Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.
Inselspital Bern University Hospital, Nursing Research Unit, Bern, Switzerland.
J Am Geriatr Soc. 2019 Dec;67(12):2574-2580. doi: 10.1111/jgs.16148. Epub 2019 Aug 27.
To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions.
An implementation science pilot study using a quasi-experimental effectiveness-implementation (hybrid II) design.
Four NHs in Switzerland.
All consenting long-term residents aged 65 years and older with pain at baseline (N = 62) and all registered and licensed practical nurses (N = 61).
Implementation of a contextually adapted pain management guideline, interactive training workshops for all care workers, and specifically trained pain champions.
Interference from pain, worst and average pain intensity over the previous 24 hours; proxy ratings of pain with the Pain Assessment in Advanced Dementia scale; and care workers' appraisal of the guideline's reach, acceptability, and adoption.
Pain-related outcomes improved for self-reporting residents (n = 43) and residents with proxy rating (n = 19). Significant improvements of average pain from baseline to T1 (P = .006), and in worst pain from baseline to T1 (P = .003) and T2 (P = .004). No significant changes in interference from pain (P = .18). With regard to the implementation efforts, about 76% of care workers indicated they were familiar with the guideline; 70.4% agreed that the guideline is practical and matches their ideas of good pain assessment (75.9%) and treatment (79.7%).
Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary. J Am Geriatr Soc 67:2574-2580, 2019.
评估包含疼痛管理指南、护理人员培训和疼痛拥护者的多层面疼痛管理干预措施在养老院（NH）中的效果和实施情况。
采用准实验效果-实施（混合 II）设计的实施科学试点研究。
瑞士的 4 家 NH。
所有同意参加的年龄在 65 岁及以上且基线时有疼痛的长期居民（N=62）和所有注册和持照的执业护士（N=61）。
实施了一项经上下文调整的疼痛管理指南，对所有护理人员进行了互动培训研讨会，并专门培训了疼痛拥护者。
疼痛相关干扰，前 24 小时内最痛和平均疼痛强度；用高级痴呆症疼痛评估量表进行疼痛的代理评估；以及护理人员对指南的可及性、可接受性和采用程度的评价。
自我报告的居民（n=43）和有代理评估的居民（n=19）的疼痛相关结果得到改善。平均疼痛从基线到 T1（P=0.006），最痛疼痛从基线到 T1（P=0.003）和 T2（P=0.004）均有显著改善。疼痛干扰无显著变化（P=0.18）。关于实施工作，约 76%的护理人员表示熟悉指南；70.4%的人认为该指南实用，符合他们对良好疼痛评估（75.9%）和治疗（79.7%）的想法。
多层面疼痛管理干预的实施显著改善了 NH 居民的平均和最痛疼痛强度。然而，要使疼痛干扰方面产生有临床意义的变化，可能需要采取更全面的方法，涉及其他学科。美国老年学会杂志 67:2574-2580，2019 年。
