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Cotton K, Booth RG, McMurray J, Treesh R. Understanding health information exchange processes within Canadian long-term care: A scoping review. Int J Older People Nurs 2023; 18:e12501. [PMID: 36117493 DOI: 10.1111/opn.12501] [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: 04/23/2021] [Revised: 07/06/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Providing supportive care to long-term care residents with complex medical conditions generates substantial amounts of health information. This information must be documented, shared and acted upon by the various care providers within the circle of care. OBJECTIVES The purpose of this scoping review is to describe the current digital health information exchange (HIE) processes used within Canadian long-term care facilities (LTCFs). METHODS The scoping review followed Arksey and O'Malley's approach to the methodology. Electronic databases (e.g. CINAHL, MEDLINE and SCOPUS) were searched between 2010 and 2020 using terms including 'health information exchange', 'communication' and 'health information technology'. Articles were included if they were Canadian-based and relevant to our definition of health information exchange. RESULTS The search yielded 2091 citations for title and abstract screening; 78 citations were selected for independent full-text review, 42 of those met study criteria. The findings revealed gaps between the expectations of HIE for quality health care and the realities of HIE processes that impact the provision of care in long-term care. CONCLUSIONS We conclude that increased provider engagement and effective use of HIE processes is recommended to improve the safety and quality of health care in the long-term care sector. IMPLICATIONS FOR PRACTICE HIE implementation should be preceded a review of various aspects of workflow to identify information gaps and inefficiencies that can be addressed by digitization.
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Affiliation(s)
- Kendra Cotton
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Richard G Booth
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Josephine McMurray
- Lazaridis School of Business & Economics/Community Health, Wilfrid Laurier University, Brantford, Ontario, Canada
| | - Rianne Treesh
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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2
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Gallant N, Hadjistavropoulos T, Winters EM, Feere EK, Wickson-Griffiths A. Development, evaluation, and implementation of an online pain assessment training program for staff in rural long-term care facilities: a case series approach. BMC Geriatr 2022; 22:336. [PMID: 35436906 PMCID: PMC9016985 DOI: 10.1186/s12877-022-03020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pain among long-term care (LTC) residents, and especially residents with dementia, is often underassessed and this underassessment has been attributed, in part, to gaps in front-line staff education. Furthermore, although evidence-based clinical guidelines for pain assessment in LTC are available, pain assessment protocols are often inconsistently implemented and, when they are implemented, it is usually within urban LTC facilities located in large metropolitan centers. Implementation science methodologies are needed so that changes in pain assessment practices can be integrated in rural facilities. Thus, our purpose was to evaluate an online pain assessment training program and implement a standardized pain assessment protocol in rural LTC environments. Methods During the baseline and implementation periods, we obtained facility-wide pain-related quality indicators from seven rural LTC homes. Prior to implementing the protocol, front-line staff completed the online training program. Front-line staff also completed a set of self-report questionnaires and semi-structured interviews prior to and following completion of the online training program. Results Results indicated that knowledge about pain assessment significantly increased following completion of the online training program. Implementation of the standardized protocol resulted in more frequent pain assessments on admission and on a weekly basis, although improvements in the timeliness of follow-up assessments for those identified as having moderate to severe pain were not as consistent. Directed content analysis of semi-structured interviews revealed that the online training program and standardized protocol were well-received despite a few barriers to effective implementation. Conclusions In conclusion, we demonstrated the feasibility of the remote delivery of an online training program and implementation of a standardized protocol to address the underassessment of pain in rural LTC facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03020-8.
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Affiliation(s)
- Natasha Gallant
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada. .,Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada.
