advance care planning intervention (Aasmul et al, 2018), an intervention to prevent the use of physical restraints (Abraham et al, 2019), and an intervention to improve pain management guidelines (Brunkert et al, 2019).…”