A number without a standard
Educational use only. Not clinically reviewed84-year-old man for calm self-report attempt, behavioural observation, proxy history, bounded intent, and handoff practice. About 8 simulated minutes.
What you will practise
- Attempt self-report before scoring anyone.
- Recognize that a total is not an intensity.
- State what the total cannot license in either direction.
- Obtain a proxy history from someone who knows him.
- Review the hierarchy and its certainty.
- Hand the number over as what it is.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage. 2006;31(2):170-192. Concluded that no tool could then be recommended for broad adoption, with the instruments in early stages of development and testing.
- Herr K, Coyne PJ, Key T, et al. Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs. 2006;7(2):44-52. American Society for Pain Management Nursing. Sets out the hierarchy of pain assessment: attempt self-report, consider potential causes, observe behaviours, obtain a proxy report from a person who knows the patient, and attempt an analgesic trial. Behavioural scores are not intensity scores, and physiologic indicators are placed at the bottom of the hierarchy.
- Pain in non-communicative older adults beyond dementia: a narrative review. Front Med. 2024;11:1393367. Notes that behavioural item sets are non-comprehensive and that subtle behavioural change may be missed.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.