This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published i... more This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Arnstein, P., et al. Managing Older Adults' Chronic Pain: Lower-Risk Interventions. Am J Nurs 2023; 123 (2): 46-52.
More individuals develop and endure constant or recurring pain in older adulthood. Although 40% o... more More individuals develop and endure constant or recurring pain in older adulthood. Although 40% of these individuals receive no treatment, many evidence-based treatments are available. Accurate assessment of pain, its impact on functioning, and preventing treatment-related harms lay the foundation of safe, effective pain control. Analgesic agents are often necessary, but require a delicate balance to prevent undertreatment, the unnecessary abandonment of therapy, or exposure to potentially serious adverse effects. Nondrug therapies must be better integrated into the treatment plan to ensure overall safety. Evidencebased approaches help older adults thrive and survive longer despite living with persistent pain.
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published i... more This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published i... more This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional i...
How to Obtain Contact Hours by Reading this Article Instructions 1.3 contact hours will be awarde... more How to Obtain Contact Hours by Reading this Article Instructions 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at https://villanova.gosignmeup.com . To obtain contact hours you must: 1. Read the article, “Risk Evaluation and Mitigation Strategies for Older Adults with Persistent Pain” found on pages 56–65, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the qui...
The purpose of this document is to provide guidance for clinicians caring for populations in whic... more The purpose of this document is to provide guidance for clinicians caring for populations in which pain assessment is difficult. Recommendations provided are based on the best evidence available at the time of preparation.
Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorder... more Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. The systematic study of facial expressions through a computerised system has identified core features that are highly specific to the experience of pain, with potential future effects on assessment practices in people with dementia. Various observational-behavioural pain assessment instruments have been reported to be both reliable and valid in individuals with dementia. These techniques need to be interpreted in the context of observer bias, contextual variables, and the overall sta...
Gerontological nursing research is critical for developing the science that will be needed to pro... more Gerontological nursing research is critical for developing the science that will be needed to provide the evidence base required to care for the unprecedented growth of the older adult population in the 21st century. This article describes the research initiatives of the 5 Hartford Centers of Geriatric Nursing Excellence (HCGNE), the key features that made them successful, the lessons learned, the challenges during implementation, and the outcomes; it concludes with conclusions and recommendations. The HCGNE developed highly successful initiatives to increase gerontological nursing research capacity focused on assisting faculty and students to write and conduct pilot studies. Key features of these initiatives included mentoring by senior gerontological nurse researchers over an extended period of time, dedicated time free from the demands of teaching, and financial support, either in the form of money or release time from regular responsibilities. The research initiatives described in this article can serve as models upon which other schools can build their own initiatives, based on their own strengths and resources. Ongoing strategies to increase gerontological nursing research are needed at both the national and individual school levels.
This paper represents an expert-based consensus statement on pain assessment among older adults. ... more This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.
The U.S. Food and Drug Administration issued Risk Evaluation and Mitigation Strategies for certai... more The U.S. Food and Drug Administration issued Risk Evaluation and Mitigation Strategies for certain analgesic agents, but all medicines for older adults warrant risk-reduction considerations. Although not all older adults have pain, a higher prevalence of persistent pain exists in this population. Nursing actions are needed to minimize the negative impact persistent pain, analgesic agents, or both have on physical, mental, and social functioning. Practices vary considerably, ranging from failing to use analgesic agents for older adults with considerable pain to exposing them to potentially life-threatening toxicities, overdoses, or drug interactions. Older adults tend to be more vulnerable to side effects and drug interactions due to differences in drug distribution, metabolism, and elimination; thus, vigilant assessment and monitoring is needed to mitigate risks whenever analgesic agents are used. This review delineates these vulnerabilities while informing clinicians of the strategies needed to promote safe, effective use of medications when treating pain in older adults.
The purpose of this article is 1) to present the historical context and rationale for competency-... more The purpose of this article is 1) to present the historical context and rationale for competency-based pain management education; and 2) to suggest learning tools that faculty might apply into their teachings and their institutions' pre-licensure curricula for promoting conceptual learning based on competency-based pain management education. Based on the well-documented need to improve the competency of health care professionals in pain assessment and management, an interprofessional group of health care providers collaborated and then convened in August 2012 to develop core competencies for pain management for the pre-licensure programs of study across health care disciplines. This interprofessional group of pain educators achieved consensus on a common set of pain-related competencies intended to be implemented across a variety of pre-licensure professional programs. A group of the interprofessional faculty, who participated in the development of the core competencies for pain management, provides a follow-up of how to implement learning tools within teaching and curricula, based on competency education in pre-licensure health care. Broad questions about how to incorporate competencies into pre-licensure curricula, for all health provider pre-licensure programs, including how to assess competency across individuals and how to teach in ways that emphasize the demonstration of conceptual learning, remain unanswered. This article reviews how the use of competencies creates historical context for a shift from teaching to learning and concludes with suggestions and exemplars in applying core competencies for pain management in pre-licensure programs.
