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Knopp-Sihota JA, MacGregor T, Nuspl M, Reeves J, Kennedy M. Healthcare aide-focused interventions to improve pain management in long-term care homes: A systematic review. Arch Gerontol Geriatr 2023; 104:104808. [PMID: 36137462 DOI: 10.1016/j.archger.2022.104808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/19/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pain is common in long-term care residents. We examined the effectiveness of interventions involving healthcare aides that aim to manage pain for these residents. DESIGN A systematic review which follows PRISMA reporting guidelines. SETTING AND PARTICIPANTS We examined controlled trials and intervention studies that included long-term care residents aged ≥60 years who received interventions to reduce chronic pain. Interventions were either delivered by healthcare aides at the resident level or were directed at healthcare aides to improve their pain management practices for residents. METHODS We searched 7 databases to identify relevant studies. After screening 400 articles, we reviewed 131 full-text articles and included them if they reported a pain management intervention and measured pain with a standardized pain scale. Data were synthesized narratively. Risk of bias was assessed using the Mixed Methods Assessment Tool. RESULTS In total, 9 studies were examined in the narrative review. Six studies described pain interventions involving education, new pain protocols and/or new assessment tools delivered to healthcare aides. Three studies described pain interventions delivered by healthcare aides to residents, which included a new incontinence care routine, light touch massage, and a bathing intervention. CONCLUSIONS AND IMPLICATIONS Interventions involving healthcare aides may be beneficial to pain management for long-term care residents as they have the potential to reduce residents' pain and improve both pain assessment and reporting practices. Further research is warranted on specific elements that contribute to an improvement in residents' pain and to the overall role of healthcare aides care of residents.
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Affiliation(s)
- Jennifer A Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, 1 University Drive, Edmonton, AB, Canada.
| | - Tara MacGregor
- Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Megan Nuspl
- Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Reeves
- Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Public Services Librarian, University of Alberta, Edmonton, AB, Canada
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Helvik AS, Bergh S, Šaltytė Benth J, Selbaek G, Husebo BS, Tevik K. Pain in nursing home residents with dementia and its association to quality of life. Aging Ment Health 2022; 26:1787-1797. [PMID: 34251936 DOI: 10.1080/13607863.2021.1947968] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We aimed to describe pain, use of analgesics and quality of life (QoL) in people with dementia admitted to a Norwegian nursing home (NH), and to explore if and how pain was associated with their QoL when adjusting for sociodemographic characteristics, other health conditions and use of analgesics. METHOD A total of 953 Norwegian NH residents with dementia (mean age 84.0, SD 7.5 years, 35.8% men) were included at admission to the NH. Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the use of psychotropic drugs and analgesics were assessed. RESULTS In total, 36% of the participants had clinically relevant pain intensity (MOBID-2 ≥ 3) and 52% received analgesics. Paracetamol was most frequently prescribed (45%). In an adjusted linear mixed model, more severe pain was associated with higher QUALID total scores, indicating poorer QoL (regression coefficient 0.52, 95% CI 0.36-0.69). CONCLUSION Pain prevalence at NH admission was high in residents with dementia; half used analgesics, particularly paracetamol. More severe pain was associated with poorer QoL when adjusting for sociodemographic characteristics, other health conditions, and use of analgesics. The routine assessment of pain at NH admission can uncover undiagnosed and untreated pain and allow for adequate non-pharmacological and pharmacological pain management and likely increased QoL.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
| | - Sverre Bergh
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway.,The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbaek
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Vestfold Hospital Trust, Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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Manietta C, Labonté V, Thiesemann R, Sirsch EG, Möhler R. Algorithm-based pain management for people with dementia in nursing homes. Cochrane Database Syst Rev 2022; 4:CD013339. [PMID: 35363380 PMCID: PMC8973420 DOI: 10.1002/14651858.cd013339.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with dementia in nursing homes often experience pain, but often do not receive adequate pain therapy. The experience of pain has a significant impact on quality of life in people with dementia, and is associated with negative health outcomes. Untreated pain is also considered to be one of the causes of challenging behaviour, such as agitation or aggression, in this population. One approach to reducing pain in people with dementia in nursing homes is an algorithm-based pain management strategy, i.e. the use of a structured protocol that involves pain assessment and a series of predefined treatment steps consisting of various non-pharmacological and pharmacological pain management interventions. OBJECTIVES To assess the effects of algorithm-based pain management interventions to reduce pain and challenging behaviour in people with dementia living in nursing homes. To describe the components of the interventions and the content of the algorithms. