Nurses' Pain Management Competency in Nursing Home Residents With Dementia

Nursing home (NH) residents with dementia experience undertreated pain. Nurses have inconsistent pain management practices in dementia, and limited studies have examined nurses' pain management competencies using observations.

Thus, this study examined NH nurses' pain management competency in dementia using the Pain Competency Evaluation in Dementia (PACED) scale.

This descriptive study recruited NH Licensed practical nurses (LPN) and registered nurses (RN) in Pennsylvania. Each nurse performed pain management on two randomly assigned virtual simulation cases that emulated NH residents with varying severity and type of dementia and pain. Trained raters rated nurses' pain management competency using the PACED scale. Descriptive statistics, t-test, correlation, and multiple linear regression were performed.

Eighty-five nurses completed the study (mean age = 31 years; 68.2% female). RNs (n = 31) had a significantly higher level of education than LPNs (n = 54; p < .001). Nurses' overall competency was 69.8%, with pain treatment being the least competent domain. Nurses who were older (r = -0.16, p = .037), with more pain management (r = -0.16, p = .036) and clinical experience (r = -0.16, p = .037) had worse pain management competency. Notably, LPNs (70.7%) performed slightly better than RNs (68.3%; p = .047). Multiple linear regression showed that RNs had significantly lower pain management competency than LPNs (β = -3.45, p < .01) after controlling for age, education level, and pain management experience.

NH nurses' pain management competency needs improvement, specifically in pain treatment areas. Continuing education is needed for nurses who are older and have more experience. More research is needed to replicate this result in different settings, on a larger scale, and in other healthcare roles.