| | - Thomas Hadjistavropoulos
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada.,Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Emily M Winters
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada.,Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Emma K Feere
- Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Abigail Wickson-Griffiths
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada.,Faculty of Nursing, University of Regina, Regina, SK, S4S 0A2, Canada
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3
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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: 9] [Impact Index Per Article: 3.0] [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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Manias E, Bucknall T, Hutchinson A, Dow B, Borrott N. Resident and family engagement in medication management in aged care facilities: a systematic review. Expert Opin Drug Saf 2021; 20:1391-1409. [PMID: 34058923 DOI: 10.1080/14740338.2021.1935862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Medication-related harms may occur if residents and families are not involved when important medication decisions are made. We examined how residents and families engage in the management of residents' medications in aged care facilities.Areas covered: A systematic review was undertaken, which was registered with PROSPERO (CRD42020152700). Electronic databases were searched from inception until 27 August 2020 using MEDLINE/PubMed, CINAHL, PsycINFO and EMBASE. Data synthesis was undertaken using thematic analysis.Expert opinion: Forty studies were included. Communication tended to be unidirectional comprising consultations where residents and families provided medication information to health care providers or where health care providers provided medication information to residents and families. Many challenges prevailed that prevented effective engagement, including families' hesitation about making decisions, and the lack of adequately-trained health care providers. Testing of interventions often did not include residents or families in developing these interventions or in examining how they participated in medication decisions following implementation of interventions. Areas for improvement comprise actively involving residents and families in planning interventions for resident-centered care. Health care providers need to have greater appreciation of families' ability to detect dynamic changes in residents' behavior, which can be used to enable optimal alterations in medication therapy.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia.,Foundational Chair in Nursing and Director of Nursing Research, Alfred Health, Prahran, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Institute for Health Transformation, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Victoria, Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Victoria, Australia.,School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Narelle Borrott
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Goodwin J, Kirkland S. Barriers and facilitators encountered by family physicians prescribing opioids for chronic non-cancer pain: a qualitative study. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 41:182-189. [PMID: 34164970 DOI: 10.24095/hpcdp.41.6.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Harms caused by prescription opioid analgesics (POAs) have been identified as a major international public health concern. Recent statistics show rising numbers of opioid-related deaths across Canada. However, Canadian family physicians appear to have inadequate resources to safely and effectively prescribe opioid analgesics to treat chronic non-cancer pain (CNCP). METHODS We completed a qualitative study of the barriers and facilitators to safe and effective prescribing of opioid analgesics for CNCP through semi-structured interviews with eight family physicians in Nova Scotia. Thematic analysis was used to identify the barriers and facilitators. RESULTS Family physicians identified challenges in prescribing opioid analgesics for CNCP: the complexity of CNCP management, addictions risks and prescribing tools, physician training, the physician-patient relationship, prescription monitoring and control, and systemic factors. CONCLUSION Family physicians described themselves as inadequately supported in their prescribing of opioid analgesics for CNCP and could benefit from an integrated and coordinated approach to prescriber support.
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Affiliation(s)
- Joshua Goodwin
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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6
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Brunkert T, Simon M, Ruppen W, Zúñiga F. A Contextual Analysis to Explore Barriers and Facilitators of Pain Management in Swiss Nursing Homes. J Nurs Scholarsh 2020; 52:14-22. [PMID: 31898860 DOI: 10.1111/jnu.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE As part of a contextual analysis, this study aimed to generate a comprehensive understanding of barriers and facilitators to pain management in nursing homes to identify potential leverage points for future implementation studies. DESIGN An explanatory sequential mixed-methods study embedded in a cross-sectional study in 20 Swiss nursing homes (data collection: July-December 2016). METHODS Quantitative data were collected via care worker questionnaire surveys comprising 20 items assessing perceptions of barriers to pain management. Descriptive statistics were computed. In the subsequent qualitative strand we conducted four focus group discussions with care workers (registered nurses, licensed practical nurses, and nursing aides) using a knowledge-mapping approach. Findings of both strands were merged and mapped onto domains of the Capability, Opportunity, and Motivation determine Behavior (COM-B) system, a model for behavior, to identify determinants for behavior change. FINDINGS Data from 343 completed care worker surveys (response rate 67.3%) and four focus groups with care workers were analyzed. Items rated most problematic were as follows: lack of availability of nonpharmacological treatment (60.9%), lack of application of nonpharmacological treatment (53.6%), reluctance of residents to report pain (51.1%), and lack of time for a comprehensive pain assessment (50.5%). Focus groups partly corroborated quantitative findings and complemented them with facilitators, such as close collaboration with physicians and further barriers (e.g., organizational factors such as high turnover and a lack of established routines in pain management). CONCLUSIONS Our approach using a behavioral model highlighted a need for implementation strategies that improve pain management knowledge and focus on motivational aspects to establish new routines and habits related to pain management among care workers. CLINICAL RELEVANCE Our findings suggest that future approaches to improve pain management in nursing homes should go beyond provision of education and training. To establish new practices or adapt existing ones, a more complex approach (e.g., introduction of external or internal facilitators) is necessary to influence motivation and ultimately change behavior.
