Publications
APS Bulletin • Volume 15, Number 2, Spring 2005
Resource Reviews
John D. Loeser, MD, Department Editor
Nursing Home Pain Toolbox
Reviewed by Carol Leppa, PhD RN
University of Colorado Health Sciences Center, School of Nursing, Denver CO, 2004, $24.72. (workbooks, videos, guides, and brochures). Print out an order form from http://www2.uchsc.edu /son /centers /content /PainToolBoxOrderForm.pdf.
The Nursing Home Pain Toolbox includes a variety of materials for training staff in pain management as well as in the assessment of pain. Two workbooks—one for nursing staff and one for nursing assistant staff—cover the same material but reflect the different perspectives and knowledge bases of the two groups. A training video (with three cases providing a variety of resident situations common in nursing homes) and a training manual supplement the workbooks and video. The toolbox also includes pain assessment guides, a resident education video and brochure, and a pocket-size analgesic reference guide. The resident education video and brochure and the pain assessment guide are in both English and Spanish. The documentation with the materials identifies the intention “to assist you and your staff in providing optimal pain management in your facility.”
The workbooks are clearly presented, and the brief chapter format makes them a good fit for staff to use, either in one sitting or to study or review various sections as needed. The supplemental training manual provides answers to the self-assessment questions at the end of each section as well as answers to the discussion questions accompanying the video case studies.
The strongest section of the nursing workbook is the chapter on treating pain, which provides a clear and concise review of analgesic therapy for elderly people. This is a good reference for nursing staff to have on hand. The sections on nondrug therapies and pain beliefs, however, are very limited and underscore the medication bias of the materials.
The resident education video reviews the same material as the nursing workbooks. The tone of the video is faintly condescending, and the dismissal of the resident’s concern with side effects of medication as a “myth or misconception” is particularly insulting. While the side effects may be treated with increased fluids and additional medications, the concerns are real, and many elderly do not like to take medications in any form. The issue of polypharmacy is not addressed at all.
There are some minor confusing parts in the written materials and errors in the citations. The copy of the training video provided for review was of poor quality, with jumpy images when played on a variety of VCR equipment. The resident video did not have this technical problem. The laminated pain assessment cards are clear and would be very useful.
The Nursing Home Pain Toolbox provides helpful materials that the staff of nursing homes could use in assessing pain medication needs. The toolbox would benefit by additional materials on nonmedication approaches to pain management and material on issues of polypharmacy in the elderly population.
Dr. Loeser is Professor of Neurological Surgery and Anesthesiology at the University of Washington in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu.