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Open Access Optimizing the Role of the Nurse Practitioner to Improve Pain Management in Long-Term Care L'optimisation du rôle de l'infirmière praticienne en matière d'amélioration de la gestion de la douleur en soins de longue durée

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The purpose of this study was to examine the role of the nurse practitioner (NP) within an interdisciplinary model of pain management in long-term care (LTC). In a cross-sectional survey, 16 NPs in the Canadian province of Ontario (89%) indicated whether they currently performed and whether they should be performing 33 activities related to pain management and identified barriers to the fulfilment of their pain-management role. Most NPs (81.3%) reported use of pain-assessment tools, but less than half reported use of pain-management clinical practice guidelines. NPs were less involved in activities related to (a) prescribing and adjusting pain medications, (b) providing leadership in pain management, and (c) engaging in pain-related research initiatives. However, most felt that they should be more involved in these activities. Barriers to NP management of pain included time constraints; prescribing restrictions; lack of knowledge; difficulties with assessing pain; MD, staff, resident, and family reservations about use of opioids; and poor collaboration with physicians. The results indicate that NPs are not being used to their full potential in managing pain among elderly LTC residents.

French
Cette étude vise à examiner le rôle de l'infirmière praticienne (IP) dans le cadre d'un modèle interdisciplinaire de la gestion de la douleur, en soins de longue durée (SLD). Dans une enquête ponctuelle, un questionnaire a été soumis à 16 IP pratiquant dans la province canadienne de l'Ontario (89 %) dans le but d'identifier celles qui exécutaient actuellement ou devaient exécuter 33 activités liées à la gestion de la douleur, et de cerner les obstacles qui les empêchaient de mener à bien leur rôle d'intervenantes quant à la gestion de la douleur. La majorité des IP (81,3 %) ont signalé qu'elles utilisaient des outils d'évaluation de la douleur. Par contre, moins de la moitié bénéficiaient de lignes directrices en matière de pratiques cliniques portant sur la gestion de la douleur. Les IP (a) effectuaient moins d'activités liées à la prescription et à la modification du dosage de médicaments contre la douleur, (b) occupaient moins de fonctions de leadership en gestion de la douleur, et (c) étaient moins nombreuses à mener des initiatives de recherche traitant de la douleur. Toutefois, la plupart ont exprimé le désir de participer davantage à ces activités. Les contraintes de temps, les restrictions en matière 'ordonnance, le manque de connaissances, la difficulté à évaluer la douleur, les réserves des médecins, du personnel, des bénéficiaires et des familles quant à l'utilisation des opioïdes, et le peu de collaboration des médecins figurent parmi les obstacles qui entravent la participation des IP à la gestion de la douleur. Les résultats de l'étude indiquent que les compétences des IP ne sont pas utilisées pleinement en ce qui a trait à la gestion de la douleur chez les bénéficiaires âgés recevant des SLD.

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Keywords: LONG-TERM CARE; NURSE PRACTITIONERS; OLDER ADULTS; PAIN MANAGEMENT

Document Type: Research Article

Publication date: 2007-06-01

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