Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Developing a Training for Certified Nursing Assistants to Recognize, Communicate, and Document Discomfort in Residents With Dementia

Rodriguez, Vanessa, MD; Reinhardt, Joann, P., PhD; Spinner, Ruth, MD, CMD; Blake, Sharon, RN

Journal of Hospice & Palliative Nursing: April 2018 - Volume 20 - Issue 2 - p 120–126
doi: 10.1097/NJH.0000000000000424
Symptom Management Series

Nursing home residents with advanced dementia experience significant symptom burden and may be unable to articulate their needs. Observational tools, such as the Pain Assessment in Advanced Dementia (PAINAD) scale, are available to evaluate changes in behavior that may signify discomfort or pain. Studies proposing a short and effective curriculum, primarily for certified nursing assistants (CNAs) on how to use and incorporate the PAINAD in daily patient care, are scarce. This performance improvement project involves the design and implementation of a training curriculum for CNAs for using the PAINAD and discusses barriers to be considered for further projects. Certified nursing assistant perceptions of their experience with the training and the use of the tool were also assessed with a brief evaluation. Seventy-three initial PAINAD forms were completed along with 52 follow-up PAINAD forms. A paired t test (N = 52) showed a significant decrease in the PAINAD scores from initial (mean, 6.06) to follow-up (mean, 1.85) (P < .001), suggesting a reduction of patient discomfort. The process of collecting and examining these data was meant to reinforce the identification and reduction of behavioral distress through the application of this tool. The training was perceived as effective and the tool as easy to use, indicating it can be incorporated into daily care responsibilities of CNAs.

Vanessa Rodriguez, MD, is assistant professor, Icahn School of Medicine at Mount Sinai Hospital, New York.

Joann P. Reinhardt, PhD, is director of research, The New Jewish Home, New York.

Ruth Spinner, MD, CMD, is associate medical director, The New Jewish Home, New York.

Sharon Blake, RN, is nurse manager, The New Jewish Home, New York.

Address correspondence to Vanessa Rodriguez, MD, Icahn School of Medicine at Mount Sinai Hospital, 1440 Madison Ave, New York, NY 10029 (

The authors have no conflicts of interest to disclose.

© 2018 by The Hospice and Palliative Nurses Association.