Objective: To test the effect on nurse behavior of an intervention designed to promote adoption of an evidence-based guideline for acute pain management in the elderly.
Design: A multi-site, experimental design was used to test the effect of a multifaceted TRIP intervention. 12 acute care hospitals were enrolled and randomized to an experimental or comparison arm.
Sample/Setting: The sample consisted of 2110 patients 65 years of age or older, admitted to one of the 12 sites for a hip fracture; and 172 nurses providing care to these patients.
Concepts Studied: The independent variable is the TRIP intervention, and the dependent variables are the rate and extent of adoption of evidence-based practices for acute pain management of hospitalized elders.
Methods: Self-report data regarding nursing practices were collected from nurses at baseline/prior to randomization of sites, immediately before and after the TRIP intervention. Medical records of patients 65 years of age or older were abstracted to determine nursing practices before site enrollment, prior to, and following implementation of the TRIP intervention. Data were analyzed using generalized estimating equations, treating nurses and medical records/patients as the unit of analysis, and controlling for baseline scores.
Findings: Nurses in the E group reported a more advanced stage of adoption for use of research findings in acute pain management than those in the comparison group (OR=3.2; p<. 05). Significant (p<. 05) treatment effects include: every four hour pain assessment; around the clock administration of opioids, and of nonopioids; avoiding Demerol administration; administration of an opioid and nonopioid together; and administration of a stool softener/laxative for patients receiving opioids.
Conclusions: The TRIP intervention had a positive treatment effect on nurses’ acute pain management practices for hospitalized elders.
Implications: Nurses can provide evidence-based practice when specific TRIP strategies are used to assist them in improving care.
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