Pain assessment and cognitive impairment: part 2.

AIM: To evaluate the use of a tool for pain assessment in cognitively impaired adults. METHOD: A multi-dimensional tool was implemented and evaluated in relation to use rate; frequency of specific pain indicators; staff perceptions of advantages and disadvantages of pain assessment in this patient group; and factors that aid or impede this assessment. RESULTS: Some indicators are more likely to be observed and documented. There was a lack of compliance by nurses in making and recording pain observations on every shift. Observations that were recorded occurred most frequently on the morning shift. Factors that were identified as assisting in the assessment of pain related to nursing staff having the appropriate knowledge and skills gained through experience of caring for cognitively impaired adults. CONCLUSION: Pain assessment for cognitively impaired adults should continue to be based on a combination of physiological and behavioural indicators. Assessment should be conducted as indicated by the nurse's clinical judgement and follow-up pain assessment should be undertaken after implementation of appropriate comfort measures.

Pain assessment and cognitive impairment: part 1.

People with cognitive impairment are often unable to inform others of their pain. Nurses need to be able to assess pain in cognitively impaired adults so that appropriate pain management strategies can be implemented. Evidence suggests that certain verbal, facial and behavioural signs may be indicative of pain. This article describes the process undertaken in developing a specific tool to facilitate pain assessment. The tool was developed after extensive analysis of pain research literature, input from experienced nurses and critical review by a panel of experts in dementia care. The research study will be published in next week's Nursing Standard.