1. WILDA Pain Assessment in a Long-Term Care Facility
Katelyn Victorsen
Minnesota School of Business Bachelor of Science in Nursing program
ASSESSMENT & IDENTIFICATION
ANALYSIS OF THE IDENTIFIED NEED
CONCLUSIONS
PROJECT DESIGN & IMPLEMENTATIONEVIDENCE BASED PRACTICE
REFERENCES
ABSTRACT
Augustana Care is an
assisted living facility in
Minneapolis, Minnesota that
provide transitional and long-
term care services. Areas of
need within this organization
were identified through
clinical experience and staff
interviews. Adequate
education and training of
staff are significant
challenges within this
organization. Primarily,
education regarding the
assessment and monitoring
of pain management in
transitional and long-term
care settings. Pain is a
common symptom within this
patient population; its’ effects
directly impact the quality of
life of residents.
Implementation of the
WILDA pain assessment
guide will enhance the
quality of pain assessments,
and consistency of
documentation throughout
the facility.
The WILDA approach to pain assessment ensures
that essential components within a pain assessment
are adressed, as outlined by the Joint Commission
on Accreditation of Healthcare Organizations (Opus
Communications, 2002). WILDA is an acronym that
stands for: words to describe pain, intensity,
location, duration, and alleviating and aggravating
factors (Fink, 2000). The gold standard of pain
assessment is the patient’s self-report (Fink, 2000).
In populations where communication is more
difficult, such as elderly patients or those with
language barriers, the Wong/Baker faces scale can
be utilized (Fink, 2000).
Education and training of staff will occur over one
week. Details and recommendations to the nurse
leader included:
•Staff education sessions to include:
• Use of the WILDA assessment model
• Appropriate documentation
• Impact of pain on resident’s quality of life
• Use of non-pharmacologic interventions
•Provide pocket guides and post fliers in nurse
stations with the WILDA assessment model
•Continue audits of documentation related to
administration of PRN pain medication
•Implement a charting template in the electronic
medical record system to reflect the WILDA pain
assessment model
Between 45-80% of residents in long term care
facilities experience untreated, moderate to severe
pain (Tse, Leung, & Ho, 2012). The adequacy of pain
assessment directly impacts the appropriateness of
patients’ pain management and plan of care
(Jablonski & Ersek, 2009). If pain assessment is non-
existent or inadequate, treatments and care provided
to the patient are sub-optimal, and recovery is
prolonged; which negatively affects healthcare staff
and resources. Individuals experiencing pain show
lower levels of happiness, life satisfaction, ability to
perform activities of daily living, and desire to
participate in social events, and an increase in
loneliness, depression, anxiety and suicidal thoughts
(Tse et al., 2012). Utilization of non-pharmacological
therapies are often less costly to organizations than
medication, and have shown to increase patients’
perception of control over their pain (Tse et al., 2012).
Providing education to nurses about pain assessment
and management results in increased knowledge,
skill and performance in this area (Ben Natan, Ataneli,
Admenko, & Har Noy, 2013).
Nursing leadership directly impacts organizational
structure and patient care through the facilitation
and implementation of policies driven to improve
the quality of patient care.
Collaboration with the Assistant Director of Nursing
and Nursing Supervisors to identify a specific area of
need within the facility.
Chart audits performed in long-term and transitional
care units revealed 20% of pain assessments failing
to address pain rating, use of non-pharmacological
alternative, and follow up assessment. Information
such as the location, words describing the pain, and
the patient’s perception were missing in the majority
of nurse documentation.
Augustana Care. (2013). Augustana Care Minneapolis Campus. Retrieved from
http://minneapoliscampus.org/
Ben Natan, M., Ataneli, M., Admenko, A., Har Noy, R. (2013). Nurse assessment of
residents’ pain in a long-term care facility. International Nursing Review, 60(2), 251-
257. doi:10.1111/inr.12006
Fink, R. (2000). Pain assessment: the cornerstone to optimal pain management. Baylor
University Medical Center Proceedings, 13(3), 236-239. Retrieved from
www.ncbi.nlm.nih.gov/pmc/articles/PMC1317046/
Huber, D. (2014). Leadership and nursing care management. Available from
https://online.vitalsource.com/#/books/9781455740710/pages/113156932
Jablonski, A., & Ersek, M. (2009). Nursing home staff adherence to evidence-based pain
management practices. Journal of Gerontological Nursing, 35(7), 28-34.
doi:10.3928/00989134-20090701-02
Opus Communications. (2002). Pain points in long-term care: assessing, coding and
treating residents’ pain. Retrieved from http://www.hcpro.com/content/31650.pdf
Tse, M., Leung, R., & Ho, S. (2012). Pain and psychological well-being of older persons
living in nursing homes: an exploratory study in planning patient-centered
intervention. Journal of Advanced Nutrition, 68(2), 312-321. doi: 10.1111/j.1365-
2648.2011.05738.x
GOALS & OBJECTIVES
Increase the frequency and number of charts that have documented pain assessments which contain the components of WILDA
Increase the level of staff knowledge related to pain and the use of non-pharmacological methods to manage pain