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Affiliation(s)
- Thekla Brunkert
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland, and Inselspital Bern University Hospital, Nursing Research Unit, Bern, Switzerland
| | - Wilhelm Ruppen
- Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
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7
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Gallant NL, Peckham A, Marchildon G, Hadjistavropoulos T, Roblin B, Stopyn RJN. Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis. BMC Geriatr 2020; 20:458. [PMID: 33167897 PMCID: PMC7650170 DOI: 10.1186/s12877-020-01758-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/08/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. METHODS Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. RESULTS Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. CONCLUSION The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.
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Affiliation(s)
- Natasha L. Gallant
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004 USA
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Blair Roblin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Rhonda J. N. Stopyn
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
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8
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Dirk K, Rachor GS, Knopp-Sihota JA. Pain Assessment for Nursing Home Residents: A Systematic Review Protocol. Nurs Res 2019; 68:324-328. [PMID: 31261236 DOI: 10.1097/nnr.0000000000000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of pain in nursing homes is substantial; however, pain assessment for both acute and chronic conditions remains inadequate, resulting in inappropriate or inadequate treatment. Complexities in assessing resident pain have been attributed to factors (barriers and facilitators) arising at the resident, healthcare provider, and healthcare system levels. OBJECTIVES In this systematic review protocol, we identify our research approach that will be used to critically appraise and synthesize data in order to assess barriers and facilitators to pain assessment in nursing home residents aged ≥65 years. METHODS This is a Cochrane style systematic review protocol adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols reporting standards. This review will include primary (original) qualitative literature concerning either barriers or facilitators to pain assessment in older adult nursing home residents. A thematic analysis approach will be employed in collating and summarizing included data and will be categorized into resident, healthcare provider, and system-level factors. Database searches will include Abstracts in Social Gerontology, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and Web of Science. DISCUSSION The identification of barriers and facilitators to pain assessment in older adult nursing home residents may assist healthcare providers across all platforms and levels of education to improve pain assessment among nursing home residents. Improving the assessment of pain has the potential to improve quality of care and ultimately quality of life for older adult nursing home residents.
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Affiliation(s)
- Kennedy Dirk
- Kennedy Dirk, is Research Assistant, Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. Geoffrey S. Rachor, BA, is Research Assistant, Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. Jennifer A. Knopp-Sihota, PhD, NP, is Associate Professor, Faculty of Health Disciplines, Athabasca University; Associate Adjunct Professor, University of Alberta; and Co-Investigator, Translating Research in Elder Care (TREC) Program, University of Alberta, Edmonton, AB, Canada
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9
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Brunkert T, Simon M, Ruppen W, Zúñiga F. Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness-Implementation Study. J Am Geriatr Soc 2019; 67:2574-2580. [PMID: 31454068 DOI: 10.1111/jgs.16148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 12/30/2022]
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.
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Affiliation(s)
- Thekla Brunkert
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Nursing Research Unit, Bern, Switzerland
| | - Wilhelm Ruppen
- Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
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10
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Desveaux L, Saragosa M, Kithulegoda N, Ivers NM. Family Physician Perceptions of Their Role in Managing the Opioid Crisis. Ann Fam Med 2019; 17:345-351. [PMID: 31285212 PMCID: PMC6827657 DOI: 10.1370/afm.2413] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/01/2019] [Accepted: 03/03/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We examined the perspectives of family physicians (FPs) on opioid prescribing and management of chronic pain to better understand the barriers to safer prescribing in primary care and differences in perspectives that may be potential drivers of practice variation. METHODS We used an exploratory qualitative study design. Semistructured interviews were conducted in June and July 2017 with 22 FPs in Ontario and coded inductively. Thematic analysis was used to identify themes, and a framework analysis explored the influence of physician demographics on prescribing experience. RESULTS Three key themes emerged: the discrepancy between FPs' training and current practice, the tension between the FP's role and patient and system expectations, and the influence of length of time in practice and strength of therapeutic relationships on perspectives on opioid prescribing. There was an overarching sentiment among participants that FPs are unsupported in their efforts to manage chronic pain. More years in practice (≥15 years) seems to influence practice patterns by increasing trust in therapeutic relationships and decreasing reliance on emergent guidelines (vs clinical experience). CONCLUSION Number of years in practice influences FPs' response to emergent evidence, requiring initiatives to include strategies tailored to individual beliefs. Initiatives must move beyond dissemination and education to equip FPs with the skills they need to navigate emotionally charged conversations. External pressures and misaligned system and patient expectations place FPs at the center of a challenging situation, which may result in a higher risk of burnout compared with that of their specialist colleagues.
