Savvas Steven, Toye Christine, Beattie Elizabeth, Gibson Stephen J
National Ageing Research Institute, Victoria, Australia.
School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Formerly (now adjunct) School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Western Australia, Australia.
Pain Manag Nurs. 2014 Dec;15(4):819-25. doi: 10.1016/j.pmn.2013.09.002. Epub 2014 Mar 25.
Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice.
疼痛在老年护理机构（RACFs）中很常见。2005年，澳大利亚疼痛协会针对这些机构中疼痛的识别、评估和管理制定了27条良好实践建议。本研究旨在探讨这些标准的实施情况并评估结果。澳大利亚的五家机构参与了对老年护理机构疼痛实践和结果的全面评估。在引入一项基于证据的疼痛管理计划之前，将现有的疼痛管理实践与这27条建议进行了比较，该计划包括对员工的培训和教育以及修订内部疼痛管理程序。实施后的审计评估了该计划的成效。还对老年护理工作人员团队在疼痛管理方面的自我效能报告进行了评估。结果显示，在实施该计划之前，老年护理机构在6至12条标准上完全符合要求。到项目结束时，老年护理机构在10至23条标准上完全符合要求，并且在其余标准的合规性方面有了重大改进。实施后，工作人员还报告说对标准（p < .001）或机构疼痛管理指南（p < .001）的理解更好了，对疼痛管理疗法的信心增强了（p < .001），对评估疼痛的培训（p < .001）以及识别无语言能力的痴呆症居民疼痛的信心增强了（p = .003）。结果表明，通过适当的培训和教育，可以在老年护理机构中实现更好的循证实践。通过该实施计划对老年护理劳动力投入资源已显示出工作人员自我效能和实践方面的改善。
