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A Contextual Analysis to Explore Barriers and Facilitators of Pain Management in Swiss Nursing Homes
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
 
ID 4524594
Author(s) Brunkert, Thekla; Simon, Michael; Ruppen, Wilhelm; Zúñiga, Franziska
Author(s) at UniBasel Brunkert, Thekla
Simon, Michael
Zúñiga, Franziska
Year 2020
Title A Contextual Analysis to Explore Barriers and Facilitators of Pain Management in Swiss Nursing Homes
Journal Journal of Nursing Scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing
Volume 52
Number 1
Pages / Article-Number 14-22
Keywords COM-B; mixed-methods; nursing home; pain management
Abstract As part of a contextual analysis, this study aimed to generate a comprehensive understanding of barriers and facilitators to pain management in nursing homes to identify potential leverage points for future implementation studies. An explanatory sequential mixed-methods study embedded in a cross-sectional study in 20 Swiss nursing homes (data collection: July-December 2016). Quantitative data were collected via care worker questionnaire surveys comprising 20 items assessing perceptions of barriers to pain management. Descriptive statistics were computed. In the subsequent qualitative strand we conducted four focus group discussions with care workers (registered nurses, licensed practical nurses, and nursing aides) using a knowledge-mapping approach. Findings of both strands were merged and mapped onto domains of the Capability, Opportunity, and Motivation determine Behavior (COM-B) system, a model for behavior, to identify determinants for behavior change. Data from 343 completed care worker surveys (response rate 67.3%) and four focus groups with care workers were analyzed. Items rated most problematic were as follows: lack of availability of nonpharmacological treatment (60.9%), lack of application of nonpharmacological treatment (53.6%), reluctance of residents to report pain (51.1%), and lack of time for a comprehensive pain assessment (50.5%). Focus groups partly corroborated quantitative findings and complemented them with facilitators, such as close collaboration with physicians and further barriers (e.g., organizational factors such as high turnover and a lack of established routines in pain management). Our approach using a behavioral model highlighted a need for implementation strategies that improve pain management knowledge and focus on motivational aspects to establish new routines and habits related to pain management among care workers. Our findings suggest that future approaches to improve pain management in nursing homes should go beyond provision of education and training. To establish new practices or adapt existing ones, a more complex approach (e.g., introduction of external or internal facilitators) is necessary to influence motivation and ultimately change behavior.
Publisher Wiley
ISSN/ISBN 1527-6546 ; 1547-5069
edoc-URL https://edoc.unibas.ch/74162/
Full Text on edoc Available
Digital Object Identifier DOI 10.1111/jnu.12508
PubMed ID http://www.ncbi.nlm.nih.gov/pubmed/31898860
ISI-Number MEDLINE:31898860
Document type (ISI) Journal Article
 
   

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