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Affiliation(s)
- Laura Desveaux
- Women's College Research Institute, Toronto, Canada .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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11
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Brunkert T, Simon M, Haslbeck J, Zúñiga F. Who to Talk to About my Pain? A Brief Qualitative Study on Perception of Pain and its Management in Swiss Nursing Home Residents. Pain Manag Nurs 2019; 21:151-156. [DOI: 10.1016/j.pmn.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/27/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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12
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Knopp-Sihota JA, Dirk KL, Rachor GS. Factors Associated With Pain Assessment for Nursing Home Residents: A Systematic Review and Meta-Synthesis. J Am Med Dir Assoc 2019; 20:884-892.e3. [DOI: 10.1016/j.jamda.2019.01.156] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
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13
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McCleary L, Thompson GN, Venturato L, Wickson-Griffiths A, Hunter P, Sussman T, Kaasalainen S. Meaningful connections in dementia end of life care in long term care homes. BMC Psychiatry 2018; 18:307. [PMID: 30249213 PMCID: PMC6154884 DOI: 10.1186/s12888-018-1882-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/11/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. METHOD This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. RESULTS Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. DISCUSSION Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives' questions about end of life. CONCLUSIONS Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents' experiences of deaths of other residents is needed.
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Affiliation(s)
- Lynn McCleary
- Department of Nursing, Brock University, St. Catharines, Canada.
| | - Genevieve N Thompson
- 0000 0004 1936 9609grid.21613.37College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Lorraine Venturato
- 0000 0004 1936 7697grid.22072.35Faculty of Nursing, University of Calgary, Calgary, Canada
| | | | - Paulette Hunter
- 0000 0001 2154 235Xgrid.25152.31Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, Canada
| | - Tamara Sussman
- 0000 0004 1936 8649grid.14709.3bSchool of Social Work, McGill University, Montreal, Canada
| | - Sharon Kaasalainen
- 0000 0004 1936 8227grid.25073.33School of Nursing, McMaster University, Hamilton, Canada
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Brunkert T, Ruppen W, Simon M, Zúñiga F. A theory-based hybrid II implementation intervention to improve pain management in Swiss nursing homes: A mixed-methods study protocol. J Adv Nurs 2018; 75:432-442. [PMID: 30109728 DOI: 10.1111/jan.13817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/11/2018] [Accepted: 06/26/2018] [Indexed: 12/01/2022]
Abstract
AIM To present a protocol for evaluating an implementation intervention to improve pain management in nursing homes by addressing behaviour change of the care workers. BACKGROUND Pain management in nursing homes often is inadequate despite the availability of evidence-based pain management guidelines. Barriers to pain management in nursing homes occur on several levels including lack of knowledge and negative beliefs towards pain of care workers. A comprehensive approach incorporating contextual and behavioural factors is needed to sustainably improve pain management practice. DESIGN A hybrid type II effectiveness-implementation design comprising an incomplete non-randomized stepped-wedge design and concurrent focus groups is proposed. METHODS A convenience sample of six nursing homes will be included. Implementation of a facility pain management policy will be facilitated by introduction of a facility pain champion and training of all care workers in pain assessment and management. Quantitative outcomes assessed at baseline, after 3 and 6 months include self-efficacy in pain management and attitudes to pain of care workers and functional interference from pain and pain intensity in residents. Feasibility and acceptability of the intervention and implementation strategies and potential barriers to implementation will be explored in focus groups and interviews. (Protocol approved in October 2017). CONCLUSION The proposed intervention implementation has been developed in a participatory approach involving relevant stakeholders. To further improve the contextual fit, development of implementation strategies was guided by the consolidated framework of implementation research. Findings of this research are expected to inform adaptions to the implementation of the intervention. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT03471390.
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Affiliation(s)
- Thekla Brunkert
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Wilhelm Ruppen
- Department of Anesthesiology, Perioperative, Preclinical Emergency and Pain Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Nursing Research Unit, Bern, Switzerland
| | - Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
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Holloway H, Parker D, McCutcheon H. The complexity of pain in aged care. Contemp Nurse 2018; 54:121-125. [PMID: 30051773 DOI: 10.1080/10376178.2018.1480399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Older people living in residential aged care often experience complex persistent pain because of the presence of multiple comorbidities and geriatric syndrome. Complex persistent pain is associated with physical, psychological and emotional burdens. All of these factors can result in existential suffering. Current pain management in aged care is targeted at passive strategies. More consideration needs to be given to how assessment and management of pain in this population can be improved, using a biopsychosocial model, to decrease unnecessary suffering.
