Assessing pain in older adults with dementia

As dementia progresses older adults may lose the ability to communicate their pain experiences to healthcare providers, relying on the ability of the provider to infer their pain (Kelley, Siegler, & Reid, 2008; Pesonen et al., 2009). In the long-term care setting, the licensed nurse and certified nurse aide provide direct patient care to these residents and may be more likely to identify nonverbal behaviors that may indicate pain (Nygaard & Jarland, 2006; Pautex, Herrmann, Michon, Giannakopoulos, & Gold, 2007). The Conceptual Model for Assessing Pain in Nonverbal Persons with Dementia highlights provider, patient, and method-related factors that can hinder the process of inferring pain in nonverbal persons with dementia. The purpose of this dissertation is to explore the impact of these potential barriers on pain assessment/screening. Each chapter of this dissertation explores provider, patient, or method-related factors that impair the judgment of pain in others, either through an integrative review of the literature or by secondary analysis of a data set that was originally collected for the psychometric evaluation of the Non-communicative Patient's Pain Assessment Instrument. Statistical analysis was completed using SPSS version 21.0. Results indicate that nurse-related factors are well supported in the literature as barriers to pain assessment and can impair the nurses' pain assessment decisions. Ethnic differences in the expression of the nonverbal pain behavior "pain words," signify the role of patient-related factors on the pain assessment process. Lastly, examination of method-related factors support the benefits of training staff to use nonverbal pain assessment tools, with those staff members who were trained having greater accuracy in pain assessment when compared to untrained raters. In closing, this dissertation has implications for nursing science, education, policy, and practice and serves as a valuable contribution to the current literature.