This assignment is the first step in preparing the background section of the innovation project proposal. Develop a search strategy that will find key articles summarizing ?what

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Matrix Table Facilitator/Barriers – Qualitative – Excellent

Source Citation Purpose/Problem Design/Sample Instruments/Measures [Include Reliability/Validity]

Results [Include actual data]

Strengths/Weaknesses

Kaasalainen, S., Coker, E., Dolovich, L., Papaioannou, A., Hadjistavropoulos, T., Emili, A. & Ploeg, J. (2007). Pain management decision making among long-term care physicians and nurses. Western Journal of Nursing Research, 29(5), 561-580. DOI 10.1177/0193945906295522

To explore attitudes and beliefs that affect decisions about prescribing and administering pain medications to older adults who reside in long-term care, with an emphasis on cognitive impairment

Grounded Theory Methodology 9 out of 45 (20%) Physicians agreed to a 1 hour face-to- face semistructured interview RNs and RPNs (LPNs) from four long-term institutions were recruited were placed into focused groups with four RN and Four RPN focus groups conducted with 24 and 33 participants, respectively (Median number per focus group was

Physician Group Face-to-face semistructured interviews RN and RPN Groups Focused groups N-Viso was used to manage the data. Used open coding = concepts and categories were identified and their properties and dimensions were discovered in the data. Used descriptive analysis tech. to examine the focus group data.

General participants felt pain management in LTC is problematic. Close link between treatment of pain to assessment of pain. Major Themes: Lack of Awareness of Residents’ Pain

– Pain assessment complicated by negative myths about pain and aging.

– Residents’ with dementia at greater risk of not having pain assessed.

– Some assure the absent of pain report equals absent of pain.

Uncertainty About

Strengths

– Good number of participants

– Identifies facilitator and barriers

Weaknesses – No discussion of

the make-up of the group, however the names used in the text show that men and women with multiple pain causing illnesses made up the sample.

– No discussion on how themes were identified and no discussion on the coding methodology.

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Kaasalainen, S., et al (2007) Continued

7 with a min of 5 and max of 10. Theoretical sampling used – data gathered was driven by the concepts derived from the evolving theory. RN Group 53% older than 46 yrs, 96% female, and 27% worked in LTC for more than 10 yrs. RPN Group 74% older than 46 yrs, 97% female and 64% worked in LTC for more than 10 yrs. Physician Group Mean age was 52 yrs, 67% male and

the Accuracy of Pain Assessment andà Diagnosis

– Question accuracy of pain diagnosis

– Impact of dementia on pain assessment accuracy concern of both groups

– Unsure of the cause of resident behaviors during assessment, is behavior pain related or some other underlying cause, usually treating cause as something other than pain.

Reluctance of Heath Care Providers to Use Opioids

– Only

(Cont. with Themes) Working to Individualize Pain Treatment

– Need to work toward an individualized approach to pain treatment.

– Not all residents need or want to achieve a pain- free state.

– Physician often trial and error and use a “start low and go slow” approach.

– Both groups concerned with anagement of side effects of pain management in older adults such as increase risk of falls, lethargy and liver toxicity.

– Both group concerned about poly-pharmacy and associated risk with LTC residents.

Influence of Physician

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all had an independent family practice with hospital privileges.

prescribed after all other nonopioid treatments had been tried and failed.

– Increased reluctance to use with dementia patients.

– Both agrees were more likely to use opioids if resident was deeded palliative.

Barriers and Facilitators Barriers

– Lack of time/high workload

– Lack of compensation for physicians time spent in LTC

– Language barriers for residents

– Physician availability to

Trust of the Nurse on Prescribing Patterns

– Since physician have limited patient contact they must rely on the nurse to assess and manage pain.

– Communication and trust between physician and nurse are critical.

– Physicians were concerned with the skills of nurse largely by the kinds of reports they received on residents.

– If the physician has little trust or respect for the nurse’s clinical skills and decision-making ability, the physician was more reluctant to prescribe pain medications other than acetaminophen.

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TLC nurses – Conflict

among providers

– Lack of continuity of care across shifts/settings

– Lack of research in the area of pain management in LTC

– Poor knowledge transfer to providers who work in LTC

Facilitators à – Knowledge

for all providers around pain management

– Good com- munication with patients, family and other providers

– Inter- disciplianary collaboration

– Documentation of pain assessment and treatments.

– Resources included clinics, coworkers, medical specialists, conferences

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