Meeting the needs of elderly patients
Effective pain management efforts are ot limited to hospital care, stresses Carole Patterson, MN, RN, deputy director of the department of standards for the Joint Commission on Accreditation of Health Care Organizations in Oakbrook Terrace, IL.
All health care providers will be subject to review using function-based standards when new pain management principles are implemented. For long-term care facilities, these new rules signal a significant challenge.
Use atypical methods
"Nursing homes have never assessed patient pain," laments June Dahl, PhD, executive director of the Wisconsin Cancer Pain Initiative in Madison. The nature of both long-term care and these patients’ cognitive ability to assess their own pain call for atypical methods of assessing and managing pain, she says.
Nursing home ethics committees may want to start with educating all staff, and nursing assistants in particular, about recognizing pain in the elderly. One of the most effective ways, Dahl suggests, is to produce a videotape that highlights the behavior of patients and distinguishes mannerisms, movements, and demeanor that may be outward signs of pain. (See detailed report on pain in the elderly, including behavioral indicators of pain, Medical Ethics Advisor, July 1995, p. 85.)
Educate nursing assistants
Because nursing assistants spend more time with nursing home patients than do other staff members, be sure to include them in any management program.
"Nursing assistants must be taught to recognize signs such as altered behavior in patients and report it to the nurse in charge," Dahl urges.
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