Among the cognitively intact residents who completed the survey, mean pain problem scores decreased over time, indicating an improved perception of pain management quality. However, pain problem scores did not differ significantly between the groups over time.
In an interview with Clinical Pain Advisor, Fiona Hodson, RN, BaHSc, said that another possible study limitation is that it was unclear if there were any specific validated observational and behavioral pain tools for communicating with cognitively impaired residents, such as those recommended in Australian facilities, including the Abbey Pain Scale and the Pain Assessment in Advanced Dementia (PAINAD) score.
“These can be used as an effective communication tool between staff for baseline and progressive reassessment after an intervention,” Ms Hodson pointed out.
Ms. Hodson, who was not involved in the study, is president elect of the Australian Pain Society, and a clinical nurse consultant for pain management with Hunter Integrated Pain Service in New Lambton, Australia.
She noted that more than 52% of residents aged 65 years and older in Australian eldercare facilities have some form of dementia, so it is important to ensure that all staff members understand the targeted, validated pain tools and management resources specifically developed for use in this population.
Directions for Future Research
Dr Herr and Ms Hodson concur that the key to successfully implementing change across an organization is by making pain management a priority, and that more intervention research studies such as this one are needed to better translate guidelines into practice.
“I think this is really a nicely done study. It is very challenging to do this kind of intervention in nursing homes,” Dr Herr pointed out.
“Any time you’re doing implementation research, there are so many factors that impact the ability to implement an intervention effectively. Practical clinical trials are needed to actually look at implementations like this in a real world setting, and examine the challenges and barriers along the way,” she added.