Translation research in long-term care: improving pain management in nursing homes.
BACKGROUND
Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement.


OBJECTIVE
The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain.


METHODS
A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed.


RESULTS
The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain.


CONCLUSIONS
Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices.


CONCLUSIONS
Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership.


CONCLUSIONS
Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.
Jones
Katherine R
KR
School of Nursing, Yale University, New Haven, CT 06536, USA. Katherine.jones@yale.edu
Fink
Regina
R
Vojir
Carol
C
Pepper
Ginny
G
Hutt
Evelyn
E
Clark
Lauren
L
Scott
Jill
J
Martinez
Ruby
R
Vincent
Deborah
D
Mellis
B Karen
BK
D000368:Aged; D000698:Analgesia / Q000451:nursing / Q000592:standards; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003120:Colorado / Q000453:epidemiology; D003142:Communication; D004059:Diffusion of Innovation; D004509:Education, Nursing, Continuing / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008134:Long-Term Care / Q000592:standards; D009730:Nursing Assessment; D009735:Nursing Homes / Q000458:organization & administration; D015399:Nursing Research; D009740:Nursing Staff / Q000193:education* / Q000458:organization & administration / Q000523:psychology; D010146:Pain / Q000175:diagnosis / Q000208:ethnology / Q000451:nursing*; D010147:Pain Measurement / Q000451:nursing / Q000592:standards; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000458:organization & administration*