Cohen-Mansfield Jiska
Research Institute on Aging of the Hebrew Home of Greater Washington, Rockville, MD, USA.
Pain Manag Nurs. 2005 Jun;6(2):68-75. doi: 10.1016/j.pmn.2005.05.002.
Our aim was to assess the reliability and validity of nursing staff members' assessments of pain in cognitively impaired nursing home residents. Participants were 57 cognitively impaired nursing home residents and 52 nursing staff members. Twenty-eight residents had mild/moderate cognitive impairment and 29 were severely impaired. Nursing staff members were asked to evaluate their patients' pain using 2 scales: the Nurse Global Scale of pain (NGS) and the Present Pain Inventory (PPI). Independent measures of pain were obtained from patient interviews, physician assessments, and from the Minimum Data Set (MDS) items; these were used to measure validity of the nursing staff's perception of pain. Test-retest and inter-rater reliabilities were also computed. Significant correlations were obtained between most of the physician-derived measures and the PPI for the moderately impaired group, but not for the severely impaired group. Both measures of nursing assistants' pain assessments correlated significantly with MDS-based measures; these correlations were higher for the less cognitively impaired group. Finally, the PPI correlated significantly and positively with resident-derived measures for those with moderate rather than severe cognitive impairment. Nursing staff members' ratings of pain were correlated with residents' level of cognitive functioning and with intake of pain medication. The results underscore the difficulty in assessing pain in those with severe cognitive impairment.
我们的目的是评估护理人员对认知障碍养老院居民疼痛评估的可靠性和有效性。参与者包括57名认知障碍养老院居民和52名护理人员。28名居民有轻度/中度认知障碍，29名有重度认知障碍。要求护理人员使用两种量表评估患者的疼痛：护士疼痛整体量表（NGS）和当前疼痛量表（PPI）。通过患者访谈、医生评估以及最小数据集（MDS）项目获得疼痛的独立测量值；这些用于衡量护理人员对疼痛感知的有效性。还计算了重测信度和评分者间信度。对于中度受损组，大多数医生得出的测量值与PPI之间存在显著相关性，但重度受损组则不然。护理助理疼痛评估的两种测量值均与基于MDS的测量值显著相关；认知障碍较轻的组这些相关性更高。最后，对于中度而非重度认知障碍患者，PPI与患者得出的测量值显著正相关。护理人员的疼痛评分与居民的认知功能水平以及止痛药物的摄入量相关。结果强调了评估重度认知障碍患者疼痛的困难。
