title: Positioning clinical nurse specialists and nurse practitioners as change champions to implement a pain protocol in long-term care.
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.
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario, Canada. Electronic address: kaasal@mcmaster.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada.
authors.forename: Faith
authors.initials: F
authors.lastname: Donald
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario, Canada; Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Esther
authors.initials: E
authors.lastname: Coker
authors.affiliation: Queen's University Belfast, School of Nursing and Midwifery, Belfast, United Kingdom.
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.affiliation: Dalhousie University, School of Nursing, Halifax, Nova Scotia, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Martin-Misener
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Alba
authors.initials: A
authors.lastname: Dicenso
authors.affiliation: Psychology Department, University of Regina, Regina, Saskatchewan, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hadjistavropoulos
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D055318:Evidence-Based Nursing / Q000379:methods*; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D000072184:Nurse Specialists / Q000458:organization & administration*; D024802:Nurse's Role; D009735:Nursing Homes / Q000458:organization & administration*; D009864:Ontario; D059408:Pain Management / Q000451:nursing*