Year of Publication

2006

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Dorothy Y. Brockopp

Clinical Mentor

Dr. Keela Herr

Abstract

This paper describes a clinical project using a self-reported pain diary for the assessment of chronic pain in the communicative, cognitively-intact nursing home resident. There are estimates of chronic pain among nursing home residents that range from 4 – 83%. The goal of this clinical project was to evaluate a chronic pain diary in relation to its effectiveness and efficiency in accurately assessing pain among nursing home residents. Assessment has been identified as a major barrier in the control of chronic pain, and the self-report is accepted as the most reliable measure of a person’s pain. The self-reported pain diary’s validity and reliability have been demonstrated in acute and chronic pain assessment in the community, and in acute and chronic care. If improved assessment can also be demonstrated in this selected nursing home population, the assumption is that improved pain control will follow.

Data gathered for the study included baseline data of the participating residents’ records, using the facility’s usual protocol for the assessment of chronic pain for 14 days prior to the implementation of the pain diary. That data was then compared to the data collected for 14 to 28 days after completion of the pain diary. Data related to changes in pain levels, nurses’ documentation, and medication usage are reported. A paired t test was used for the data analysis.

Twenty-one residents participated in the project. In reviewing pain levels, only seven of those twenty-one residents had pain levels recorded prior to the diary, and following the use of the diary. Findings related to those pain levels did indicate an increase in the pain levels following the diary’s use, as the literature had predicted they would, when emphasis is placed on pain assessment. The difference in the number of pain-related nursing documentation entries measured before and after the diary approached significance at a p value of 0.067. The increased number of scheduled pain medications used before the diary and after the diary did show significance with p=0.015. The pain levels, reported before and after the diary, increased, and the use of “as needed” medications also increased. Ultimately, the sample size was too small to provide any statistical significance in three of the four areas studied. The findings, however, do support a multi-site feasibility study using the chronic pain diary.

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