How incremental video training did not guarantee implementation due to fluctuating population prevalence

Area of Science:

• Neurology
• Geriatrics
• Nursing Science

Background:

• Stroke patients often have communication impairments (aphasia, delirium, language barriers), hindering self-reported pain assessment.
• Pain behaviour observation scales are crucial for accurately assessing pain in non-communicative individuals.

Purpose of the Study:

• To implement the Rotterdam Elderly Pain Observation Scale (REPOS) using video training for nurses caring for stroke patients.
• To evaluate the effectiveness of education-based implementation of a pain observation scale.

Main Methods:

• A stepped-wedge cluster design was employed over 34 weeks with biweekly questionnaires.
• The primary endpoint was the proportion of shifts nurses used the REPOS for eligible patients.
• Nurse competence and attitude towards pain measurement were assessed.

Main Results:

• Despite a high proportion of shifts with trained nurses (83%), REPOS usage decreased from 14% to 6%.
• Only 45.3% of nurses used REPOS at least once; median usage was twice.
• Nurses reported high competence and positive attitudes towards pain measurement.

Conclusions:

• Education alone is likely ineffective for implementing pain behaviour observation scales in non-communicative acquired brain injury patients.
• Individual nurse motivation and patient factors significantly influence the adoption of pain assessment tools like REPOS.