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Pain is still inadequately treated in people with dementia (PWD) due to the complexity of assessing it. Pain assessment in PWD is still challenging because of patient-related or nurse-related factors. The patient-related factors have been studied extensively. However, the nurse-related factors, e.g., nurses’ certainty regarding suspected pain in PWD, have been given little attention by researchers.   Purpose:   This study aims to investigate how the degree of nurses’ certainty is compromised after pain assessment and how this affects levels of pain and agitation in PWD.   Method:   A descriptive, correlational design was used, and a convenience sample of 104 nursing home residents with dementia were recruited.   Results:   This study found that nurses’ certainty after the pain assessment mediates the relationship between the type of pain assessment and patient outcomes when the nurses had a high initial certainty. When nurses had a low initial certainty, their certainty after the assessment and the type of assessment predicted the levels of pain and agitation in PWD.   Conclusion:   Understanding how nurses’ certainty can be compromising after pain assessment and how this relates to pain management in PWD is crucial.

Responding to Varying Levels of Certainty about Pain in People with Dementia after Initial Pain Assessment