Evidence Based Practice in Nursing Homes

Ersek et al. (2016) explores on pain management algorithms in the implementation of best practices in nursing homes. The objective for this article was to understand how pain assessment and management in nursing homes are applied. The researchers attained their research aim by following a cluster, randomized controlled trial which was accomplished through the application of intensive support and training to apply pain assessment and management practices using algorithms (ALGs). The authors selected their population from 27 using homes with 485 respondents with 226 control group. The researchers concluded that pain management algorithms are effective in nursing homes. 

The type of study used in this article is clustered, randomized controlled trial which compared pain algorithms (ALGs) with pain education (EDU). Parahoo (2014) explains that in a random controlled trial (RCT) respondents are randomly allocated clinical interventions. In this article, the respondents were randomly selected to participate in the clinical trial or be the control group. The researchers selected 485 respondents among which 259 were given the clinical intervention while 226 were the control group. The 259 respondents were provided with intensive training as well as support to apply algorithm to assess and manage pain. Being that the researchers applied an RCT, this article can be rated as level II which according to Kim and Mallory (2014) includes evidence from at least one well-designed Randomized Controlled Trial (RCT)

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The respondents were provided with pocket-sized notebooks that had eleven linked evidence-based decision trees that comprised of: suitable prescribing and titration of adjuvant pain medications, opioids, non-steroidal anti-inflammatory drugs, and acetaminophen; treatment and assessment of pain in nonverbal residents; general pain assessment; and management and treatment of medication drug effects, like delirium, sedation, and constipation. The nurses in these facilities were trained through a training that lasted for four classes on algorithm and which was recorded for future use.  In addition, the nursing homes were given three ring binders which contained vital information on pain issues for nursing assistants, primary care providers, administrators, and licensed nursing staff. 

According to the research’s finding, combining algorithms with intensive strategies that embolden the application of evidence-based pain assessment and management practices is not more appropriate than basic education among individuals in nursing homes. This was based on lack of difference between the intervention and the control group in terms of pain intensity. However, the patients on algorithm had a higher adherence to the procedures in long-run but with a moderate intensity. Nevertheless, the article fails to attain clinical significant effect on outcomes and clinical practices. 

The researchers applied evidence-based approaches and theoretical framework to enhance the use of algorithm in pain management. The authors applied algorithms that led the health professionals through step by step processes in the assessment and treatment of pain. In addition, the authors applies a modular approach which allowed nurses to learn, practice and master one step before proceeding to the step that follows. This was effectively attained by following a stepped approach that incorporates regular auditing and feedbacks of pain to clinical practices. The authors trained nurses and clinicians using a comprehensive 8-week pain management program and delivered intensive non-drug interventions like multisensory stimulation therapy and physical exercise for the respondents. 

The use of evidence based practicing this article is of significance in improving patient outcomes in nursing home. For example, the use of the comprehensive 8-week pain management program impacts knowledge to the nurses and clinicians which in the long run provides high quality care. The use of evidenced based practice in this study is not only beneficial to the health professionals but also to the patients. The best aspect of this approach is that it includes patients in the care plan where in this case the use of algorithm and education was applied among the respondent through the use randomized control trials. In general, the use of evidence based practice is significant in the delivery of quality and safe care as it is patient centered and boosts behavioral changes among patients and health professionals. 


Ersek, M., Neradilek, M., Herr, K., Jablonski, A., Polissar, N., & Du Pen, A. (2016). Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial. Journal Of The American Medical Directors Association17(4), 348-356. doi: 10.1016/j.jamda.2016.01.001

Kim, M., & Mallory, C. (2014). Statistics for evidence-based practice in nursing. Jones & Bartlett Publishers.Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan International Higher Education.

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