A recently completed study by a University of Rhode Island nursing professor shows that home care agencies that use research-based pain management standards help patients at home feel better and their family caregivers feel less burdened.
The study directed by Marlene Dufault, URI professor of nursing, directly affected patients in home care agencies in South County, Providence and Woonsocket. "Patients, need to be taught to expect good pain management," said Dufault.
The study involved 164 patients and their caregivers. Seventy-five individuals were part of the experimental group, which included interventions based on improved standards of care, while the control group of 89 received the usual care. The new research-based standards addressed specific interventions in four problematic areas of care including assessment and monitoring, patient and family education, drug side effect management, and the use of complementary methods to enhance drug therapy.
URI conducted the study in collaboration with Roger Williams Home Care, Providence, Visiting Nurse Service of Greater Woonsocket and VNS Home Health Services, an affiliate of South County Hospital.
Dufault hypothesized that by involving clinicians, academic scientists and students in developing research-based pain management standards of care, patients would experience decreased severity of pain, greater satisfaction with pain management, and less impact on quality of life. She also theorized that there would be a reduced burden on family caregivers.
In fall of 2001, the standards were drafted and training began in the home care agencies. Then in January, Dufault began measuring the effects of the standards on the patients in the experimental group. Subjects in the control and experimental groups were surveyed three times during the course of study, before the first visit, and after the third and last visits. Cynthia Temkin, co-investigator and professor in the URI College of Pharmacy, assisted Dufault in analyzing the 44,000 bits of data to prepare her findings.
Before visit 1, each group reported on a scale of 1 to 10, an average pain level of 4, with the lowest level of pain being a 1 and the highest a 10. After visit 3, the experimental group reported a drop to a ranking of 3, while the control group increased to an average of 4.5. By the end of the study, those participants getting the intervention reported a pain level rank of 2.5, while the control group reported a pain ranking of 5.
Surveying participants about pain's effect on quality of life, the study found patients in the experimental group went from a ranking of 5 at the beginning of the study down to ranking of about 2.5. The control group ranked 6 throughout the life of the study.
Among the trends in the data, patients whose nurses followed the new pain management standards reported less pain at its worst level and on the average greater relief from the interventions.
Family caregivers whose nurses followed the standards reported less: sleep disturbances from patient's pain, overwhelming financial strain, family adjustment, upsetting symptoms, changes to personal plans caused by pain, time demands caused by pain and feelings of confinement.
On average, patients receiving treatment under the new standards reported: decreased severity of pain, decreased interference of pain, increased satisfaction with interventions and caregiver responsiveness, and decreased family caregiver burden
"The most exciting thing about this is to see nurses changing their practice based on empirical evidence to support such change," Dufault said. "But unless it's carried into the day-to-day care giving activities of nurses, the research is useless."
Dufault also said such research directly benefits the nursing students in the college. To establish the standards, Dufault enlisted 64 undergraduate nursing students who evaluated over 122 studies that addressed the most problematic areas for pain management. They also examined specific interventions that clinicians then incorporated into best practice standards, policies, and protocols.
"That you are conducting research that helps patients and caregivers, that gives you fuel for the next study, as well as developing future clinicians with the knowledge and skills to manage pain more effectively. In addition our work merges the teaching, research, and service mission of the university," Dufault said.
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