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Document Type

Paper

Publication Date

5-1-2026

Disciplines

Nursing

Advisor

Georgia Hogenson

Abstract

Pain is a common symptom across all areas of nursing care, yet it is often undertreated in skilled nursing facilities, particularly among residents receiving rehabilitation services. Pain in this population may result from a variety of causes, including musculoskeletal conditions, wounds and pressure injuries, neuropathic pain, and chronic illnesses. A review of Minimum Data Set (MDS) reports and resident pain reports from the short-term rehabilitation unit revealed a concern of disparity. Long-term care residents demonstrated strong quality indicator scores (9.21 out of 10), while short-term stay residents scored significantly lower (2.76 out of 10). This discrepancy raised concerns about pain assessment and management practices within the facility. Further data analysis showed that many residents were not offered nonpharmacological pain management options, and medications were frequently used without evidence of meaningful improvement. Literature reviews supported the need for an increased emphasis on the importance of pain assessments. The outcome of pain assessments often can be determined by how a nurse approaches the resident, therapeutic communication, their own understanding of the pain scale, the residents’ understanding, and distinct types of pain. Within the facility, pain assessments are done at admission, discharge, and quarterly without knowing how the resident is feeling or knowing if the resident fully understands what they are being asked at the time of assessment. When was the last time pain medication was given? Has it worn off by the time an initial assessment is done? Residents in short-term care often have acute pain due to rehabilitation programs and their current condition, compared to long-term care with more chronic conditions and pain management. After reviewing different approaches and interventions to address our identified problem, the decision was made to implement a standardized Short Stay Pain Protocol. Implementing a standardized pain protocol will help ensure that nurses are 3 consistently and appropriately completing thorough pain assessments while improving overall pain management for residents. This protocol incorporates both pharmacological and non- pharmacological strategies to support a multimodal approach to care. Using a multimodal approach can reduce reliance on opioids, thus decreasing the risk of adverse effects such as delirium in older adults, while also providing alternative options when analgesics are unavailable or contraindicated. Additionally, this protocol promotes patient-centered treatment by guiding nurses to assess the type, cause, and context of pain, including addressing anticipated pain, such as administering prophylactic interventions prior to physical therapy. Standardizing this protocol will further promote accurate documentation and ensure that pain assessments are conducted consistently and at clinically appropriate times, particularly when changes in condition occur. The anticipated outcomes would include increased attention to pain management by implementing a multimodal approach to increase staff awareness and education of pain assessments for residents. Improved pain management is expected to enhance short-term rehabilitation with overall satisfaction and comfort. The study aimed to reduce disparities between short-term rehabilitation residents and long-term care residents by focusing on short- term pain management. The project’s goal was to create a low-cost, effective pain assessment to improve residents’ comfort and reduce high pain prevalence at short-term care facilities.

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