PAIN BEHAVIORS AND CONFUSION IN ELDERLY PATIENTS WITH HIP FRACTURE.
Contributors: Catholic University of America.
Published: 1994
Number of pages: 295
Subjects: Health Sciences, Nursing.; Gerontology.
Description: A purposive sample of 31 elderly hip fracture surgery patients were interviewed on the first or second day, postoperatively, to determine common verbal pain behaviors. Videotapes from 22 patients were analyzed to describe common nonverbal pain behaviors. Differences in pain behaviors were described for patients who were confused and those who were not confused for each of the data sets.

Verbal pain behaviors described included the presence, location, quality, intensity, and pattern of pain; factors relieving and increasing pain; and symptoms accompanying pain. Ninety percent of patients acknowledged the presence of pain, but 52% used a term other than pain to describe their discomfort. Locations most commonly named were the hip, thigh, back, and knee. Pain quality words selected from the McGill Pain Questionnaire were those commonly used to describe acute and chronic pain. Pain during movement was described as "distressing", more intense than pain while not moving, and as intense as recalled worst experiences of pain. The temporal pattern of pain was described as "intermittent" and "brief". Use of medications and movement were reported as the most common pain relieving and aggravating factors, respectively.

Confused patients were able to verbalize the presence of pain, but up to 40% were unable to describe other pain characteristics. They identified fewer pain sites and were more often inconsistent in locating pain using different methodologies. There was a high failure rate for the reporting of pain intensity using a visual analogue scale.

Nonverbal pain-related behaviors described included repositioning, guarding, bracing and immobilizing behaviors; non-language vocalizations; and facial expressions. Guarding and bracing behaviors were observed more frequently than repositioning and pressure manipulation behaviors. Common non-language vocalizations were sighing, grunting, and moaning; common facial expressions were brow lowering with jaw drop or mouth open, brow lowering alone, and brow lowering with narrowing or closing of eyes.

Overall findings indicate that health professionals cannot assume confused patients are unable to verbalize pain characteristics and suggest there are more similarities than differences in the nonverbal expressions of pain between patients who are confused and those who are not confused. Recommendations are made for nursing practice and further research.
Notes: Source: Dissertation Abstracts International, Volume: 55-02, Section: B, page: 0370.

Thesis (D.N.SC.)--THE CATHOLIC UNIVERSITY OF AMERICA, 1994.

School code: 0043.