Evaluating the Intervention

After a baseline assessment of knowledge in both groups, nurses and nonprofessional staff in the intervention facilities were provided with a pain resource packet consisting of the pain identification tool, an education booklet, and lanyard-sized cue cards. Professional staff also received a pocket-sized comprehensive pain assessment guide. The information was reviewed at pain workshops over the 3-month study period, after which staff knowledge was reassessed.

Other pre- and post-intervention measures included an audit of randomly selected resident charts (50%), and a survey of cognitively intact residents to assess their perception of pain management quality.

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A total of 434 staff surveys were completed, representing a 39.5% response rate; 216 surveys were completed at baseline, and an additional 218 were returned following the intervention period. A total of 636 resident charts were audited, including 308 at baseline and 328 at follow-up. Also, 168 cognitively intact residents completed surveys, 74 at baseline and then 94 at follow-up.

In the intervention facilities, the proportion of residents with a documented routine pain review increased from less than half (48.4%) at baseline to approximately three-quarters (73.8%) at the 3-month follow-up. In the control facilities, the rate increased from 75.8% to 83.2%.

Although the average number of documented pain assessments increased slightly in the intervention group (7.0 ± 15.1 to 9.7 ± 7.8), larger improvements were observed in the control group (9.1 ± 13.7 to 19.1 ± 20.9).

Use of analgesics did not significantly change, but the intervention and control groups both showed improvement in the use of nondrug pain therapies (77.4% to 82.1% and 90.2% to 94.2%, respectively). The most commonly employed measures included massage, repositioning or limb elevation, heat or cold application, tubular compression bandaging/stockings, and distraction with music or support.

With respect to staff outcomes, researchers found no significant differences in pain knowledge and awareness between the intervention and control groups. There were notable differences in correct responses among the control group when the researchers looked at specific responses, such as understanding that pain is not an acceptable part of aging (65.8% to 74.0%), or that staff and family members caring for residents are not the best judges of the presence and severity of residents’ pain (34.2% to 48.1%).