Enhancing Knowledge and Attitudes in Pain Management: A Pain Management Education Program for Nursing Home Staff

The aim of the study was to examine the effectiveness of a pain management program (PMP) in enhancing the knowledge and attitudes of health care workers in pain management. Many nursing home residents suffer from pain, and treatment of pain is often inadequate. Failure of health care workers to assess pain and their insufficient knowledge of pain management are barriers to adequate treatment. It was a quasiexperimental pretest and posttest study. Four nursing homes were approached, and 88 staff joined the 8-week PMP. Demographics and the knowledge and attitudes regarding pain were collected with the use of the Nurse’s Knowledge and Attitudes Survey Regarding Pain–Chinese version (NKASRP-C) before and after the PMP. A deficit in knowledge and attitudes related to pain management was prominent before the PMP, and there was a significant increase in pain knowledge and attitudes from 7.9 ± SD 3.52 to 19.2 ± SD4.4 (p < .05) after the 8-week PMP. A PMP can improve the knowledge and attitudes of nursing staff and enable them to provide adequate and appropriate care to older persons in pain. PMPs for nurses and all health care professionals are important in enhancing care for older adults and to inform policy on the provision of pain management.     

Health-Related Profile and Quality of Life Among Nursing Home Residents: Does Pain Matter?

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents’ demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents’ physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents’ pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.     

The Effectiveness of Physical Exercise Training in Pain,Mobility, and Psychological Well-being of Older Persons Living in Nursing Homes

Pain is common in the aging population, particularly among older residents of nursing homes. It has been found that 50% of older people living in the community have been experiencing chronic pain, and the number increased to 80% for older residents of nursing homes. Exercise is an effective non-pharmacological intervention that can reduce pain and improve physical and psychological functions. A quasi-experimental study with a pretest–posttest control group designed was conducted to evaluate the effects of a physical exercise program (PEP) on older residents of nursing homes who have chronic pain. Three-hundred-ninety-six older residents with chronic pain were recruited from 10 nursing homes run by non-governmental organizations in Hong Kong. The average age of the older residents was 85.44 ± 6.29. Five nursing homes were randomized to the experimental group with PEP (n = 225, age = 85.45 ± 6.25); the other five nursing homes were randomized to the control group without the PEP (n = 171, age = 85.44 ± 6.35). PEP was an eight-week training program given by a physiotherapist and nurses once a week. It consisted of warm-up exercises, muscle strengthening, stretching, balancing, and self-administered massage to acupressure points. At the end of each PEP session, pamphlets with pictures illustrating the “exercise of the day” were given to the older residents of nursing homes as a tool to enhance their self-management skills. The control group received no training during the eight weeks. Upon completion of the PEP, the experimental group experienced a significantly greater reduction in pain intensity from 4.19 ± 2.25 (on an 11 point scale) to 2.67 ± 2.08, as compared to the control group (p < .05). In addition, the psychological well-being (happiness, loneliness, life satisfaction, and depression) of the experimental group was significantly improved (p < .05).     

Attitudes of Dutch, German and Swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study

Objective

To investigate the attitudes of nursing staff towards restraint measures and restraint use in nursing home residents, and to investigate if these attitudes are influenced by country of residence and individual characteristics of nursing staff.

Methods

A questionnaire on attitudes regarding restraints (subscales: reasons, consequences, and appropriateness of restraint use) and opinions regarding the restrictiveness of restraint measures and discomfort in using them was distributed to a convenience sample of nursing staff in The Netherlands (n = 166), Germany (n = 258), and Switzerland (n = 184).

Results

In general, nursing staff held rather neutral opinions regarding the use of physical restraints, but assessed the use of restraints as an appropriate measure in their clinical practice. Gender and age were not related to attitudes of nursing staff, but we did find some differences in attitudes between nursing staff from the different countries. Dutch nursing staff were most positive regarding the reasons of restraint use (p < 0.01), but were less positive than German and Swiss nursing staff regarding the appropriateness of restraint use (p < 0.01). Swiss nursing staff were less positive than German nursing staff regarding the appropriateness of restraint use (p < 0.01). Nursing staff with longer clinical experience showed a more negative attitude towards restraint use than nursing staff with less experience (p < 0.05) and charge nurses had the least positive attitude towards restraint use (p < 0.05).Opinions regarding restraint measures differed between the three countries. The use of bilateral bedrails was considered as a moderate restrictive measure; the use of belts was rated as the most restrictive measure and nursing staff expressed pronounced discomfort on the use of these measures.