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science Core Collection (ISI Web of Science), LILACS (Latin American and Caribbean Health Science Information database), ClinicalTrials.gov and the World Health Organization's meta-register the International Clinical Trials Registry Portal on 30 June 2021. SELECTION CRITERIA We included randomised controlled trials investigating the effects of algorithm-based pain management interventions for people with dementia living in nursing homes. All interventions had to include an initial pain assessment, a treatment algorithm (a treatment plan consisting of at least two different non-pharmacological or pharmacological treatment steps to reduce pain), and criteria to assess the success of each treatment step. The control groups could receive usual care or an active control intervention. Primary outcomes for this review were pain-related outcomes, e.g. the number of participants with pain (self- or proxy-rated), challenging behaviour (we used a broad definition that could also include agitation or behavioural and psychological symptoms assessed with any validated instrument), and serious adverse events. DATA COLLECTION AND ANALYSIS Two authors independently selected the articles for inclusion, extracted data and assessed the risk of bias of all included studies. We reported results narratively as there were too few studies for a meta-analysis. We used GRADE methods to rate the certainty of the results. MAIN RESULTS We included three cluster-randomised controlled trials with a total of 808 participants (mean age 82 to 89 years). In two studies, participants had severe cognitive impairment and in one study mild to moderate impairment. The algorithms used in the studies varied in the number of treatment steps. The comparator was pain education for nursing staff in two studies and usual care in one study. We judged the risk of detection bias to be high in one study. The risk of selection bias and performance bias was unclear in all studies. Self-rated pain (i.e. pain rated by participants themselves) was reported in two studies. In one study, all residents in the nursing homes were included, but fewer than half of the participants experienced pain at baseline, and the mean values of self-rated and proxy-rated pain at baseline and follow-up in both study groups were below the threshold of pain that may require treatment. We considered the evidence from this study to be very low-certainty and therefore are uncertain whether the algorithm-based pain management intervention had an effect on self-rated pain intensity compared with pain education (MD -0.27, 95% CI -0.49 to -0.05, 170 participants; Verbal Descriptor Scale, range 0 to 3). In the other study, all participants had mild to moderate pain at baseline. Here, we found low-certainty evidence that an algorithm-based pain management intervention may have little to no effect on self-rated pain intensity compared with pain education (MD 0.4, 95% CI -0.58 to 1.38, 246 participants; Iowa Pain Thermometer, range 0 to 12). Pain was rated by proxy in all three studies. Again, we considered the evidence from the study in which mean pain scores indicated no pain, or almost no pain, at baseline to be very low-certainty and were uncertain whether the algorithm-based pain management intervention had an effect on proxy-rated pain intensity compared with pain education. For participants with mild to moderate pain at baseline, we found low-certainty evidence that an algorithm-based pain management intervention may reduce proxy-rated pain intensity in comparison with usual care (MD -1.49, 95% CI -2.11 to -0.87, 1 study, 128 participants; Pain Assessment in Advanced Dementia Scale-Chinese version, range 0 to 10), but may not be more effective than pain education (MD -0.2, 95% CI -0.79 to 0.39, 1 study, 383 participants; Iowa Pain Thermometer, range 0 to 12). For challenging behaviour, we found very low-certainty evidence from one study in which mean pain scores indicated no pain, or almost no pain, at baseline. We were uncertain whether the algorithm-based pain management intervention had any more effect than education for nursing staff on challenging behaviour of participants (MD -0.21, 95% CI -1.88 to 1.46, 1 study, 170 participants; Cohen-Mansfield Agitation Inventory-Chinese version, range 7 to 203). None of the studies systematically assessed adverse effects or serious adverse effects and no study reported information about the occurrence of any adverse effect. None of the studies assessed any of the other outcomes of this review. AUTHORS' CONCLUSIONS There is no clear evidence for a benefit of an algorithm-based pain management intervention in comparison with pain education for reducing pain intensity or challenging behaviour in people with dementia in nursing homes. We found that the intervention may reduce proxy-rated pain compared with usual care. However, the certainty of evidence is low because of the small number of studies, small sample sizes, methodological limitations, and the clinical heterogeneity of the study populations (e.g. pain level and cognitive status). The results should be interpreted with caution. Future studies should also focus on the implementation of algorithms and their impact in clinical practice.
