caregiver with resident

Expanding the use of best care practices for nursing assistants, who are on the front lines of providing direct nursing home care, may help improve the early detection of pain and pain management for older nursing home residents, a new study has found.

An international research team led by Yuting Song, PhD, who serves on the nursing faculty of the University of Alberta in Canada, conducted an analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. They studied administrative data for 10,093 residents and survey data for 3,457 nursing assistants at the care unit level in those nursing homes.

The researchers found that residents on care units with higher levels of best practice use among nursing assistants had 32% higher odds of reporting mild pain compared with residents on care units with lower levels of best practice use among nursing assistants.

Researchers hypothesized the reason why residents in units with nursing assistants with higher levels of best practice reported higher rates of mild pain might be because those nursing assistants were more likely to recognize early signals of possible pain and report them to licensed clinicians. They say the findings suggest the need for increased training and education for nursing assistants in best practices on pain recognition and reporting, which would then lead to more comprehensive assessment and pain management by licensed clinicians.

“Nursing assistants are rarely involved in guideline development and quality improvement programs or offered continuing education about pain management,” the study’s authors wrote. “Current strategies to address the challenge of pain management have been heavily focused on developing and implementing more precise pain assessment tools by licensed clinicians or on better collaboration across licensed clinician groups.

“Our findings suggest that these strategies, although important, still miss a critical and necessary component of providing the best possible pain care for residents: of the position of nursing assistants,” they continued. “Their important role at the forefront of pain detection should be acknowledged and their capacity better optimized, for example, through more attention to this pivotal workforce with respect to both basic and ongoing education.”

The study appeared in the Aug. 11 issue of the Journal of the American Geriatrics Society.