Publication Date

Summer 2022

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Vivian Wong


pain management, nonpharmacologic, elderly, algorithm, nursing homes, education


Pain is often untreated or undertreated among older adults living in nursing homes. The lack of standardized pain management protocols makes it difficult to address pain in this population. Deficiencies in pain management and documentation were identified in a nursing home and a performance improvement project was implemented with the aim to improve pain management, pain documentation, and staff knowledge of pain management. A pre-and post-intervention study design was used, and data analysis included descriptive statistics and a paired samples t-test. Participants (n=12) included seven registered nurses and five licensed vocational nurses who provide direct care to the residents in a nursing home. Chart audits included all residents (n=47) who stayed at the facility during the entire study. Data (pain documentation by nurses and daily average pain scores of residents) were collected two weeks before intervention and two weeks after intervention. Intervention consisted of education on pain management protocol using a standardized pain management algorithm, pain documentation, and integration of pharmacological and non-pharmacological interventions for pain control. Staff knowledge of pain management was assessed using pre-and post-tests during the intervention. Significant improvement was seen in the initial daily average pain scores (p = 0.09) and the reassessment daily average pain scores (p = 0.031) post-intervention. Additionally, documentation of pain assessment (every 8 hours) increased from 93% to 100%, pain intervention increased from 89% to 100%, and post-intervention pain assessment (30-60 minutes) increased from 70% to 97%. Staff knowledge of pain management improved significantly after education intervention (p< 0.001). Further studies are needed to examine the use of non-pharmacologic pain interventions in nursing homes.


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