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Home healthcare teams’ assessments of pain in care recipients living with dementia: a Swedish exploratory study
Högskolan i Skövde. (Åldrandemiljön)ORCID iD: 0000-0001-6357-232X
Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.ORCID iD: 0000-0003-4149-9787
Högskolan i Skövde, Institutionen för Hälsa och Lärande.
Högskolan i Skövde, Institutionen för Hälsa och Lärande.
2015 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 10, no 3, 190-200 p.Article in journal (Refereed) Published
Abstract [en]


Pain assessment in people living with dementia is a challenge due to the complexity of pain and dementia and the difficulties in self-reporting. In home healthcare, nurses are frequently involved in pain assessment situations and there is a need to explore how home healthcare teams’ manage pain assessment in this setting.


The study aimed to explore home healthcare teams’ experiences of pain assessment among care recipients with dementia.


An exploratory qualitative design was used.


Open-ended individual interviews were conducted with thirteen registered nurses and ten nursing assistants, working in three different home healthcare teams in one municipality in western Sweden. Philosophical hermeneutics was utilised to interpret the home healthcare teams’ experiences.


Four interpretations emerged: the need for trusting collaboration, the use of multiple assessment strategies, maintenance of staff continuity in care and assessment situations, and the need for extended time to assess pain.


The home healthcare teams recognise pain assessment in people with dementia as involving a complex interaction of sensory, cognitive, emotional and behavioural components in which efforts to acquire understanding of behavioural changes mainly guides their assessments. The solid team coherence between registered nurses and nursing assistants aided the assessment procedure. To assess pain, the teams used multiple methods that complemented one another. However, no systematic routines or appropriate evidence-based pain tools were used.

Implications for Practice

The team members'concern for care recipients when assessing pain is evident and needs to be acknowledged by the organisation which is responsible for the quality of care. Future studies should focus on further exploration of nurses’ experiences with pain and dementia in home healthcare settings and address what nurses identify and how they deal with their findings. It is imperative to investigate how organisations and nurses can ensure best practices and how the implementation of evidence-based routines for assessing pain may aid in pain assessment situations.

Place, publisher, year, edition, pages
2015. Vol. 10, no 3, 190-200 p.
Keyword [en]
dementia, home healthcare, pain assessment
National Category
Health Sciences
URN: urn:nbn:se:hj:diva-25153DOI: 10.1111/opn.12072PubMedID: 25399656ScopusID: 2-s2.0-84911072485OAI: diva2:763617
Available from: 2014-11-15 Created: 2014-11-15 Last updated: 2016-09-07Bibliographically approved
In thesis
1. Detection and assessment of pain in dementia care practice: Registered nurses’ and certified nursing assistants’ experiences
Open this publication in new window or tab >>Detection and assessment of pain in dementia care practice: Registered nurses’ and certified nursing assistants’ experiences
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice.

Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV).

Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV).

Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2015. 116 p.
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 62
Abbey Pain Scale-SWE, cognitive impairment, dementia, municipal elderly care, observational behavioural pain assessment scales, pain assessment, person-centred care
National Category
urn:nbn:se:hj:diva-28113 (URN)978-91-85835-61-4 (ISBN)
Public defence
2015-10-23, Forum Humanum, Hälsohögskolan i Jönköping, Jönköping, 10:38 (Swedish)
Available from: 2015-10-07 Created: 2015-10-07 Last updated: 2015-10-07Bibliographically approved

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Karlsson, Christina ElisabethErnsth Bravell, Marie
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