Table 2.

Presentation of studies included.

First author, year, country	Aim/objectives	Participants	Design/method (including assessment tools)
Alexander, 2005, United States 54	Develop, implement and evaluate a system for pain assessment and monitoring	41 residents with dementia, 24 from secure unit 17 from open unit	Quantitative Pilot study, nonexperimental design Coloured Visual Analogue Scale (CVAS)
Andrews, 2019, Australia 43	Investigate the quality and completeness of pain documentation and assess the extent to healthcare personnel are engaged in documentation processes	114 residents with moderate-to-severe dementia, across 4 facilities. 169 pain episodes	Quantitative Descriptive design Review of medical records
Apinis, 2014, United States 66	Examine the agreement between the interdisciplinary evaluation and the validated observational pain tools PAINAD and PACSLAC	67 residents with advanced dementia and moderate-to-severe communication disability, from 6 different nursing home wards	Quantitative Cross-sectional Pain Assessment in Advanced Dementia (PAINAD) Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)
Burns, 2015, United Kingdom 56	(1) Explore nurses’ knowledge about pain assessment for people with dementia, (2) determine the factors that may influence their knowledge and attitudes towards pain assessment, (3) identify nurses’ level of training and education in pain and dementia, (4) explore the perceived barriers of effective pain assessment	32 registered nurses working in nursing home, regularly caring for people with dementia	Quantitative Cross-sectional survey design Questionnaire, including open-ended questions
Chang, 2011, South Korea 44	To clarify and conceptualize pain identification in people with dementia by nurses	13 nurses from 3 nursing homes	Quantitative Concept development Individual interviews
Chen, 2015, Taiwan 72	Investigate the reliability and validity of self-reported pain across groups with different degrees of cognitive function, and to determine the important predictors of self-reported pain intensity in four cognition groups	341 residents diagnosed with dementia from 12 dementia special care units, and 50 registered nurses Control: 73 cognitively intact residents, from 2 long-term care facilities	Quantitative Cross-sectional Multifaceted measures to validate residents’ pain reports Verbal Descriptor Scale (VDS) Doloplus-2
Chen, 2010, Taiwan 63	Validate registered nurses’ and nurse assistants’ reports in assessing present pain and to investigate potential influencing factors	304 residents with dementia from 6 dementia special care units 15 registered nurses, 21 nurse assistants	Quantitative Prospective study Doloplus-2
Closs, 2003, United Kingdom 65	(1) Assess the usability of a range of approaches to pain assessments; (2) identify and develop appropriate verbal and/or nonverbal pain assessments in varying levels of cognitive impairment; (3) relate, where possible, the severity of cognitive impairment to the most appropriate methods of assessment	113 nursing home residents	Quantitative Cross-sectional Verbal Rating Scale (VRS) Numerical Rating Scale (NRS) Colour Pain Analogue Scale (CS) Faces Pain Scale (FS) Mechanical Visual Analogue Scale (MVAS)
Cohen-Mansfield, 2008, United States 64	Compare pain assessments using self-report, informant rating and observational assessments	153 nursing home residents with dementia from 4 nursing homes 84 staff members	Quantitative Cross-sectional Functional Pain Scale Present Pain Intensity Scale Verbal Descriptor Scale Global Pain Assessment Scale Pain Assessment for Dementing Elderly (PADE) Pain Assessment in Noncommunicative Elderly (PAINE) Pain Assessment in Advanced Dementia (PAINAD) The checklist of nonverbal pain indicators (CNPI) Observational Pain Behaviour Assessment Instrument (OPBAI)
Cohen-Mansfield, 2002, United States 45	(1) To identify the behaviours and other observable indicators that are perceived by nurses to be manifestations of pain, (2) determine what cues are used to differentiate pain from other causes of unusual behaviour, (3) assess nurses’ perceptions of the prevalence and importance of specific indicators of pain, (4) validate the perceptions of nursing staff members concerning the applicability of the pain indicators provided in the previous studies, (5) to examine their perceptions of their own ability to identify pain in this population	72 staff members from 3 nursing homes	Mixed or multiple methods Individual interviews, survey and focus groups
Cohen-Mansfield, 2002, United States 60	Examine the reliability and validity of geriatricians’ assessments of pain	79 nursing home residents. 31 with mild/moderate cognitive impairment and 48 with severe cognitive impairment 2 geriatricians	Quantitative Cross-sectional
