Barriers to Managing Pain in the Nursing Home: Findings From a Statewide Survey

Objectives

The objective of this study was to identify pain management demographics, perceived resources, and perceived barriers to adequately manage pain in the nursing home setting.

Design

Mailed survey.

Setting

All licensed Connecticut nursing homes.

Participants

Directors of Nursing (DONs).

Measurements

Survey eliciting pain management demographics, perceived resources, and perceived barriers to adequately manage pain in respondents’ nursing home.

Results

A total of 113 of 260 DONs (43%) responded to the survey. Respondents believed pain was suboptimally managed, particularly for residents with malignant and nonmalignant chronic pain. Perceived barriers to providing adequate pain management included lack of knowledge about pain management among nurses and physicians, lack of a standardized approach to treating pain, physicians’ personal attitudes toward treating pain (eg, fear of addiction or overdose), lack of diagnostic precision in treating pain, and difficulty in choosing the right analgesic. Other barriers are also discussed, including low hospice enrollment of nursing home residents.

Conclusion

Improving pain management in nursing homes requires improving provider knowledge and attitudes, enhancing diagnostic precision, standardizing pain treatment, and achieving an institutional commitment. Although responding DONs seemed aware of the need for improved pain management outcomes at their facilities, the required institutional commitment to accomplish this was not evidenced by these findings.

Keywords:  Pain management , elderly , hospice , long-term care