JMIR Publications

ABSTRACT

This manuscript provides the protocol for a National Institute of Aging funded cluster randomized clinical trial implementing the use the Pain Clinical Practice Guideline in long term care settings. Pain is a commonly reported symptom among older adults living with dementia ranging from 30-80% among those in nursing homes (used interchangeably with communities) with over 50% of these individuals experiencing moderate to severe pain. Unfortunately, pain is not well assessed, diagnosed or managed among individuals with dementia. The Pain Clinical Practice Guideline using the Evidence Integration Triangle (Pain-CPG-EIT) was developed to improve staff assessment, diagnosis and management of pain among residents. The PAIN-CPG-EIT was based on the Social Ecological Model and Social Cognitive Theory and includes four components: Component I: Establishing the stakeholder team, completing the first meeting, and establishing plans for the monthly meetings; Component II: Education of the staff; Component III: Mentoring and motivating the staff to address pain using the Pain Management CPG; and Component IV: Ongoing monitoring of pain management in the community based on the Pain Management CPG. The implementation of these components and the use of the CPG among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a Stakeholder team and practical outcome measures. In addition to describing the protocol developed to test the effectiveness and feasibility of PAIN-CPG-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this work is provided.