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Affiliation(s)
- Christina Manietta
- School of Public Health, Bielefeld University, Bielefeld, Germany
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Valérie Labonté
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | | | - Erika G Sirsch
- Faculty of Nursing Science, PTVH Catholic University, Vallendar, Germany
| | - Ralph Möhler
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
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Pringle J, Mellado ASAV, Haraldsdottir E, Kelly F, Hockley J. Pain assessment and management in care homes: understanding the context through a scoping review. BMC Geriatr 2021; 21:431. [PMID: 34275442 PMCID: PMC8286436 DOI: 10.1186/s12877-021-02333-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, 2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the contexts that might influence its management. Methods Scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were also screened, and website searches carried out of key organisations. Conversations with 16 local care home managers were included to gain an understanding of their perspective. Results Inclusion criteria were met by 109 studies. Three overarching themes were identified: Staff factors and beliefs - in relation to pain assessment and management (e.g. experience, qualifications) and beliefs and perceptions relating to pain. Pain assessment – including use of pain assessment tools and assessment/management for residents with cognitive impairment. Interventions - including efficacy/effects (pharmaceutical/non pharmaceutical), and pain training interventions and their outcomes. Overall findings from the review indicated a lack of training and staff confidence in relation to pain assessment and management. This was particularly the case for residents with dementia. Conclusions Further training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02333-4.
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Affiliation(s)
- Jan Pringle
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK.
| | | | | | - Fiona Kelly
- School of Health Sciences, Queen Margaret University, Edinburgh, East Lothian, UK
| | - Jo Hockley
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Sirsch E, Lukas A, Drebenstedt C, Gnass I, Laekeman M, Kopke K, Fischer T. Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline. J Am Med Dir Assoc 2020; 21:149-163. [DOI: 10.1016/j.jamda.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 10/25/2022]
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Liu JYW, Leung DYP. Pain Treatments for Nursing Home Residents with Advanced Dementia and Substantial Impaired Communication: A Cross-Sectional Analysis at Baseline of a Cluster Randomized Controlled Trial. PAIN MEDICINE 2018; 18:1649-1657. [PMID: 27688313 DOI: 10.1093/pm/pnw242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives This is a cross-sectional analysis at baseline of a cluster randomized controlled trial to identify factors associated with the use of pharmacological and nonpharmacological pain treatments by nursing home residents with dementia and impaired communication. Methods One hundred thirty-four residents with dementia and impaired communication were recruited. Nine of them were excluded because data on their pain treatments were missing, resulting in 125 for analysis. Hierarchical generalized estimating equations analyses controlling for the clustering effect of nursing homes were used to identify factors associated with the use of pharmacological and nonpharmacological pain treatments. Results Although all participants had a confirmed pain condition, only 23 (18.4%) and 45 (36%) had received pharmacological or nonpharmacological pain treatments, respectively. Participants with a higher ability to communicate ( P = 0.031) and fewer pain locations were found to be more likely to receive pain medications, with the impact of communication ability being greater among participants with better cognitive status than among those with poor cognitive status. Participants who had been living in the home longer and who were more dependent were less likely to receive nonpharmacological treatments. Conclusion Suboptimal pain management was common among this population. Severe impairment in the ability to communicate is a major reason for the underuse of pain medications. Staff may become desensitized and fail to perceive subtle changes in the residents' behavior as indicative of pain, leading to the underadministering of nonpharmacological treatments. To improve this situation, it is suggested that observational pain assessments be systematically carried out in nursing homes.
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Affiliation(s)
- Justina Yat Wa Liu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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7
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Schofield P. The Assessment of Pain in Older People: UK National Guidelines. Age Ageing 2018; 47:i1-i22. [PMID: 29579142 PMCID: PMC5888957 DOI: 10.1093/ageing/afx192] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pat Schofield
- Positive Ageing Research Institute Anglia Ruskin University Chelmsford, Cambridge
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8
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Liu JYW, Lai CKY. Implementation of Observational Pain Management Protocol for Residents With Dementia: A Cluster-RCT. J Am Geriatr Soc 2017; 65:e56-e63. [DOI: 10.1111/jgs.14763] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Justina Y. W. Liu
- Centre for Gerontological Nursing; School of Nursing; The Hong Kong Polytechnic University; Hong Kong
| | - Claudia K. Y. Lai
- Centre for Gerontological Nursing; School of Nursing; The Hong Kong Polytechnic University; Hong Kong
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Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation. Pain Res Manag 2016; 2016:6493463. [PMID: 27445619 PMCID: PMC4904616 DOI: 10.1155/2016/6493463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.
