Poster Title (Current Submission)

Multi-level Translation of Research Application in Nursing Homes (M-TRAIN): A case study example of pain and urinary incontinence interventions for residents with dementia in nursing homes

Major(s)

Nursing

Presentation Date

3-25-2010

Abstract

Purpose and Rationale: Forty-five to 83% percent of elders in long-term care facilities experience pain, and 50% experience urinary incontinence (UI). When looking at residents with cognitive impairment (CI), 60% of residents had at least one diagnosis known to cause pain, however, they hadn’t been prescribed any pain medication in the past month; 80% of CI residents experience UI. These alarmingly high numbers warrant the need for implementation of evidence-based practices (EBP) within nursing homes. The M-TRAIN study has proposed specific pain and UI EBPs to implement in nursing homes. The purpose of using case studies to facilitate incorporation of EBP is to demonstrate strategies to help nursing home staff implement EBPs in regard to pain and UI for persons with dementia. Sharing evidence alone does not change practice; the ultimate test to determine if EBPs were implemented effectively is to change resident outcomes.

Synthesis of the evidence: Many misconceptions exist among healthcare staff and the lay public in regard to both pain and UI in the elderly population. These misconceptions have led to the under-treatment of both among many nursing home residents. A situation involving a CI resident exacerbates under-treatment, and often these residents are not properly assessed. Current EBP suggests that within 24 hours of implementing a pain treatment plan, pain and side effects of treatment will be reassessed and managed to meet comfort goals. Similar to pain, UI has been under-assessed and under-treated especially among CI residents. M-TRAIN introduces EBP recommendations for UI such as: accurately assessing the type of incontinence, establishing a baseline pattern of voiding by use of bladder diaries, and implementing a voiding plan. Research has demonstrated that both pain and UI can be managed successfully in CI individuals.

Proposed change in practice: To demonstrate improved outcomes regarding one resident with pain and one resident with UI by illustrating EBP through the use of case studies. One case study for pain and one for UI will be presented.

Implementation strategies: Sharing evidence does not ensure that new information will be accurately implemented into practice. For this reason, presenting pain and UI case studies to nursing home staff will help implement appropriate assessment and interventions regarding pain and UI for residents with dementia and will serve as a strategy to augment translating evidence into practice.

Evaluation: Case studies will be shared with nursing home staff, identifying areas frequently omitted from the planning, i.e. thorough assessment and reassessment, the need to track changes over time, and modifying the plan based on those changes. Assistance is provided to nursing home staff to review and modify care plans in order to positively affect resident outcomes.

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Mar 25th, 12:00 AM

Multi-level Translation of Research Application in Nursing Homes (M-TRAIN): A case study example of pain and urinary incontinence interventions for residents with dementia in nursing homes

Purpose and Rationale: Forty-five to 83% percent of elders in long-term care facilities experience pain, and 50% experience urinary incontinence (UI). When looking at residents with cognitive impairment (CI), 60% of residents had at least one diagnosis known to cause pain, however, they hadn’t been prescribed any pain medication in the past month; 80% of CI residents experience UI. These alarmingly high numbers warrant the need for implementation of evidence-based practices (EBP) within nursing homes. The M-TRAIN study has proposed specific pain and UI EBPs to implement in nursing homes. The purpose of using case studies to facilitate incorporation of EBP is to demonstrate strategies to help nursing home staff implement EBPs in regard to pain and UI for persons with dementia. Sharing evidence alone does not change practice; the ultimate test to determine if EBPs were implemented effectively is to change resident outcomes.

Synthesis of the evidence: Many misconceptions exist among healthcare staff and the lay public in regard to both pain and UI in the elderly population. These misconceptions have led to the under-treatment of both among many nursing home residents. A situation involving a CI resident exacerbates under-treatment, and often these residents are not properly assessed. Current EBP suggests that within 24 hours of implementing a pain treatment plan, pain and side effects of treatment will be reassessed and managed to meet comfort goals. Similar to pain, UI has been under-assessed and under-treated especially among CI residents. M-TRAIN introduces EBP recommendations for UI such as: accurately assessing the type of incontinence, establishing a baseline pattern of voiding by use of bladder diaries, and implementing a voiding plan. Research has demonstrated that both pain and UI can be managed successfully in CI individuals.

Proposed change in practice: To demonstrate improved outcomes regarding one resident with pain and one resident with UI by illustrating EBP through the use of case studies. One case study for pain and one for UI will be presented.

Implementation strategies: Sharing evidence does not ensure that new information will be accurately implemented into practice. For this reason, presenting pain and UI case studies to nursing home staff will help implement appropriate assessment and interventions regarding pain and UI for residents with dementia and will serve as a strategy to augment translating evidence into practice.

Evaluation: Case studies will be shared with nursing home staff, identifying areas frequently omitted from the planning, i.e. thorough assessment and reassessment, the need to track changes over time, and modifying the plan based on those changes. Assistance is provided to nursing home staff to review and modify care plans in order to positively affect resident outcomes.