Assessing and managing pain among nursing home residents is often complicated by resident cognitive impairment and the lack of adequate skill training among direct-care staff. Although the gold standard for measuring pain in any population is widely recognized as self-report, most nursing home residents experience some degree of cognitive impairment such that applying this gold standard is problematic. Observational measures of pain are an important corollary to self-report among cognitively impaired nursing home residents and represent the primary means by which the pain of non-communicative residents can be assessed. The proposed feasibility study (R03) will address the lack of adequate skill training among direct care staff by providing a training and communication intervention to Certified Nursing Assistants (CNAs) and Licensed Practical Nurses (LPNs). The intervention will include didactic and hands-on training, as well as a staff motivational system to encourage direct-care staff in their efforts to implement the intervention in their day-to-day routine. Treatment implementation measures will also be used to assess the adequacy of training, the degree to which direct-care staff understood the training, and the consistency of intervention use in the everyday environment.
The specific aims of this study are as follows: (1) to assess the feasibility and efficacy of a Pain Assessment and Communication Training (PACT) intervention for improving the detection of behavioral pain cues among nursing home residents with varying degrees of cognitive impairment; and (2) to assess the feasibility and efficacy of the PACT intervention for facilitating communication among CNAs and LPNs about resident pain. A secondary aim is to explore the impact of the PACT intervention on analgesic medication use, the most common pain management strategy used in nursing homes. This project attempts to extend Burgio and colleagues' staff training and motivational systems to a new area (pain assessment), using an interdisciplinary team (Drs. Ann Horgas and A. Lynn Snow) with expertise in pain assessment and nursing home research.
