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Knowledge of pain medication and its management could be improved among nursing home staff

According to a recent study, nursing home staff, particularly unlicensed staff, know little about pain medication and management. Many staff members involved in the study were reluctant to use aggressive pain management strategies, even in the face of reported severe pain and observed pain behaviors. They also underestimated the effectiveness of nonmedication strategies such as massage, positioning, and distraction.

Many staff members were unaware of safe and effective analgesia dosing levels and schedules for different types of analgesics, yet a pain management educational program was only partially successful in improving knowledge, according to the study supported by the Agency for Healthcare Research and Quality (HS11093). However, substantial staff turnover during the study period may have blunted the impact of the program, notes Katherine R. Jones, R.N., Ph.D. F.A.A.N. The study was conducted while Dr. Jones was at the School of Nursing at the University of Colorado; she is currently at the Yale University School of Nursing.

Dr. Jones and her colleagues assessed pain knowledge and attitudes among more than 300 licensed and unlicensed staff members at 12 Colorado nursing homes before and after implementation of a pain management educational program. Six of the homes were urban, and six were rural. They ranged in size from 65 to 180 beds and were both not for profit and for profit. The program included an educational pain resource binder, four staff development sessions, a staff training video on pain types, factoids posted in visible areas, a short resident educational video and pamphlet, continuing education seminar for physicians, and formation of an internal pain team.

The program did not significantly improve staff knowledge scores in the treatment homes (from 69 to 71 percent) compared with control homes (from 68 to 67 percent). The program was even less effective at changing misguided attitudes about pain (for example, residents exaggerate pain to get attention), which remained similar among staff of program and control homes. In conclusion, the researchers note that constant turnover of nursing home administrators and staff makes implementation of quality improvement interventions difficult and sustainability of improvement over time even more challenging.

See "Improving nursing home staff knowledge and attitudes about pain," by Dr. Jones, Regina Fink, R.N., Ph.D., F.A.A.N., Ginny Pepper, R.N., Ph.D., F.A.A.N., and others, in the August 2004 issue of The Gerontologist 44(4), pp. 469-478.

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