Pain Assessment Documentation Research Articles

Nurses' Assessment of Pain in Saudi Neonatal Intensive Care Units

BackgroundResearch reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses’ pain assessment practices in Saudi Arabia. AimTo assess the nurses’ pain assessment practices in the NICU in Saudi Arabia. DesignThis study used a descriptive cross-sectional design. SettingsResearch was conducted using an online survey. Participants/SubjectsThis study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. MethodsData on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. ResultsThe majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). ConclusionsNICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.

Post-operative pain assessment, management compliance with WHO guidelines and its barriers in hospitals of West Shoa zone, central of Ethiopia, 2021.

Post-Surgical pain should be consistently assessed and documented as vital signs as well as has to be better communicated and adequately managed accordingly. However, there is a limited study regarding pain assessment and management documentation in Ethiopia. This study aimed to determine pain assessment documentation, pain management compliance with WHO guidelines, and its barrier. A cross-sectional retrospective study design mixed with quantitative and qualitative study types was employed. Three hundred sixty-five Patient cards were reviewed from four public hospitals in the West Shoa zone; Central Ethiopia, as well as four key informants groups, were interviewed. WHO guideline was used to review the patient card and a semi-structured questionnaire was used to interview the key informants. Descriptive statistics were used to describe the socio-demographic characteristics; and pain characteristics, and texts, tables, and graphs were used to present the results. Data were analyzed using SPSS-20 and Data from the key informants was thematically analyzed. From the total of 365 patient cards reviewed, it was observed that only for 189(51.8%) cases pain assessment was done within 48h after Surgery. Out of the patient who had got pain assessment within 48h the location of pain was explained in 93(25.5%) cases, pain quality was assessed in 128(35.1%) cases, and pain intensity tool was used in 169(46.3%) cases. Weak opioid (tramadol) is the most commonly described followed by Non-steroid anti-inflammatory drugs to relieve pain after surgery. Only 16(4.4%), patient card side effect was documented and the most reported side effect was Nausea and vomiting (13(3.6%). Lack of regular clinical audits for pain management, lack of technical updates on pain assessment and management as well as knowledge and attitude of health professionals toward pain management were the major barrier to effective pain management. and recommendation: The pain assessment and documentation in the present study were slightly lower than in previous studies. There was a lack of clinical audit for pain management, a lack of refreshment/technical updates on pain assessment and management, and a lack of regulation of procurement for anti-pain medications. We recommend providing regular technical updates for health professionals and conducting a frequent clinical audit on pain management as well as a designing mechanism for easy availability of anti-paint medications, particularly strong opioids.

Practice of Postoperative Pain Management in Under-Five Children in A Tertiary Hospital: A Prospective Crossectional Study.

Despite advancements in pain management, children have remained undertreated for postoperative pain. Data regarding the practice of post-operative pain management in paediatric patients remains less available in the developing world. This study was aimed at evaluating practice of postoperative pain management in under five children. A prospective cross sectional one-year study was conducted on all paediatric patients who underwent major paediatric surgical procedures from February 1, 2020 to January31, 2021, at a tertiary hospital in Addis Ababa, Ethiopia. A single type of analgesic medication was used in 67.1% patients. Analgesic medications were administered on standing base only in 64.4% of patients. Patients' charts had no documentation of pain assessment both in the neonatal intensive care units and wards.32.89 % of assessed patients had moderate to severe pain record. Significant number of patients suffer from postoperative pain because of absence of proper pain assessment and inadequate administration of analgesic medication.

Enhancing the use of pain assessment at emergency department: a best practice implementation project.

The main aim of the best practice implementation project was to enhance the use of pain assessment and the compliance with evidence-based criteria regarding pain assessment among incoming patients to emergency department. Adequate approaches to pain assessment and documentation have been demonstrated beneficial for emergency department patients. Evidence-based recommendations establish a focus on education about the implications for evaluating and recording pain in order to improve outcome strategies and quality of care. The implementation project was undertaken in the emergency department following JBI Implementation framework in order to seek whether pain assessment was taken and registered as per protocols. Random selection for 100 anonymized emergency department admission episodes, which had to meet the specified inclusion criteria, was carried out. The baseline audit showed low compliance in criterion 3 (C3) 'Pain was documented in each assessment' (6%), C4 'Pain was assessed after treatment' (9%) and C5 'Pain was assessed prior to discharge' (10%). In the follow-up audit, noticeable improvement was shown for four of the criteria; C3 (14%), C4 (22%) and for C5 (41%). C1 'Pain was assessed in a timely manner' improved from 81% up to 95%. C2 'Use of a validated scoring tool' had a compliance of 100% as the hospital's assessing system default has NRS-11 scale set up. We performed an audit of pain assessment documentation. Enhancing the use of pain assessment among emergency department nurses by means of specific training emphasizing the importance of documentation showed a positive impact on practice. Follow-up audit results justify the continuity of the implemented strategies.

