Addressing Pain in Older Adults through an Interprofessional Lens

Saturday, 7 November 2015

Sharon R. Rainer, PhD, APRN-BC
College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA

The basis of this project was individual leadership development and the creation of an interprofessional team to address quality of pain management of older adults in ambulatory health care settings.  Leadership development based on the  Kouze and Posner model was used to focus on identifying aspects of leadership within five domains (model the way, inspire a shared vision, challenge the process, enable others to act, encourage the heart) that enhanced individual leadership and also allowed the team to function at its highest level. While all domains of leadership development were important to the project plan and implementation, emphasis was on inspiring a shared vision, challenging the process, and modeling the way as top domain areas.  The relationship of three (mentor, scholar and advisor), a unique feature of Sigma Theta Tau's Nurse Faculty Leadership Academy, was a major catalyst in moving the project forward. The overall approach to the project was to focus on team building within the relationship of three and within the larger team assembled to create and implement the team's project.  What evolved was an interprofessional, innovative, and sustainable learning opportunity for clinicians across several disciplines within the university.

Pain care of older adults is challenging across many clinical settings. Pain is highly subjective and deeply personal experience, yet its management necessitates an objective standard of care. Pain is a worldwide public health epidemic in spite of years of dedicated research. Pain negatively affects physical, psychological, social and financial well-being yet is not adequately recognized and treated by health care providers.  Research shows that unrelieved pain interferes with sleep and increases anxiety, depression, morbidity and mortality among older adults.  Poorly managed pain can have numerous deleterious effects such as difficulty concentrating, lack of energy, lost productivity, decreased quality of life and inability to complete everyday tasks. In addition untreated pain in older adults decreases physical function and increases risk of deadly falls and injuries.  Few educational opportunities exist for health care professionals to enhance their knowledge and skills in the area of pain management of older adults.   

 A half day program for clinicians from nursing, medicine, pharmacy, physical and occupational therapy was established to address the need for education in pain management of older adults.  Participants completed a pre and post survey using the “Knowledge and Attitudes Survey Regarding Pain” tool.  Teams addressed four areas of pain care:  taking the pain history, the physical exam, deciding on treatment and evaluations and outcomes. A simulation session with a standardized patient with multiple comorbidities and chronic back pain was part of the learning experience. Outcomes from the survey and course evaluations were presented and future programs and curriculum enhancements have been recommended.

The project was used to enhance scope of influence within and beyond the university setting.   More educational opportunities for students and experienced clinicians are needed.  Within the organization the team that came together to develop the project will disperse and become part of other teams and committees throughout the learning community.  An important aspect of the interprofessional team and goals for expanding the scope of influence of nursing was realized as a result of this project. Nurses are the pivotal professional who can prioritize pain for patients across all health care settings yet their ability to adequately address pain in the ambulatory setting is not fully realized.   Continued efforts at the education, research and policy levels to effect change in this area will continue