Nurse Intervention Beneficial to Patients Dealing with Chronic Pain

Nurses can help lead efforts to ease psychological distress and reduce suffering for people with chronic pain, according to a new study of U.S. veterans.

Nurse care managers in the study provided support, motivation, and encouragement that “many of the participants really clung to,” lead author Marianne Matthias tells Pain Medicine News. Nurses were also very important in providing cognitive-behavioral therapy (CBT) to the veterans.

Matthias’s paper is one of several being published from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) study, which involved 242 U.S. veterans of the recent Afghanistan and Iraq wars. The study was funded by the Department of Veterans Affairs. In 2010, a U.S. Army Pain Management Task Force made recommendations on the best approach to helping veterans with chronic pain, which included making support available and creating a spectrum of best evidence-based practices for the continuum of care. The ESCAPE studies were conducted in response to those recommendations.

For Matthias’s study, patients were put into randomized groups to either receive “usual care” or “a nurse-led intervention” that included pain medication management and 12 phone conversations. During the conversations nurses provided information on medication management, pain self-management instruction, and CBT. The most recent findings from the study, which explored the pain’s emotional toll on 26 patients and their perceptions of need for support, found that nurses in particular had a positive impact on the patients.

An INQRI funded study: SPEACS 2: Improving Patient Communication and Quality Outcomes in the ICU, examined the value of a nurse-generated and nurse-led innovation on ICU patient care outcomes, including pain symptom management. The study was led by Mary Beth Happ and Amber Barnato.

‘Teamwork Works’: Lessons Learned From the Front Line of Team-Based Care

This blog post first appeared on the Robert Wood Johnson Foundation Human Capital Blog.

As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.

The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.

The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.

“The data behind teamwork are very powerful,” said the report’s lead author, Theodore Long, MD, an Robert Wood Johnson Foundation Clinical Scholar and one of the first physician residents at the CoEPCE in Connecticut, “but having strong data doesn’t necessarily mean that teamwork is universally appreciated. There can be uncertainty about the meaning and purpose of teamwork. Seeing it in action has made a big impression on me, and on other trainees, giving us all a personal understanding of what teamwork is about and why it’s crucial to promote it on a wide scale in health care.”

In addition to increases in productivity and clinic access, the report describes clinical innovations developed by trainees, including a tool for communicating about patients as trainees change rotations, and a tool focused on safe transitions of care for high-risk patients.

Long pointed out that the PCMH in the CoEPCE setting is geared toward specific needs of veterans, of course, and “there are different challenges in different populations.” There are also “financial challenges to implementing patient-centered medical homes in general,” he said. “In the VA environment, we were fortunate to have a strong degree of buy-in from leadership up front”—something the report emphasizes as important to the success of PCMHs.

“Our experience lends support to expansion of the PCMH model across care environments,” Long added. “Teamwork works, and let’s focus on that.”

Read the report “Moving From Silos to Teamwork.”

Nursing Schools Seek to Improve Training on Veteran Care

Earlier this spring, we shared a story with all of you regarding an initiative led by First Lady, Michelle Obama, and Second Lady, Dr. Jill Biden focused on improving education for the treatment of PTSD and other mental illnesses affecting military families. The program, better known as the Joint Forces Initiative, continues to be expanded upon by nursing schools around the country. Kate Thayer, of the Chicago Tribune, detailed how Chicago area educational institutions have pledged to enhance training for maladies commonly seen in veterans.

To read more about the Chicago area initiatives, click here.