Corbett, 2016, United Kingdom 40	Explore the current landscape of pain management in people with dementia living in nursing homes	12 healthcare personnel, including junior care assistants, senior carers, nurses and care home managers	Mixed or multiple methods Triangulation of stakeholder consultation and quality review of pain management Focus groups with care home staff
Ersek, 2011, United States 69	Explore whether a combination of pain indicators would be significantly better in predicting self-reported pain intensity than any single pain indicator	326 residents, from 24 nursing homes	Quantitative Chart review, resident interviews, surrogate reports from certified nursing assistants Iowa pain thermometer Checklist for nonverbal pain indicators
Ford, 2015, United States 55	Examine ethnic differences in the presentation and intensity of nonverbal pain behaviours among African Americans, Caucasians and Hispanics	28 residents with moderate-to-severe dementia and pain-related diagnosis, from 4 nursing homes 6 certified nursing assistants	Quantitative Cross-sectional Noncommunicative Patients Pain Assessment Instrument (NOPPAIN)
Gilmore-Bykovskyi, 2013, United States 46	(1) Examine how nurses make decisions to pharmacologically treat pain, as well as identify the conditions that influence treatment decisions, (2) identify conditions that influence nurses’ actions related to pain management	13 nurses from four facilities (3 licensed practice nurses and 10 registered nurses)	Qualitative In-depth interviews Grounded dimensional analysis
Kaasalainen, 2007, Canada 39	Explore the decision-making process of pain management of physicians and nurses and how their attitudes and beliefs about pain affect their decisions about prescribing and administering pain medications	24 registered nurses and 33 registered practice nurses from 4 nursing homes 9 physicians	Qualitative Grounded theory Semi-structured, individual interviews
Karlsson, 2012, Sweden 41	Interpret certified nursing assistants’ perception of pain	12 certified nursing assistants working in dementia care	Qualitative Hermeneutic design Individual interviews
Lautenbacher, 2017, The Netherlands 47	Identify which facial descriptors are used by caregivers to evaluate and influence their diagnostic decision-making process when assessing pain	284 residents with dementia (mostly advanced stage) from 79 nursing homes	Quantitative Survey Questionnaire
Liu, 2012, China 76	Report the development and implementation of an observational pain assessment protocol and its impacts on pain management. To report the opinions of the nursing home staff about the protocol	11 healthcare personnel (8 nursing assistants, 2 registered nurses and 1 physiotherapist) 30 residents	Mixed or multiple methods Intervention: Pre-/posttest Group interviews Chinese version of Pain Assessment in Advanced Dementia (C-PAINAD)
Lundin, 2021, Sweden 48	Describe the experiences of nurses in caring for people with advanced dementia and pain at the end-of-life	13 registered nurses from 12 nursing homes	Qualitative Descriptive explorative design Individual semi-structured interviews
Manfredi, 2003, United States 57	(1) Identify a clinical condition consistently described as painful by residents who were able to verbally communicate the experience of pain (2) Assess the reliability and validity of facial expressions as pain indicators in residents with severe dementia undergoing a painful procedure	39 residents with decubitus ulcers able to reliably answer questions about pain 9 residents with dementia and decubitus ulcers	Quantitative
Mezinskis, 2004, United States 49	Examine which formal and informal methods of pain assessment nurses and caregivers use	From 14 long-term care facilities: Sample A was 160 direct caregivers (35 registered nurses, 41 licensed practice nurses and 84 certified nursing assistants) Sample B was 307 residents in dementia units, with chronic painful illnesses	Quantitative Survey/document analysis Sample A: Questionnaire Sample B: Chart review
Monroe, 2015, United States 50	Assess nursing home personnel’s cues and practices to identify and alleviate pain	29 healthcare personnel, including registered nurses and licensed practice nurses with direct care responsibilities, from two long-term care facilities	Qualitative Exploratory study Focus group interviews
Monroe, 2014, United States 74	Determine if a diagnosis of dementia influenced pain self-reports and pain medication use	52 nursing home residents able to self-consent, including 20 people with dementia	Quantitative Between groups, cross-sectional Discomfort Behaviour Scale
Monroe, 2012, United States 58	Use medical records to assess advanced cancer pain at the end-of-life	48 records from 9 nursing homes 43 people with Alzheimer’s dementia (90%), 4 people with vascular dementia (8%) and 1 person with Lewy body dementia (2%)	Quantitative Retrospective between groups cross-sectional design Retrospective chart audit
