The impact of a pain assessment intervention on pain score and analgesic use in older nursing home residents with severe dementia: A cluster randomised controlled trial

Rostad, Hanne Marie; Utne, Inger; Grov, Ellen Karine; Småstuen, Milada Cvancarova; Puts, Martine; Halvorsrud, Liv

doi:10.1016/j.ijnurstu.2018.04.017

Cited by 22 publications

(50 citation statements)

References 53 publications

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“…5 Consequently, their pain is often undertreated or inadequately treated. 11,[18][19][20] Other studies examined different aspects of pain and medication management-related issues. For example, Nakanishi and her colleagues reported that residents with dementia in nursing homes were less likely to receive pain management in the last month of life.…”

Section: Introductionmentioning

confidence: 99%

Do Nursing Home Residents With Dementia Receive Pain Interventions?

Nakashima

Young

Hsu

2019

Am J Alzheimers Dis Other Demen

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This study compares pain interventions received by nursing home residents with and without dementia. Secondary data analyses of cross-sectional data from 50,673 nursing home residents in New York State were collected by the Minimum Data Set 3.0. Frequency distributions and bivariate analyses with w 2 tests were used to organize and summarize the data. Logistic regression analyses were performed to quantify the relationship between dementia and pain interventions. Our results show that residents with dementia had significantly fewer pain assessments and less reported pain presence than their counterparts. After adjusting for covariates, the results indicate that residents with dementia were significantly less likely to receive pro re nata and nonmedication pain intervention. However, there were no significant differences in scheduled pain medication between the 2 groups. To address the gap, we need more research to design a pain assessment tool that can differentiate severity of pain so that appropriate interventions can be applied.

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Section: Introductionmentioning

confidence: 99%

Do Nursing Home Residents With Dementia Receive Pain Interventions?

Nakashima

Young

Hsu

2019

Am J Alzheimers Dis Other Demen

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“…This is in line with another study about the impact of specific pain assessment interventions on pain scores in NHR with severe dementia. 36 Although a special focus was set on assessing pain in NHR with severe cognitive impairment, the sole knowledge about pain assessment might not have an impact on further appropriate steps in pain management and our training videos for the nursing staff may have increased awareness but may not be able to change nurses' behavior to a significant extent. 30,63 A recent European survey on pain assessment in older adults with dementia provides further insights into perceived challenges in pain management for persons with severe cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…9,11,[31][32][33][34] Only few studies have focused explicitly on effects of more general interventions in pain management strategies in NH, indicating that implementing changes in pain management practices is challenging regardless of the health-care setting. 35,36 Educational interventions which aim at improving nurses' knowledge and competencies in pain management are rather rare, yet some were found to have positive outcomes for individuals' pain situation. 30,[36][37][38] There is a clear need for studies to test large-scale pain management intervention effects in NH.…”

Section: Introductionmentioning

confidence: 99%

“…35,36 Educational interventions which aim at improving nurses' knowledge and competencies in pain management are rather rare, yet some were found to have positive outcomes for individuals' pain situation. 30,[36][37][38] There is a clear need for studies to test large-scale pain management intervention effects in NH. In particular, randomized controlled trials and evidence-based studies are scarce and most warranted.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, randomized controlled trials and evidence-based studies are scarce and most warranted. 27,36,39 Purpose…”

Section: Introductionmentioning

confidence: 99%

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

Kutschar¹,

Berger²,

Brandauer³

et al. 2020

JPR

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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.

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