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behaviors, dementia, discomfort, long-term care, pain



  1. Rodriguez, Vanessa MD
  2. Reinhardt, Joann P. PhD
  3. Spinner, Ruth MD, CMD
  4. Blake, Sharon RN


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.