Original ArticlesElderly pain assessment and pain management knowledge of long-term care nurses*,**
Section snippets
Pain assessment
Pain assessment in nursing home residents is complex and challenging (Stein & Ferrell, 1996). According to Ferrell et al. (1990), the average elderly resident in a nursing home has 5 medical conditions and is prescribed 8 medications. The complexity of the geriatric nursing home patient makes pain assessment particularly challenging for long-term care nurses.
Measurement or assessment of pain is essential for effective management of pain. Melzack and Katz (1994) identified 4 reasons why pain
Research objective
The research objective was to determine the knowledge base of long-term care nurses regarding pain assessment and management in the elderly. An important part of any pain knowledge base is understanding the subjective experience of pain and, thus, believing and acting on patients' self-reports of pain despite lack of objective manifestations. Based on nurse responses to a questionnaire, the following research questions were addressed: (1) do nurses believe their patients' self-reports of pain;
Sample and data collection
This descriptive study used a convenience sampling of long-term care nurses from 6 rural counties in California. Long-term care facilities with at least 50 beds were asked by phone and letter to participate in the study by agreeing to distribute a questionnaire to their licensed nursing staff. The directors of nurses from 42 skilled nursing facilities agreed to participate and 879 questionnaires were mailed to the agencies. A reminder postcard was sent to participating nursing directors 2 weeks
Sample
Long-term care nurses returned 89 questionnaires. Three (0.3%) of the questionnaires were returned after data analysis was completed and were not included in the results. The sample consisted predominately of women (88.4%, n = 76). The mean age of all respondents was 46.8 years. Forty-six percent of the respondents (n = 40) were licensed vocational nurses, 28% (n = 24) were associate degree nurses, and 16% (n = 14) were bachelor-prepared nurses. The nurses' mean years of nursing experience was
Discussion
In this small sample of long-term care nurses, only 36% believed the smiling patient's report of pain and 56% believed the grimacing patient. According to McCaffery (1972), believing the patient is inherent in her definition of pain, “Pain is whatever the experiencing person says it is, existing whenever he says it does” (p. 8). Based on the responses to this survey, the majority of the respondents did not believe the patient's self-report of pain. In analyzing the cause of this disbelief, it
Implications
The results of this study are important to practice, however, there are limitations. First, the response rate to the mailed questionnaire was small (10%). Variables impacting this poor response rate are (1) the questionnaires were not delivered directly to the long-term care nurses, they were distributed by the directors in the facilities; (2) it is difficult to determine if all the questionnaires were distributed and in what manner they were given to the nurses; and (3) the nurses may have
Acknowledgements
The authors would like to acknowledge the following individuals: Stephen Fall, RN, BSN; Arlene Ison, RN, MS; Terry Mundy; and Danae Reneau, PhD.
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Cited by (22)
Nurses’ perceptions of pain management for older-patients in the Emergency Department: A qualitative study
2017, Patient Education and CounselingCitation Excerpt :Second, there are no biological markers or vital signs that correlate with the existence or intensity of pain, making nurses’ communication with patients central to pain assessment. Third, frequent discrepancies between patients’ verbal self-report of pain, and nurses’ observed nonverbal pain behavior in the same patient [27–29], can cause conflict in nurses trained to use the 0–10 Numeric Rating Scale (NRS) as the gold standard for pain assessment [6]. This underscores the vital need for understanding older-patient verbal and nonverbal communication during pain assessment [30–33].
Nurses' opinions of pain and the assessed need for pain medication for the elderly
2013, Pain Management NursingCitation Excerpt :Their study used the nurses’ own patients as subjects, and our results showed a similar pattern despite the use of scenarios. According to Katsma and Souza Hallow (2000), registered nurses with longer work experience were less inclined to agree with the findings than those nurses with less experience. In the present sample, the registered nurses with less experience often documented the patient’s self-reported NRS more often than the registered nurses with longer work experience.
How nursing personnel judge patients' pain
2007, European Journal of PainCitation Excerpt :Tait and Chibnall (2002) and Chuk (2002) also found that nurses’ judgments of patients’ pain were correlated with behavioral signs of discomfort. The lesser impact of the patient’s verbal complaint of pain is consistent with physicians’ and nurses’ practice of adjusting patients’ own pain ratings in accordance with other signs of pain (Chibnall et al., 1997; Katsma and Souza, 2000; Tait and Chibnall, 1997, 2002). Nurse’s aides gave lower pain ratings than did nurses.
Chronic pain in the elderly: A continuing education program for certified nursing assistants
2005, Geriatric NursingThe assessment and management of pain among older people in care homes: Current status and future directions
2003, International Journal of Nursing Studies
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Supported by a California State University, Stanislaus research, scholarship, and creative activity grant.
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Address correspondence and reprint requests to Diane Katsma, FNP, MN, RN, CSUS, Department of Nursing, 801 West Monte Vista, Turlock, CA 95382. E-mail: [email protected].