Timing in the Communication of Pain Among Nursing Home Residents, Nursing Staff, and Clinicians

Pain is common among nursing home residents and a key 1990 study found that greater than 70 percent of residents reported pain. In the last 10 years, research has addressed various barriers to pain relief. This new study examined the communication of pain information among residents, nursing staff and clinicians. The proposed steps in this process include: 1) nursing assessment of pain, 2) notification of clinicians, 3) clinician assessment and intervention (i.e., administration of a new medication) and 4) nursing reassessment after intervention. Interviews with the directors of nursing at 63 of the 68 nursing homes in New Haven County, Connecticut, revealed substantial variation among nursing homes in the communication of pain. Nurses in 76 percent of nursing homes assessed pain at least quarterly in residents without known pain, but in only 46 percent of nursing homes did nurses assess pain in residents with known pain at least every shift. In 42 percent of nursing homes, clinicians were notified about pain assessments at least when a treatment was ineffective. Fifty-five percent of the directors of nursing believed that clinicians conducted pain assessments on a routine basis (every 30 to 60 days). Nurses reassessed pain at least one hour after intervention in 73 percent of nursing homes. The authors recommend further studies to identify optimal timing in the communication of pain information with the aim of reducing pain in nursing home residents.