Journal of Gerontological Nursing

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CNE Article 

Use of Pain-Behavioral Assessment Tools in the Nursing Home: Expert Consensus Recommendations for Practice

Keela Herr, PhD, RN, FAAN, AGSF; Heide Bursch, MS, RN; Mary Ersek, PhD, RN, FAAN; Lois L. Miller, PhD, RN, FGSA, FAAN; Kristen Swafford, MS, RN, CNS

Abstract

Many tools are available for the assessment of pain in nonverbal older adults; however, guidelines are needed to help clinicians select the proper instrument for use in the nursing home setting. This article describes a project to identify clinically useful pain-behavioral assessment tools that have undergone sufficient psychometric testing. Phase 1 of the project included a comprehensive review and critique of currently available tools. In Phase 2, the National Nursing Home Pain Collaborative developed criteria to evaluate an updated list of tools and then rated 14 tools using these criteria. As a result, two tools were recommended as most representative of current state of the science, most clinically relevant, and practically applicable to integrate into everyday practice and support adherence to regulatory guidelines. Such recommendations for selection of best-available pain assessment tools are a cornerstone for clinicians in regard to managing pain of nursing home residents who, due to dementia, are unable to self-report pain.

Abstract

Many tools are available for the assessment of pain in nonverbal older adults; however, guidelines are needed to help clinicians select the proper instrument for use in the nursing home setting. This article describes a project to identify clinically useful pain-behavioral assessment tools that have undergone sufficient psychometric testing. Phase 1 of the project included a comprehensive review and critique of currently available tools. In Phase 2, the National Nursing Home Pain Collaborative developed criteria to evaluate an updated list of tools and then rated 14 tools using these criteria. As a result, two tools were recommended as most representative of current state of the science, most clinically relevant, and practically applicable to integrate into everyday practice and support adherence to regulatory guidelines. Such recommendations for selection of best-available pain assessment tools are a cornerstone for clinicians in regard to managing pain of nursing home residents who, due to dementia, are unable to self-report pain.

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Authors

Dr. Herr is Professor and Chair, Adult and Gerontological Area, and Ms. Bursch is a John A. Hartford Predoctoral Scholar, The University of Iowa College of Nursing, Iowa City, Iowa; Dr. Ersek is Associate Director, John A. Hartford Center of Geriatric Nursing Excellence, and Associate Professor, Center for Integrative Science in Aging, The University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; and Dr. Miller is Professor, and Ms. Swafford is a John A. Hartford Predoctoral Scholar, John A. Hartford Center of Geriatric Nursing Excellence, Oregon Health & Science University, Portland, Oregon.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. This project was supported by The MayDay Fund.

The authors thank Brianne Black for efforts in the original critique process, other members of the Collaborative (Deb Bakerjian, Suzanne Prevost, and Pao Feng Tsai), and the expert consultants (Ann Horgas, Christine Kovach, Janet Specht, and Joan Teno).

Address correspondence to Keela Herr, PhD, RN, FAAN, AGSF, Professor and Chair, Adult and Gerontological Area, The University of Iowa College of Nursing, 50 Newton Road, Iowa City, Iowa 52242; e-mail: keela-herr@uiowa.edu.

Received: April 7, 2009
Accepted: October 5, 2009
Posted: January 22, 2010

10.3928/00989134-20100108-04

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