Accuracy and bias of licensed practical nurse and nursing assistant ratings of nursing home residents' pain.

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Abstract
Background. This study evaluated the accuracy of licensed practical nurses' (LPN) and nursing assistants' (NA) Minimum Data Set (MDS) pain ratings of nursing home residents and evaluated the bias in pain ratings associated with residents' race, gender, mental status, function, depression, or disruptive behavior. Methods. Data were obtained on the same day directly from residents, LPNs, and NAs by trained interviewers in two safety-net nursing homes. A total of 252 residents were included in this study: 79% were Black, and 60% were men. MDS items J2a and J2b evaluated pain frequency and pain intensity during the last 7 days (weekly pain frequency and weekly pain intensity). A parallel question evaluated pain intensity on the day of the interview (daily pain intensity). MDS data were obtained for the MDS Cognition Scale, the MDS Activities of Daily Living-Long Form Scale, the MDS Depression Rating Scale, and the MDS Disruptive Behavior Scale. Results. Kappa coefficients documented fair to good resident–LPN (K = .70, .56, and .50) and resident–NA (K = .72, .58, and .60) agreement for weekly pain frequency, weekly pain intensity, and daily pain intensity ratings. LPNs and NAs underestimated residents' weekly pain frequency (p < .001 for LPNs, and p < .001 for NAs), weekly pain intensity (p < .001 for LPNs, and p < .001 for NAs), and daily pain intensity (p < .001 for LPNs, and p = .002 for NAs). LPNs underestimated weekly and daily pain intensity more than NAs did (p = .016 for weekly pain intensity, and p = .035 for daily pain intensity). LPN and NA pain ratings were not biased by resident race, gender, mental status, function, depression, or disruptive behavior. Conclusions. Results documented that (i) LPNs and NAs underestimated residents' pain frequency and pain intensity, (ii) NAs were more accurate than LPNs for pain intensity, and (iii) resident characteristics did not bias LPN or NA pain ratings.