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Affiliation(s)
- Helen Holloway
- a School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Science , University of Queensland , St Lucia , Queensland , Australia
| | - Deborah Parker
- a School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Science , University of Queensland , St Lucia , Queensland , Australia.,b Faculty of Health , University of Technology Sydney , Sydney , Australia
| | - Helen McCutcheon
- a School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Science , University of Queensland , St Lucia , Queensland , Australia
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Toye F, Seers K, Barker K. A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundPeople with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research.Objectives(1) To undertake a qualitative evidence synthesis (QES) to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain; (2) to make our findings easily available and accessible through a short film; and (3) to contribute to the development of methods for QESs.DesignWe used the methods of meta-ethnography, which involve identifying concepts and progressively abstracting these concepts into a line of argument.Data sourcesWe searched five electronic bibliographic databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Allied and Complementary Medicine Database) from inception to November 2016. We included studies that explored HCPs’ experiences of providing health care to people with chronic non-malignant pain. We utilised the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework to rate our confidence in the findings.ResultsWe screened 954 abstracts and 184 full texts and included 77 studies reporting the experiences of > 1551 HCPs. We identified six themes: (1) a sceptical cultural lens and the siren song of diagnosis; (2) navigating juxtaposed models of medicine; (3) navigating the patient–clinician borderland; (4) the challenge of dual advocacy; (5) personal costs; and (6) the craft of pain management. We produced a short film, ‘Struggling to support people to live a valued life with chronic pain’, which presents these themes (seeReport Supplementary Material 1; URL:www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419807/#/documentation; accessed 24 July 2017). We rated our confidence in the review findings using the GRADE-CERQual domains. We developed a conceptual model to explain the complexity of providing health care to people with chronic non-malignant pain. The innovation of this model is to propose a series of tensions that are integral to the experience: a dualistic biomedical model compared with an embodied psychosocial model; professional distance compared with proximity; professional expertise compared with patient empowerment; the need to make concessions to maintain therapeutic relationships compared with the need for evidence-based utility; and patient advocacy compared with health-care system advocacy.LimitationsThere are no agreed methods for determining confidence in QESs.ConclusionsWe highlight areas that help us to understand why the experience of health care can be difficult for patients and HCPs. Importantly, HCPs can find it challenging if they are unable to find a diagnosis and at times this can make them feel sceptical. The findings suggest that HCPs find it difficult to balance their dual role of maintaining a good relationship with the patient and representing the health-care system. The ability to support patients to live a valued life with pain is described as a craft learnt through experience. Finally, like their patients, HCPs can experience a sense of loss because they cannot solve the problem of pain.Future workFuture work to explore the usefulness of the conceptual model and film in clinical education would add value to this study. There is limited primary research that explores HCPs’ experiences with chronic non-malignant pain in diverse ethnic groups, in gender-specific contexts and in older people living in the community.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Toye F, Seers K, Barker KL. Meta-ethnography to understand healthcare professionals' experience of treating adults with chronic non-malignant pain. BMJ Open 2017; 7:e018411. [PMID: 29273663 PMCID: PMC5778293 DOI: 10.1136/bmjopen-2017-018411] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We aimed to explore healthcare professionals' experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care. DESIGN Qualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals' experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings. RESULTS We screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high. CONCLUSIONS This is the first qualitative evidence synthesis of healthcare professionals' experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Toye F, Seers K, Tierney S, Barker KL. A qualitative evidence synthesis to explore healthcare professionals' experience of prescribing opioids to adults with chronic non-malignant pain. BMC FAMILY PRACTICE 2017; 18:94. [PMID: 29178843 PMCID: PMC5702226 DOI: 10.1186/s12875-017-0663-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/15/2017] [Indexed: 01/08/2023]
Abstract
Background Despite recent guidelines suggesting that patients with chronic non-malignant pain might not benefit, there has been a significant rise in opioid prescription for chronic non-malignant pain. This topic is important because an increasing number of HCPs are prescribing opioids despite very limited evidence for long-term opioid therapy for chronic non-malignant pain outside of end-of-life care. To better understand the challenges of providing effective treatment, we conducted the first qualitative evidence synthesis to explore healthcare professionals’ experience of treating people with chronic non-malignant pain. We report findings that explore healthcare professionals’ experience of prescribing opioids to this group of patients. Methods We searched five electronic bibliographic databases (Medline, Embase, CINAHL, PsychINFO, AMED) from inception to November 2015 and screened titles, abstracts and full texts of potential studies. We included studies in English that explored healthcare professionals’ experience of treating adults with chronic non-malignant pain. Two reviewers quality appraised each paper. We used the methods of meta-ethnography developed and refined for large reviews, and the GRADE-CERQual framework to rate confidence in review findings. Results We screened 954 abstracts and 184 full texts, and included 77 studies in the full review. 