IMPROVING PAIN MANAGEMENT IN NURSING HOMES

改善疗养院的疼痛管理

• 批准号: 6528255
• 负责人: KATHERINE R JONES
• 金额: $ 46.89万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-27 至 2004-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6528255
• 关键词: Hispanic Americans; analgesia; behavioral /social science research tag; clinical research; cooperative study; culture; education evaluation /planning; educational resource design /development; health care personnel education; health care service evaluation; health care service planning; health service demonstration project; health services research tag; human subject; nursing homes; pain; patient care management

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.

医疗保健机构中的疼痛管理不足已得到充分记录。这是疗养院中的一个特殊问题，疗养院的疼痛患病率很高，但在有效诊断和治疗方面面临重大障碍。障碍包括工作人员知识匮乏、居民、家庭成员和工作人员对疼痛和止痛药物的社会文化信仰，以及人员配置水平、流动率和药物处方政策等系统问题。认知障碍或来自种族/族裔群体的居民镇痛不足的风险较高。本研究建议制定并实施文化上有效的干预措施，以提高疗养院疼痛管理的质量。教材的开发基于能力教育和崇拜学习的原则。实施策略基于创新扩散理论。具体目标是 l) 制定和实施多模式、具有文化能力、循证的教育和行为干预措施，以改善疗养院的疼痛评估和疼痛管理； 2) 改进疗养院使用的疼痛评估程序和疼痛管理策略； 3) 提高住院医师、家属和工作人员对疼痛评估和疼痛管理的知识和态度； 4）评估组织变量对实现期望的临床和教育结果的影响； 5) 评估向疗养院传播疼痛评估和疼痛管理知识的多模式干预的成本效益。具体干预内容包括用于员工培训的录像带和手册；疼痛资源粘合剂；医师和药剂师研讨会；图表审查并向临床医生反馈；建立内部疼痛小组；实地考察和互动电视会议。衡量干预影响的具体方法包括焦点小组、调查、居民访谈和观察、图表审查、组织观察以及使用最小数据集的二次数据分析。该项目的独特之处在于它关注疼痛评估和治疗的文化差异，通过纳入讲西班牙语的工作人员和居民、开发西班牙语版本的干预措施、使用跨学科的内部疼痛团队来维持变革以及纳入现有的 AHEC 基础设施用于跨环境的沟通和协调，促进教育计划的未来扩展。