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.