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Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial

Authors Kutschar P, Berger S, Brandauer A, Freywald N, Osterbrink J, Seidenspinner D, Gnass I

Received 2 November 2019

Accepted for publication 7 March 2020

Published 26 March 2020 Volume 2020:13 Pages 633—648


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr E Alfonso Romero-Sandoval

P Kutschar,1 S Berger,1 A Brandauer,1 N Freywald,1 J Osterbrink,1,2 D Seidenspinner,3 I Gnass1

1Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; 2Brooks College of Health, University of North Florida, Jacksonville, FL, USA; 3Nursing Science and Practice Development, University Hospital of Munich-Großhadern (LMU), Munich, Germany

Correspondence: P Kutschar
Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, Salzburg 5020, Austria
Tel +43 662 80 344

Purpose: Pain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016– 2018).
Participants: Clusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included.
Intervention: In addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses.
Methods: Based on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10– 30) using self-report instruments or observed (MMSE 0– 9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatment-relevant pain above cut-off (≥ 2) on the Pain Assessment in Advanced Dementia (PAINAD).
Results: Out of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10– 30) and logistic regression (n=222 residents, MMSE 0– 9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p< 0.01), decreased with a better quality of life (B=− 0.07, p< 0.001), and was lower when dementia diagnoses were present (B=− 1.12, p< 0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p< 0.05).
Conclusion: While no significant positive intervention effect was measured, findings suggest nurses’ raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.

Keywords: nursing home residents, pain management, nurse-related intervention, nursing education, cognitive impairment, dementia

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