LTCO. Managing Pain and Distress in Long-Term Care (Clinical Team Members)

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Stopwatch icon Time to complete: Approximately 20-25 minutes

About this Course

Managing Pain and Distress in Long-Term Care is a self-paced orientation course that will equip or refresh long-term care team members on the knowledge and skills required to support residents.

Pain and distress often indicate a medical condition that requires assessment, intervention, and treatment. A person can experience pain and distress in different ways including physically, socially, spiritually and psychologically. This course will equip clinical team members with the skills and confidence to recognize signs of pain and distress and develop and implement pain/distress management care plans.

After taking this course, learners will be able to:

  • explain how frequently/when residents should receive a pain/distress assessment and reassessment; how to conduct a pain/distress assessment of residents, including residents living with dementia and/or cognitive impairment and/or unable to self-report pain/distress
  • explain the different aspects of pain/distress and the concept of “Total Pain”
  • suggest pharmacological and nonpharmacological approaches to managing pain/distress
  • argue against common myths and misconceptions about pain/distress and the assessment of pain/distress
  • understand the importance of communicating with other team members about assessing a resident for pain/distress and a resident’s pain/distress care plan
  • explain what non-registered clinical team members need to report to registered team members and what non-clinical team members should report to clinical team members
  • understand health care consent, specifically for pain/distress management

Learners will receive an Ontario CLRI certificate for completing this course.

About the Orientation eLearning series

The Orientation eLearning courses, created by the Ontario CLRI at the RIA, provide education for new team members during orientation, and for existing team members during their annual training. These scenario-based learning courses ensure that learners have the knowledge and skills needed to assist the people they support and are in line with Ministry of Long-Term Care guidelines. They were developed using evidence-based best practices and adult education principles, in collaboration with subject matter experts and LTC leaders.

Audience

This course is for long-term care team members in clinical roles.

Acknowledgements

This eLearning course, part of the Orientation course series, was developed by the Ontario CLRI at RIA with the generous support of Schlegel Villages.

We would like to thank the people who contributed to the development and review of content for this course:

Subject Matter Experts 

Trisha Wilson, RSW, Performance Improvement Lead, NW Regional Palliative Care Program, Hogarth Riverview Manor LTC, St Joseph’s Care Group

Tara Moffatt MN, RN, CHPCN (C), CON (C), Clinical Nurse Specialist, Palliative Pain and Symptom Management Consultant, Nipissing and Parry Sound Districts, VON Canada

Gwendolyn Cleveland, RN, BScN, MEd, CHPCN(C), Palliative Pain and Symptom Management Consultant (PPSMC), Community Health Team, Scarborough Centre for Healthy Communities

Kim Arquette, RN, BScN, Clinical Specialist, Schlegel Villages

Advisors 

This course was developed in collaboration with an advisory panel of LTC team members: Abena Nyarko, Alison Harper, Berlyn Gozorate, Julia Karls, Rosemarie Cruz, and Tammy Casado.

References

Alzheimer Society of Ontario, & brain Xchange. (n.d.). Pain matters. A family guide to pain management in dementia. https://archive.alzheimer.ca/sites/default/files/files/on/pain%20matters/painmattersbooklet.pdf

Ammaturo, D. A., Hadjistavropoulos, T., & Williams, J. (2016). Pain in dementia: Use of observational pain assessment tools by people who are not health professionals. Pain Medicine, 18, 1895–1907. https://doi.org/10.1093/pm/pnw265

Brant, J. M. (2017). Holistic total pain management in palliative care: Cultural and global considerations. Palliative Medicine and Hospice Care – Open Journal, SE(1), S32–S38. https://doi.org/10.17140/PMHCOJ-SE-1-108

Brown, S., Lascarides, P., & Stickevers, S. (2014). Treating pain in patients with chronic kidney disease: A review of the literature. Practical Pain Management, 14(9). https://www.practicalpainmanagement.com/treatments/pharmacological/treating-pain-patients-chronic-kidney-disease-review-literature

Depression. (n.d.). CAMH. Retrieved June 28, 2022, from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/depression

Eppel, D. (2020, December 1). Pain Management with As Needed Medications (PRNs). HPC Consultation Services. Waterloo Wellington. https://hpcconnection.ca/pain-management-with-as-needed-medications-prns/

Hadjistavropoulos, T. (2016, November 17). Pain Assessment in Persons with Dementia. https://vimeo.com/192469020

Lowe, K. M., & Robinson, D. R. J. (2020). Pain management for patients with chronic kidney disease in the primary care setting. The Nurse Practitioner, 45(1), 18–26. https://doi.org/10.1097/01.NPR.0000615544.81303.9c

Mehta, A., & Chan, L. S. (2008). Understanding of the concept of “Total Pain”: A prerequisite for pain control. Journal of Hospice & Palliative Nursing, 10(1), 26–32. https://doi.org/10.1097/01.NJH.0000306714.50539.1a

MJHS Institute for Innovation in Palliative Care, & Community Care of Brooklyn. (2016). Spiritual distress. https://www.mjhspalliativeinstitute.org/wp-content/plugins/pdf-patient-education/uploads/Spiritual_Distress_1472626249.pdf

Noble, M., Treadwell, J. R., Tregear, S. J., Coates, V. H., Wiffen, P. J., Akafomo, C., Schoelles, K. M., & Chou, R. (2010). Long‐term opioid management for chronic noncancer pain. Cochrane Database of Systematic Reviews, 1. https://doi.org/10.1002/14651858.CD006605.pub2

Ontario Association of Non-Profit Homes and Services for Seniors. (2010a). Appendix G: Pain assessment and management training. “Where does it hurt?”

Ontario Association of Non-Profit Homes and Services for Seniors. (2010b). Appendix H: Pain assessment and management training. “Where does it hurt?”

Ontario Regulation 246/22 made under the Fixing Long-Term Care Act, 2021., (2022). https://www.ontario.ca/laws/regulation/r22246#BK66

Pasero, C. (2018). Margo McCaffery: Resolute and visionary. Pain Management Nursing, 19(2), 89–91. https://doi.org/10.1016/j.pmn.2018.01.005

Quality Palliative Care in Long Term Care. (2011). Palliative Performance Scale (PPS) and palliative care conferences. https://www.palliativealliance.ca/assets/files/Alliance_Reources/Physical_Care/PPS._edited_Jan_242013.pdf

Registered Nurses’ Association of Ontario. (n.d.). Appendix E: Pain assessment scales. https://bpgmobile.rnao.ca/sites/default/files/Pain%20Assessment%20Scales.pdf

Registered Nurses’ Association of Ontario. (2007). Assessment and management of pain in the elderly: Self-directed learning package for nurses in long-term care. Registered Nurses’ Association of Ontario.

Terminology. (2021). International Association for the Study of Pain (IASP). https://www.iasp-pain.org/resources/terminology/