Objective. The objective of this project was to develop core competencies in pain assessment and ... more Objective. The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.
The opinion literature has promoted the concept of mentoring in nursing with little scientific ev... more The opinion literature has promoted the concept of mentoring in nursing with little scientific evidence of its validity. Investigation of this concept has been limited to the exploratory and descriptive stages. Additional research is needed concerning the mentor-protégé relationship to provide empirical support for many of the claims in the literature. It is anticipated that as empirical and theoretical support accumulates, mentorship will become a more deliberate process.
National legislation (Affordable Care Act) emphasizes quality and equitable pain care for all pat... more National legislation (Affordable Care Act) emphasizes quality and equitable pain care for all patient populations, but frequently, pain management is not effective and equitable in African American (AA) elders, placing them at higher risk for severe pain and persistent pain. Research shows that AAs are less likely to receive guideline-based pain care. This underscores the need for perianesthesia nurses to be knowledgeable and capable of integrating cultural practices and evidence-based recommendations into their care of older AAs to ensure adequate pain management in this vulnerable population. This article describes differences and disparities in pain management in AA older adults and provides a cultural framework to guide perianesthesia pain management.
Ineffective assessment and management of pain is a significant problem. A gap in prelicensure hea... more Ineffective assessment and management of pain is a significant problem. A gap in prelicensure health science program pain content has been identified for the improvement of pain care in the United States. Through consensus processes, an expert panel of nurses, who participated in the interdisciplinary development of core competencies in pain management for prelicensure health professional education, developed recommendations to address the gap in nursing curricula. Challenges and incentives for implementation of pain competencies in nursing education are discussed, and specific recommendations for how to incorporate the competencies into entry-level nursing curricula are provided. Embedding pain management core competencies into prelicensure nursing education is crucial to ensure that nurses have the essential knowledge and skills to effectively manage pain and to serve as a foundation on which clinical practice skills can be later honed. [J Nurs Educ. 2015;54(6):317-327.].
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published i... more This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Arnstein, P., et al. Managing Older Adults' Chronic Pain: Lower-Risk Interventions. Am J Nurs 2023; 123 (2): 46-52.
More individuals develop and endure constant or recurring pain in older adulthood. Although 40% o... more More individuals develop and endure constant or recurring pain in older adulthood. Although 40% of these individuals receive no treatment, many evidence-based treatments are available. Accurate assessment of pain, its impact on functioning, and preventing treatment-related harms lay the foundation of safe, effective pain control. Analgesic agents are often necessary, but require a delicate balance to prevent undertreatment, the unnecessary abandonment of therapy, or exposure to potentially serious adverse effects. Nondrug therapies must be better integrated into the treatment plan to ensure overall safety. Evidencebased approaches help older adults thrive and survive longer despite living with persistent pain.
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published i... more This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published i... more This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional i...
How to Obtain Contact Hours by Reading this Article Instructions 1.3 contact hours will be awarde... more How to Obtain Contact Hours by Reading this Article Instructions 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at https://villanova.gosignmeup.com . To obtain contact hours you must: 1. Read the article, “Risk Evaluation and Mitigation Strategies for Older Adults with Persistent Pain” found on pages 56–65, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the qui...
The purpose of this document is to provide guidance for clinicians caring for populations in whic... more The purpose of this document is to provide guidance for clinicians caring for populations in which pain assessment is difficult. Recommendations provided are based on the best evidence available at the time of preparation.
Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorder... more Chronic pain is highly prevalent in the ageing population. Individuals with neurological disorders such as dementia are susceptible patient groups in which pain is frequently under-recognised, underestimated, and undertreated. Results from neurophysiological and neuroimaging studies showing that elderly adults are particularly susceptible to the negative effects of pain are of additional concern. The inability to successfully communicate pain in severe dementia is a major barrier to effective treatment. The systematic study of facial expressions through a computerised system has identified core features that are highly specific to the experience of pain, with potential future effects on assessment practices in people with dementia. Various observational-behavioural pain assessment instruments have been reported to be both reliable and valid in individuals with dementia. These techniques need to be interpreted in the context of observer bias, contextual variables, and the overall sta...