Conclusions

Nursing staff from three European countries have different attitudes and opinions regarding the use of physical restraints. The results underline the importance of more tailored, culturally sensitive interventions to reduce physical restraints in nursing homes.     

Pain Management Best Practice with Older Adults: Effects of Training on Staff Knowledge,Attitudes, and Patient Outcomes

This study examined the effects of staff training regarding best practice of pain management on knowledge and attitudes and patient outcomes in a rehabilitation hospital. Nursing, occupational therapy, and physiotherapy staff (N = 75) viewed videos based on the 2002 American Geriatrics Society (AGS) clinical practice guidelines. Training resulted in improved pain management knowledge and attitudes (p < .002), as measured by “barriers to the assessment and treatment of pain” questionnaire () and by higher frequency of documentation of pain ratings up to 5 months after training (p < .05) as determined through chart audits. Length of stay decreased by 4 to 6 days, and functional outcomes improved, possibly indicating an improvement in efficiency of patient recovery after staff training.     

Efficacy of a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan

Promoting psychological health in older populations is important. This study evaluated a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan. A convenience sample of 150 older residents of three nursing homes were recruited and randomly assigned to either an experimental group or a control group. The experimental group (n = 75) participated in an 8-week horticultural activity program. The control group (n = 75) received routine care. Generalized estimating equations analyses revealed significant time by treatment interaction effects for depression (p < .001) and loneliness (p < .001). This study provides a reference for improving psychological health in older people.     

Pain Management Education in Long-Term Care: It Can Make a Difference

Acute and chronic pain management for persons residing in long-term care settings is a serious problem. In an effort to change practice in pain management and improve resident outcomes, the Campaign Against Pain education program was instituted at Beatitudes Health Care Center in Phoenix, Arizona. In this pilot study, professional and certified nursing assistant (CNA) staff were surveyed before and after the training program to ascertain change in knowledge, attitudes, and barriers about pain. After the intensive training program and onsite consultation with the concomitant changes in policies, procedures, and documentation, professional and CNA staff knowledge improved after 6 months (F = 6.273; p = .02), attitudes changed (F = 12.26; p = .002), and barriers were mitigated. With a comprehensive quality improvement pain plan in place, the findings suggest that education in pain management in long-term care and program changes that adopt best practices in pain can make a difference.     

Psychometric Evaluation of the MOBID Dementia Pain Scale in U.S. Nursing Homes

PurposeThe Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US.DesignCross-sectional study.SettingsSixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama.ParticipantsOne hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment.MethodsValidity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician’s pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach’s alpha.ResultsMOBID overall scores were significantly associated with expert clinician’s rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (α = 0.83).Conclusions and Clinical ImplicationsResult of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff.     

Development and Testing of the Pain Assessment Tool in Cognitively Impaired Elders (PATCIE): Nonverbal Pain Behaviors in African American and Caucasian Nursing Home Residents with Dementia

BackgroundPeople with dementia experience a decline in language skills required to self-report pain; researchers thus recommend the use of nonverbal behaviors to assess pain. Although multiple instruments exist for assessing nonverbal pain behaviors, psychometric data are lacking for African American nursing home residents with dementia.Aims and DesignThe purpose of this methodological study was to describe the development and testing of the Pain Assessment Tool in Cognitively Impaired Elders (PATCIE) in African American and Caucasian nursing home residents with dementia.Settings/ParticipantsThe convenience sample included 56 African American and 69 Caucasian residents with dementia in multiple nursing homes from three states. The research staff completed the pain assessments when the nursing home staff transferred the residents.Results/ConclusionsInitially, 15 nonverbal pain behaviors were evaluated. Based on the alpha scores and additional literature review, the 15 nonverbal pain behaviors were expanded to 28 behaviors. The PATCIE had a Cronbach's alpha of .73 during movement. Construct validity for the pain behaviors was demonstrated because higher scores were noted during movement, and scores before movement were significantly higher than those obtained after movement. For movement over time, there was a significant difference in the PATCIE score, regardless of ethnicity or time (p < .0001). There were no significant differences found between ethnic groups, either overall or in change over time between movements or between the categories of cognitive function. African Americans were more likely to display frowning, and Caucasians to display irritability. The PATCIE demonstrates preliminary reliability and validity in assessing pain in African American and Caucasian nursing home residents with dementia.     

