TY - JOUR
T1 - Factors Associated With Pain Assessment for Nursing Home Residents
T2 - A Systematic Review and Meta-Synthesis
AU - Knopp-Sihota, Jennifer A.
AU - Dirk, Kennedy L.
AU - Rachor, Geoffrey S.
N1 - Publisher Copyright:
© 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2019/7
Y1 - 2019/7
N2 - Objectives: The burden of pain in nursing home residents is substantial; unfortunately, many times it goes undiagnosed and is inadequately treated. To improve identification of pain in this population, we aimed to review and synthesize findings from qualitative studies that report primary barriers and facilitators to pain assessment in nursing home residents. Design: This is a Cochrane-style systematic review and narrative synthesis of qualitative evidence adhering to PRISMA guidelines. Databases were searched from inception to June 2018, supplemented by hand searching of references. We assessed the quality of included studies using the Critical Appraisal Skills Program Quality Appraisal Checklist. Setting and participants: We included studies conducted in nursing homes. Studies focused on nursing home residents, nursing home staff, or both. Measures: Extracted data were subject to thematic analyses and were collated and summarized into 3 groups: resident, health care provider, and health care system factors. Results: Thirty-one studies met our inclusion criteria. Resident factors had 3 subthemes: physical or cognitive impairments, attitudes and beliefs, and social/cultural/demographic characteristics. Health care provider factors had 3 subthemes: knowledge and skills, attitudes and beliefs, and social/cultural/demographic characteristics. Health care system-level factors had 3 subthemes: interpersonal factors, resources, and policy. Key barriers to pain assessment included the presence of resident cognitive impairment, health care providers' lack of knowledge, and the breakdown of communication across organizational hierarchies. Key facilitators to pain assessment included the identification of pain-related behaviors in residents, the experience and skills of health care providers, and establishing facility-level pain assessment protocols and guidelines. Conclusion and implications: Findings from this review identify primary barriers and facilitators to pain assessment in nursing home residents, highlighting key considerations for stakeholders, including health care providers, and health care policy decision makers. These efforts have the potential to improve the identification of pain in residents, and may ultimately improve pain management and residents' quality of life.
AB - Objectives: The burden of pain in nursing home residents is substantial; unfortunately, many times it goes undiagnosed and is inadequately treated. To improve identification of pain in this population, we aimed to review and synthesize findings from qualitative studies that report primary barriers and facilitators to pain assessment in nursing home residents. Design: This is a Cochrane-style systematic review and narrative synthesis of qualitative evidence adhering to PRISMA guidelines. Databases were searched from inception to June 2018, supplemented by hand searching of references. We assessed the quality of included studies using the Critical Appraisal Skills Program Quality Appraisal Checklist. Setting and participants: We included studies conducted in nursing homes. Studies focused on nursing home residents, nursing home staff, or both. Measures: Extracted data were subject to thematic analyses and were collated and summarized into 3 groups: resident, health care provider, and health care system factors. Results: Thirty-one studies met our inclusion criteria. Resident factors had 3 subthemes: physical or cognitive impairments, attitudes and beliefs, and social/cultural/demographic characteristics. Health care provider factors had 3 subthemes: knowledge and skills, attitudes and beliefs, and social/cultural/demographic characteristics. Health care system-level factors had 3 subthemes: interpersonal factors, resources, and policy. Key barriers to pain assessment included the presence of resident cognitive impairment, health care providers' lack of knowledge, and the breakdown of communication across organizational hierarchies. Key facilitators to pain assessment included the identification of pain-related behaviors in residents, the experience and skills of health care providers, and establishing facility-level pain assessment protocols and guidelines. Conclusion and implications: Findings from this review identify primary barriers and facilitators to pain assessment in nursing home residents, highlighting key considerations for stakeholders, including health care providers, and health care policy decision makers. These efforts have the potential to improve the identification of pain in residents, and may ultimately improve pain management and residents' quality of life.
KW - Nursing home residents
KW - barriers and facilitators
KW - nursing homes
KW - pain assessment
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85063194844&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2019.01.156
DO - 10.1016/j.jamda.2019.01.156
M3 - Review article
C2 - 30910552
AN - SCOPUS:85063194844
SN - 1525-8610
VL - 20
SP - 884-892.e3
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 7
ER -