Abstract
Translation of pain management evidence into practice is slow, and therefore pain in older adults continues to be under-recognized and under-treated. Several barriers to pain management in older adults have been identified, and they may be addressed through implementation science—the study of methods to promote integration of research findings into policy and practice. Successful knowledge translation relies on the use of a conceptual framework to guide the development, implementation, and sustainability of evidence-based pain management strategies. The Knowledge to Action and Promoting Action on Research Implementation in Health Services frameworks lend themselves to this purpose.
Knowledge translation involves behaviour change, especially around nurses’ decision-making. Some of the knowledge translation interventions applied to pain management are educational meetings, audit and feedback, reminders, opinion leaders and change champions, educational outreach, and appreciative inquiry. Tailoring interventions to address barriers can serve to support implementation of pain guideline recommendations. Determinants of guideline uptake are outlined in this chapter along with factors impacting the sustainability of use of guidelines. Leadership involvement; credible evidence; staff buy-in and education; experiencing small, successive “wins”; and monitoring and feedback contribute to successful implementation of pain management clinical practice guidelines.
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American Geriatrics Society Panel on Persistent Pain in Older Persons. Management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(6 Suppl):S205–24.
American Medical Directors Association. Pain management in the long term care setting. American Medical Directors Association (AMDA); 2012.
Australian Pain Society. Pain in residential aged care facilities-management strategies. 2005. https://www.apsoc.org.au/publications.
Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD005470.pub3.
Brown D, McCormack B. Developing postoperative pain management: utilising the promoting action on research implementation in health services (PARIHS) framework. Worldviews Evid-Based Nurs. 2005;2(3):131–41. https://doi.org/10.1111/j.1741-6787.2005.00024.x.
Canadian Foundation for Healthcare Improvement. Glossary of knowledge exchange terms. 2017. http://www.cfhi-fcass.ca/PublicationsAndResources/ResourcesAndTools/GlossaryKnowledgeExchange.aspx.
Canadian Institutes of Health Research. Knowledge translation. 2016. http://www.cihr-irsc.gc.ca/e/29418.html.
Carlson C. Prior conditions influencing nurses’ decisions to adopt evidence-based postoperative pain assessment practices. Pain Manag Nurs. 2010;11(4):245–58. https://doi.org/10.1016/j.pmn.2009.05.003.
Colquhoun HL, Squires JE, Kolehmainen N, Fraser C, Grimshaw JM. Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review. Implement Sci. 2017;12(1):30. https://doi.org/10.1186/s13012-017-0560-5.
Douglas C, Haydon D, Wollin J. Supporting staff to identify residents in pain: a controlled pretest-posttest study in residential aged care. Pain Manag Nurs. 2016;17(1):25–37. https://doi.org/10.1016/j.pmn.2015.08.001.
Drake G, Williams AC. Nursing education interventions for managing acute pain in hospital settings: A systematic review of clinical outcomes and teaching methods. Pain Manag Nurs. 2017;18(1):3–15. https://doi.org/10.1016/j.pmn.2016.11.001.
EPOC Taxonomy. Effective practice and organisation of care (EPOC). 2015. https://epoc.cochrane.org/epoc-taxonomy.
Ersek M, Neradilek MB, Herr K, Jablonski A, Polissar N, Du Pen A. Pain management algorithms for implementing best practices in nursing homes: results of a randomized controlled trial. J Am Med Dir Assoc. 2016;17(4):348–56. https://doi.org/10.1016/j.jamda.2016.01.001.
Estabrooks CA, Rutakumwa W, O’Leary KA, Profetto-McGrath J, Milner M, Levers MJ, et al. Sources of practice knowledge among nurses. Qual Health Res. 2005;15(4):460–76.
Etheridge F, Couturier Y, Denis J, Tremblay L, Tannenbaum C. Explaining the success or failure of quality improvement initiatives in long-term care organizations from a dynamic perspective. J Appl Gerontol. 2014;33(6):672–89. https://doi.org/10.1177/0733464813492582.
Feldman K, Berall A, Karuza J, Senderovich H, Perri G, Grossman D. Knowledge translation: an interprofessional approach to integrating a pain consult team within an acute care unit. J Interprof Care. 2016;30(6):816–8. https://doi.org/10.1080/13561820.2016.1195342.
Fleiszer A, Semenic S, Ritchie J, Richer M, Denis J. Nursing unit leaders’ influence on the long-term sustainability of evidence-based practice improvements. J Nurs Manag. 2016;24(3):309–18. https://doi.org/10.1111/jonm.12320.
Foster R. Our incredible failure to incorporate evidence about pediatric pain management into clinical practice. J Spec Pediatr Nurs. 2013;18(3):171–2. https://doi.org/10.1111/jspn.12039.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof. 2006;26(1):13–24. https://doi.org/10.1002/chp.47.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629. https://doi.org/10.1111/j.0887-378X.2004.00325.x.
Grimshaw J, Eccles M, Lavis J, Hill S, Squires J. Knowledge translation of research findings. Implement Sci. 2012;7:50. https://doi.org/10.1186/1748-5908-7-50.
Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12(4):230–50. https://doi.org/10.1016/j.pmn.2011.10.002.
Higuchi KS, Davies B, Ploeg J. Sustaining guideline implementation: a multisite perspective on activities, challenges and supports. J Clin Nurs. 2017;26:4413–24. https://doi.org/10.1111/jocn.13770.
