Pain Assessment Practices With Nursing Home Residents

Abstract

The purpose of this research was to describe the kinds of pain assessments nursing home staff use with nursing home residents and the characteristics and behaviors of residents that staff consider as they assess pain. Twenty-one focus groups were held in 12 nursing homes. Nurses and other nursing home staff attended the focus groups. Coding techniques consistent with ethnographic methodology were used for data analysis. Four themes identified an underlying uncertainty in assessing residents' pain, the staff relationship-centered approach to pain assessment, the resident cues that alert staff to pain, and residents' characteristics important to the nursing assessment. Composition of focus groups made a difference in participation of certified nursing assistants in focus group discussion. Urban and rural differences were noted across the focus groups. Research is needed to further refine pain assessment techniques specifically for nursing home settings.

Understanding Nurses’ Decisions to Treat Pain in Nursing Home Residents with Dementia

“…This practice limits the degree to which future interventions can be individualized. Consistent with findings from other qualitative studies (Clark, L., Jones, K., Pennington, K., 2004; Parke, B., 1998; Kovach, Griffie, Muchka, Noonan, & Weissman, 2000), personal knowledge and the use of an individualized approach for addressing behavioral changes was identified by some nurses as particularly important for identifying and responding to hypoactive behavioral changes. Decision support systems capable of accommodating and even recommending individualized assessment and treatment approaches may be particularly useful as nurses’ described very little documentation of results from any approaches.…”

Exploring healthcare assistants’ role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study

“…Many participants in this study reported difficulties and limitations in recognising pain in residents with whom they were unfamiliar. Previous research reported similar findings for nurses and certified nursing assistants (CNAs) [34]. Interestingly, in the present study, most HCAs sought to gain insight into residents’ past pain experiences and behaviours through liaison with patients’ families, friends and other key health and social care staff.…”

“…However, participants’ narratives revealed that most regularly performed informal relationship-centred pain assessments as an inherent part of care provision. Such assessments occur when knowledge and understanding of patients’ normative patterns of behaviour, physical and cognitive functioning and past reactions to pain are used to inform recognition and interpretation of behavioural and nonverbal pain cues [34]. Daily care provision brought HCAs in this study into close physical and social contact with residents, allowing them to develop a comprehensive knowledge and understanding of their care-recipients over time [19–22].…”

“…Future studies may wish to examine nurses’ and physicians’ experiences of and perspectives on communicating with HCAs, or explore communication dyads and triads among these staff in order to elucidate how information provided by HCAs is received, understood and processed by qualified health professionals. This is particularly important given that tensions in relationships between CNAs and RNs have been previously reported [34]. …”

Case report: A patient with dementia presenting with hip fracture in the emergency department – Challenges of acute pain assessment

“…Nurses were required to learn the meaning of the cues, because the impaired older adults could not verbalise what they wanted the nurses to know (Parke, 1998). A deeper level of knowing was achieved by some nurses who could interpret certain patients' non-verbal cues (Clark et al, 2004;Tutton and Seers, 2004).…”