Joy R Goebel1, Michelle Ferolito2, Nicholas Gorman3. 1. School of Nursing, California State University Long Beach, Long Beach, California. Electronic address: Joy.Goebel@csulb.edu. 2. Department of Geriatrics, University of California Los Angeles, Los Angeles, California. 3. Keck Graduate Institute, Claremont, California.
Abstract
BACKGROUND: In patients with cognitive impairments who are unable to self-report pain, nurses must rely on behavioral observation tools to assess and manage pain. Although frequently employed in medical-surgical units, evidence supporting the psychometric efficacy of the Pain in Advanced Dementia (PAINAD) for pain screening in older adults with delirium is lacking. AIM: To examine the psychometrics of the PAINAD for older adults with delirium in medical-surgical settings. DESIGN: A descriptive repeated measures design. SETTING: Medical-surgical units in an urban tertiary care hospital. PARTICIPANTS: Sixty-eight older adults with delirium. METHODS: Patients with delirium unable to self-report pain were screened by two data collectors with the PAINAD and the Critical Care Pain Observation Tool (CPOT). Patients with a PAINAD score ≥3 or a CPOT score ≥2 received a pain intervention. Pain assessments were repeated 30 minutes post baseline or pain intervention. RESULTS: Patients were predominately female (58.8%) with dementia (71%). Thirty-nine patients screened positive for pain and received a pain intervention. PAINAD reliability was strong (Cronbach's α = 0.81-0.87; interrater intraclass coefficients [ICC] = 0.91-0.94; test-retest ICC = 0.76-0.77). Construct validity was supported by a statistically significant interaction effect between time (baseline versus follow-up) and condition (pain intervention versus no pain group; Rater 1: F(1,66) = 8.31, p = 0.005, ηp2 = 0.11; Rater 2: F(1,66) = 8.22, p = 0.006, ηp2 = 0.11. CONCLUSIONS: The PAINAD is a reliable and valid tool for pain screening for older adults with delirium in medical-surgical settings. CLINICAL IMPLICATIONS: Pain and delirium frequently co-occur in the older adult population. Best practices require a holistic assessment for contributing pain and non-pain factors in patients exhibiting distress.
BACKGROUND: In patients with cognitive impairments who are unable to self-report pain, nurses must rely on behavioral observation tools to assess and manage pain. Although frequently employed in medical-surgical units, evidence supporting the psychometric efficacy of the Pain in Advanced Dementia (PAINAD) for pain screening in older adults with delirium is lacking. AIM: To examine the psychometrics of the PAINAD for older adults with delirium in medical-surgical settings. DESIGN: A descriptive repeated measures design. SETTING: Medical-surgical units in an urban tertiary care hospital. PARTICIPANTS: Sixty-eight older adults with delirium. METHODS:Patients with delirium unable to self-report pain were screened by two data collectors with the PAINAD and the Critical Care Pain Observation Tool (CPOT). Patients with a PAINAD score ≥3 or a CPOT score ≥2 received a pain intervention. Pain assessments were repeated 30 minutes post baseline or pain intervention. RESULTS:Patients were predominately female (58.8%) with dementia (71%). Thirty-nine patients screened positive for pain and received a pain intervention. PAINAD reliability was strong (Cronbach's α = 0.81-0.87; interrater intraclass coefficients [ICC] = 0.91-0.94; test-retest ICC = 0.76-0.77). Construct validity was supported by a statistically significant interaction effect between time (baseline versus follow-up) and condition (pain intervention versus no pain group; Rater 1: F(1,66) = 8.31, p = 0.005, ηp2 = 0.11; Rater 2: F(1,66) = 8.22, p = 0.006, ηp2 = 0.11. CONCLUSIONS: The PAINAD is a reliable and valid tool for pain screening for older adults with delirium in medical-surgical settings. CLINICAL IMPLICATIONS: Pain and delirium frequently co-occur in the older adult population. Best practices require a holistic assessment for contributing pain and non-pain factors in patients exhibiting distress.
Authors: Barbara Resnick; Marie Boltz; Elizabeth Galik; Ashley Kuzmik; Jeanette Ellis; Chris Wells; Shijun Zhu Journal: Res Nurs Health Date: 2022-03-11 Impact factor: 2.238
Authors: Barbara Resnick; Kimberly Van Haitsma; Ann Kolanowski; Elizabeth Galik; Marie Boltz; Jeanette Ellis; Liza Behrens; Karen Eshraghi; Cynthia L Renn; Susan G Dorsey Journal: Front Pain Res (Lausanne) Date: 2021-12-02