Inferring pain in non-communicative persons with dementia: considering the role of nurse-related factors in pain assessment decisions

      The identification of pain in non-communicative persons with dementia and the factors that hinder the pain assessment process are significant concerns. Research has explored the patient-related factors that affect pain assessment decisions. However, exploration of nurse-related factors affecting pain assessment decisions needs to be explored in greater detail. Using the Conceptual Model for Pain Assessment for Non-communicative Persons with Dementia as a guide, this integrative review highlights five nurse-related factors that have a direct impact on nurses’ pain assessment decisions in non-communicative persons with dementia: demographical characteristics, personal pain beliefs, relationship with the patient, pain history, and pain knowledge. CINAHL, PubMed, Academic Search Complete, PsychINFO, and Cochrane Database of Systematic Reviews were reviewed for relevant articles. A total of 26 articles specifically discussed nurse-related factors that contributed to pain assessment decisions. Classical work by Davitz and Davitz has laid a solid foundation for further exploring the impact of nurse-related factors on pain assessment. More recent works have expanded the work of these authors, both supporting and refuting their findings in this research area. In conclusion, nurse-related factors can negatively impact pain assessment decisions and bias rater judgments, which is particularly alarming for non-communicative persons who rely on the inferences of others to identify pain. In order to eliminate health care disparities in pain assessment and management for these older adults, it is important to further consider and address these contributing nurse-related factors and the factors presented by the rest of the health care team (Snow, O'Malley, Cody, Kunik, Ashton, Beck, Bruera, Novy, The Gerontologist, 2004). This study is supported by Pain and Associated Symptoms: Nurse Research Training [NINR/NIH, T32 NR011147].