Case Study on Nursing Pain Interpretation and Residents’ Ability to be Understood

Pain Manag Nurs. 2026 Nov 14:S1524-9042(26)00326-7. doi: 10.1016/j.pmn.2026.10.007. Online ahead of print.

ABSTRACT

INTRODUCTION: In long term care [LTC], the high prevalence of painful illnesses and dementia contributes to complex care needs and challenging pain management. What further complicates matters for residents in this context is the inability to be understood.

PURPOSE: In addition to not being understood in the expression of their pain, many residents with a cognitive impairment will exhibit behavioral and psychological symptoms of dementia [BPSDs]. Pain indicators may then resemble BPSDs and be interpreted and treated as such. Little is known about this interpretation and subsequent interventions by nurses.

DESIGN: To explore the management of pain in the LTC context, a single-site retrospective case-study was conducted in a Canadian province using a predefined list of indicators drawn from validated observational pain assessment instruments and the pain literature.

METHODS: These indicators guided the review of residents’ charts by abstracting data from nursing documentation and medication administration records. Nursing interpretation of symptoms, as documented in their notes, as either pain or behavior, as well as their actions, were examined. Also explored were associations between the resident’s ability to be understood and the nursing interpretation of their symptoms.

RESULTS: The analysis discovered that many symptoms were more likely to be interpreted as behavior versus pain. Furthermore, a relationship was discovered between the resident’s ability to be understood and the interpretation of some symptoms as behavior versus pain.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Recommendations are made to better support nurses with this important yet challenging role of pain and behavior interpretation with residents who cannot be understood.

PMID:43034136 | DOI:10.1016/j.pmn.2026.10.007