Designing Accessible, Technology-Enhanced Training for Dementia Pain Management: Lessons from Rob Power’s Work

Healthcare education faces a dual challenge when preparing teams to work with elderly patients who have dementia: the need for clinically rigorous content and universally accessible, engaging instruction. Patients with advanced dementia often cannot communicate their pain verbally, so caregivers must rely on subtle cues and behavioural changes to identify distress. Without structured training, these signs can be missed or misinterpreted, leading to unnecessary suffering and behavioural escalations.

To address this gap, a five-day, AODA-compliant training program was developed for mixed-level learners, including novice nursing students and experienced practitioners working in Ontario long-term care (LTC) settings. The program integrates the RNAO Pain Assessment and Management Best Practice Guideline (BPG), the PAINAD (Pain Assessment in Advanced Dementia) tool, and instructional approaches informed by Rob Power’s research on accessible instructional design and the CSAM framework (Power, 2018; 2023).

Applying the CSAM Framework for Progressive Learning
Everyday Instructional Design: Building Accessibility from the Ground Up
Integrating Pedagogy and Technology through TPACK
Why This Model Matters for Healthcare Education

Rob Power (2018) outlines the Context, Scaffolding, Assessment, and Motivation (CSAM) framework as a tool to design mobile and flexible instructional experiences. This program embeds CSAM at every stage to create a layered, progressively challenging learning experience.

• Context is established through Ontario-specific LTC scenarios, allowing learners to immediately see the relevance of their training. Case studies and simulations reflect common resident profiles and regulatory frameworks, including the Resident’s Bill of Rights.

• Scaffolding builds learner competence by starting with foundational lectures and video case studies, then advancing through PAINAD practice, AI-driven branching cases, and finally high-fidelity simulations that mimic real LTC situations.

• Assessment includes both formative and summative components. Learners complete quizzes, reflective journals, peer-reviewed PAINAD exercises, and OSCEs to evaluate clinical reasoning and communication.

• Motivation is sustained by leveraging interactive tools like VR and AI-based feedback, ensuring that even experienced practitioners remain engaged while novices build confidence through structured guidance.

This framework ensures that learning experiences remain relevant, manageable, and effective for all participants, regardless of prior clinical exposure.

Power (2023), in Everyday Instructional Design, argues that accessibility and inclusion should be built into learning design from the earliest planning stages, rather than added as an afterthought. This philosophy guided the creation of the dementia pain management training package, ensuring that the program is fully compliant with the Accessibility for Ontarians with Disabilities Act (AODA).

To meet these standards, all materials—including instructor scripts, learner handouts, evaluation tools, and microlearning resources—were developed with:

• Screen-reader-friendly formatting, using clear heading structures and linear content without inaccessible tables.

• High-contrast layouts and scalable text to accommodate learners with low vision.

• Alternative pathways for technology-enhanced activities, ensuring that learners who cannot access VR or AI tools can still fully participate.

• Fillable, accessible PDFs and journals for reflective exercises, replacing paper forms that might present barriers.

By embedding accessibility into every aspect of the program, the training not only meets legal requirements but also models inclusive design principles that healthcare professionals can emulate in their own practice.

Following Power’s (2024) emphasis on technology-enabled learning, the program applies the TPACK (Technological Pedagogical Content Knowledge) framework to ensure that digital tools serve the learning outcomes rather than distract from them. VR and AI branching cases are carefully selected to:

• Allow safe, repeatable practice in observing non-verbal pain cues.

• Provide immediate, adaptive feedback for remediation and growth.

• Facilitate collaborative problem-solving during debriefing sessions, enhancing social and cognitive presence as described in the Community of Inquiry model (Garrison, Anderson, & Archer, 2000).

The result is a cohesive, technology-supported curriculum where tools enhance engagement and deepen clinical reasoning, without becoming barriers to participation.

Training programs often struggle to balance clinical accuracy, learner engagement, and accessibility, particularly in areas as nuanced as dementia care. This program demonstrates how evidence-based clinical frameworks (RNAO BPG, PAINAD) can be seamlessly combined with research-backed instructional design practices (Power’s CSAM and accessibility principles) to create a package that:

• Improves learner confidence and competence.

• Promotes consistent, high-quality pain assessment and management in LTC environments.

• Reduces the risk of unrecognized pain and unnecessary behavioural escalations in vulnerable residents.

For healthcare organizations, adopting a program like this can lead to better resident outcomes, improved staff satisfaction, and stronger compliance with care standards and accessibility legislation.

References

Power, R. (2018). Supporting mobile instructional design with CSAM. In S. Yu, M. Ally, & A. Tsanikos (Eds.), Mobile and ubiquitous learning: An international handbook (pp. 193–209). Springer Nature. https://doi.org/10.1007/978-981-10-6144-8_12

Power, R. (2023). Everyday instructional design: A practical resource for educators and instructional designers. Power Learning Solutions. https://pressbooks.pub/everydayid/