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An Action-Based Approach to Improving Pain Management in Long-Term Care*

Published online by Cambridge University Press:  07 December 2010

Sharon Kaasalainen ,
Kevin Brazil ,
Esther Coker ,
Jenny Ploeg ,
Ruth Martin-Misener ,
Faith Donald ,
Alba DiCenso ,
Thomas Hadjistavropoulos ,
Lisa Dolovich  and
Alexandra Papaioannou
...Show all authors
Sharon Kaasalainen*
Affiliation:
School of Nursing, McMaster University Department of Family Medicine, McMaster University
Kevin Brazil
Affiliation:
Department of Family Medicine, McMaster University Department of Clinical Epidemiology and Biostatistics, McMaster University St Joseph’s Health SystemResearch Network
Esther Coker
Affiliation:
School of Nursing, McMaster University Hamilton Health Sciences
Jenny Ploeg
Affiliation:
School of Nursing, McMaster University
Ruth Martin-Misener
Affiliation:
School of Nursing, Dalhousie University
Faith Donald
Affiliation:
Daphne Cockwell School of Nursing, Ryerson University
Alba DiCenso
Affiliation:
School of Nursing, McMaster University Department of Clinical Epidemiology and Biostatistics, McMaster University
Thomas Hadjistavropoulos
Affiliation:
Psychology Department, University of Regina
Lisa Dolovich
Affiliation:
Department of Family Medicine, McMaster University Department of Clinical Epidemiology and Biostatistics, McMaster University Centre for Evaluation of Medicine, St Joseph’s Healthcare Department of Medicine, McMaster University
Alexandra Papaioannou
Affiliation:
Department of Medicine, McMaster University
Anna Emili
Affiliation:
Department of Family Medicine, McMaster University
Tim Burns
Affiliation:
Ontario Ministry of Health and Long-Term Care
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Sharon Kaasalainen, R.N., Ph.D. Faculty of Health Sciences, 3N25F, McMaster University 1200 Main Street West, Hamilton, ON, L8N 3Z5 (kaasal@mcmaster.ca)
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Abstract

Purpose: The study purposes were twofold: (1) to explore barriers to pain management and those associated with implementing a pain management program in long-term care (LTC); and (2) to develop an interprofessional approach to improve pain management in LTC.

Methods: A case study approach included both qualitative and quantitative components. We collected data at two LTC sites using seven focus groups for the licensed nurses, unregulated care providers and physicians, and 10 interviews with other health care provider groups, administration, and residents. We reviewed documents and administered a short survey to study participants to assess perceptions of barriers to pain management.

Results: The findings revealed barriers to effective LTC pain management at the resident/family, health care provider, and system levels. We then developed a six-tiered model with proposed interventions to address these barriers.

Conclusions: This model can guide the development of innovative approaches to improving pain management in LTC settings.

Résumé

Objectif : Les objectifs de cette étude étaient double : (1) d’explorer les obstacles à la gestion de la douleur et ceux associés à la mise en œuvre d’un programme de gestion de la douleur en soins de longue durée (SLD) et (2) de développer une approche interprofessionelle afin d’améliorer la gestion de la douleur en soins de longue durée.

Méthodes : Une étude de cas a inclus tous les deux éléments, quantitatifs et qualitatifs. Nous avons recueilli des données sur deux sites LTC à l’aide de sept groupes de discussion pour les infirmières autorisées, fournisseurs de soins non réglementés, et médecins, et 10 entretiens avec des autres groupes de fournisseurs de soins de santé, l’administration et des résidents. Nous avons examiné les documents et administré un sondage à court aux participants à l’étude pour évaluer les perceptions des obstacles à la gestion de la douleur.

Résultats : Les résultats ont révélé des obstacles à la gestion efficace de la douleur au niveau des soins de longue durée des résidents et des familles, des fournisseurs de soins de santé, et des systèmes de santé. Nous avons ensuite élaboré un modèle à six niveaux, avec les interventions proposées pour surmonter ces obstacles.

Conclusions : Ce modèle peut guider le développement d’approches novatrices pour améliorer la gestion de la douleur dans les établissements de soins de longue durée.

Keywords

gestion de la douleursoins de longue duréeinterdisciplinaireévaluation des obstaclespain managementlong-term careinterdisciplinarybarriers assessment
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 29 , Issue 4 , December 2010 , pp. 503 - 517
Copyright
Copyright © Canadian Association on Gerontology 2010

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Footnotes

*

This study was supported by a grant from the Canadian Institutes of Health Research and the Ontario Ministry of Health and Long-Term Care. The authors are grateful for the willingness of the study participants to share their time and expertise with us for this study. This project benefited greatly from the commitment and expertise of research assistants Nancy Carter and Kenzie Greenhalgh. The first author (SK) was supported by a Canadian Health Services Research Foundation (CHSRF) Postdoctoral Fellowship and an Ontario Ministry of Health and Long-Term Care Career Scientist award, at separate times, during this study and the writing of this article. Dr. Alba DiCenso holds a Canadian Health Services Research Foundation (CHSRF)/Canadian Institutes for Health Research (CIHR) Chair in Advanced Practice Nursing. Dr. Thomas Hadjistavropoulos’ work is supported, in part, by the RBC Foundation. Dr. Faith Donald was supported by a CHSRF Postdoctoral Fellowship. Dr. Ploeg holds a mid-career award from the Ontario Ministry of Health and Long-Term Care, and Dr. Papaioannou is a CIHR Ely Lilly Chair in Osteopososis and Geriatrics.

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