Development of a Brief Survey to Measure Nursing Home Residents' Perceptions of Pain Management

Persistent severe pain in nursing home residents remains an important public health problem. One major key to quality improvement efforts is the development of tools to assist in auditing and monitoring the quality of health care delivery to these patients. A qualitative synthesis of existing pain guidelines, and input from focus groups and an expert panel, were used to develop a 10-item instrument, the Resident Assessment of Pain Management (RAPM). The psychometric properties of the RAPM were examined in a sample of 107 (82% female, average age 85) cognitively intact nursing home residents living in six Rhode Island nursing homes. Reliability and internal consistency were evaluated with test-retest and Cronbach's alpha, respectively, and validity was examined against independent assessment of pain management by research nurses. After comparing the results of RAPM with the independent pain assessment and examining a frequency distribution and factor analysis, five of the 10 items were retained. Internal reliability of the final instrument was 0.55. The rate of reported concerns ranged from 8% stating that they were not receiving enough pain medication to 43% stating that pain interfered with their sleep. The median pain problem score (i.e., the count of the number of opportunities to improve) was 1, with 23% of residents reporting three or more concerns. Overall, RAPM was moderately correlated (Spearman correlation coefficient r = 0.43) with an independent expert nurse assessment of the quality of pain management. Evidence of construct validity for RAPM is based on the correlation of the pain problem score with nursing home resident satisfaction with pain management (r = 0.26), reported average pain intensity (r = 0.41), research nurse completion of the Minimum Data Set pain items (r = 0.52), and the quality of pain documentation in the medical record (r = 0.28). In conclusion, RAPM is a brief survey tool easily administered to nursing home residents that identifies important concerns with pain management. Although there is concern with the low internal consistency, RAPM demonstrates both criterion and construct validity that suggests its potential use in quality improvement efforts.