By Manuela Hoedl (Institute of Nursing Science, Medical University of Graz)
Why do we need a toolkit for pain management in nursing homes?
The complexity of pain in older people in nursing homes requires comprehensive pain management plans including both pharmacological and non-pharmacological interventions. Many studies investigating pain management in nursing homes have only examined pharmacological interventions. Although pharmacological therapy is important, these interventions often have limited therapeutic effects, compromise the Activities of Daily Living, and may even result in adverse side effects in older adults. Therefore, non-pharmacological approaches, are the preferred first-line treatment for mild pain as a complementary therapy for more severe pain. Moreover, such approaches enable nurses to actively participate in residents’ pain management through their direct implementation.
There are countless guidelines available for different indications, e.g., back pain, arthritis or chronic pain. These different guidelines include chapters about non-pharmacological interventions for each indication. Many promising non-pharmacological interventions could be practiced in nursing homes, e.g., exercise and movement, relaxation techniques, music, and empathic support, but these are even more rarely used. However, there was no collection of non-pharmacological interventions independent of the indication for pain management in nursing homes.
Such a collection can help nurses and nursing aids, in quickly finding and selecting the right evidence-based non-pharmacological intervention for each resident. However, to ensure the effective implementation of non-pharmacological interventions, such a collection has to include the various interventions, indications, as well as practical applications of these interventions. Therefore, we collaboratively developed a practical and user-friendly toolkit with a selection of evidence-based, non-pharmacological pain management interventions specifically designed for use in nursing homes.
What is the Toolkit?
The toolkit is a collection of non-pharmacological interventions for pain management. It is freely available:
Werkzeugkoffer_Opinion_Lab_OPINION_LAB_en_V01
https://pflegewissenschaft.medunigraz.at/frontend/user_upload/OEs/institute/pflegewissenschaft/pdf/Werkzeugkoffer_Opinion_Lab_OPINION_LAB_en_V01.pdf
The toolkit is divided into three chapters: (1) introduction including e.g., definitions, basic information’s about pain assessment and evaluation; (2) a list of each indication with all non-pharmacological interventions; and (3) each intervention including the type of interventions, indications, contraindications/adverse effect, tips and tricks and source of knowledge. The non-pharmacological interventions are divided into interventions, that are recommended; interventions with unclear evidence; and non-recommended interventions.
How was the toolkit developed?
This toolkit was developed through a collaboration between the Institute of Nursing Science of the Medical University of Graz, Austria, and Caritas Styria, Austria, as part of the FWF project OPINION Lab (CM 300).
The toolkit was developed following a three-step systematic approach and including nursing staff from the onset: 1) identification of relevant interventions, 2) synthesis of the current evidence using up-to-date evidence summaries or rapid reviews, and 3) discussion of the findings with nursing staff and residents regarding acceptability, feasibility, and resources.
In the first step, we compiled a list of 50 non-pharmacological interventions based on the international literature, those already being implemented in the nursing home or reported by residents, and those suggested by (inter)national experts. Then, the nursing home staff ranked the interventions based on their relevance for pain management in nursing home residents. Based on this ranking, 18 interventions were selected for inclusion in the toolkit, as this number of interventions was considered workable.
In step two, we used up-to-date evidence summaries from trustworthy websites. The evidence summaries include interventions such as physical exercise, relaxation techniques, promoting sleep, as well as heat or cold application. No evidence summaries were found for empathic attention and communication, aromatherapy, distraction, and garden therapy. Insufficient evidence was found for relief of the affected body part/positioning, and in particular for positioning with aides. Therefore, rapid reviews were carried out for these five interventions to find further evidence.
In step three, workshops were hold with the nursing home staff. Each intervention was discussed in terms of the acceptability of the intervention to the residents, its feasibility, required resources, and who would implement or delegate the intervention. Nursing home residents were asked in individual interviews to assess the interventions for their acceptance, feasibility, and required resources. The results of this step are only incorporated within the toolkit version for the nursing home, and not within the publicly accessible version.
How to find out more?
We have recently launched a website: https://pflegewissenschaft.medunigraz.at/en/opinion-lab, where you can find out more about the OPINION Lab as well as the toolkit or how to contact us.
The toolkit was developed as part of the OPINION Lab project. The OPINION Lab project is fully funded by the Austrian Science Fund (FWF) [doi:10.55776/CM3]. For the purpose of open access, the authors have applied a CC BY license to the toolkit. This license enables users to distribute, remix, adapt, and build upon the toolkit in any medium or format, provided appropriate credit is given to the original creator. The license allows for commercial use.