KINGSTON, R.I. -- April 13, 2001 -- When the University of Rhode Islands College of Nursing asked 40 health care agencies in the state how the Colleges researchers could most help them, they responded overwhelmingly with one main answer pain management.
In the six years since URI surveyed those agencies, URI Associate Professor of Nursing Marlene Dufault has found out why pain management was such an area of concern. "Pain affects nearly every facet of life, including sleep, concentration, mood, walking ability, relationships with others and ones ability to enjoy life."
In fact, effective pain management can help people recover from serious illness and injury, Dufault said. "Research on cancer patients has found that where their pain has been managed well, they live longer. There is a real positive effect on the immune system."
And now the Narragansett resident, who has done research on improving hospital-based pain management, is in the final stages of a collaborative research project of home care pain management with Roger Williams Home Care, VNS of Greater Woonsocket and VNS Home Health Services, an affiliate of South County Hospital.
Dufault and a cadre of undergraduate and graduate nursing students want to close the research-to-practice gap in home care pain management. Dufault hypothesizes that by involving clinicians, academic scientists and students in developing research-based pain management standards of care, there will be decreased severity of pain, greater patient satisfaction with pain management, less impact on quality of life, and a reduced burden on family care-givers.
"Using this model may significantly improve pain management for patients in home care as it has for hospitalized patients in previous studies," Dufault said. "With increased numbers of patients and families assuming greater responsibility for pain management at home, this research-to-practice gap widens even further."
In an earlier study at one of the proposed sites, it was found that the pain intensity (on a 0-10 scale) exceeded 7.81 on the day following discharge, which was even greater than the pain level experienced before admission to a hospital, Dufault said.
For the research on how integrating pain management standards will improve patients care, Dufault and her team have already worked with 84 subjects after their discharge from the hospitals. Dufault found many of the subjects reported high levels of pain and interference in daily living activities.
"We have found that the standards that we have implemented in hospitals have been successful, but when patients get home, they resort to pre-hospital levels of pain," Dufault said. "One of the most challenging areas we have to address is their fear of addiction."
To establish the standards for both hospital and home care, Dufault called on 64 undergraduate nursing students who researched the most problematic areas for pain management. They also looked at previous studies to see what has been successful.
In January, the standards for home care were drafted, and this month, Dufault began training with staffs at VNS Home Care, which is based in Narragansett, Roger Williams Home Care in Providence, and the VNS of Greater Woonsocket.
From January to March, planning sessions were held to develop strategies and methods for training on each standard of care for staff, patients and families in each of the agencies.
This month, Dufault started measuring the effects of the standards on reduction of pain and improvement in daily living with 75 patients of the various home care agencies. "We are going to test our model to see if we achieve better outcomes. We are going to test outcomes with family caregivers. There is a great discrepancy among patients, family members and health care professionals about the perception of pain.
We want to teach the patients that they can ask for and expect good pain management," she said.
The research-based standard of care will be tested for its effectiveness in improving outcomes in patients and their family caregivers. Data will then be obtained on the variables of pain intensity, interference of pain with quality of life outcomes, satisfaction with caregiver responsiveness to pain, and burden of pain management experienced by family caregivers. Data will be analyzed at and the results given to each agency. The agency will then decide whether to adopt or revise the standard of care.
Dufault and her team will disseminate the standard of care through continuing education, professional journals and conferences.
While Dufault acknowledged that tackling issues like pain management is a challenge in todays health care environment, she said that if an agency adopts standards and documents adherence to those standards, then the system is more likely to cue its nurses into those standards. "We are trying to build better tools for clinicians," Dufault said.
She credits the three home care agencies for their role in the effort. "In order for research to move an organization forward, there has to be a strong body of empirically validated knowledge, organizational systems that promote innovation, and skilled clinicians with a commitment to using research to improve their practice. We have all three"
For Information: Marlene Dufault, 401-874-5307, Dave Lavallee , 401-874-2116