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Douglas C, Haydon D, Wollin J. Supporting Staff to Identify Residents in Pain: A Controlled Pretest-Posttest Study in Residential Aged Care. Pain Manag Nurs 2016; 17:25-37. [DOI: 10.1016/j.pmn.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 08/03/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
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Guo LL, Li L, Liu YW, Herr K. Evaluation of two observational pain assessment scales during the anaesthesia recovery period in Chinese surgical older adults. J Clin Nurs 2014; 24:212-21. [PMID: 25236497 DOI: 10.1111/jocn.12677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Li-Li Guo
- Department of Nursing; Zhujiang Hospital; Southern Medical University; Guangzhou Guangdong China
| | - Li Li
- Department of Nursing; Zhujiang Hospital; Southern Medical University; Guangzhou Guangdong China
| | - Yao-Wei Liu
- Department of Nursing; Zhujiang Hospital; Southern Medical University; Guangzhou Guangdong China
| | - Keela Herr
- The University of Iowa College of Nursing; Iowa City IA USA
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Liu JYW, Lai C. Implementation of observational pain management protocol to improve pain management for long-term institutionalized older care residents with dementia: study protocol for a cluster-randomized controlled trial. Trials 2014; 15:78. [PMID: 24625010 PMCID: PMC3995611 DOI: 10.1186/1745-6215-15-78] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/05/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Systematic use of observational pain tools has been advocated as a means to improve pain management for care home residents with dementia. Pain experts suggest that any observational tool should be used as part of a comprehensive pain management protocol, which should include score interpretation and verification with appropriately suggested treatments. The Observational Pain Management Protocol (Protocol) was therefore developed. This study aims to investigate the extent to which the implementation of this Protocol can improve pain management in care home residents with dementia. METHODS/DESIGN In this two-group, single-blinded, cluster-randomized controlled trial, 122 care home residents with dementia and pain-related diagnoses will be recruited from eight care homes (that is 15 to 16 residents from each care home). Invitations will be sent to all local care homes who meet the home selection criteria. The eight care homes will be randomly selected from all care homes that agree to join this trial. They will then be randomized to either the control or experimental conditions. Participants from each care home will be placed into their home's corresponding group to avoid 'contamination' effects across participants. Each intervention cycle will take 16 weeks (that is, baseline assessment and care home staff training for 4 weeks and Protocol implementation for 12 weeks). The Protocol will guide the pain management of the participants in the experimental care homes. Meanwhile, the control care homes will continue their usual pain management strategies. Intervention effects will be measured weekly during the protocol implementation period and compared with the baseline measurements, as well as between the experimental and control conditions. DISCUSSION Although similar pain protocols have been suggested previously, the recommendations were based on experts' opinions rather than evaluation of research studies. The feasibility and effectiveness of this kind of pain management protocol, tailored to older people with dementia, remains unknown. The findings of this trial will offer strong evidence that better strategies for pain management should be used in the care home daily routine. TRIAL REGISTRATION The Chinese University of Hong Kong, Centre for Clinical Trials: CUHK-CCT00367.
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Affiliation(s)
- Justina Yat Wa Liu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Claudia Lai
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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13
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Liu JYW. Exploring nursing assistants' roles in the process of pain management for cognitively impaired nursing home residents: a qualitative study. J Adv Nurs 2013; 70:1065-77. [PMID: 24102751 DOI: 10.1111/jan.12259] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2013] [Indexed: 12/01/2022]
Abstract
AIM To explore nursing assistants' roles during the actual process of pain management (assessment, reporting, implementation of pain-relieving interventions and re-assessment) for cognitively impaired home residents with pain. BACKGROUND Nursing assistants provide most of the direct care to residents and represent the major taskforce in nursing homes. They may develop specialized knowledge of residents' pain experience that enables them to play both a pivotal role in pain assessment and possibly a supporting role in pain treatment. Currently, there is a lack of research into nursing assistants' functions in pain management. DESIGN This is a descriptive, exploratory qualitative study. METHODS Forty-nine nursing assistants were recruited from 12 nursing homes, 12 of them participating in semi-structured individual interviews and 37 in 8 semi-structured focus groups. All interviews were carried out from May to September 2010. Data collected via both data collection methods were transcribed verbatim and analysed by content analysis. RESULTS Nursing assistants were found to play four roles in the pain management process: (1) pain assessor; (2) reporter; (3) subordinate implementing prescribed medications; and (4) instigator implementing non-pharmacological interventions. CONCLUSIONS This study highlights the importance of nursing assistants in successful pain assessment and identifies their possible supporting roles in other aspects of pain management. However, nursing assistants' scope of practice resulted in their functions in pain management being continually undervalued by other healthcare professionals. Continuous in-service training, the use of a standardized pain management protocol and strategies for building coherent work teams in nursing homes are suggested to improve this situation.
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Affiliation(s)
- Justina Y W Liu
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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