• Rita Gorawara-Bhat, Alexandra Wong, William Dale, and Teresita Hogan.
• Section of Geriatrics and Palliative Medicine, Chicago, IL, USA. Electronic address: rbhat@medicine.bsd.uchicago.edu.
• Patient Educ Couns. 2017 Feb 1; 100 (2): 231-241.

Objectives1) Identify themes arising from nurses' perceptions of assessing older-patients' pain; 2) use themes to guide development of optimal interventions to improve quality of pain assessment in the emergency department (ED).MethodsNurse interviews (n=20) were conducted until theme saturation. They were transcribed, coded, and analyzed using qualitative methodology.ResultsTwo major themes-nurse 'challenges' and 'strategies' to overcome challenges, and their subthemes - classified as 'patient-related' or 'system-related,' were salient in nurses' perceptions. Strategies nurses reported for managing challenges were based in their own professional lived experiences.Discussion And ConclusionA 2×2 framework was developed to conceptualize challenges, strategies, subthemes and their classifications, yielding 4 typologies comprising challenge types matched with appropriate strategy types. While emergent challenges and strategies are corroborated in the literature, the present study is the first to develop a scheme of typologies beneficial for guiding the development of optimal interventions to improve the quality of assessing pain in older-patients.Practice ImplicationsThe typology framework can guide the development of pain assessment tools and the needed combinations for assessing multidimensional pain in older-patients. Using the present findings, a new clinical intervention was shown to significantly improve pain management for older-patients in the ED.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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