Implementation of Sustainable Evidence-Based Practice for the Assessment and Management of Pain in Residential Aged Care Facilities

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice.     

Knowledge of and attitudes toward assisting patients with dementia during mealtime among nursing staff in acute care settings: A cross-sectional study

BackgroundMealtime difficulties are exacerbated in acute care settings, which further complicate health issues in people with dementia (PWD). Understanding staff knowledge and attitudes is crucial for providing better care for PWD in nursing home settings. However, little is known about the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.AimTo explore the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.MethodsWe conducted a cross-sectional study between August and December 2020 at three acute care hospitals in Illawarra region, New South Wales, Australia. Surveys were distributed to nursing staff including registered nurses, enrolled nurses, and nurse assistants, who worked in geriatric wards. Medical practitioners and casual staff were excluded from the survey. Demographics, knowledge, attitudes, and intentions toward mealtime assistance of PWD were included in the survey.FindingsA higher level of knowledge in mealtime assistance of PWD was found to be associated with positive attitudes toward mealtime assistance of PWD (r = 0.464, p < 0.001). No differences were found between educational levels and knowledge and attitudes of mealtime assistance for PWD.DiscussionThe need for mealtime assistance training to enhance knowledge of and attitudes toward assisting PWD during mealtimes is highlighted and needs more attention. Future studies could consider including a simulation training program and adopting a mealtime engagement scale to provide training and assess changes in nursing staff knowledge of and attitudes toward mealtime assistance for PWD in acute care settings.ConclusionsThe study findings can inform future research in raising awareness of the need for and developing mealtime assistance training programs for nursing staff in acute care settings.     

Nurses' reflections on pain management in a nursing home setting.

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

Impact of a pain management program on nurses' knowledge and attitude toward pain in United Arab Emirates: Experimental-four Solomon group design

BackgroundLack of knowledge about pain is a common barrier to effective pain management. Educational pain management programs directed to health care professionals can improve knowledge and attitudes about pain. However, changing practice is more challenging, but can be achieved with more targeted educational interventions within the clinical setting.ObjectivesThe main objective of this study was to examine which of four separate pain management educational designs improved nurses' knowledge and attitudes toward pain over time. Secondary objectives were to compare and contrast nurse's knowledge and attitudes toward pain before and after the educational intervention.DesignThis randomized controlled trial using a four Solomon group design.SettingThis study took place in Dubai Hospital, Dubai Health Authority, in United Arab Emirates between January 2019–April 2019.ParticipantsThe sample consisted of 200 registered nurses who were randomly selected and assigned into four separate educational groups. Participants had at least one year of experience in Dubai hospital prior to data collection.Resultspaired t-test has shown the experimental group scored significantly higher than the control group (p < 0.01). One-way ANOVA revealed significant post-test score differences between groups p < 0.001. A repeated measures ANOVA with a Greenhouse-Geisser correction determined that mean scores over three months was not statistically significant. Indicating that the level of knowledge did not change over time within any of the groups.Conclusion and recommendationsThe most important findings were the relatively low pre-test knowledge scores among staff nurses, and the significant improvement in knowledge for most test items following the educational intervention. Moreover, the level of knowledge and attitudes were maintained over three months. The pain management program proved to be effective in improving nurses' pain knowledge, attitudes, and assessment practices. Nurses in the experimental group increased their pain score significantly after the pain management program.Registration number: NETUBR.     

Symptom occurrence and associated clinical factors in nursing home residents with cancer

Little is known about the factors that contribute to symptoms in nursing home residents with cancer. We compared rates of symptoms in residents with (n = 1,022) and without cancer (n = 9,910) and examined physiologic, psychologic and situational factors potentially related to symptoms in residents with cancer. Pain, shortness of breath, vomiting, weight loss, and diarrhea were significantly (p < .05) more prevalent in residents with cancer. Cancer treatments, comorbid illnesses, and situational factors were not consistently correlated with symptoms. Improved symptom control was especially needed for the 30% of residents with cancer who clinically deteriorated within 3 months of admission; physical dependence and deteriorating clinical status were associated with pain, shortness of breath, and weight loss. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32: 453–464, 2009