Documentation for Assessing Pain in Postoperative Pain Management Pre- and Post-intervention

PurposeAlthough Norwegian law requires the documentation of patients’ care processes, including pain assessment, research has shown that the quality of postoperative documentation for assessing pain does not meet an acceptable standard and requires improvement. The purpose of this study was to investigate whether an educational intervention can increase nurses’ documentation of postoperative pain assessments, alter patients’ opioid consumption, and ensure that patients have at least one documented Numeric Rating Scale (NRS) ≤3 at rest before being discharged. A secondary aim was to investigate whether the nurses’ education and experience influenced their pain assessments. DesignAn observational study with a pre-post intervention. MethodsThe study following a pre-post design involved documenting pain assessments of 304 patients undergoing cancer surgeries in a postoperative unit at the Norwegian Radium Hospital, Oslo University Hospital. In an educational intervention, two 45-minutes teaching sessions within two weeks, addressed validated pain assessment tools and the documentation of pain assessment. Descriptive frequency analysis and partial correlation with Pearson's r - value were used, with P < .05 indicating significance. FindingsPostintervention, pain assessments in general increased significantly from a mean of two times per patient to three times. Overall, the use of assessment tool Critical -Care Pain Observation Tool increased from 6.1% to 25.8%, opioid consumption increased in mean from 3.34 to 4.79 in milligram and the documentation at discharge increased from 81.4% to 91.4%. The documentation of nurses with more than 10 years’ experience in the unit especially improved from 17.5% to 31.7%. ConclusionsEducational intervention and reminders about basic systematic pain assessment and the evaluation of pain measures improved nurses’ documentation of postoperative pain management and documentation at discharge. The findings underscore the importance of regularly ensuring the quality of patients’ treatment by systematically documenting nurses’ clinical tasks and the outcome of patients’ care.

Nurses' improved provision of infants’ procedural pain assessment and management with non-pharmacological interventions following a training program in Jordan

This study aims to compare the frequency of nurses’ documented assessment and performance of non-pharmacologic interventions to relieve procedural pain in neonates before and after a training intervention. Forty neonatal nurses received knowledge and clinical training about procedural pain assessment and non-pharmacological management related to neonates.The charts of 70–80 Neonatal Intensive Care Units admissions were compared at three-time points: once before and twice after the training intervention. Nurses’ documentation of pain assessment and non-pharmacological pain management techniques demonstrated significantly higher frequencies one month after the training than baseline (p = .00) and three months after the training than after the first month (p = .00). The training positively affected the pain management practices of nurses and clinical practice showed progressive improvement over time; all of which emphasize the importance of nurses' in-service training in improving the application of pain assessment and non-pharmacologic pain reduction strategies in NICUs.