17 of these 77 studies included concepts that explored the experience of prescribing opioids. We abstracted these concepts into 6 overarching themes: (1) Should I, shouldn’t I? (2) Pain is Pain; (3) Walking a fine line; (4) Social guardianship; (5) Moral boundary work; (6) Regulations and guidelines. We used the GRADE-CERQual framework to evaluate confidence in findings. A new overarching concept of ‘ambiguity’ explains the balancing required around the factors taken into account when prescribing opioids. Managing this ambiguity is challenging and these findings can inform healthcare professionals dealing with these decisions. Conclusions This conceptual model demonstrates the complexity of making a decision to prescribe opioids to someone with chronic non-malignant pain. Although opioid prescription is underpinned by the therapeutic aim of alleviating pain, this aim may be misplaced. This has implications for education in light of the new regulations for opioid prescription. Findings also demonstrate that the decision is influenced by intra- and interpersonal factors and broader external concerns.
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Affiliation(s)
- Fran Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, 0X3 7HE, UK.
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Stephanie Tierney
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Karen Louise Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, 0X3 7LD, UK
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Kaasalainen S, Zacharias R, Hill C, Wickson-Griffiths A, Hadjistavropoulos T, Herr K. Advancing the pain management in older adults agenda forward through the development of key research and education priorities: A Canadian perspective. Can J Pain 2017; 1:171-182. [PMID: 35005352 PMCID: PMC8730549 DOI: 10.1080/24740527.2017.1383139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 11/04/2022]
Abstract
Background: The undermanagement of pain in older adults has been identified as a problem worldwide. Aims: The purpose of this research is to identify priority areas in education and research for future development with the aim of improving pain management in older persons. In addition, barriers to addressing these priorities are identified. Methods: This mixed methods study, based on a modified Delphi approach, included three distinct components: (1) a qualitative component using focus groups with key informants or experts in the field of pain management in older adults (n = 17), (2) a scoping review of the literature, and (3) a survey of ranked responses completed by the same key informants who attended the focus groups. Thematic analysis was used to identify the initial list of issues and descriptive statistics were used for ranking them. Results: A number of concerns related to both education and research were frequently endorsed by participants. For education, they identified the need for more content in both undergraduate and continuing education programs related to documenting about pain; assessing pain, and learning about the complexities of pain. Research priorities included the need to explore successful practice models; costs of untreated pain; effects of mobility on pain; and patient preferences for pain management. Key barriers to addressing these barriers included lack of staff time and resources and unfamiliarity with pain assessment tools. Conclusion: These findings highlight priority issues related to pain management in older adults from a nationwide perspective.
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Affiliation(s)
- Sharon Kaasalainen
- Department of Family Medicine, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ramesh Zacharias
- Chronic Pain Management Unit, Chedoke Hospital & Village of Erin Meadows, Hamilton, Ontario, Canada
| | - Courtney Hill
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Park HR, Park E, Park JW. Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives. Collegian 2016. [DOI: 10.1016/j.colegn.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ersek M, Neradilek MB, Herr K, Jablonski A, Polissar N, Du Pen A. Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial. J Am Med Dir Assoc 2016; 17:348-56. [PMID: 26897592 PMCID: PMC4988793 DOI: 10.1016/j.jamda.2016.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To enhance pain practices in nursing homes (NHs) using pain assessment and management algorithms and intense diffusion strategies. DESIGN A cluster, randomized controlled trial. The intervention consisted of intensive training and support for the use of recommended pain assessment and management practices using algorithms (ALGs). Control facilities received pain education (EDU) only. SETTING Twenty-seven NHs in the greater Puget Sound area participated. Facilities were diverse in terms of size, quality, and ownership. PARTICIPANTS Data were collected from 485 NH residents; 259 for the intervention and 226 for the control group. MEASUREMENTS Resident outcomes were nursing assistant (proxy) report and self-reported resident pain intensity. Process outcomes were adherence to recommended pain practices. Outcomes were measured at baseline, completion of the intervention (ALG) or training (EDU), and again 6 months later. RESULTS Among 8 comparisons of outcome measures between ALG and EDU (changes in 4 primary pain measures compared at 2 postintervention time points) there was only 1 statistically significant but small treatment difference in proxy- or self-reported pain intensity. Resident-reported worst pain decreased by an average of 0.8 points from baseline to 6 months among the EDU group and increased by 0.2 points among the ALG (P = .005), a clinically nonsignificant difference. There were no statistically significant differences in adherence to clinical guideline practice recommendations between ALG and EDU following the intervention. CONCLUSIONS Future research needs to identify and test effective implementation methods for changing complex clinical practices in NHs, including those to reduce pain.
