Translation Research in Long‐Term Care: Improving Pain Management in Nursing Homes

Jones, Katherine R.; Fink, Regina; Vojir, Carol P.; Pepper, Ginny; Hutt, Evelyn; Clark, Lauren; Scott, Jill; Martinez, Ruby; Vincent, Deborah; Mellis, B. Karen

doi:10.1111/j.1524-475x.2004.04045.x

Cited by 65 publications

(92 citation statements)

References 27 publications

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“…The overall methodology for the study is presented in detail elsewhere [28][29]. In short, research assistants (RAs) conducted a quarterly pain interview on a 20 percent random sample of nursing home residents living in 12 nursing homes in one state.…”

Section: Methodsmentioning

confidence: 99%

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents

Jones¹,

Vojir

Hutt³

et al. 2007

JRRD

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146

103

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Abstract-Older adults in nursing homes experience pain that is often underassessed and undertreated. Visual analog painintensity scales, recommended for widespread use in adults, do not work well in the older adult population. A variety of other tools are in use, including the Verbal Descriptor Scale, the Faces Pain Scale (FPS), and the Numeric Rating Scale. These tools are more acceptable to older adults, but no agreement exists about how to compare the resulting pain-intensity scores across residents. This study examined the equivalency of painintensity scores for 135 nursing home residents who reported their pain on the three different instruments. The results were validated with a second sample of 135 nursing home residents. The pain levels across the three tools were highly correlated, but residents were found to underrate higher pain intensity on the FPS. A modification of scoring for the FPS led to greater agreement across the three tools. The findings have implications for use of these tools for quality improvement and public reporting of pain.

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Section: Methodsmentioning

confidence: 99%

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents

Jones¹,

Vojir

Hutt³

et al. 2007

JRRD

Self Cite

146

103

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 99%

“…As noted earlier, adherence to evidence-based guidelines for pain assessment was less than optimal in this sample. Underassessment of pain or communication of an incomplete picture of a resident's pain by nursing home staff make it difficult for prescribers to order appropriate kinds and dosages of medications (AMDA, 2003;Jones et al, 2004).Evidence-based guidelines also emphasize the role of nonpharmacological methods in pain management. These strategies alter the perception of pain through physical (e.g., application of ice and/or heat) or cognitive-behavioral (e.g., distraction) means (McLennon, 2005) and have been shown to optimize pain relief (AGS Panel, 2002;Gatlin & Schulmeister, 2007).…”

mentioning

confidence: 99%

“…First, long-term care facilities are relatively isolated from other sectors of the health care system and the current emphasis on evidence-based practice. Second, most of the direct care is provided by certified nursing assistants (CNAs) and licensed practical nurses who receive little to no formal education about pain or evidence-based practice (Allcock, McGarry, & Elkan, 2002;Jones et al, 2004;Kovner, Mezey, & Harrington, 2000). Third, there are few RNs on staff and even fewer who are prepared to assist in translating research-based practices to care (DiCenso, 2003;McConnell, Lekan, Hebert, & Leatherwood, 2007).…”

mentioning

confidence: 99%

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Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

Jablonski¹,

Ersek²

2009

J Gerontol Nurs

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The purpose of this study was to determine the extent to which nursing home staff adhere to current evidence-based guidelines to assess and manage persistent pain experienced by elderly residents. A retrospective audit was conducted of the medical records of 291 residents of 14 long-term care facilities in western Washington State. Data revealed a gap between actual practice and current best practice. Assessment of persistent pain was limited primarily to intensity and location. Although prescribing practices were more in line with evidence-based guidelines, a significant number of residents did not obtain adequate pain relief. Nonpharmacological pain management methods were rarely implemented. Nursing home staff and administrators must critically examine both system and individual staff reasons for failure to comply with best pain management practices. Research is needed to determine factors that contribute to less-than-optimal adherence to evidence-based guidelines for pain management, as well as the best methods for implementing practice change.The quality of care provided in U.S. nursing homes has long been a concern of policy makers, health care providers, and consumers. Following a study conducted in 1986, the Institute of Medicine (IOM) concluded that care provided in nursing homes was often seriously inadequate. These findings provided the impetus for enactment of the Omnibus Budget Reconciliation Act of 1987, which established higher standards of care for nursing homes receiving Medicare and Medicaid funding. Although the quality of care in nursing homes improved after this legislation went into effect, it is well known that care remains less than optimal in many instances (Weiner, Freiman, & Brown, 2007). The prevalence of pressure ulcers, malnutrition, and incontinence remains at unacceptable levels (IOM, 2001;Weiner et al., 2007). Of particular concern is the high number of nursing home residents who experience pain (AGS Panel on Persistent Pain in Older Persons [AGS Panel], 2002;Gibson, 2007;Zanocchi et al., 2007).Research indicates that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated (AGS Panel, 2002;Teno, Kabumoto, Wetle, Roy, & Mor, 2004;Zanocchi et al., 2007). This is significant in that the presence of persistent pain adversely affects mood, sleep quality, functional ability, and quality of life (AGS Panel, 2002;Leong & Nuo, 2007). From a systems perspective, the high prevalence of pain is a Address correspondence to Anita Jablonski, PhD, RN, Assistant Professor, Seattle University College of Nursing, 901 12th Avenue, PO Box 222000, Seattle, WA 98122-1090; jablonsk@seattleu.edu.. The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. 2003). The guidelines synthesize current best practice through integration of scientific evidence, clinical experience, and expert opinion. These resources can potentially increase the effe...

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“…Common organizational-level barriers cited included limited nurse/resident staffing ratios [42,46], high staff turnover [43,46], limited physician presence [46], and variable involvement of facility leadership [42]. Common clinical staff-level barriers included physicians' and nurses' beliefs about pain [42] and attitudes toward pain management (particularly concerns about use of pain medications) [43], physicians' and nurses' beliefs and attitudes about managing pain in patients with cognitive impairments [42], clinical staff's level of pain knowledge [41][42], and difficulties getting participation from all levels of key clinical staff [41][42].…”

Section: Best Practices In Pain Management In Persons With Dementiamentioning

confidence: 99%

Cognitive impairment and pain management: Review of issues and challenges

Buffum

Hutt²,

Chang³

et al. 2007

JRRD

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102

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Abstract-The assessment and treatment of pain in persons with cognitive impairments pose unique challenges. Disorders affecting cognition include neurodegenerative, vascular, toxic, anoxic, and infectious processes. Persons with memory, language, and speech deficits and consciousness alterations are often unable to communicate clearly about their pain and discomfort. Past research has documented that persons with cognitive impairments, particularly dementia, are less likely to ask for and receive analgesics. This article provides an overview of the assessment, treatment, and management of pain in adults with cognitive impairments. We review types of cognitive impairment; recent work specific to best practices for pain management in patients with dementia, including assessmenttool development and pharmacological treatment; challenges in patients with delirium and in medical intensive care and palliative care settings; and directions for future research.

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Translation Research in Long‐Term Care: Improving Pain Management in Nursing Homes

Abstract: Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.

Cited by 65 publications

References 27 publications

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents

Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

Cognitive impairment and pain management: Review of issues and challenges

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