Horgas AL, Yoon SL, Grall M. Pain management. In: Boltz M, Capezuti E, Fulmer T, Zwicker D, editors. Evidence-based geriatric nursing protocols for best practice. 4th ed. New York: Springer; 2012. p. 246–67.
Jeffs L, Indar A, Harvey B, McShane J, Bookey-Bassett S, Flintoft V, et al. Enabling role of manager in engaging clinicians and staff in quality improvement: being present and flexible. J Nurs Care Qual. 2016;31(4):367–72. https://doi.org/10.1097/NCQ.0000000000000196.
Kaasalainen S, Brazil K, Coker E, Ploeg J, Martin-Misener R, Donald F, et al. An action-based approach to improving pain management in long-term care. Can J Aging. 2010;29(4):503–17. https://doi.org/10.1017/S0714980810000528.
Kaasalainen S, Brazil K, Akhtar-Danesh N, Coker E, Ploeg J, Donald F, et al. The evaluation of an interdisciplinary pain protocol in long term care. J Am Med Dir Assoc. 2012;13(7):664.e1–8. https://doi.org/10.1016/j.jamda.2012.05.013.
Kaasalainen S, Ploeg J, Donald F, Coker E, Brazil K, Martin-Misener R, et al. Positioning clinical nurse specialists and nurse practitioners as change champions to implement a pain protocol in long-term care. Pain Manag Nurs. 2015;16(2):78–88. https://doi.org/10.1016/j.pmn.2014.04.002.
Kavanagh T, Stevens B, Seers K, Sidani S, Watt-Watson J. Examining appreciative inquiry as a knowledge translation intervention in pain management. Can J Nurs Res. 2008;40(2):40–56.
Maher L, Gustafson D, Evans A. Sustainability model and guide. NHS Institute for Innovation and Improvement; 2007.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33. https://doi.org/10.1136/qshc.2004.011155.
Milat A, Li B. Narrative review of frameworks for translating research evidence into policy and practice. Public Health Res Pract. 2017;27:2711704. https://doi.org/10.17061/phrp2711704.
National Information Center on Health Services Research and Health Care Technology (NICHSR). Dissemination and implementation science. 2017. https://www.nlm.nih.gov/hsrinfo/implementation_science.html.
Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):53. https://doi.org/10.1186/s13012-015-0242-0.
Ortiz MM, Carr E, Dikareva A. An integrative review of the literature on pain management barriers: implications for the Canadian clinical context. Can J Nurs Res. 2014;46(3):65–93.
Ploeg J, Davies B, Edwards N, Gifford W, Miller PE. Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. Worldviews Evid-Based Nurs. 2007;4(4):210–9. https://doi.org/10.1111/j.1741-6787.2007.00106.x.
Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; 2003.
Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, et al. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci. 2013;8(1):28. https://doi.org/10.1186/1748-5908-8-28.
Saunders H. Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice. J Clin Nurs. 2015;24(13-14):2035–51. https://doi.org/10.1111/jocn.12812.
Savvas S, Toye C, Beattie E, Gibson S. Implementation of sustainable evidence-based practice for the assessment and management of pain in residential care facilities. Pain Manag Nurs. 2015;15:819–25. https://doi.org/10.1016/j.pmn.2013.09.002.
Schofield P, Sofaer-Bennett B, Hadjistavropoulos T, Zwakhalen S, Brown C, Westerling D, et al. A collaborative expert literature review of pain education, assessment and management. Aging Health. 2012;8(1):43–54.
Scott-Findlay S, Estabrooks C. Knowledge translation and pain management. In: Finley G, McGrath PJ, Chambers C, editors. Bringing pain relief to children: treatment approaches. Totowa: Humana; 2006. p. 199–227.
Song W, Eaton LH, Gordon DB, Hoyle C, Doorenbos AZ. Evaluation of evidence-based nursing pain management practice. Pain Manag Nurs. 2015;16(4):456–63. https://doi.org/10.1016/j.pmn.2014.09.001.
Stevens B. Challenges in knowledge translation: integrating evidence on pain in children into practice. Can J Nurs Res. 2009;41:109–14.
Swafford KL, Miller LL, Tsai PF, Herr KA, Ersek M. Improving the process of pain care in nursing homes: a literature synthesis. J Am Geriatr Soc. 2009;57(6):1080–7.
Twycross A. Educating nurses about pain management: the way forward. J Clin Nurs. 2002;11(6):705–14.
Yost J, Thompson D, Ganann R, Aloweni F, Newman K, McKibbon A, et al. Knowledge translation strategies for enhancing nurses’ evidence-informed decision making: a scoping review. Worldviews Evid-Based Nurs. 2014;11(3):156–67. https://doi.org/10.1111/wvn.12043.
Zwakhalen SM, Hamers JP, Abu-Saad HH, Berger MP. Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr. 2006;6(1):3. https://doi.org/10.1186/1471-2318-6-3.
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Coker, E., Kaasalainen, S. (2018). Translating Knowledge to Improve Pain Management Practices for Older Adults. In: Pickering, G., Zwakhalen, S., Kaasalainen, S. (eds) Pain Management in Older Adults. Perspectives in Nursing Management and Care for Older Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-71694-7_10
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