Development and Evaluation of a Pain Assessment Training Program for Long-Term Care Staff
Pain underassessment among older adults living in long-term care has been recognized as an ethical concern and an area requiring further attention. It is estimated that up to 80% of older adults in long-term care suffer from pain (Charlton, 2005). Several researchers have identified discrepancies in the quality of pain assessment and management provided to individuals with and without dementia. Inadequate pain education for staff at the formal training level and through continuing education programs is a possible factor contributing to this problem (Watt-Watson et al., 2004). This study was designed to address the dearth of education through the development and evaluation of a training video on pain assessment in long-term care. Nurses and care aides evaluated the training video, which focused on the use of self-report and observational pain assessment measures in long-term care for individuals with dementia. Individual difference variables, such as maladaptive beliefs about the nature of pain in old age and beliefs about reduced patient personhood in individuals with dementia, were examined to determine if these variables influenced participants’ evaluation of the video. Overall, evaluations of the video were positive. Nurses saw more value in the content than care aides. Pain assessment knowledge increased after watching the video, and this increase was maintained over one month. Individuals with stronger beliefs that pain is primarily “organic” in nature perceived more value in the video content. Differences in the pain beliefs held by nurses and care aides emerged, with nurses holding stronger beliefs about the “psychological” nature of pain. Focus group and individual interviews were conducted to understand video evaluations and to identify barriers or facilitators influencing the implementation of the practices. Despite seeing value in the video content, most participants indicated that the video did not result in changes to practices. Barriers identified as influencing the implementation of the practices included lack of time, overwhelming workload, and resistance to change. Identified facilitators to the implementation of practices included being provided with standardized and user-friendly tools, seeing the benefits prior to implementation, and continued management support throughout training and implementation. Implications and directions for future research are discussed.