Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions.

AIMS AND OBJECTIVES To investigate the feasibility of regular pain assessment using an observational scale in nursing home residents with dementia and; determine interventions applied after diagnosing possible pain. BACKGROUND Pain occurs regularly among nursing home residents with dementia and is frequently undertreated. Over the last decade a variety of observational scales have been developed to assess pain in elderly people with dementia. One of these observational scales is pain assessment using an observational scale. There are indications that the regular use of pain assessments scales can contribute to an adequate diagnosis of pain and therefore would improve pain treatment. DESIGN In this exploratory descriptive observational study regular pain assessment using an observational scale as an intervention was evaluated. METHODS Data were collected during a 6-week period (August-September 2009) where pain was measured twice a week among 22 residents of a psychogeriatric nursing home ward, using the pain assessment using an observational scale scale. Interventions undertaken as a result of the pain score were recorded on a datasheet. After the third and sixth week the implementation of pain assessment was evaluated with staff members using interviews. RESULTS In total, 264 pain assessments were conducted using the pain assessment using an observational scale. Of all scheduled standardized assessments, 90% were completed. Sixty out of 264 assessment resulted in a pain score. The completed datasheets (n = 39), including information on the selected intervention and the reason for selecting a specific intervention, showed that a pain score (n = 17) did not often result in any intervention. The majority of interventions undertaken consisted of a non-pharmacological approach (n = 19). CONCLUSION This study demonstrates that although there was a high compliance rate, pain relieving interventions were not frequently applied. Interventions undertaken after pain assessment were mainly non-pharmacological. RELEVANCE TO CLINICAL PRACTICE Providing nursing staff with adequate pain assessment tools alone is not sufficient to change the pain management practices.