Nurse's Compliance with Pain Assessment Documentation at Aceh General Hospital

Nurse's Compliance with Pain Assessment Documentation at Aceh General Hospital

99 ASSESSMENT AND MANAGEMENT OF PAIN IN OLDER ADULTS WITH ACUTE FRACTURE ADMITTED UNDER AN ORTHOPAEDIC SERVICE

Abstract Background Older adults with acute fractures often have suboptimal pain control, in particular those with cognitive impairment. Effective pain management improves rehabilitation engagement and earlier discharge from acute care. Our study aimed to evaluate pain management of older adults with acute fracture admitted under an orthopaedic service in a tertiary hospital. Methods Prospective review of patients over 65 years with an acute fracture admitted under an orthopaedic service. Review of chart, medication prescription and pain status. Data included type of fracture, comorbidities, cognitive status and analgesia prescribed. Data analysed using Excel. Results 40 inpatients included. Median age 82 years (range 65-93 years), 70% female. 53% had cognitive impairment, ranging from mild to severe dementia. 75% had &amp;gt;5 regular medications pre-admission. 80% had &amp;gt;5 comorbidities. Two-thirds (73%) had an acute hip fracture. Most (80%) inpatients had a surgical intervention, the remaining were managed conservatively. Analgesia prescriptions included paracetamol for almost all patients (95%), non-steroidal anti-inflammatory drugs for 3 (8%) and regular opioids in only 3 (8%). 43% of patients reported pain at time of data collection. 13% had analgesia changed in the 24 hours beforehand. Pain adversely affected function in 205 and mobility in 28%. 2 patients were unable to verbalise pain however no pain scales or visual assessments were used. Documentation of pain assessment was best by nurses (100%) followed by doctors (60%) and allied health professionals (40%). Conclusion Older adults with acute fracture are often multimorbid with cognitive impairment. This patient population are often untreated for pain with suboptimal pain assessment and analgesia review or prescriptions. Consequently we developed a pain policy for use on our orthopaedic service as a guide for effective pain assessment and management for older adults with acute fracture.

416 ANALGESIA AND PERI-OPERATIVE PRACTICE IN FRACTURED NECK OF FEMURS AT YORK TEACHING HOSPITALS NHS FOUNDATION TRUST

Abstract Introduction Fractured neck of femurs are a significant public health issue. Prompt assessment and response to pain as per NICE guidelines aids speedy recovery and helps to prevent complications such as delirium in and already high risk, elderly population. Previous audits have found poor documentation of the assessment of pain and the rate of nerve blocks in A + E and theatres. This completed cycle audit will assess the interventions made in response to these audits including adding pain scores to e-observations and training staff to perform nerve blocks. The aim of this audit was to assess current anaesthetic and analgesic practice. Method This was a retrospective review of 32 case notes and electronic prescribing over November—December 2019. Data collected included documentation of pain assessment, which analgesia was prescribed as per NICE guideline CG124 [1] and rate of nerve block in A + E and theatres. Results The audit found that 100% of patients received analgesia as per NICE guidelines. Documenting the assessment of pain scores has improved from 44% to 63% in A + E, 64% to 81% on the ward pre-operatively and 0 to 100% post op. On admission, 41% of patients received a nerve block and 94% intra-operatively, up from 22% and 55% respectively, the majority of patients received a fascia iliaca block (FIB). Conclusions The large increase in post op pain assessment is likely credited to mandatory input as part of e-observations and overall practice has improved significantly. A refresher training session will be provided for nursing staff to re-iterate the importance of assessing and responding to pain. The Hip Fracture Specialist Nurse is now competent to perform FIBs which may further increase the number performed on admission. Reference 1. NICE. Hip fracture: management. Clinical guideline [CG124]. https://www.nice.org.uk/guidance/cg124 (accessed 15/11/2020).

Determinants of pain assessment documentation in intensive care units.

The underassessment of pain is a major barrier to effective pain management, and the lack of pain assessment documentation has been associated with negative patient outcomes. This study aimed to 1) describe the contextual factors related to pain assessment and management in five Québec intensive care units (ICUs); 2) describe their pain assessment documentation practices; and 3) identify sociodemographic and clinical determinants related to pain assessment documentation. A descriptive-correlational retrospective design was used. Sociodemographic data (i.e., age, sex), clinical data (i.e., diagnosis, mechanical ventilation, level of consciousness, severity of illness, opioids, sedatives), and pain assessments were extracted from 345 medical charts of ICU admissions from five teaching hospitals between 2017 and 2019. Descriptive statistics and multiple linear regression were performed. All sites reported using the 0-10 numeric rating scale, but the implementation of a behavioural pain scale was variable across sites. A median of three documented pain assessments were performed per 24 hr, which is below the minimal recommendation of eight to 12 pain assessments per 24 hr. Overall, pain assessment was present in 70% of charts, but only 20% of opioid doses were followed by documented pain reassessment within one hour post-administration. Higher level of consciousness (β = 0.37), using only breakthrough doses (β = 0.24), and lower opioid doses (β = -0.21) were significant determinants of pain assessment documentation (adjusted R2 = 0.25). Pain assessment documentation is suboptimal in ICUs, especially for patients unable to self-report or those receiving higher opioid doses. Study findings highlight the need to implement tools to optimize pain assessment and documentation.

