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Implementation of a Nursing Home Quality Improvement Project to Reduce Resident Pain: A Qualitative Case Study

Abrahamson, Kathleen PhD, RN; DeCrane, Susan PhD, RN, ACNS-BC; Mueller, Christine PhD, RN, FAAN; Davila, Heather Wood MPA; Arling, Greg PhD

doi: 10.1097/NCQ.0000000000000099

This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.

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Purdue University School of Nursing, West Lafayette, Indiana (Drs Abrahamson, DeCrane, and Arling); University of Minnesota School of Nursing, Minneapolis (Dr Mueller and Ms Davila).

Correspondence: Kathleen Abrahamson, PhD, RN, Purdue University School of Nursing, 502 North University St, West Lafayette, Indiana 47907 (

This project was supported by grant number R18HS018464 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: September 27, 2014

Published ahead of print: November 18, 2014

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