Nurses’ Reflections on Pain Management in a Nursing Home Setting yyy Lauren Clark, RN, PhD, FAAN,* Regina Fink, RN, PhD, FAAN, AOCN, † Karen Pennington, RN, PhD, ‡ and Katherine Jones, RN, PhD, FAAN § y ABSTRACT Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physi- cians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improve- ment research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who par- ticipated in a study to develop and evaluate a multifaceted pain-man- agement intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and atti- tudes about pain and their pain-assessment and management prac- tices. Progressive solutions and suggestions for changing practice in- clude establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strate- gies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and moni- tor their own process-improvement programs using a participatory research approach. © 2006 by the American Society for Pain Management Nursing Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge nurses, physicians, administrators, and health policy makers. Incomplete knowledge, outdated attitudes, myths, and miscon- ceptions about pain and its treatment among staff and residents contribute to unsafe, inadequate, and inappropriate pain management. Up to 84% of the elderly in residential facilities experience pain (Stein & Ferrell, 1996; Won, et al., 2004), and one-quarter to one-third of nursing homes residents are known to have moderate to severe pain on a daily basis (Gaston-Johansson, Johansson & Johansson, 1996; Teno, Weitzen, Wetle, & Mor, 2001). Even with an increasing evidence-based armamentarium of pharmacologic and nonpharmacologic inter- ventions for the management of pain, researchers have found the nursing home environment a difficult one in which to make sustained, positive clinical prac- tice improvements (Stein, 2001). An overall institutional commitment and in- From the *University of Colorado at Denver and Health Sciences Center School of Nursing, † University of Colorado Hospital, ‡ Regis University, Denver, Colorado; and § Yale University College of Nursing, New Haven, Connecticut. Address correspondence and reprint requests to Lauren Clark, RN, PhD, FAAN, University of Colorado School of Nursing, Health Sciences Center, 4200 East Ninth Avenue, C288, Denver, CO 80262. E-mail: lauren.clark@uchsc.edu. This project was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ U-18- HS11093) awarded to Katherine Jones, Principal Investigator. 1524-9042/$32.00 © 2006 by the American Society for Pain Management Nursing doi:10.1016/j.pmn.2006.02.004 Original Articles Pain Management Nursing, Vol 7, No 2 (June), 2006: pp 71-77