One nurse's personal experiences with pain were the catalyst for an innovative program at United Methodist Homes' Hilltop Campus James G. Johnston (JGJ) Memorial Nursing Home in Binghamton, NY. JGJ is one of four skilled nursing facilities that are part of United Methodist Homes' multilevel, multicampus facilities in New York and Pennsylvania.

Kate McHugh, RN, assistant director of nursing at JGJ, was disappointed when she had a laminectomy in 2002 and caregivers managed her pain strictly with medications. Her resolve to "do better" in managing residents' chronic pain led to an interdisciplinary pain management program and the creation of a "Comfort Zone" for interventions.

McHugh first shared her ideas for improving the facility's pain management program via an interdisciplinary approach with Jackie Otremba, RN, director of nursing, in the spring of 2006. Otremba and the staff at JGJ have a history of implementing successful programs to improve resident care, including a interdisciplinary approach to prevention and treatment of pressure ulcers. Otremba said "go for it!" and the interdisciplinary pain management team was born.

Interdisciplinary Approach

The team includes not only representatives from all disciplines but RNs from each of the three units that comprise the facility. Certified nursing assistants also are included in the team because they are often the first set of eyes and ears for evaluating residents.

McHugh and Otremba selected people for the team and then offered them a place on it. No one was required to be on the team; they wanted those involved to be excited about the work they were about to do. A key to gaining commitment of team members was McHugh's pledge to conduct short, meaningful meetings weekly, which later became monthly.

Based on the daily morning report, the team makes recommendations for pain management to whomever provides the intervention - from physicians for medication orders to the care planning team. The pain management team doesn't include all care planning team members from every floor, so the planning team must pass on information. Education of the staff of the facility has been a very large component of the program, especially regarding nonpharmacological approaches to manage pain and improve pain assessment.

Pain assessment strategies include a standardized scale for residents to self-report pain as well as methods of assessing nonverbal pain in cognitively or communicatively impaired residents. McHugh reported there has been a shift in pain management at the facility: what was often reactive is now proactive. Today, nurses are more likely to anticipate pain, implement approaches to prevent pain and assure availability of interventions in case of pain.

Complementary Treatments

Complementary treatments for management of pain were a large part of the recommendations the team made to unit staff regarding individual residents.

"What if residents in pain could go to a quiet, soothing place to have treatments?" McHugh asked. Perhaps a spa (of sorts) would make the massage, reiki or other treatment even more effective in relieving pain.

The team's brainstorming resulted in the conversion of an underused residents' lounge into the "Comfort Zone." In the fall of 2006, the room was transformed into a sensory room where adjunctive pain relief modalities such as aromatherapy, heat and visual imaging are used in conjunction with massage and reiki.

A licensed massage therapist volunteers her time for the program. Initially, some residents were a bit unsure of the treatments such as massage or reiki, McHugh said, but by introducing them slowly, the residents' acceptance increased remarkably. The team tried soft music in the room but, because it interfered with residents' hearing, stopped it during interventions.

Staff assess pain prior to and after a visit to the Comfort Zone and McHugh said approximately 75 percent of residents report a decrease in pain after a visit.

The JGJ pain team plans to expand the program by adding another Comfort Zone to help manage discomfort as well as mood and behavior problems in residents on the facility's dedicated dementia unit.

Janine Savage, RN, vice president of clinical operations for United Methodist Homes, reported similar programs are being planned for the organization's three other skilled nursing facilities.

"Programs can't be successful without individual champions," Savage said, "but it takes the whole team of people to contribute and provide their expertise and make it a quality program."

Jennifer Pettis is policy analyst/consultant at New York Association of Homes and Services for the Aging, Albany, NY.