Patients with Opioid Use Disorder and Chronic Pain: Improving Pain Assessment Documentation

Opioid use disorder (OUD) is a growing problem that has reached epidemic status in the United States (Substance Abuse and Mental Health Services Administration, 2017), and people are gaining access...

Cross-sectional study of pediatric pain prevalence, assessment, and treatment at a Canadian tertiary hospital

ABSTRACT Background Painful experiences are common among hospitalized children. Long-term negative biopsychosocial consequences of undertreated pain are recognized. Aims The study benchmarks pain prevalence, assessment, and treatment as first steps to improve pain care in a Canadian tertiary hospital. Methods Single-day audits were undertaken on the pediatric ward (PW), pediatric emergency department (ED), and maternal services (MS). Participants (child or caregiver proxy) reported hospital pain experiences in the preceding 24 h; medical records were reviewed for assessment and treatment. Results Among 84 participants, pain prevalence ranged from 75% to 88%; mean pain intensity ranged from 5.7 to 6.5/10. Prevalence of moderate to severe pain was 78% on PW, 65% in ED, and 55% on MS; needle pokes were the most frequent cause of worst pain. Documentation of pain assessment varied by setting (PW, 93%; ED, 13%; MS, 0%). Documented maximum pain scores were significantly lower compared to participant report (mean difference 4.5/10, SD 3.1, P < 0.0001). A total 29% (6/21) of infants with heel lance or injection received breastfeeding or sucrose, and 29% (7/24) of participants receiving other needle procedures had documented or reported topical lidocaine use. All participants on MS underwent needle procedures. Conclusions Pain is experienced commonly by infants and children in PW, ED, and MS. Pain assessment documentation is not routine and underestimates participant report. Evidence-based pain management strategies are underutilized. An institution-wide quality improvement approach is required to address pain care. Pain assessment and needle pain prevention and treatment should be prioritized in these pediatric acute care and newborn care settings.

Pediatric Pain Assessment in the Intensive Care Unit: An Evidence-Based Algorithm

BackgroundConducting an adequate pain assessment in the Pediatric Intensive Care Unit (PICU) is multifactorial and complex due to the diversity of the population. It is critical that validated pain assessment methods are used appropriately and consistently to aid in evaluation of pain and pain management interventions. PurposeThe aim of this evidence-based practice project was to improve pain assessment practices in the PICU through a decision-support algorithm. Design & MethodsThe Iowa Model-Revised was used to guide the development and implementation of an evidence-based decision algorithm. Pre- and postdata were collected via surveys (nursing knowledge and confidence) and documentation audits (nursing pain assessments). Various implementation strategies were used to facilitate the integration and sustainability of the algorithm in practice. ResultsThe majority of survey items showed an increase in nursing knowledge and confidence. Audits of pain assessment documentation displayed an increase in appropriate pain assessment documentation related to a child's communicative ability. However, there is a need for reinfusion related to the documentation of sedation assessments. ConclusionsThe use of an algorithm supported the ability of PICU nurses to critically consider and choose the pain assessment method most appropriate for the patient's condition. The algorithm promotes nursing clinical judgement, prioritizes pain management, and includes patients receiving sedation. The algorithm supports a comprehensive pain assessment in a difficult pediatric patient population. Future research is needed to strengthen and standardize the usage of terms “assume pain present” and “assume pain managed,” and to also improve the overall feasibility and effectiveness of the algorithm.

Perianesthesia Nurses Pain Management Practices: Findings and Recommendations From a National Descriptive Study of Members of the American Society of Perianesthesia Nurses

PurposeThe purpose of this study was to identify current individual practice of perianesthesia nurses regarding assessment and documentation of pain. DesignDescriptive cross-sectional design using vignette technique. MethodsVignettes with questions available via electronic survey offered to attendees of the 2017 American Society of PeriAnesthesia Nurses National Conference. FindingsTotal of 1,680 perianesthesia nurses participated; 41.4% reported assessment of pain compared with 36.7% who reported documentation of pain assessment. The numeric (0 to 10) pain intensity score was the most commonly used assessment method. Only 16.4% assessed for and documented pain location, 14.4% assessed for and documented quality of pain. ConclusionsPain assessment should include intensity, location, quality, and functional impact. The gap between nurses' practices in assessment and documention of pain may be related to system barriers. Embedding evidence-based best practice within electronic health records may improve both. Prior literature, as well as our findings, indicate these trends (missed documentation and assessment) are more global than only perianesthesia nursing.