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Affiliation(s)
- Mary Ersek
- Professor of Palliative Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, University of Pennsylvania School of Nursing, 418 Curie Blvd., Room 329, Philadelphia, PA 19104-6096, Phone: (215) 746-3563, Fax: (215) 222-2592
| | - Moni Blazej Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA 98112-2913, Phone: (206) 329-9325, Fax: (206) 324-5915
| | - Keela Herr
- Professor & Chair, Adult & Gerontology Nursing, College of Nursing, University of Iowa, 101 Nursing Building, 50 Newton Road, Iowa City, IA 52242-1121, Phone: (319) 335-7080
| | - Anita Jablonski
- Associate Professor, College of Nursing, Seattle University, 410 Garrand, Seattle, WA 98122, Phone: (206) 296-5679
| | - Nayak Polissar
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA 98112-2913, Phone: (206) 329-9325, Fax: (206) 324-5915
| | - Anna Du Pen
- Retired, 14555 Wild Swan NE, Bainbridge Island, WA 98110-4102, Phone: (206) 780-8373
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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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Abstract
Some researchers have suggested that qualitative research is increasing in the gerontology field, but little systematic analysis has tested this assertion. Using the Canadian Journal on Aging/La Revue canadienne du vieillissement as a case study, we analysed articles reporting on original research from 1995 to 2012. One in four articles were qualitative, and results in three-year intervals show a clear increase in qualitative research findings during this 18-year time frame: (a) 1995-1997: 10 per cent; (b) 1998-2000: 19 per cent; (c) 2001-2003: 25 per cent; (d) 2004-2006: 25 per cent; (e) 2007-2009: 29 per cent; and (f) 2010-2012: 43 per cent. In all time intervals (with the exception of 2004-2006), French language articles were more likely to use a qualitative research design compared to English language articles. Topics, methodologies, and data collection strategies are also discussed.
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Kaasalainen S, Ploeg J, Donald F, Coker E, Brazil K, Martin-Misener R, Dicenso A, Hadjistavropoulos T. Positioning clinical nurse specialists and nurse practitioners as change champions to implement a pain protocol in long-term care. Pain Manag Nurs 2014; 16:78-88. [PMID: 25439111 DOI: 10.1016/j.pmn.2014.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 04/03/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
Pain management for older adults in long-term care (LTC) has been recognized as a problem internationally. The purpose of this study was to explore the role of a clinical nurse specialist (CNS) and nurse practitioner (NP) as change champions during the implementation of an evidence-based pain protocol in LTC. In this exploratory, multiple-case design study, we collected data from two LTC homes in Ontario, Canada. Three data sources were used: participant observation of an NP and a CNS for 18 hours each over a 3-week period; CNS and NP diaries recording strategies, barriers, and facilitators to the implementation process; and interviews with members of the interdisciplinary team to explore perceptions about the NP and CNS role in implementing the pain protocol. Data were analyzed using thematic content analysis. The NP and CNS used a variety of effective strategies to promote pain management changes in practice including educational outreach with team members, reminders to nursing staff to highlight the pain protocol and educate about practice changes, chart audits and feedback to the nursing staff, interdisciplinary working group meetings, ad hoc meetings with nursing staff, and resident assessment using advanced skills. The CNS and NP are ideal champions to implement pain management protocols and likely other quality improvement initiatives.
