Developing Pain Assessment and Management for Older People in Nursing Care Homes

Project Duration

January 2006 - August 2008

Funder

Health Foundation

Aims

Work with a consultative group and nursing home staff to: 

1. Identify factors that nursing home care staff consider affect pain assessment and management 
2. To develop a resource pack to support pain assessment in Nursing Homes 
3. To evaluate the impact of or the resource pack

Methods

The study uses an action research framework to work with nursing home staff to identify barriers to effective pain assessment and management and develop practice through the identification of resources that would support pain assessment and management. The study consists of three stages: 

Stage one: To explore the factors that staff consider influence their ability to assess and manage pain in nursing home residents group interviews were held consisting of 5-10 staff at seven nursing homes purposively selected ensuring agreement to participate and the support of the nurse in charge of the home. The group interviews were conducted in the nursing homes and will involve both trained staff and health care assistants who have contact with patients and are responsible for pain assessment. The groups also identified resources and information that would help staff to assess and manage pain more effectively as well as reviewing the possible resources to be developed. The content will include a variety of assessment tools to use with individuals with different needs as well as guidance and educational material based on existing guidelines (eg. American Geriatric Society 2002) and information leaflets for residents and their relatives. 

Stage two: The information gathered from the group interviews will be used to develop a resource pack that will support nursing home staff to assess and manage pain more effectively and to inform possible development of organisational policies and procedures. The resource pack will include: 

• different assessment tools and guidance and how to use them 
• examples of policies and procedures relating to pain assessment and management 
• decision making flow charts 
• educational information and key literature relating to pain assessment and management 

The pack will be introduced into the nursing homes and a member of staff from the home will be identified as a key facilitator for the project and will be supported through 3x1 hour workshops to look at pain assessment and management issues and using the resource pack in their own practice setting. The workshops will prepare the facilitator to act as a resource person in the care home to support the implementation of the resource pack and to promote the use of the pack by staff in the home. 

Stage three, Evaluation: The evaluation stage will include, discussing the effects of the project with the groups, interviews with key stakeholders in the nursing homes, reflections on the impact of the study on the policies and procedures of the nursing homes and the impact of the resource pack will be assessed using a before and after design.

Outcomes and Findings

The initial project has now been completed and a final report submitted to the Health foundation. The project identified that pain assessment in care homes is currently limited and there is a need for additional education and support for care home staff. The use of a resource pack improved the awareness and documentation of pain although there was no evidence of an improvement in knowledge. The impact of the resource pack was varied depending on a number of contextual issues at the different care homes. A follow up study is planned for 2010-2011.