Implementation and evaluation of a pain management core competency education program for surgical nurses

ObjectiveTo investigate the effect of a pain management core competency education program on surgical nurses’ pain knowledge and pain management nursing practice behaviors. MethodsAn 8-h education program focused on pain management core competency was provided twice in two weeks including the multidimensional nature of pain, pain assessment, pharmacological and non-pharmacological management, and knowledge application was developed and implemented for surgical nurses by a multidisciplinary team. Multimodal teaching approaches such as didactic teaching and vignettes of cases for nurses to discuss were used. The Clinical Pain Knowledge Test (CPKT) was completed by 135 and 107 nurses from 17 surgical wards pre and post-program, respectively. Two hundred and three patients’ medical records were randomly sampled according to the number of operations in each ward one week before and in the fifth week after the intervention, respectively. Documentation of patients’ postoperative pain management nursing practice behaviors and pain intensity scores were collected. ResultsAfter the intervention, the CPKT scores of nurses significantly increased from 45.6% ± 12.3% to 54.2% ± 10.2% (t = 5.786, P < 0.001). Nurses’ postoperative pain management nursing practice improved, with proportion of pain assessment documentation increased from 59.6% (121/203) to 74.9% (152/203) (χ2 = 10.746, P = 0.001), those using pain intensity assessment tools increased from 81.8% (99/121) to 95.4% (145/152) (χ2 = 13.079, P < 0.001), and intramuscular injection of nonopioids decreased from 12.6% (13/103) to 2.7% (3/111) (χ2 = 7.598, P = 0.006). Patients’ average worst pain score on the operation day significantly decreased (Z = −2.486, P = 0.013), and scores from the first to the third postoperative day also decreased (Z = −2.172, P = 0.030). ConclusionsImplementation of a pain management core competency education program for surgical nurses can increase their knowledge of core competencies of pain management, improve selected pain management practices, and decrease patients’ postoperative pain intensity.

The Intersection of Quality and Clinical Care: Approach to Improve Ventricular Assist Device Patient Care

Background Improving outcomes in the Ventricular Assist Device (VAD) patient population is an on-going challenge. Incorporating comprehensive quality into a VAD program ensures not only meeting accreditation standards, but helps improve patient care. We used performance measure data to identify deficiencies and garner stakeholder buy-in with the intended goal of improving care. Methods The quality specialist worked closely with the VAD team to identify the performance measures for the program as well as establish benchmarks using evidenced based best practices. Each performance measure was distinctly tied to a data point that would subsequently be abstracted from the chart for each patient. The quality specialist and VAD Coordinator then incorporated the quality measures and performance goals into a QAPI Plan and encouraged stakeholders to review and provide feedback. By engaging stakeholders to review and revise, we promoted buy-in to the QAPI elements of the VAD program. Performance measures were tracked monthly. Variance on the scorecard was presented to the VAD multidisciplinary team as well as Hospital Quality Council. If variance occurred, performance improvement activities were developed. Results A unique color-coded QAPI scorecard was created in which different colors represented different levels of compliance. The metrics were tracked using the Scorecard and presented at the monthly meetings. At baseline, driveline dressing change compliance was 63%. After implementation of our improvement measures, compliance increased to 81%. Similarly, performance of Daily Weights increased from 36% to 96%. Documentation of Nursing VAD Education increased from 57% to 97% and documentation of Pain Assessment increased from 64% to 97%. We maintained a zero percent rate of driveline infection. Conclusion Creating stakeholder awareness of gaps in performance increased commitment to performance improvement plans. Use of a unique color coded QAPI scorecard can be useful in improving quality metrics and subsequently patient care. This approach can be utilized beyond the VAD population to improve quality among all heart failure and transplant patients.

Nursing Documentation of Postoperative Pain Management: A Documentary Analysis.

Although proper documentation of pain for postoperative patients is essential to promote patient health outcomes, there is limited examination of nurses' documentation of pain management. The purpose of this study was to qualitatively analyze nursing documentation of pain management among postoperative patients in Jordan. A documentary analysis method was used. A purposive sample of 80 medical records were reviewed, and a total of 720 nursing records were analyzed. The analysis revealed that nurses' documentation of pain management was limited, vague, incomplete, and largely dependent on their subjective evaluation. Many of the documented goals were broad, not specific, not measurable, and with no time frame. Documentation patterns revealed a lack of proactive and systematic approach to pain assessment and management. Furthermore, there was little documented evidence of efforts to evaluate the effectiveness of pain management interventions. Findings have important implications for standardizing documentation of pain assessment, intervention, and evaluation.