Nakashima, 2019, United States 36	Compare pain interventions (including assessment) between nursing home residents with and without dementia	50,673 nursing home residents, 34,658 with dementia	Quantitative Cross-sectional
Neville, 2006, Australia 71	A needs analysis of the pain management skills of regional nurses caring for older people with dementia	197 staff members (120 unlicensed nurses, 19 enrolled nurses and 55 registered nurses)	Quantitative Survey Questionnaire
Parkman, 2020, United States 51	(1) Explore the relationship between two observational pain scales, expressed need-driven behaviours and likelihood of medication administration, (2) examined nurses’ perceptions regarding ease of and barriers to use of the scales	28 nursing home residents with dementia 4 registered nurses and 2 licensed practical nurses	Mixed or multiple methods Abbey Pain Scale The Pain Assessment in Advanced Dementia (PAINAD)
Peisah, 2014, Australia 52	Explore attitudes and processes relating to pain assessment and management	20 staff members (10 registered nurses and 6 nurse assistants)	Quantitative Descriptive design A topical survey typology with semi-structured interviews
Rababa, 2019, Jordan 75	Examine the relationship among comorbid burden, ability to self-report symptoms, severity of dementia and patient outcomes of pain and agitation	78 nursing home residents with dementia	Quantitative Descriptive correlational design Discomfort-DAT
Rababa, 2018, Jordan 70	Examine temporally based relationships between change in behaviour, the nurses’ level of certainty regarding pain, assessment scope and outcomes of pain	76 nursing home residents with dementia and known pain or a known pain diagnosis	Quantitative Descriptive correlational design Discomfort-DAT
Rababa, 2018, Jordan 68	Examine the associations of pain assessment scope, nurses’ certainty, patient outcomes, and cognitive and verbal characteristics	76 nursing home residents with dementia and known pain/known pain diagnosis	Quantitative Descriptive correlational design Discomfort-DAT
Rostad, 2018, Norway 59	Assess the effectiveness of regular pain assessment on analgesic use and pain score	112 residents with dementia and unable to self-report, from 16 nursing homes that did not routinely use a pain assessment tool	Quantitative Single-blinded, parallel cluster randomized controlled trial Doloplus-2
Scherder, 2004, The Netherlands 73	Compare the assessment by nursing assistants of pain experienced by residents with the residents’ own evaluation	20 residents with Alzheimer’s dementia and 17 residents without dementia, from 2 nursing homes. Both groups with chronic painful conditions	Quantitative Case–control study Checklist for Nonverbal Pain Indicators (CNPI) Coloured Analogue Scale (CAS)
Sloane, 2007, United States 53	To describe the amount of staff time spent in care provision of morning care and the sources of discomfort and pain that were identified	17 nursing home residents with dementia who were likely to have chronic pain	Mixed or multiple methods Study and analysis of 51 videotaped morning care and care plans
Vitou, 2022, France 61	To analyse whether a diagnosis label of Alzheimer’s disease or the stage of the disease may bias pain assessment scores and empathic reactions of healthcare staff in nursing homes	152 certified nursing assistants From 19 nursing homes	Quantitative Experimental between subjects’ design Visual Analogue Scale (VAS) Algoplus
Vitou, 2021, France 62	(1) Characterize pain assessment behaviours; (2) compare assessments with individuals with no professional experience in the field of care (controls) and (3) explore the impact of demographic, psychological and socio-professional determinants on pain assessment	50 certified nursing assistants from 5 nursing homes Controls: 96 adults living in the community	Quantitative Experimental between subjects’ design Visual Analogue Scale (VAS) Algoplus
Yang, 2024, China 42	To elucidate the methodologies employed by nursing assistants in identification and management of pain	17 nursing assistants	Qualitative Phenomenological design Semi-structured individual interviews
Zahid, 2020, Canada 67	(1) Evaluate whether pain assessment frequency improved with the use of the tablet app compared with that for the paper-and-pencil method of administration of the PACSLAC-II, (2) evaluate the impact of each method of administration of the PACSLAC-II on frontline staff stress and burnout levels, (3) obtain the perspectives of healthcare personnel on each method of administration	121 staff (33 registered nurses and 88 special care aides)	Mixed or multiple methods Case series design, quasi-experimental and exploratory design Pain Assessment Checklist for Seniors with Limited Ability to Communicate II (PACSLAC-II)