Responding to Varying Levels of Certainty about Pain in People with Dementia after Initial Pain Assessment

INTRODUCTION: Pain is still inadequately treated in people with dementia (PWD) due to the complexity of assessing it. Pain assessment in PWD is still challenging because of patient-related or nurse-related factors. The patient-related factors have been studied extensively. However, the nurse-related factors, e.g., nurses' certainty regarding suspected pain in PWD, have been given little attention by researchers. PURPOSE: This study aims to investigate how the degree of nurses' certainty is compromised after pain assessment and how this affects levels of pain and agitation in PWD. METHOD: A descriptive, correlational design was used, and a convenience sample of 104 nursing home residents with dementia were recruited. RESULTS: This study found that nurses' certainty after the pain assessment mediates the relationship between the type of pain assessment and patient outcomes when the nurses had a high initial certainty. When nurses had a low initial certainty, their certainty after the assessment and the type of assessment predicted the levels of pain and agitation in PWD. CONCLUSION: Understanding how nurses' certainty can be compromising after pain assessment and how this relates to pain management in PWD is crucial.