“I Don’t Need a Piece of Paper with Scores to Tell Me that Somebody’s in Pain and I Need to Do Something about it”. Nurses’ and Healthcare Assistants’ Perspectives on and Use of Pain Assessment Tools with People Dying with Advanced Dementia

Background: The use of pain assessment tools in patientswith advanced dementia is widely recommended in healthcarepolicy but their impact on clinical outcomes for dyingDownloaded from pmj.sagepub.com at University-Ulster at Belfast on June 23, 2016NP46 Palliative Medicinepatients is unclear. Healthcare assistants have a significantrole in caring for the dying but their contribution to painrecognition is unexplored.Aims: Explore nurses’ use of pain assessment tools inpatients dying with advanced dementia in hospice, secondaryand nursing home care settings and investigate the roleof healthcare assistants in pain assessment.Methods: Semi-structured, face-to-face interviews wereconducted with 24 nurses and 14 healthcare assistants. Thematicanalysis of verbatim transcripts was used to identifyemergent themes. Three researchers confirmed final themes.Results: The Abbey Pain Scale formed part of the painassessment protocol for nurses across care settings but mostreported challenges in using it with dying patients. Scoresbased on brief observation were perceived as a poor substitutefor knowledge of the patient, observation over time andcollateral history from healthcare assistants and family.Most nurses reported pain tools resulted in no measurableclinical outcomes for patients nearing death. Healthcareassistants described methods of recognising and reportingpain and their role in observing for treatment response andside effects. Nurses and healthcare assistants describedmixed experiences discussing pain with physicians.Conclusion: Nursing staff described challenges with integratingpain assessment tools in practice and preferredpatient knowledge, observation and collateral history fromfamily and healthcare assistants to assess pain. The contributionof healthcare assistants in recognizing and reportingpain and assessing treatment response is described.These findings have important implications for healthpolicy, nurse education and healthcare provision.Funding: HSC Research and Development Division, PublicHealth Agency, Northern Ireland.