Emergency nurses' evaluation of observational pain assessment tools for older people with cognitive impairment.
OBJECTIVE
To explore emergency nurses' perceptions of the feasibility and utility of Pain Assessment in Advanced Dementia tool in people over 65 with cognitive impairment. The Pain Assessment in Advanced Dementia tool was then compared with The Abbey Pain Scale, Doloplus-2 and PACSLAC. The objective was to determine which observational pain assessment tool was the most appropriate for the emergency department context and the cognitively impaired older person.


BACKGROUND
The number of older people with cognitive impairment conditions, such as dementia, presenting to the emergency department is increasing. Approximately 28% of people over 65 years who present will have cognitive impairment. Older people with cognitive impairment often receive suboptimal pain management in the ED. There is limited evidence of the use and/or appropriateness of dementia-specific pain observation assessment tools in the ED.


METHODS
This was a multicentre exploratory qualitative study, which was conducted within a constructivist paradigm.


METHODS
Focus group interviews were conducted with nurses across three hospital emergency departments. Data were subject to thematic analysis.


RESULTS
Six focus groups were conducted with 36 nurses over a 12-week period. Four themes emerged from the analysis: 1) cognitive impairment is a barrier to pain management; 2) PAINAD gives structure to pain assessment; 3) PAINAD assists to convey pain intensity; and 4) selection of an appropriate observational pain assessment tool.


CONCLUSIONS
This study identified that emergency nurses find it challenging to detect, assess and manage pain in cognitively impaired people. While the use of the PAINAD helped to address these challenges compared to other tools, nurses also identified the important role that family and carers can play in pain assessment and management for older people with cognitive impairment.


CONCLUSIONS
This study has generated new knowledge that has broad application across clinical settings, which can assist to transform pain management practice and reduce human suffering. The use of an observational pain assessment tool can provide for greater practice consistency for patients with communication difficulties. Pain management for older people with cognitive impairment is best achieved by the use an appropriate observational pain assessment tool and with a multidisciplinary approach that includes the person and their family/carer.
Northern Sydney Local Health District, Faculty of Health University of Technology, Sydney, Australia.
Margaret
M
Fry
School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia.
Glenn
G
Arendts
Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia.
Lynn
L
Chenoweth
D059787:Acute Pain / Q000451:nursing; D000368:Aged; D060825:Cognitive Dysfunction / Q000150:complications*; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009730:Nursing Assessment / Q000592:standards*; D059408:Pain Management / Q000379:methods* / Q000592:standards*; D010147:Pain Measurement
dementia; emergency department; older care; pain assessment; qualitative study