Inadequate pain management has been well documented across health care settings. It is a particular problem in nursing homes, which have a high prevalence of pain but face significant barriers to its effective diagnosis and treatment. Barriers include staff knowledge deficits, socio-cultural beliefs about pain and pain medication held by residents, family members, and staff, and system issues such as staffing levels, turnover, and drug formulary policies. Residents who are cognitively impaired or are from racial/ethnic minority groups are at higher risk for inadequate analgesia. This study proposes to develop and implement a culturally-competent intervention to improve the quality of pain management in nursing homes. Development of the educational materials is based on principles of competency-based education and cult learning. Implementation strategies are based on innovation diffusion theory.
Specific aims are to l) develop and implement a multi-modal, culturally-competent, evidence-based educational and behavioral intervention to improve pain asessment and pain management in nursing homes; 2) improve pain assessment procedures and pain management strategies being used in nursing homes; 3) improve resident, family, and staff knowledge and attitudes towards pain assessment and pain management; 4) evaluate the influence of organizational variables on achieving desired clinical and educational outcomes; and 5) assess the cost-effectiveness of the multi-modal intervention for disseminating pain assessment and pain management knowledge to nursing homes. Specific intervention components include videotapes and manuals for staff training; a pain resource binder; physician and pharmacist seminars; chart review and feedback to clinicians; creation of an internal pain team; site visits and interactive television conferencing. Specific methods for measuring the impact of the intervention include focus groups, surveys, resident interviews and observations, chart review, organizational observations, and secondary data analysis using the Minimum Data Set. The uniqueness of this project is its attention to cultural variability in pain assessment and treatment through the inclusion of Spanish speaking gaff and residents, development of Spanish versions of the intervention, use of an inter-disciplinary internal pain team to sustain change, and incorporation of the existing AHEC infrastructure for communication and coordination across settings, facilitating future extension of the educational program.