A review of compliance with pain assessments within a UK ICU.

clinical audits highlight areas where care may not be of the desired quality; they are essential to ensure care is safe and effective. Effective assessment and management of pain have been shown to improve patient wellbeing and clinical outcomes. this audit aimed to identify compliance with pain assessment tools and documentation within intensive care and make recommendations to improve practice. compliance with documenting pain assessments was poor, a finding that is consistent with the literature. Although a wealth of evidence has shown pain assessments are not being completed effectively, this continues to be a problem. Intensive care has significant areas for improvement in this area, which would improve patients' experiences and outcomes. Nurses should be educated in the use of pain assessment tools and compliance. providing patients in intensive care with appropriate analgesia benefits their physical and psychological health. Areas for improvement identified in this audit include that pain assessments need to be carried out and documented regularly. The audit has implications for practice in that it shows a need for reinforced education for staff, better communication and updates to promote pain assessment and the implementation of guidelines.

Assessment of Acute Pain Management and Associated Factors among Emergency Surgical Patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia, 2018: Institutional Based Cross-Sectional Study.

Background Adequate pain management has led to increased comfort in emergency patients, reducing morbidity and improving long term outcomes. Different pain management modalities have been applied in the emergency department among which systemic analgesia is commonly used by preceding a nerve block. Several factors have been associated with poor pain management in low resource setting areas. We aimed to determine pain management modalities and associated factors among emergency surgical patients. Patients and Methods After obtaining ethical approval from Ethical Review Committee, 203 volunteer patients were enrolled. Institutional based cross-sectional prospective study was conducted from April to May 2018 in Gondar University Specialized Hospital Emergency Department. The severity of pain was measured through Numerical Rating Scale and statistical analysis was performed using SPSS statistical package version 23. Descriptive statistics cross-tab and binary logistics were performed to identify factors related to pain management in emergency department. Results A total of 203 patients, 138 (68%) males and 65 (32%) females with response rate of 94%, participated in this study. Among them, 66% patients received analgesia within two hours of ED presentation with a mean ± SD of 61.0 ± 34.1 minutes. 70.4 % of patients complained of moderate and severe pain after receiving analgesia. There was a significant difference between trauma and nontrauma patients in mean time of analgesia receiving and residual pain severity (p < 0.001). Age, trauma, physician pain assessment, and severity of pain were the predicting factors for analgesia delivery. Conclusion The overall practice of pain management in Gondar University Specialized Hospital Emergency Department was not adequate. Therefore, it is vital to implement an objective pain assessment method and documentation of the pain severity to improve pain management practice.

Pain Assessment and Management by Nurses in a Geriatric Setting: Discrepancies between Guidelines and Documented Practice

Background: Pain is a common subjective symptom among older adults in general and among older adult residents in long-term geriatric facilities in particular. Pain diminishes older adults’ quality of life and may impair their ability to recover from various illnesses. Therefore, the Israeli Ministry of Health has issued guidelines on effectively assessing and treating pain in this population. Aims: To examine discrepancies between the Ministry of Health's pain assessment guidelines and documented practice by nursing staff at a long-term geriatric care facility and whether these discrepancies correlate to characteristics of the nurses, the wards, and the patients' characteristics. Design and Settings: A descriptive cross-sectional design study conducted at a large geriatric facility in central Israel. Participants: A random sample of 200 computerized patient records of pain assessment and management performed by 69 individual nurses. Methods: The study used an original checklist based on Israeli Ministry of Health guidelines to assess nursing documentation regarding 19 aspects of pain assessment and management. Results and Conclusions: There were discrepancies found between the Ministry of Health's pain assessment guidelines and documented practice by the nursing staff. An average of 13.8 out of 19 aspects of pain assessment and management were documented. As nurses' knowledge about pain assessment and management increased and as staffing ratios improved, the greater was the adherence to Ministry of Health guidelines, resulting in fewer discrepancies between the guidelines and documented practice. There was less pain assessment and management documentation for mechanically ventilated patients and for male patients.