Gerontological nursing research is critical for developing the science that will be needed to pro... more Gerontological nursing research is critical for developing the science that will be needed to provide the evidence base required to care for the unprecedented growth of the older adult population in the 21st century. This article describes the research initiatives of the 5 Hartford Centers of Geriatric Nursing Excellence (HCGNE), the key features that made them successful, the lessons learned, the challenges during implementation, and the outcomes; it concludes with conclusions and recommendations. The HCGNE developed highly successful initiatives to increase gerontological nursing research capacity focused on assisting faculty and students to write and conduct pilot studies. Key features of these initiatives included mentoring by senior gerontological nurse researchers over an extended period of time, dedicated time free from the demands of teaching, and financial support, either in the form of money or release time from regular responsibilities. The research initiatives described in this article can serve as models upon which other schools can build their own initiatives, based on their own strengths and resources. Ongoing strategies to increase gerontological nursing research are needed at both the national and individual school levels.
This paper represents an expert-based consensus statement on pain assessment among older adults. ... more This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.
The U.S. Food and Drug Administration issued Risk Evaluation and Mitigation Strategies for certai... more The U.S. Food and Drug Administration issued Risk Evaluation and Mitigation Strategies for certain analgesic agents, but all medicines for older adults warrant risk-reduction considerations. Although not all older adults have pain, a higher prevalence of persistent pain exists in this population. Nursing actions are needed to minimize the negative impact persistent pain, analgesic agents, or both have on physical, mental, and social functioning. Practices vary considerably, ranging from failing to use analgesic agents for older adults with considerable pain to exposing them to potentially life-threatening toxicities, overdoses, or drug interactions. Older adults tend to be more vulnerable to side effects and drug interactions due to differences in drug distribution, metabolism, and elimination; thus, vigilant assessment and monitoring is needed to mitigate risks whenever analgesic agents are used. This review delineates these vulnerabilities while informing clinicians of the strategies needed to promote safe, effective use of medications when treating pain in older adults.
The purpose of this article is 1) to present the historical context and rationale for competency-... more The purpose of this article is 1) to present the historical context and rationale for competency-based pain management education; and 2) to suggest learning tools that faculty might apply into their teachings and their institutions' pre-licensure curricula for promoting conceptual learning based on competency-based pain management education. Based on the well-documented need to improve the competency of health care professionals in pain assessment and management, an interprofessional group of health care providers collaborated and then convened in August 2012 to develop core competencies for pain management for the pre-licensure programs of study across health care disciplines. This interprofessional group of pain educators achieved consensus on a common set of pain-related competencies intended to be implemented across a variety of pre-licensure professional programs. A group of the interprofessional faculty, who participated in the development of the core competencies for pain management, provides a follow-up of how to implement learning tools within teaching and curricula, based on competency education in pre-licensure health care. Broad questions about how to incorporate competencies into pre-licensure curricula, for all health provider pre-licensure programs, including how to assess competency across individuals and how to teach in ways that emphasize the demonstration of conceptual learning, remain unanswered. This article reviews how the use of competencies creates historical context for a shift from teaching to learning and concludes with suggestions and exemplars in applying core competencies for pain management in pre-licensure programs.
Objective. The objective of this project was to develop core competencies in pain assessment and ... more Objective. The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.
The opinion literature has promoted the concept of mentoring in nursing with little scientific ev... more The opinion literature has promoted the concept of mentoring in nursing with little scientific evidence of its validity. Investigation of this concept has been limited to the exploratory and descriptive stages. Additional research is needed concerning the mentor-protégé relationship to provide empirical support for many of the claims in the literature. It is anticipated that as empirical and theoretical support accumulates, mentorship will become a more deliberate process.
National legislation (Affordable Care Act) emphasizes quality and equitable pain care for all pat... more National legislation (Affordable Care Act) emphasizes quality and equitable pain care for all patient populations, but frequently, pain management is not effective and equitable in African American (AA) elders, placing them at higher risk for severe pain and persistent pain. Research shows that AAs are less likely to receive guideline-based pain care. This underscores the need for perianesthesia nurses to be knowledgeable and capable of integrating cultural practices and evidence-based recommendations into their care of older AAs to ensure adequate pain management in this vulnerable population. This article describes differences and disparities in pain management in AA older adults and provides a cultural framework to guide perianesthesia pain management.
Ineffective assessment and management of pain is a significant problem. A gap in prelicensure hea... more Ineffective assessment and management of pain is a significant problem. A gap in prelicensure health science program pain content has been identified for the improvement of pain care in the United States. Through consensus processes, an expert panel of nurses, who participated in the interdisciplinary development of core competencies in pain management for prelicensure health professional education, developed recommendations to address the gap in nursing curricula. Challenges and incentives for implementation of pain competencies in nursing education are discussed, and specific recommendations for how to incorporate the competencies into entry-level nursing curricula are provided. Embedding pain management core competencies into prelicensure nursing education is crucial to ensure that nurses have the essential knowledge and skills to effectively manage pain and to serve as a foundation on which clinical practice skills can be later honed. [J Nurs Educ. 2015;54(6):317-327.].
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