gms | German Medical Science

Background and Purpose: There is a significant gap between current evidence in pain management (PM) and daily practice in nursing homes. Translation of knowledge into practice is prone to barriers on multiple levels. This study illustrates an exemplary approach of a contextual assessment to facilitate subsequent implementation of evidence-based guidelines.

Framework: This study is guided by the Consolidated Framework of Implementation Research (CFIR).

Methods: A comprehensive mixed-methods assessment focusing on the CFIR domains: inner/outer setting and individuals involved was conducted in the participating NHs. Nursing staff and NH administrators completed questionnaire surveys assessing potential barriers to PM and contextual factors (e.g. infrastructure, work environment) of the NHs. Further, to generate a broader understanding of barriers and facilitators towards PM, interviews with residents, physicians and focus groups with the nursing staff were conducted.

Results: Besides barriers and facilitators specific to pain (e.g. knowledge and attitudes of nurses and residents), a range of contextual factors (e.g. high staff turnover, insufficient communication between nurses and physicians) were found to impede an efficient PM. To establish a sustainable change in PM the developed approach comprises implementation of standardized assessment instruments and PM guidelines on the organizational level, in-depth training of nurse Pain Champions in each NH including support in nurse-physician communication and training courses in PM on the nursing staff level.

Conclusions: Involving perspectives of all stakeholders in a contextual assessment prior to implementation of practice guidelines can enhance the understanding of the context considerably. Consequently, implementation strategies can be tailored to the specific requirements.