Improving nursing home staff knowledge and attitudes about pain.
OBJECTIVE
Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain.


METHODS
Twelve nursing homes participated in this intervention study: six treatment homes and six control homes, divided evenly between urban and rural locations. Three hundred licensed and unlicensed nursing home staff members completed written knowledge and attitude surveys at baseline, and 378 staff members completed the surveys after intervention implementation.


RESULTS
Baseline results revealed notable knowledge deficits in the areas of pharmacology, drug addiction and dependence, side effect management, and nonpharmacologic management-strategy effectiveness. Significant differences were noted by job title (registered nurse/licensed practical nurse/certified nursing assistant). Case studies displayed a knowledge application problem, with nurses often filtering resident pain reports through observed resident behaviors. The intervention led to significant improvement in knowledge scores in some, but not all, the treatment homes. Perceived barriers to effective pain management showed a significant decline across all study nursing homes.


CONCLUSIONS
Knowledge deficits related to pain management persist in nursing homes. An interactive multifaceted educational program was only partially successful in improving knowledge across settings and job categories. Attitudes and beliefs appear more difficult to change, whereas environmental and contextual factors appeared to be reducing perceived barriers to effective pain management across all participating nursing homes.
Jones
Katherine R
KR
School of Nursing, Yale University, 100 Church St. S., Box 9740, New Haven, CT 06536-0740, USA. katherine.jones@yale.edu
Fink
Regina
R
Pepper
Ginny
G
Hutt
Evelyn
E
Vojir
Carol P
CP
Scott
Jill
J
Clark
Lauren
L
Mellis
Karen
K
D000328:Adult; D000704:Analysis of Variance; D005260:Female; D005853:Geriatrics / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education* / Q000523:psychology; D006801:Humans; D007318:Inservice Training; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010146:Pain / Q000451:nursing*; D011361:Professional Competence