Acceptability of the Use of Pain Behavior Observational Methods (PBOMs) by Nursing Home Nurses

Wednesday, 14 July 2010: 11:20 AM

Yat-wa Justina Liu, PhD
School of nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong

Learning Objective 1: understand the factors affect the acceptability of Pain Behavior Observational Methods by nursing home nurses.

Learning Objective 2: explore the utilization of Pain Behavior Observational Methods for pain assessment of cognitively impaired older people


Inability to verbally report pain is a major obstacle to successful pain management in cognitively impaired elderly people (CIEP).  Hence, much effort has been devoted to developing PBOMs during the last decade.  Their structure is similar to that basically formed by common pain behaviors recommended by the American Geriatrics Society (AGS).1  Although many studies have demonstrated the psychometric soundness of several PBOMs, none of these are well validated for use with CIEP.  A possible hurdle is the acceptability of PBOMs by nursing home nurses.  This study helps to explore the extent to which nurses find PBOMs acceptable in their daily routines. 


A questionnaire was used to explore nurses’ perceptions of common pain behaviors of CIEP, to evaluate the clinical relevance/frequency of pain behaviors for routine pain assessment, and to self-appraise the acceptability of using PBOMs in their daily practice.  A panel of experts in pain and gerontology was set up to determine the content validity index (CVI).  The final scale level CVI was 0.9, indicating an acceptable level of content validity.


104 questionnaires were distributed and 77 nurses returned them.  Although none of the participants had used PBOMs before, they were able to describe divergent pain behaviors.  “Facial expressions” was identified as the most clinically relevant/frequent pain behaviour.  This was followed by “body movements” and “vocalizations & verbalizations.”   They stated that they had successfully identified pain among CIEP by observing their pain behaviors.   Generally, they believed that PBOMs were useful for pain assessment.


Observing CIEPs’ pain behavior for pain assessment occurs in nurses’ daily practice.  Even with no formal training in the use of PBOMs, participants indicated their confidence in using PBOMs in their daily routine.