An Intervention for Improving Pain Assessment Skills

描述（由申请人提供）：评估和管理养老院居民的疼痛往往是复杂的居民认知障碍和缺乏足够的技能培训之间的直接护理人员。虽然测量任何人群疼痛的金标准被广泛认为是自我报告，但大多数养老院居民都经历了某种程度的认知障碍，因此应用这个金标准是有问题的。疼痛的观察措施是一个重要的推论，自我报告认知受损的养老院居民和代表的主要手段，通过它的疼痛非沟通的居民可以进行评估。拟议的可行性研究（R 03）将通过向注册护士助理（CNA）和执业护士（LPN）提供培训和沟通干预，解决直接护理人员缺乏足够技能培训的问题。干预措施将包括教学和实践培训，以及工作人员激励制度，以鼓励直接护理工作人员努力在日常工作中实施干预措施。治疗实施措施还将用于评估培训的充分性、直接护理人员对培训的理解程度以及日常环境中使用干预措施的一致性。本研究的具体目的如下：（1）评估疼痛评估和沟通训练（PACT）干预的可行性和有效性，以改善不同程度的认知障碍的养老院居民的行为疼痛线索的检测;（2）评估PACT干预的可行性和有效性，以促进CNA和LPN之间关于居民疼痛的沟通。次要目的是探索PACT干预对镇痛药物使用的影响，这是养老院最常见的疼痛管理策略。这个项目试图将Burgio及其同事的员工培训和激励系统扩展到一个新的领域（疼痛评估），使用跨学科团队（Ann Horgas和A。林恩雪）与疼痛评估和疗养院研究的专业知识。

DESCRIPTION (provided by applicant): 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.