Elsevier

Geriatric Nursing

Volume 35, Issue 6, November–December 2014, Pages 423-427
Geriatric Nursing

Feature Article
Geriatric pain competencies and knowledge assessment for nurses in long term care settings

https://doi.org/10.1016/j.gerinurse.2014.06.001Get rights and content

Abstract

Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with a grant from the MayDay Fund to provide a single site for evidenced-based, easy-to-use, downloadable resources on pain management. This paper describes the development of the most recent addition to the website, a set of evidence-based core geriatric pain management competencies and a geriatric pain knowledge assessment, and discusses their potential uses in improving pain care for older adults. Geriatric Pain Competencies and Knowledge Assessment for Nurses in Long Term Care Settings.

Introduction

Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Effective pain management in these settings has been a regulatory and policy priority of The Joint Commission as well as the Centers for Medicare and Medicaid for a number of years.1, 2 Several resources on pain management in older adults are now available to practicing nurses (e.g., National Guideline Clearinghouse, American Geriatric Society, Nurses Improving Care for Healthsystem Elders (NICHE), Portal of Geriatrics Online education (POGOe), End of Life Nursing Education Consortium-Geriatric (ELNEC-Geriatric), John A. Hartford Institute of Geriatric Nursing's How to Try This series, and the Institute of Medicine's report, Relieving Pain in America).3, 4, 5, 6, 7, 8, 9 Despite the priority of pain management and increased number of resources available to clinicians, nurses' insufficient knowledge about geriatric pain is a documented barrier to effective geriatric pain management in most long term care (LTC) settings.10, 11 Geriatric pain is defined as physical pain experienced by adults aged over 65. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative (Collaborative) with a grant from the MayDay Fund to provide a single site for evidenced-based, easy-to-use, downloadable resources on geriatric pain management. The resources on the site are primarily for nurses, both registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPNs/LVNs), and administrators in nursing homes and other LTC facilities with a goal to improve pain outcomes for residents, change organizational standards for pain processes and outcomes, and help users to improve practices by providing direct access to quality improvement tools. That being said, many of the resources apply to older adults in a variety of settings and nurses in acute care, home care, and hospice are accessing the website as well. This paper describes the development of the most recent addition to the website, a set of evidence-based core geriatric pain management competencies and a geriatric pain knowledge assessment (hereafter referred to as test), and discusses their potential uses in improving pain care for older adults.

Specific core competencies for geriatric pain management to guide clinical practice have not been published. Because a common understanding of essential pain management competencies for quality practice, in general, was also lacking, a recent landmark interprofessional consensus project established core pain management competencies that apply to all health disciplines.12 Although the authors of the consensus competencies include considerations for special populations as a caveat, identification of specific core geriatric pain competencies for LTC settings is important because the prevalence of pain is high and characteristics of many older adults (e.g., frailty, physiological changes, cognitive impairment) require modification of both assessment parameters and treatment choices used with younger adults. Thus, this work began with core competencies specific to older adults in LTC settings which served as the basis for knowledge/skill evaluation.

Section snippets

Development of geriatric pain competencies

Core competencies were developed by Collaborative members. The Collaborative was originally comprised of experts and researchers in geriatric pain, one member from five Hartford Centers of Geriatric Nursing Excellence, at the University of Iowa, Oregon Health & Science University, University of California San Francisco, University of Arkansas for Medical Science, and University of Pennsylvania. With technical support from Sigma Theta Tau International, the Collaborative maintains //GeriatricPain.org

Geriatric pain knowledge assessment development

After establishing the 19 Geriatric Pain Competencies, the workgroup then focused on the development of a tool to evaluate nurses' knowledge and skills related to pain care for older adults. A user-friendly, online multiple choice test format was chosen. Priorities included: 1) each competency should be addressed by at least one test item; 2) a clinically relevant, case-based approach should be used; 3) the most current evidence should guide test answers; and 4) the test should be appropriate

Pilot testing and psychometric evaluation

Pilot testing of the Geriatric Pain Knowledge Assessment was conducted with nurses working in nursing homes from three states: Iowa, Massachusetts, and Oregon. The test was distributed to 55 RNs and LPN/LVNs; 33 nurses returned the completed test for a 60% response rate. Demographic characteristics of the sample can be found in Table 2. Thirty RNs and three LPN/LVNs completed the test.

Psychometric testing was conducted by the University of Iowa Test Center. Psychometric evaluation of the pilot

How the online test works

The Geriatric Pain Knowledge Assessment is free and can be accessed via a link on the GeriatricPain.org homepage. The test is made readily available for online use or can be accessed as a downloadable file for educators wishing to use the test in a pen/paper format. A brief form requesting access to the test to is required from both individuals wishing to take the test online and educators seeking the hard copy format. For online use, test-takers are provided a login and then access the test

Applications

It is our intent that these Geriatric Pain Competencies and the associated Geriatric Pain Knowledge Assessment contribute to effective educational initiatives to enhance knowledge and skills of nurses caring for older adults with pain. The 19 Geriatric Pain Competencies are ideal for use in educational curricula that promote improvements in geriatric pain practice. To this end, the next phase for the Collaborative is the development of educational modules to further the learning opportunities

Conclusion

Improving basic knowledge of pain management principles by all providers has been a national and international priority.20 For the older adult population, core competencies for geriatric pain care are critical to effectively address this priority by providing a foundation by which knowledge and skills can be taught as well as evaluated. The Geriatric Pain Competencies and associated Geriatric Pain Knowledge Assessment offer new options for those working to enhance excellence in geriatric pain

Acknowledgments

The members of the Collaborative wish to extend special thanks to the following geriatric pain experts for their assistance with the external expert review of the Pain Competencies and the associated Geriatric Pain Assessment: Patricia Berry, PhD, APRN, ACHPN, FAAN, College of Nursing, University of Utah; Carol Long, PhD, RN, FPCN; Chris Kovach, PhD, RN, College of Nursing, University of Wisconsin–Milwaukee; Ann Horgas, PhD, RN, FAAN, University of Florida, Gainesville; and Barbara Resnick,

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