Original article
Nurses’ Reflections on Pain Management in a Nursing Home Setting

https://doi.org/10.1016/j.pmn.2006.02.004Get rights and content

Abstract

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Section snippets

Background

This study was funded by the Agency for Healthcare Research and Quality under the TRIP-II initiative in 2000. The aims of the study included the following: (1) developing and implementing a multimodal, evidence-based, culturally competent educational and behavioral intervention to improve the quality of pain assessment and management in nursing homes, (2) improving nurses’ knowledge and attitudes about pain assessment and management, and (3) improving pain-assessment and management practices.

Methods

At the conclusion of the study, the treatment and control nursing homes in the study were contacted by telephone and up to 10 personnel from each nursing home were invited to participate in semistructured interviews. For comparability, specific personnel were sought from each nursing home. Specifically, administrators (administrator, director of nursing, staff development coordinator, Minimum Data Set/quality coordinator), and nursing home staff members (Registered Nurses, Licensed Practical

Data Analysis

Participants’ experiences of participating in the 3-year pain study in their respective nursing homes comprised the data. All data were analyzed using a qualitative descriptive data analysis process (Marshall and Rossman 1999, Struebert and Carpenter 1999). Data analysis began with the collection of interview data, followed by the research team engaging a cyclical process of questioning and verifying coding, analyzing coding hierarchies, and discussing inherent meanings of data. First,

Findings

Nurses’ ideas about participation in the study involved their perceptions of how pain knowledge, attitudes and practices were affected in their nursing homes. The treatment and control nursing homes had different levels of study involvement with the study, with the treatment homes receiving frequent contact with the intervention team to increase staff knowledge and change attitudes about modern pain-assessment and management practices. The control nursing homes had quarterly contact with study

Discussion and Implications

The information obtained from the key informant interviews was valuable in terms of assessing the success of the study intervention and identifying the barriers that continue to challenge practice improvements in this arena. Engaging the research subjects in end-of-study debriefing interviews also brought full-circle the participatory engagement of the nursing home staff. By hearing their reflections on the experience of research participation and the challenges of implementing pain practice

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  • Factors Associated With Pain Assessment for Nursing Home Residents: A Systematic Review and Meta-Synthesis

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    Some residents were hesitant to report pain because they did not want to be seen as a difficult patient, bother busy staff, or be perceived as a medication seeker.20,21,33,35,39,41,45,50,52–54 Social, cultural, and demographic variables affected resident pain assessment in 5 studies.20,32,33,35,50 For example, rural-based residents were less likely to report pain.32,33

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This project was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ U-18-HS11093) awarded to Katherine Jones, Principal Investigator.

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