Development, evaluation, and implementation of an online pain assessment training program for staff in rural long-term care facilities: a case series approach

Abstract

Background Pain among long-term care (LTC) residents, and especially residents with dementia, is often underassessed and this underassessment has been attributed, in part, to gaps in front-line staff education. Furthermore, although evidence-based clinical guidelines for pain assessment in LTC are available, pain assessment protocols are often inconsistently implemented and, when they are implemented, it is usually within urban LTC facilities located in large metropolitan centers. Implementation science methodologies are needed so that changes in pain assessment practices can be integrated in rural facilities. Thus, our purpose was to evaluate an online pain assessment training program and implement a standardized pain assessment protocol in rural LTC environments. Methods During the baseline and implementation periods, we obtained facility-wide pain-related quality indicators from seven rural LTC homes. Prior to implementing the protocol, front-line staff completed the online training program. Front-line staff also completed a set of self-report questionnaires and semi-structured interviews prior to and following completion of the online training program. Results Results indicated that knowledge about pain assessment significantly increased following completion of the online training program. Implementation of the standardized protocol resulted in more frequent pain assessments on admission and on a weekly basis, although improvements in the timeliness of follow-up assessments for those identified as having moderate to severe pain were not as consistent. Directed content analysis of semi-structured interviews revealed that the online training program and standardized protocol were well-received despite a few barriers to effective implementation. Conclusions In conclusion, we demonstrated the feasibility of the remote delivery of an online training program and implementation of a standardized protocol to address the underassessment of pain in rural LTC facilities.

Initiatives Targeting Health Care Professionals

“…KT-I programs met HCP needs with suitable resources and suggestions to practice 16,79 . Barriers to change were high staff turnover, limited administrative support, scheduling conflicts, heavy workload, and staff perceptions 86,88–91 …”

“…Inadequate staff management and mismanagement of resource materials also hindered program fidelity 89 . Technological barriers to fidelity were identified in web-delivered initiatives 82,88 …”

“…16,79 Barriers to change were high staff turnover, limited administrative support, scheduling conflicts, heavy workload, and staff perceptions. 86,[88][89][90][91] Adoption Adoption was considered as knowledge users' uptake of initiative practices and program tools after education. 25 Adoption was reflected through the uptake of evidencebased suggestions into practice.…”

“…89 Technological barriers to fidelity were identified in web-delivered initiatives. 82,88 Sustainability Sustainability is the extent to which an implemented program is maintained in a service setting. 25 Overall, sustainability was considered in 5 KT-I initiatives.…”

Dementia Education for Workforce Excellence: Evaluation of a Novel Bichronous Approach

“…Asynchronous workbooks provided participants with access to dementia education at any time and place. Convenience and flexibility are benefits of technology-enabled dementia education [ 32 , 33 , 34 ]; however, asynchronous learning may result in feelings of isolation [ 35 ]. DEWE implemented various active learning strategies to compensate the effects of learner isolation.…”