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Affiliation(s)
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Faith Donald
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Esther Coker
- School of Nursing, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kevin Brazil
- Queen's University Belfast, School of Nursing and Midwifery, Belfast, United Kingdom
| | | | - Alba Dicenso
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Kaasalainen S. Advancing the pain management agenda forward in long-term care. Pain Manag 2013; 3:163-5. [DOI: 10.2217/pmt.13.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, Faculty of Health Science, 1200 Main Street West Hamilton, ON, Canada
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Corazzini KN, Mueller C, Anderson RA, Day L, Hunt-McKinney S, Porter K. Pain Medication Management in Nursing Homes and Nursing Scope of Practice. J Gerontol Nurs 2013; 39:40-6. [DOI: 10.3928/00989134-20130220-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022]
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Kaasalainen S, Brazil K, Kelley ML. Building capacity in palliative care for personal support workers in long-term care through experiential learning. Int J Older People Nurs 2012; 9:151-8. [PMID: 23051621 DOI: 10.1111/opn.12008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Providing palliative care in long-term care (LTC) homes is an area of growing importance. As a result, attention is being given to exploring effective palliative care learning strategies for personal support workers (PSWs) who provide the most hands-on care to LTC residents. AIM The purpose of this intervention was to explore hospice visits as an experiential learning strategy to increase the capacity of PSWs in palliative care, specifically related to their new learning, and how they anticipated this experience changed their practices in LTC. DESIGN This study utilised a qualitative descriptive design. METHODS Eleven PSWs from four Ontario LTC homes were sent to their local hospice to shadow staff for one to two days. After the visit, PSWs completed a questionnaire with open-ended questions based on critical reflection. Data were analysed using thematic content analysis. RESULTS PSWs commented on the extent of resident-focused care at the hospice and how palliative care interventions were tailored to meet the needs of residents. PSWs were surprised with the lack of routine at the hospice but felt that hospice staff prioritised their time effectively in order to meet family and client care needs. Some PSWs were pleased to see how well integrated the PSW role is on the community hospice team without any hierarchical relationships. Finally, PSWs felt that other LTC staff would benefit from palliative care education and becoming more comfortable with talking about death and dying with other staff, residents and family members. CONCLUSION This study highlighted the benefits of PSWs attending a hospice as an experiential learning strategy. Future work is needed to evaluate this strategy using more rigorous designs as a way to build capacity within PSWs to provide optimal palliative care for LTC residents and their family members. IMPLICATIONS FOR PRACTICE PSWs need to be recognised as important members within the interdisciplinary team. PSWs who shadow staff at hospices view this experience as a positive strategy to meet their learning needs related to palliative care.
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Kaasalainen S, Brazil K, Akhtar-Danesh N, Coker E, Ploeg J, Donald F, Martin-Misener R, DiCenso A, Hadjistavropoulos T, Dolovich L, Papaioannou A. The evaluation of an interdisciplinary pain protocol in long term care. J Am Med Dir Assoc 2012; 13:664.e1-8. [PMID: 22739020 DOI: 10.1016/j.jamda.2012.05.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents. DESIGN A controlled before-after design was used to evaluate the effectiveness of the pain protocol, whereas qualitative interviews and focus groups were used to obtain additional context-driven data. SETTING Four LTC facilities in southern Ontario, Canada; 2 for the intervention group and 2 for the control group. PARTICIPANTS Data were collected from 200 LTC residents; 99 for the intervention and 101 for the control group. INTERVENTION Implementation of a pain protocol using a multifaceted approach, including a site working group or Pain Team, pain education and skills training, and other quality improvement activities. MEASUREMENTS Resident pain was measured using 3 assessment tools: the Pain Assessment Checklist for Seniors with Limited Ability to Communicate, the Pain Assessment in the Communicatively Impaired Elderly, and the Present Pain Intensity Scale. Clinical practice behaviors were measured using a number of process indicators; for example, use of pain assessment tools, documentation about pain management, and use of pain medications. A semistructured interview guide was used to collect qualitative data via focus groups and interviews. RESULTS Pain increased significantly more for the control group than the intervention group over the 1-year intervention period. There were significantly more positive changes over the intervention period in the intervention group compared with the control group for the following indicators: the use of a standardized pain assessment tool and completed admission/initial pain assessment. Qualitative findings highlight the importance of reminding staff to think about pain as a priority in caring for residents and to be mindful of it during daily activities. Using onsite champions, in this case advanced practice nurses and a Pain Team, were key to successfully implementing the pain protocol. CONCLUSIONS These study findings indicate that the implementation of a pain protocol intervention improved the way pain was managed and provided pain relief for LTC residents.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada.
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Marcella J, Nadarajah J, Kelley ML, Heckman GA, Kaasalainen S, Strachan PH, McKelvie RS, Newhouse I, Stolee P, McAiney CA, Demers C. Understanding organizational context and heart failure management in long term care homes in Ontario, Canada. Health (London) 2012. [DOI: 10.4236/health.2012.429113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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