Nursing assistants (NAs) should report subjective and objective signs of clients’ pain to the nurse for further assessment. After assessing the client, the nurse may choose to administer medication with provider order and/or provide other nonpharmacological treatments. The nurse may delegate tasks to the NA such as the application of over-the-counter topical medications, ice, or heat. The NA may also assist with repositioning and massage.

Topical Medications

Topical medications are applied to the skin and are typically over-the-counter (OTC) medications, meaning no prescription is needed to obtain them. Topical analgesics may come as a cream, gel, spray, or patch. An example of a topical analgesic is “Icy-Hot” cream.

There are also other types of topical medications an NA may be delegated to apply, such as antifungal medications (e.g., Nystatin in powder or cream form) or barrier creams to reduce the risk of skin breakdown or assist in healing of opened areas. When applying topical medications, it is important to use diligent infection control measures to prevent the medication from becoming contaminated. See the “Topical Medications” Skills Checklist for steps on how to properly apply topical medications.

Ice and Heat Applications

Applying ice and heat can also be delegated from the registered nurse to the NA. To safely apply ice or heat, first place a thin barrier on the skin, such as a towel or washcloth, to avoid damaging the tissue. Ice may be placed in a plastic bag, or cold therapy may be available in a disposable package. In some situations, a reusable gel pack may be placed in the freezer between uses.

Heat applications may include using an electrical heating pad or a reusable microwavable pack. The NA should discuss the setting for the heating pad or the time the pack should be warmed in the microwave with the delegating nurse. The NA should feel the pack’s temperature before placing it on the resident.

Ice or heat applications are typically left on for 15-20 minutes. If the resident is unable to communicate, the NA should lift the pack, check the skin temperature, and look for any redness every five minutes to prevent damage to the skin. If the ice or heat applications are not disposable, ensure they are sanitized according to agency policy before providing them to the resident.

Positioning and Massage

Pain may arise when a client remains in one position too long or is placed in a position that causes pressure on a sensitive area such as a joint, tendon, or muscle. Residents who are unable to move on their own should be repositioned at least every two hours, and some may require more frequent repositioning due to pain or skin issues. Clients can be maintained in a position of comfort by placing pillows to prevent discomfort between joints and bony prominences or to support the body and prevent them from rolling out of the position. For information on proper positioning, see Chapter 8.

Massage provides relaxation by reducing soreness and tension in muscles. It also increases circulation by promoting blood flow. However, a massage should never be provided over red or swollen areas. A massage given to a resident for pain relief should last about 3-5 minutes. For specifics on giving a massage, see the 5.17 “Back Rub” Skills Checklist in Chapter 5.

Other Comfort Measures

In addition to the previously described interventions to reduce pain, NAs can further help reduce clients’ pain by offering distractions, such as talking with the resident about pleasant or interesting things that the resident enjoys, looking at photos or magazines, playing board games, or listening to music. Deep breathing, mindfulness techniques, aromatherapy, and light range of motion (ROM) activities can also help calm the resident and ease their pain. Read more about providing ROM activities in Chapter 9. See Figure 6.9^[1] for images of nonpharmacological treatments for pain.